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Brisk reflexes in knee. Having fear of paraneoplastic disease. Taking gabapentin. Having headache and chest pain. Advise?

Nov 2013
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Practicing since : 1994
Answered : 5571 Questions

I have messaged with you a couple of times over the past weeks. I have had my follow up neurology appointment. My exam was once again normal with brisk reflexes in the knee as the only abnormality. I showed him video of my calf fasciculations and cramping in my hand. He decided it is time for an EMG which I had a clean EMG after the initial onset of fasciculation. I still have no clinical weakness or loss of sensation. Is it possible to have a neuropathy either sensory or motor with a normal neurologic examination. I also mentioned to him my fear of paraneoplastic disease which he mostly dismissed and said the only possibility worth mentioning with my symptoms would be stiff many syndrome which generally is not paraneoplastic. He was not willing to do any antibody testing until my EMG results come back and have major abnormalities. He placed me on gabapentin. I have now had neurologic symptoms for 11 months. If this was something terrible motor neuron disease/ paraneoplastic syndrome would I be severly disabled by now. I still am abe to attend work.
My concerns are that the headaches that I am having don't feel like any normal headache, they feel as though my brain is being attacked. My chest has continued pain in the sternum with a cough very rarely(1-2 times per day) going on 3 months, and I feel dizzy disoriented and very much anxious about these constant symptoms.

With additional neurologic exam I am interested to see what you think.

Thanks in advance.
Posted Wed, 4 Sep 2013 in Brain and Spine
Answered by Dr. Sudhir Kumar 1 hour later
Brief Answer:
Normal neurological examination is a good news

Detailed Answer:

Thank you for getting back with more information.

It is good to note that your recent neurological examination by the neurologist was also normal. This excludes a possibility of most of the serious neurological illnesses.

Motor or sensory neuropathy is unlikely with a normal neuro exam.

Brisk knee reflex is often seen normally, especially if one is anxious. So, I would not give this isolated "abnormality" too much of significance.

I would agree with your neurologist that paraneoplastic syndrome is unlikely with your current examination findings.

Also, I do not think one can have motor neuron disease, and still have normal neurological examination, 11 months into the illness.

Stiff man syndrome is a possibility, and EMG would help in that (I have published a research paper in Journal of Royal Society of Medicine on the topic about 10 years ago).

Headache seems to be unrelated and you can take symptomatic treatment with analgesics for the time being.

I hope it helps.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Above answer was peer-reviewed by
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