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Having fasciculation, cramping and very tense muscles in arms and legs. Constant pain in back of head and severe anxiety. Treatment?

Nov 2013
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Practicing since : 1994
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I have fasciculation, cramping and very tense muscles in arms and legs. There is constant pain in the back of my head which is not similar to any other headache. I feel disoriented and have visual light flashing which has been seen by neuropthamalogist. Could this be Neuromyotonia. Is encephalomyelitis always have memory loss. This disease process has caused severe anxiety and discomfort. I have had all appropriate imaging, tried numerous medications but found no relief. I have even done cognitive based therapy which was also unsuccesful. I have not had CSF fluid examined. Does pain in the head and neck indicate possible CNS damage? I feel lost even after numerous testing by GP, neurologist etc. As discussed before I am scheduled for EMG for diffuse fasciculations and muscle thumping. The brisk reflexes in both of my legs have occured at 3 neurologist appointments at this point. Any additional advice is appreciated. I am still worried of lung carcinoma causing these symptoms with 5 pack year smoking history, but with negative chest ct 8 months ago as well as xray 1 month ago and my young age no one seems to think this is reasonable. For the past 11 months I havd had increasingly uncomfortable neurologic symptoms of CNS and PNS but everyone says anxiety.
Upon reviewing symptoms for PEM with sensorimotor neuropathy, a number of symptoms seem to fit what is happening to me. There is certainly Motor and peripheral nerve involvement instances of numbness and tingling primarily motor with fasciculation(brisk reflexes) Additionally my brain does not function the way it normally would. I have dizziness and fatigue vision problems and the rest is very difficult to explain. My back of my head feels as though it is being attacked. My cognitieve ability including memory and critical thinking seems intact. Due to my age and previous radiographs no one wants to think I could have paraneoplastic disease occuring. Does this disease process occur due to sclc in people under age 30. You said you see this 3-4 times a year is there anyway you can think of to rule it out besides antibody test my neurologist doesn't think this is necessary? I am still functioning, but at a very impaired level. I can work, go out etc. I am just very uncomfortable all the time.
As mentioned before I also have chest discomfort of 3-4 months but had x XXXXXXX one month ago. Would this likely show a tumor or it seems in paraneoplastic syndromes they remain hidden for a significant period of time. Sorry to continually ask similar questions I just seem to be getting nowhere with my doctors including neurologists.
Posted Thu, 19 Sep 2013 in Brain and Spine
Answered by Dr. Sudhir Kumar 7 days later
Brief Answer:
Detailed answers are below.

Detailed Answer:

Thank you for being in touch again.

I still feel your symptoms are not conclusive for paraneoplastic encepahlomyelitis. In addition, if left untreated, we expect disease progression (worsening of symptoms over time).

I agree you have some symptoms of sensory and motor neuropathy. However, deep tendon reflexes should be sluggish or absent in neuropathy, rather than exaggerated.

NCV and EMG studies would further help in the above diagnosis.

Regarding SCLC, I would recommend PET CT of the chest to conclusively diagnose or exclude the diagnosis. In the absence of chest symptoms and young age, it is unlikely, however, PET CT would confirm it one way or the other, giving you peace of mind.

I hope it helps. I would be pleased to answer any follow up queries.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Above answer was peer-reviewed by
Follow-up: Having fasciculation, cramping and very tense muscles in arms and legs. Constant pain in back of head and severe anxiety. Treatment? 10 hours later
Thank you once again for a thoughtful response. With my brisk reflexes and peripheral nerve hyperexcitability and pschological/cns symptoms. This could maybe be neuromyotonia, stiff man syndrome, encephalomyelitis with rigidity and myoclonus. I will have my emg this week and subsequently ask for anitbodies panel or chest ct/pet. After having a ct 9 months ago and xray 1 month ago do you think this largely excludes the chances of sclc this is my biggest concern and as an ex smoker with chest discomfort and neuro symptoms it is difficult when nothing can be found.
Answered by Dr. Sudhir Kumar 1 hour later
Brief Answer:
Normal CT chest and X XXXXXXX almost rules out sclc.

Detailed Answer:
Thank you for getting back.

It would be good to know the EMG results when it is available.

Yes, I would feel that normal CT chest and normal chest X XXXXXXX in addition to lack of any symptoms (chest pain, cough, hemoptysis) would rule out sclc. But as I said, if we want 100% exclusion, PET CT would be useful.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
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