Neurological issue?

[cmanthomas]

Back in 2006 I had radial nerve palsy from leaning on my elbow, and experienced "wrist drop" for about 1.5 months. Eventually my nerve healed and the wrist returned to full functionality. Shortly afterwards, I began experiencing pinprick like sensations around my body (especially on arms and legs) and small muscle twitching throughout (especially in legs). I saw a neurologist who performed a complete physical exam and said everything was normal and decided not to investigate further. Since then, I have continued to experience body wide muscle twitching (only at rest) and off and on pinpricking (occurs randomly throughout my body). There has been no noticeable increase or change in these symptoms over the past 6 years. Recently, however, I began experiencing panic attack like events that last for about 30 minutes--feeling like i was going to get dizzy, very anxious/nervous, overheated feeling followed by pounding heartbeat in neck and eyes--all followed by tiredness from the neck up (these started 2 months ago shortly after coming off of a sinus cold and working out fairly intensively for 3 days). I have had difficulty sleeping at night for months and wake up loopy.
Finally, about 5 weeks after experiencing the first anxiety attack-like event, i started to feel a fleeting feeling of weakness in my right arm and both my legs--almost like an internal itch through the nerves stemming from my fingertips and soles of my feet, and radiating up my extremities. Typically these come and go throughout the day, but there doesn't seem to be any actual weakness either during or after the occurrence.
Note: the arm issue seems to be agitated when i type or use the arm for any strenuous activity, and is sometimes relieved by shoulder massage.
-physical neuro tests dont indicate anything abnrmal, but i am still experiencing all the pinpricking, twitching, tiredness with lightheadedness, and now potentially connected arm and leg symptoms.
- All blood/heart tests normal

Thoughts?

[cmanthomas]

thanks for the reply,

in Nueropathy and ALS would the weakness or sensation target specific areas and spread, or would they be sporadic and throughout the whole body? Also, I have had the pin ***** feeling and twitching come and go for many years (6) but have not felt weakness or noticed atrophy before during or after--can that rule anything out?

Also, does the fleeting nature of the muscle fatigue in my arm and legs make it less likely to be als, neuropathy or MS (it is almost as if the nerves are easily irritated for a few hours leaving those limbs feeling rubbery or tired, then it will resolve for hours or even days with no real weakness throughout)?

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

It must be emphasized that in the MAJORITY of cases muscle twitches are benign meaning that they are of no consequence and are not resulting from a serious cause. In such cases, the twitches may be related to anxiety/stress, caffeine, and often occur after recent strenuous activity or muscle over-use. It is important in such cases to reduce stress/anxiety levels and to reduce caffeine intake. Tremors of the hands can be physiological that is exacerbated by stress/anxiety and caffeine.

Benign fasciculation syndrome, which I will abbreviate as BFS, is a condition in which there are involuntary twitches of various muscle groups, most commonly the legs but also the face, arms, eyes, and tongue. If the diagnosis is confirmed and other causes are excluded, it can be safely said that the likelihood of progression or occurrence of a serious neurologic condition is low.

When BFS is present but not particularly bothersome or disabling, treatment is not necessary. If severe and it requires treatment, there are a few medication options though this condition is not very common, and the research that has been done on its treatment is limited. Minimizing caffeine and stress, and treating anxiety if it is present, will improve your symptoms.

However in general (and please understand I am not trying to imply I feel this is the case in you), when fasciculations occur in the setting of associated symptoms such as progressive loss of sensation, tingling or numbness, weakness, trouble swallowing and other symptoms, the cause may be due to a peripheral nervous system problem, such as in ALS.

Another nervous system problem, neuropathy, may also lead to fasciculations. There will again be associated weakness or sensory changes.

Often these symptoms may reflect emotional/psychiatric problems related to stress (what is called somatization disorder). The latter is a true medical condition whereby instead of a patient experiencing depression or anxiety, they experience physical symptoms, and once the stress is addressed, the symptoms resolve.

I suggest follow up with your primary doctor and you may benefit from evaluation (or second opinion) by a neurologist as your primary doctor feels fit. It is important that you discuss your concerns with him/her. You may need basic lab work to ensure your blood chemistry, particularly your potassium, sodium, thyroid, and calcium, is normal. Further workup such as EEG, EMG/NCS, or MRI would have to be decided upon by your neurologist depending on the clinical examination and historical findings.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.