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Avatar universal

Paresthesia, fasicullations and peripheral neuropathyy

Question for you. 50 year old male. Unremarkable medical history except for graves disease diagnosed 22 years ago with subsequent ablation of the thyroid and thyroid replacement with levoxyl ever since. Over the last 20 years or so I have had recurrent episodes (typically lasting many months at a time) where I had prickling/itchy feeling of the skin particularly the  legs and arms,  widespread fasiculations most obvious in  calves and lower legs (sometimes arms, eyelids), a bit of muscle cramping in the legs and intermittent nueropathy of the hand and fingers. The symptoms are almost always more obvious late at night and will often wake me up at 3 or 4 am. Needless to say over the years I have been checked out by several doctors and had  EMG's, MRI's  lots of blood work and everything has always been normal including the thyroid hormones, B12 levels and Mg, Ca ect. Several neurologists ruled out issues of concern such as MS and ALS and the conclusion seemed to be (for lack of a better explanation) benign fasiculation syndrome. It comes and goes and has been stable for so long  I am not particularly worried about it but it continues to be an annoyance. It has started up again a few weeks ago after  over a year of no symptoms. I just had a complete physical with all the standard blood work and everything was normal. Primary care doc really has no suggestions. Don't really need to go back to the neurologist  but giving the diurnal dependence of the symptoms..especially the waking up every night a 4am,

I wonder if there any other factors - hormones,  Ca, Mg,  vitamin levels, thyroid hormones that might peak or decline in the early morning hours that might be cause such symptoms? Also, I would be looking for any suggestions for over the counter symptom relief. I did cut out all coffee and sodas and that did not seem to have any effect. Life is good so anxiety levels are low and no particular stress to speak of.
2 Responses
Avatar universal
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.

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 (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.

There is a surge of cortisol in the early morning. It is good that you have had a thorough workup for other causes of fasciculations (ALS, neuropathy, metabolic abnormalities – thyroid, calcium, etc).

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

1314782 tn?1323184185
I sent you a private e-mail, as I have the exact same symptoms, should be in your inbox.  Thanks
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