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Suggest Treatment For Mitochondrial Disorder And Worsened Symptoms Of Peripheral Neuropathy
Question: Friend with peripheral neuropathy, has gotten worse even on current meds. Upper extremities worse than lower. Emg positive in upper extremities. Suggested getting second opinion as md won't do mri. Has son with mitochondrial disorder complexes I iii IV
Brief Answer:
Please upload NCS-EMG images/examination records.
Detailed Answer:
Hi XXXX,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
If you would have presented to as an outpatient with this much complaint,I would have told you that-your friend is currently on 'Gabapentin' and 'duloxetine' which are excellent anti-neuralgic medicines.Still,if he is worsening,then knowing what is the cause for his peripheral neuropathy is crucial to treat him.It even,does not appear to be peripheral neuropathy,rather proximal neuropathy or neuronopathy ,because upper limbs worse than lower limbs are against peripheral neuropathy.
Please answer a few questions so that I can answer your query better-
1)What is the duration of illness(months or years)?
2)Did it start in upper limbs or lower limbs?
3)Is he having weakness in hands and loss of sensations,any one or both of them?(Describe the symptoms in detail)
4)Any significant medicines history?Is he diabetic or any other past medical history?
5)Any history of rash,fever or joint pains?
Please provide answers to these questions and upload the scanned image of Nerve conduction studies and EMG reports as well as images of the documents ,on which the neurologist has recorded his history and physical examination details of the patient.
Waiting for your follow up question.
Dr.Ajay Panwar,
MD,DM(Neurology)
Please upload NCS-EMG images/examination records.
Detailed Answer:
Hi XXXX,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.
If you would have presented to as an outpatient with this much complaint,I would have told you that-your friend is currently on 'Gabapentin' and 'duloxetine' which are excellent anti-neuralgic medicines.Still,if he is worsening,then knowing what is the cause for his peripheral neuropathy is crucial to treat him.It even,does not appear to be peripheral neuropathy,rather proximal neuropathy or neuronopathy ,because upper limbs worse than lower limbs are against peripheral neuropathy.
Please answer a few questions so that I can answer your query better-
1)What is the duration of illness(months or years)?
2)Did it start in upper limbs or lower limbs?
3)Is he having weakness in hands and loss of sensations,any one or both of them?(Describe the symptoms in detail)
4)Any significant medicines history?Is he diabetic or any other past medical history?
5)Any history of rash,fever or joint pains?
Please provide answers to these questions and upload the scanned image of Nerve conduction studies and EMG reports as well as images of the documents ,on which the neurologist has recorded his history and physical examination details of the patient.
Waiting for your follow up question.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Yogesh D
He does not have copies of the EMG. He only knows that it was positivein the upper extremities and was told this rules out ms. I have pushed him to get a second opinion as his pcp does not want to do an mri. As far as length of condition it began in oct 2013 and he started treatment with gabapentin. They have increased this over the past 15 months with no relief. They added cymbalta within the past 5 weeks. Other medications currently taking are litium and provigil. Provigil was started after lyrica mad him manic. He has a history of epilepsy as a child with two seizures as an adult at 28 yo and 35 yo. He attempted to use lamictal after the last one but it made him violent so he stopped it. He has had no seizures since. He had an eeg to rule this out as seizure activity. I only know that he was told this is not seizure activity i do not know if he had a normal eeg neither does he. Medications he has been on throughout his life other than short term antibiotics: dilantin as a child, seroquel, zyprexa, haladol, prozac, zoloft, lamictal, lyrica, clonazepam. He was a car painter for many years and often did not use a mask appropriately. Other than that he has had minimal environmental exposures. ROS: cardiac, integumentry, respiratory, musculoskeletal, hematological, gastrointestinal, reproductive, vision, hearing, taste, smell all normal.
Neurological: bipolar, epilepsy, neuropathy
Genitourinary: dribbles urine at times secondary to litium.
