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Muscle cramps, weakness, CNS disease?

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Practicing since : 2001
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Hi, I am a 41 year old female with severe muscle cramps in calve muscles and spacticity in feet. I also have been experiencing fasciculations in lower legs and less common in abdomen and upper torso. I have had slight weakness in left arm which is also intermittent (every four to six months).

I have had two MRI's, the recent one with contrast, which both showed no evidence of demyelination or ALS. My blood results are normal also, although I'm awaiting more blood results regarding Vit D levels. I had a clinical evaluation about 7 months ago which I passed as I had no symptoms at the time. My concern is that because I am a discordant monozygotic twin to MS, as well as my mum having MS, how likely is the severe spacticity in my feet (regular cramping accompanied with my toes contracting together and spreading apart etc.) a sign of early onset of a CNS disease? Do you think given my circumstance I should follow up with a lumber puncture etc? Thank you.
Posted Fri, 13 Apr 2012 in Bones, Muscles and Joints
Answered by Dr. Shiva Kumar R 33 minutes later

Thanks for the query.

From the description it looks like you have muscular cramps, stiffness in the legs and diffuse fasciculations with episodic weakness of the left upper limb indicating multiple neuraxis involvement ( that means that multiple neural pathways are involved). To add MRI does not show any evidence for ALS or brain and spinal cord demyelination.

So I personally feel you are not suffering from multiple sclerosis or amyotrophic lateral sclerosis (ALS)from the description provided to me. However I would be interested in confirming the findings by a good clinical examination. If confirmed, then further investigations would be required in you based on the syndrome. If the neurological examination is normal, no further work up is required.

Regarding the risk of contracting multiple sclerosis, it is 1 in 50, if your mother has the disease. If you are a discordant monozygotic twin, risk of having multiple sclerosis, is approx 4%. However these statistics do not mean that you will definitely get the disease.

I am sorry you are dealing with this frustrating concern and I hope you can find yourself in better health soon with the help of your neurologist. I personally feel you do not have MS or ALS and it is possible that your symptoms are related to excessive anxiety (since you already have a family history of multiple sclerosis). Measures to reduce anxiety like XXXXXXX breathing, yoga, meditation will help. If it doesn’t become ok consult your physician who can prescribe some anti-anxiety medication.

Let me know if I have missed out any other concern in your question.

Yet again, I duly appreciate your query to me, I do hope that you have found something useful to help you and I shall be glad to answer any further apprehensions.


Dr Shiva Kumar R
Neurologist & Epileptologist
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