Question: muscle twitches and tingling in hands and feet
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I am a 42 year old male who, starting about 5 weeks ago, had a sudden onset of muscle twitching in my left bicep (it went on for about one hour). The next day i noticed that my left food had some tingling (pins and needle feeling). Over the past 5 weeks the tingling has spread to both feet and sometimes my hands. Sometimes there is a burning feeling in my feet. The muscle twitching has spread to my entire body. The twitches last only about 1 second, but when they happen they will occur in about 3-5 places around my body then stop (left tricep, right shoulder, legs, back). This usually happens when my body is at rest, but not always. In addition, my left hand has been falling asleep at night. also have had some "prickly feeling" on my thigh and right arm. this was only present for a day or two and is not occurring now.

Other information. I have a hx of gi issues and was on rifaxamin twice in XXXXXXX and Feb of this year. I also had gall bladder surgery in Dec 2011 and then got shingles in XXXXXXX (my doc thinks it may have been triggered by operation). I also started cymbalta (60 mg) in early XXXXXXX (for anxiety). So i was on both meds when this started.

I saw my PCP last week. He did some tests (thyroid, electrolytes, Sed rate, checking for muscle breakdown, vitamin b ect) that all came back normal (sed rate was like 4). He gave me a vitamin B shot. My PCP states that he is not worried about MS at this time. He states that it is not that common in men my age and does not feel my symptoms are compatible with MS (no optical problems, no walking issues). At this point he does not want to refer me to a neurologist.

I am not worried about ALS, but i am concerned about possible MS.

Questions:
1. Does this presentation sound like MS?
2. Do you think a neurological eval is warrented at this time?

Thank you for taking the time to look this over.

sincerely, XXXXXXX