I feel like he needs the Mri to definatively rule out ms, assess for possible als or spinal causes. He started having the pain on the right side arm and leg it then became bilateral with pain worse in upper extremities. He says his hands are weak sometimes but attributes this to the pain being worse those days. His hands have been numb at times and he complains of constant pins and needles. No diabetes, fever, or joint pains. He has had a significant rash in his under arms and groin 3 times as an adult typically in sunmer months following working outside. Appeared to be chaffing but was very painful and did not clear quickly. Use of antifungal creams provided no relief but use of cream for yeast did.
Neurological: bipolar, epilepsy, neuropathy
Genitourinary: dribbles urine at times secondary to litium.
I feel like he needs the Mri to definatively rule out ms, assess for possible als or spinal causes. He started having the pain on the right side arm and leg it then became bilateral with pain worse in upper extremities. He says his hands are weak sometimes but attributes this to the pain being worse those days. His hands have been numb at times and he complains of constant pins and needles. No diabetes, fever, or joint pains. He has had a significant rash in his under arms and groin 3 times as an adult typically in sunmer months following working outside. Appeared to be chaffing but was very painful and did not clear quickly. Use of antifungal creams provided no relief but use of cream for yeast did.
Brief Answer:
It does not appear like MS. MRI spine/NCS are mandatory.
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up and providing extremely detailed medical history.
I have gone through the clinical history and drug history in details. Based on that, my sincere suggestions and interpretation are:
1)Disease is progressive in nature,so unlikely to be classical MS,unless we are talking about primary progressive MS. However, it is mandatory to do MRI spine here to rule out any degenerative spine changes thus causing nerve roots compression(radiculopathy) and thus the resulting symptoms.
2)You said that copies of EMG are not available, but I again request you to procure them somehow or get it repeated.This is so because without Nerve conduction studies(NCS) and EMG traces and reports,a second opinion on this is essentially incomplete.There is nothing like EMG positive. EMG positive means it can be either myopathic(muscle disease) or neuropathic(nerve disease,nerve root disease,anterior horn disease). But yes,one thing is clear,EMG positive indicates that MS is not the likely diagnosis. For ALS,again EMG traces and reports are mandatory.
So, I sincerely request you to procure NCS and EMG somehow and get in touch. I will be glad to advise you well.
Hope I have answered your query for now.If you have some follow up questions,I shall be glad to answer else,please close the thread-rate it and write a review.
Dr.Ajay Panwar,
MD,DM(Neurology)
It does not appear like MS. MRI spine/NCS are mandatory.
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up and providing extremely detailed medical history.
I have gone through the clinical history and drug history in details. Based on that, my sincere suggestions and interpretation are:
1)Disease is progressive in nature,so unlikely to be classical MS,unless we are talking about primary progressive MS. However, it is mandatory to do MRI spine here to rule out any degenerative spine changes thus causing nerve roots compression(radiculopathy) and thus the resulting symptoms.
2)You said that copies of EMG are not available, but I again request you to procure them somehow or get it repeated.This is so because without Nerve conduction studies(NCS) and EMG traces and reports,a second opinion on this is essentially incomplete.There is nothing like EMG positive. EMG positive means it can be either myopathic(muscle disease) or neuropathic(nerve disease,nerve root disease,anterior horn disease). But yes,one thing is clear,EMG positive indicates that MS is not the likely diagnosis. For ALS,again EMG traces and reports are mandatory.
So, I sincerely request you to procure NCS and EMG somehow and get in touch. I will be glad to advise you well.
Hope I have answered your query for now.If you have some follow up questions,I shall be glad to answer else,please close the thread-rate it and write a review.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Shanthi.E
Thank you i will speak to him and work on getting them
Brief Answer:
That's nice.
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.
That's really nice.
Will wait for you to get back with the reports.
Dr.Ajay Panwar,
MD,DM(Neurology)
That's nice.
Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.
That's really nice.
Will wait for you to get back with the reports.
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Prasad
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