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Re: Numb, tingling hands and feet, Raynaud's, leg cramps & twitching

Posted By CCF Neurology MD:NT on October 29, 1998 at 22:06:06:

In Reply to: Numb, tingling hands and feet, Raynaud's, leg cramps & twitching posted by gb on October 29, 1998 at 18:42:31:

I am a 44 year old female in generally good health, born & raised in Canada, currently living in southern California.
For the past 15 years, I have had patches of tingling, burning pain and numbness in my hands, and for the past 2 years in my feet as well. I typically have painful flare-ups several times a year, each lasting a few weeks, resulting in increased areas of numbness, tingling and burning pain each time.
About every five years or so, I go see a doctor to see if they can figure out what's wrong.
I have a younger sister and a great aunt with MS, and am naturally concerned about my own symptoms.
I also suffer from joint pains especially in the winter, but generally only one or two joints are affected per season (for instance a knee or a wrist, or toes on one foot) and there is never any noticeable redness or swelling of the joint.
My neurologist has diagnosed Raynaud's and peripheral neuropathy, and feels strongly that there is an autoimmune component to my illness as I also suffer from asthma starting at age 40, and an assortment of other allergies. So far the Dr. hasn't been able to pin it down any further than that. She has prescribed Elavil for the neuropathy, which has been very effective in reducing the pain, though it has of course not done anything for the numbness.
Blood tests have so far ruled out Lyme, Lupus, Sjogrens and B12 deficiency. ANA was negative, though I did have a very high positive result for anti-smooth muscle antibody. Brain MRI one year ago was negative for MS-type "plaques" however the radiologist noted a diffused inflammation of "uncertain significance".
I don't seem to have have the "trigger points" or overwhelming pain and fatigue that might suggest Fibromyalgia or Chronic Fatique Syndrome. I am a nonsmoker, and drink no more than three glasses of wine a week. I am not overweight, nor diabetic. I am not in a risk group for Lyme disease (never lived in or been to an area where I could have been exposed) nor silver amalgam dental fillings (look ma, no cavities).
Am currently having a flare-up of symptoms over the past three weeks, some of which are new for me: twitching and cramping in my calves and thighs, a burning feeling in my spine, and tingly feeling on left side of face that comes and goes.
Can you think of a possible explanation for these symptoms?

Dear GB:
You apparently have had a fairly extensive work-up for your symptoms. And you enumerate many of the appropriate diagnostic considerations. The history of asthma makes me wonder about Churg-Strauss syndrome (a form of vasculitis associated with eosinophilia and asthma). The fact that you have done quite well for the 15 years, however, suggests that you have a rather benign process that is unlikely to be a serious connective tissue disorder.
Your symptoms are rather atypical for a run-of-the-mill peripheral neuropathy (or, for that matter, even mononeuritis multiplex) that is commonly seen to be associated with medical disorders including connective tissue disorders. This makes it difficult to formulate a rational diagnostic approach to your case.
I would recommend an opinion from a neuromuscular specialist at at major academic department near you (UCLA, USC).
Good luck!
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