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Hi Dr. Taka, I Haven't Written You In A While.
Question: Hi Dr. Taka, I haven't written you in a while. hope all is good/okay where you are and corona numbers are low.
I want to ask you about problems my sister (age 57) has been having: she is having trouble with vestibular migraines but there is also
Muscle weakness when walking standing or bending over triggers sensations
legs quivering , wobbly from buttocks upward,
gravity like pressure makes her feel like it's pulling her forward ...
like she should take another step when she shouldn't!
when she's standing absolutely still, she's actually swaying...
whole thing started (first signs) with tingling in feet and legs then went up her body to face and head, that tingling has subsided (correct?)
only thing that stops the symptoms now is sitting, or laying down.
The sensations are sporadic throughout the day (?) , but they are daily (?) and last less than 30 seconds.
The muscle heaviness in legs is problematic at times...? please clarify what that means...like every other day? is this the same thing as legs quivering or different?
Additional information this from a couple of months ago below. But still no one has really figured it out? !! Do you have any ideas? She is getting desperate.
Had shock wave therapy (EPAT) at high intensity for plantar fasciitis in DEC. Tingling sensations developed in feet after last treatment and traveled all
over body. They have since subsided.
Muscle weakness and instability while walking. Legs tense up/ heavy feeling like hard to move and sometimes quiver. Swaying to one side sometimes while walking and sometimes standing still. Challenging to walk, but all symptoms are sporadic and last for less than 30 seconds. Gravity pulling sensations in upper body while bending over, standing and walking i.e. Feels like pushing forward or sideways and taking extra step at times even after step is completed.
Feel wobbly from buttocks upwards while sitting. Piriformis muscle in buttocks is also painful at times and feel pressure on tailbone.
Have seen multiple specialists and have had multiple tests, MRI’s of lumbar and cervical spine, and brain/inner ear. Also had EMG nerve/muscle test. Fibromyalgia, Lymes, MS, ALS and neuropathies have been ruled out.
Was also diagnosed with BPPV, so sent to vestibular therapy along with PT for lumbar. Developed severe case of vertigo. Had vestibular function test and will get results on Monday from ENT. Also diagnosed with sinus infection and was put on high dose of Amoxicillan for 10 days. (tingling sensations subsided during this time).
Seeing a new orthopaedic PT and she says it’s “central sensitization”. It can be treated, but not cured. Others say ischia femoral impingement syndrome?
I want to ask you about problems my sister (age 57) has been having: she is having trouble with vestibular migraines but there is also
Muscle weakness when walking standing or bending over triggers sensations
legs quivering , wobbly from buttocks upward,
gravity like pressure makes her feel like it's pulling her forward ...
like she should take another step when she shouldn't!
when she's standing absolutely still, she's actually swaying...
whole thing started (first signs) with tingling in feet and legs then went up her body to face and head, that tingling has subsided (correct?)
only thing that stops the symptoms now is sitting, or laying down.
The sensations are sporadic throughout the day (?) , but they are daily (?) and last less than 30 seconds.
The muscle heaviness in legs is problematic at times...? please clarify what that means...like every other day? is this the same thing as legs quivering or different?
Additional information this from a couple of months ago below. But still no one has really figured it out? !! Do you have any ideas? She is getting desperate.
Had shock wave therapy (EPAT) at high intensity for plantar fasciitis in DEC. Tingling sensations developed in feet after last treatment and traveled all
over body. They have since subsided.
Muscle weakness and instability while walking. Legs tense up/ heavy feeling like hard to move and sometimes quiver. Swaying to one side sometimes while walking and sometimes standing still. Challenging to walk, but all symptoms are sporadic and last for less than 30 seconds. Gravity pulling sensations in upper body while bending over, standing and walking i.e. Feels like pushing forward or sideways and taking extra step at times even after step is completed.
Feel wobbly from buttocks upwards while sitting. Piriformis muscle in buttocks is also painful at times and feel pressure on tailbone.
Have seen multiple specialists and have had multiple tests, MRI’s of lumbar and cervical spine, and brain/inner ear. Also had EMG nerve/muscle test. Fibromyalgia, Lymes, MS, ALS and neuropathies have been ruled out.
Was also diagnosed with BPPV, so sent to vestibular therapy along with PT for lumbar. Developed severe case of vertigo. Had vestibular function test and will get results on Monday from ENT. Also diagnosed with sinus infection and was put on high dose of Amoxicillan for 10 days. (tingling sensations subsided during this time).
Seeing a new orthopaedic PT and she says it’s “central sensitization”. It can be treated, but not cured. Others say ischia femoral impingement syndrome?
Brief Answer:
Read below.
Detailed Answer:
Hello! I am fine thank you for your concern! Coronavirus cases are rising alarmingly in the last two months as in many parts of the world but so far me and my family haven't been directly affected apart from naturally the added stress at work. I hope you remain safe as well.
I read your sister's case carefully several times. To be honest it is a difficult one and hard to suggest a diagnosis confidently. She has had tests which exlude involvement of the brain, spinal cord as well as peripheral nerve and muscle disease which would first jump to mind. Of course blood tests to rule out metabolic issues are necessary but given the in depth testing you describe I would bet those have been done and the issue ruled out as well. In particular vitamin B12 deficiency should be considered, but again, most likely has already been considered and ruled out by tests.
A vestibular issue remains most likely, in particular given the short duration of the episodes. It may have been complicated with central sensitization which leads to perpetuation of the symptoms. I am afraid also by exclusion, I do not see any other possibility to investigate. Impingement is not likely.
I am aware that I have perhaps not been of much help. I imagine you expected some new lead, I am sorry and wouldn't blame you if you asked for refund. But with the information at hand, without being able to directly examine, we are dependent in our judment on tests and in this case they've all turned normal. Perhaps a last possibility would be also that of stress and anxiety being superimposed on the BPPV issue, but I wouldn't want to label a case as due to anxiety from a computer unless I am really certain of it. I hope your sister feels better soon.
Read below.
Detailed Answer:
Hello! I am fine thank you for your concern! Coronavirus cases are rising alarmingly in the last two months as in many parts of the world but so far me and my family haven't been directly affected apart from naturally the added stress at work. I hope you remain safe as well.
I read your sister's case carefully several times. To be honest it is a difficult one and hard to suggest a diagnosis confidently. She has had tests which exlude involvement of the brain, spinal cord as well as peripheral nerve and muscle disease which would first jump to mind. Of course blood tests to rule out metabolic issues are necessary but given the in depth testing you describe I would bet those have been done and the issue ruled out as well. In particular vitamin B12 deficiency should be considered, but again, most likely has already been considered and ruled out by tests.
A vestibular issue remains most likely, in particular given the short duration of the episodes. It may have been complicated with central sensitization which leads to perpetuation of the symptoms. I am afraid also by exclusion, I do not see any other possibility to investigate. Impingement is not likely.
I am aware that I have perhaps not been of much help. I imagine you expected some new lead, I am sorry and wouldn't blame you if you asked for refund. But with the information at hand, without being able to directly examine, we are dependent in our judment on tests and in this case they've all turned normal. Perhaps a last possibility would be also that of stress and anxiety being superimposed on the BPPV issue, but I wouldn't want to label a case as due to anxiety from a computer unless I am really certain of it. I hope your sister feels better soon.
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Above answer was peer-reviewed by :
Dr. Prasad
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