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What Causes Foot Paresthesia, Tinnitus And Facial Twitching After Alcohol Withdrawal?
Question: Please forgive the CAPS......I AM DESPERATE....I stopped drinking 17 months ago after years of heavy drinking... EXTREME PARESTHESIA IN BOTH FEET, BAD TINNITUS, FACIAL TWITCHING WHICH MOVES AROUND.... FOR 8 MONTHS NOW!!.....FULL exam within 2 months of stopping drinking, and MANY MORE since then....10 visits to PCP, neurologist, orthopedist....every test imaginable.....blood workups (including several CBC's, B-12 testing, A1C's, ABG, PFT's, Brain MRI, cervical spine MRI, chest CT, brain CT....you name it).....ALL NORMAL, with the exception of mild airway obstruction (69% spirometry, but ALL other PFT values normal) and a diagnosis of "respiratory alkalosis", which my PCP said was due to "hyperventilation"
I have a history of psychosomatic problems, but have always been in good health....(PCP yesterday, BP 98/60, pulse ox 97).
I am TERRIFIED OF ALS.... or Parkinson's, which my sister has....cannot get in to see new neurologist for another month....I'm assuming he will order EMG.....
I'm so scared......IS it ALS??.....I know EMG is probably warranted to rule this out.....but does this all present as ALS?
I power walk/run 15-25 miles a week, eat well and get relatively good rest....
Also of note....have been on 1.5 mg. of alprazolam at bedtime for 10 years now....could this have adverse effects??
I know you cannot answer the bulk of these questions without an exam....but seeking some reassurance until I can see new neurologist....
....it's a "Catch 22"....the longer these symptoms persist, the more frightened I become, which exacerbates the symptoms.....is this possibly stress or anxiety induced?
I feel so alone.....and no one seems to be able to help.....
I have a history of psychosomatic problems, but have always been in good health....(PCP yesterday, BP 98/60, pulse ox 97).
I am TERRIFIED OF ALS.... or Parkinson's, which my sister has....cannot get in to see new neurologist for another month....I'm assuming he will order EMG.....
I'm so scared......IS it ALS??.....I know EMG is probably warranted to rule this out.....but does this all present as ALS?
I power walk/run 15-25 miles a week, eat well and get relatively good rest....
Also of note....have been on 1.5 mg. of alprazolam at bedtime for 10 years now....could this have adverse effects??
I know you cannot answer the bulk of these questions without an exam....but seeking some reassurance until I can see new neurologist....
....it's a "Catch 22"....the longer these symptoms persist, the more frightened I become, which exacerbates the symptoms.....is this possibly stress or anxiety induced?
I feel so alone.....and no one seems to be able to help.....
Brief Answer:
Certainly not suggestive of ALS or Parkinson
Detailed Answer:
I read your question carefully and I am sorry about the anguish you seem to be in.
Regarding what you fear, those symptoms are not suggestive either of ALS or Parkinson. And actually, while not with certainty, I can say that pretty confidently without an exam.
ALS is a motor neuron disease, meaning it affects motor functions while most of your symptoms are sensitive ones. Distribution is not typical at all either, it usually starts as insidious weakness in one limb, often not noticed, gradually progressing in other areas.
Parkinson's is manifested with tremor at rest (disappearing on movement), rigidity, slowness of movements starting on one side, later on bilateral, again not all those sensations you report, no reason to suspect it. As for your sister, Parkinson is familial in only about 5% of cases and those familial cases usually appear at an earlier age than usual.
What I think is the cause, well you mention yourself to have a historry of psychosomatic disorder. I believe the symptoms are related to anxiety.
Anxiety might have been a preexisting condition in you, often people head to alcohol because it relieves their anxiety initially. In the long run though it develops dependence and tolerance and ends up making you even more prone to anxiety.
Similarly goes for alprazolam. Alprazolam is a benzodiazepine, a class of drugs which relieve anxiety by actually acting on same receptors as alcohol. Again though, with prolonged use they develop dependance and tolerance, meaning the usual dose is not enough. That is why I don't prescribe them for regular use for over a month, 10 years is a long time.
