more follow up re. peripheral neuropapthy

[stephenpd69]

I am a 42 yr old, generally healthy male.  have had the following symptoms since Feb 2012:  symmetrical tingling in hands and feet, on/off burning in feet, all-over body muscle twitches, on/off patches of skin that are sensitive to touch, and most recently dark bruising in left calve for   8 weeks (improved last two weeks). I did have gi issues for past year (better now) and shingles in Jan 2012.
I saw a neurologist in March 2012 he need a physical exam, nerve conductivity test, and had labs done, all of which were normal.  He did not do a needle emg. I saw him again in May 2012, again physical exam normal. He ordered a neck mri, came back normal.  He said nothing else to do, see you in 6 months. He never commented on it being large or small nerve, axonal vs demylating (sp?). He does not see the need to order a mri of the brain.
My PCP started my on 400mg of Neurontin (seems to help some) and ran a few more blood tests to look at "rare things".  
I am frustrated about not being able to find answers to what this is.  if it is nothing serious, then it will help me move on to some extent.  It is hard for my mind not to wonder if there is something serious going on.
Questions:
1. the nerve conduct. test should rule out large nerve issues, but could this be a small nerve issue?
2. small nerve issues seem to be limited in cause?
3. should i expect this to improve or not?
4. should i get another opinion (getting into another neuro means a referral from my dr...hard to get)
5. any recommendation on how i should go forward?
thanks for your help and thoughts,

stephen

[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.

There are two types of sensory neuropathies in the body – large and small fibers. With small fiber neuropathies, symptoms including burning or buzzing or other vague symptoms starting in the feet and hands then in some cases spreading to other parts of the body. The EMG/nerve conduction studies (NCS) (tests done to check for neuropathy) will not show an abnormality, and a definitive diagnosis can only be made with a skin biopsy so that the number of nerve endings can literally be counted. There are other tests of the function of small nerves that can be ordered, such as QSART testing which looks at how much sweat the skin makes, since sweating is in a sense of function of these small nerves. Some of these tests are not available at every institution. The causes for small fiber neuropathy include diabetes, vitamin deficiencies, and autoimmune problems, to name a few.

Treatment for neuropathic pain (pain coming from nerves) includes neurontin and lyrica, and medications such as elavil (which is an antidepressant but has actually been found to be helpful with neuropathic pain as well).

I recommend that you be seen by a neurologist. It is not uncommon for patients to seek second opinions.

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

[Paula428]

I would definitely get a 2nd opinion from another neuron have Fahrs disease and I saw 3 neuros before I settled on one.