tingling, buzzing, and twitches

[Robin]

I am a 32-year-old female.  I gave birth to my first child 10 months ago (no anesthesia, no complications).  two months after my daughter was born, and several weeks after a viral illness, i developed a buzzing or humming sensation in my left foot.  a few weeks later i developed tingling in my left big toe and heel, especially after walking.  several days later i developed tingling in the fingers of my right hand, then my left.  within two months the buzzing and tingling was present in both my legs, the buzzing sometimes up to my knees.  from the beginning, i noticed small random muscle twitches in all parts of my body.  i also experienced a buzzing sensation in my perineum which lasted 4-5 weeks, then resolved.  i had some shakiness (tremor?) in my hands/arms that seemed to improve with the elimination of caffeine (though i never had more than 1 cup coffee/day). the tingling in my fingers and toes has decreased substantially.

i saw a neuro ~2 months after symptoms, who diagnosed anxiety/stress (runs in my family, though i have not been diagnosed as such).  she suggested paxil/zoloft.  (i am not suffering from depression at this time.)  i sought a second opinion at a teaching hospital (head of neuro).  i have had a head MRI, cervical spine MRI, and cervical spince follow up w/gamma enhancement -- all normal.  i have had two neg lyme tests, and all normal thyroid, sed rate, anti-nuclear antibody, rhuematoid factor, b-12, gestational diabetes.  i have not had an EMG (probably will next).  my neuro exams (~1 month, 2-1/2 months, and 3-1/2 months post-onset) have all been normal.  i have no perceived weakness.  i am not fatigued beyond the fatigue of a new parent.

i have been nursing my daughter since she was born (hence did not want to take zoloft, etc.).  i did experience extreme anxiety at the onset of symptoms (fear of MS, etc.), but anxiety resolved with normal head MRI (march).  i have not slept through the night without waking since my daughter was born.

Aplogies for the length here.  My questions are:

1.  from what i've read, i'm assuming ALS is unlikely, due to symptoms of tingling (sensory) and duration of symptoms without weakness. is this correct?

2.  should i retest for lyme?  are some tests/labs more accurate than others?

3.  could there be other nutritional deficiencies that could account for my symptoms?  could nursing cause such deficiencies? what should i be screened for, if anything?

4.  could sleep deprivation combined w/stress cause this constellation of symptoms? how much normal sleep before resolution could be expected? (we're close to sleeping through the night)

5.  is such a constellation of symptoms unusual, that is, sensory combined with twitching (motor?)?  can BFS include tingling and buzzing/humming?

Thank you.  This is a wonderful resource!

[CCF Neuro[P] MD, RPS]

Thanks for the comments.

CCF Neuro MD

[stephanie]

Dear Robin:
I experienced very similar symptoms following the birth of my child almost 2 1/2 years ago.  It started with buzzing sensations, then twitching, and burning pain in my hands, legs and feet.  I also had lots of tests and then went to a very good neurologist at a teaching hospital for a second opinion.  He said he had seen other patients with the same thing.  He said that he doesn't know exactly what it is, but that it does not progress and become disabling.  That really gave me some peace of mind, and he was right.  I have not had any worsening of symptoms for over 1 1/2 years.
I did not want to try drugs for the burning pain (as you probably don't, since you're nursing), but on the advice of my doctor, I finally decided to try physical therapy about three months ago.  They showed me some exercises that have really helped with the pain.  I still get pain, but it is now less severe and I recover more quickly.  I hope that you find some answers and some things that help to relieve your symptoms.  Even if no cause can be found, you may find some treatment that helps.  Good luck and don't give up

[CCF Neuro[P] MD, RPS]

Dear Robin:

Sorry to hear about your tingling and muscle twitches (tremors).  First of all, congradulations with your newborn and especially the breast feeding.  I am also a board certified pediatrician and applaud the breast feeding.  Without muscle weakness, you do not have ALS.  I would not revisit the Lyme idea.  A negative test is usually a good sign, but with the description of your symptoms and without a rash, together with the negative test makes lyme very, very remote.  Yes, vitamin deficiency of B12 can give you sensory changes.  But your symptoms do not sound like B12. Here, sensory losses usually have muscle weakness and some cramping.  I would continue your prenatal vitamins while your nursing.  It is cheaper than baby vitamins and it has the same effect.  Yes, anxiety, caffeine, or lack of sleep can make symptoms worse.  

Actually, your signs and symptoms are very compatible with benign fasciculations.  About 30% of benign fasciculation arise after a viral infection.  Yes, this can be accompanied by sensory changes. There is no way of telling how long these will last, some patients have their fasciculations for years and some only a few weeks.

I hope this helps.

Sincerely,

CCF Neuro MD

[robin - to CCF Neuro 8/20 post]

i can not access the CCF Neuro comment posted on 8/20.  could you repost??

[robin to cathy]

what i know is that tingling sensations (which i have along with the twitching and buzzing) are sometimes the result of b-12 deficiency.  nursing a baby can sometimes result in a b-12 deficiency.

[Robin]

in reply to jeff, no i was not taking any medications.

[Robin]

in reply to jeff, no i was not taking any medications.

[Cathy]

I do not think I am doing this the correct way but in the answer forum I was wondering about the Dr's comment.  If one had symptoms simular to what is described, what would a low vitamin B-12 indicate?  This makes curious that it was mentioned.
If this can be answered this way, I would appreciate it!
Thanks!

[CCF Neuro[P] MD, RPS]

X

[CCF Neuro[P] MD, RPS]

Get your answer.

CCF Neuro MD

[jeff]

Were you taking any medications when this started?

[CCF Neuro[P] MD, RPS]

Dear Robin:

Congradulations on your healthy newborn. Since I am also a board certified pediatrician, I can empathize about your fatigue because of the many mothers I have seen and as a father I can understand your fatigue from a parents point of view.  The good news is that all your tests are normal, MRI normal, and neurological examination normal.  That pretty much rules out the badness types of diagnosis such as ALS, MS, vitamin B12 deficiency, low magnesium, diabetes, etc.  The numbness and tingling in your pelvic area is not uncommon after childbirth, especially if it was vaginal.  The way the OBs push the hips back and have you strain can give you a mild sensory neuropathy.  

From what you have told me, I would think that it is likely that you have what we call benign fasciculations.  Not that I can diagnose you over the internet without seeing all the studies and examining you.  But, it is likely.  Approximately 30% of patients with benign fasciculations report it following a viral illness.  The symptoms that you have follow this diagnosis.  Usually, fatigue and anxiety make it worse, it can last weeks to years, and there are really no medications to give you.  We could give you medications to calm your nerves, help you sleep, but none are that effective.  I would continue to look for possible other causes with your neurologist, but I think you have BFS.  The EMG would give you the diagnosis.

Since breast feeding is best, I would continue with that.  You know you are saving your financial pocketbook alot by breast feeding as well as giving your child great nutrition.  No, I would not be retested for lyme.  Yes, you will be tired for the next 18 years or so.  However, the rewards far out weigh the fatigue.  Best of luck and keep us informed.