Another additional explanation for the paresthesias might be also alcoholic polyneuropathy, for that nerve conduction studies might be done. But whether there is neuropathy or not I still believe that anxiety is a contributor as well.
So I would suggest cognitive behavioural psychotherapy and if not enough perhaps the addition of an antidepressant which have also very good anti anxiety properties without developing the tolerance and dependence that the benzodiazepines do.
I remain at your disposal for other questions.
Certainly not suggestive of ALS or Parkinson
Detailed Answer:
I read your question carefully and I am sorry about the anguish you seem to be in.
Regarding what you fear, those symptoms are not suggestive either of ALS or Parkinson. And actually, while not with certainty, I can say that pretty confidently without an exam.
ALS is a motor neuron disease, meaning it affects motor functions while most of your symptoms are sensitive ones. Distribution is not typical at all either, it usually starts as insidious weakness in one limb, often not noticed, gradually progressing in other areas.
Parkinson's is manifested with tremor at rest (disappearing on movement), rigidity, slowness of movements starting on one side, later on bilateral, again not all those sensations you report, no reason to suspect it. As for your sister, Parkinson is familial in only about 5% of cases and those familial cases usually appear at an earlier age than usual.
What I think is the cause, well you mention yourself to have a historry of psychosomatic disorder. I believe the symptoms are related to anxiety.
Anxiety might have been a preexisting condition in you, often people head to alcohol because it relieves their anxiety initially. In the long run though it develops dependence and tolerance and ends up making you even more prone to anxiety.
Similarly goes for alprazolam. Alprazolam is a benzodiazepine, a class of drugs which relieve anxiety by actually acting on same receptors as alcohol. Again though, with prolonged use they develop dependance and tolerance, meaning the usual dose is not enough. That is why I don't prescribe them for regular use for over a month, 10 years is a long time.
Another additional explanation for the paresthesias might be also alcoholic polyneuropathy, for that nerve conduction studies might be done. But whether there is neuropathy or not I still believe that anxiety is a contributor as well.
So I would suggest cognitive behavioural psychotherapy and if not enough perhaps the addition of an antidepressant which have also very good anti anxiety properties without developing the tolerance and dependence that the benzodiazepines do.
I remain at your disposal for other questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
.....god bless you for your clear, concise and comprehensive analysis of my questions!!.....you've given me some hope, and I can at least enjoy my Mermorial Day weekend a bit more....
....one more question regarding the possibility of "alcoholic polyneuropathy"....
.....the paresthesias did not present until 8 months after I stopped drinking....could it take that long for the absence of alcohol to reveal these symptoms?
I TOTALLY can relate to your assessment that I used alcohol to help with anxiety....I have dealt with so many anxiety-related problems in my life that I cannot count them all.....
THANK YOU SO MUCH, Doctor!!
....one more question regarding the possibility of "alcoholic polyneuropathy"....
.....the paresthesias did not present until 8 months after I stopped drinking....could it take that long for the absence of alcohol to reveal these symptoms?
I TOTALLY can relate to your assessment that I used alcohol to help with anxiety....I have dealt with so many anxiety-related problems in my life that I cannot count them all.....
THANK YOU SO MUCH, Doctor!!
Brief Answer:
If after 8 months less likely.
Detailed Answer:
Thank you for your appreciative words, it feels good to know I could be of such comfort.
Your question has a good point, the fact that the symptoms started 8 months after quitting makes alcoholic neuropathy a much less likely cause, it should have improved anyway, as quitting alcohol and healthy nutrition is its best therapy.
I hope to have been of help.
If after 8 months less likely.
Detailed Answer:
Thank you for your appreciative words, it feels good to know I could be of such comfort.
Your question has a good point, the fact that the symptoms started 8 months after quitting makes alcoholic neuropathy a much less likely cause, it should have improved anyway, as quitting alcohol and healthy nutrition is its best therapy.
I hope to have been of help.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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