Dear Doctor: I'm a 63-year-old female, and for the last four months, I've had tingling sensations in my arms, legs, eyes and other parts of the body. These are followed by muscle spasms. Two doctors have told me they don't know the cause. What do you think is happening?
Dear Reader: As we've mentioned in the past, our column is not designed to offer specific diagnoses. What we can do, though, is look at the big picture and try to shed light on the symptoms you're experiencing. We also think it's important, despite the two doctors who were unable to help, that you seek out another medical opinion. To that end, we have some thoughts on specific information you can provide that can be useful to the next doctor you see.
When patients report a collection of symptoms that include tingling or prickling sensations in the extremities, as well as muscle spasms, one of the things to consider is a condition known as peripheral neuropathy. This occurs as a result of injury or damage to the peripheral nervous system. That's the complex network of nerves and other structures that allow the brain and the spinal cord to communicate with the rest of the body.
About 20 million Americans have some form of peripheral neuropathy, according to statistics kept by the National Institutes of Health. Additional symptoms can include numbness, sensitivity to touch, phantom pain, burning sensations, muscle weakness and muscle wasting. These can develop over the course of a few days, or take months and even years to become apparent.
With more than 100 different types of peripheral neuropathy identified thus far, each with its own distinct set of symptoms, it's a fairly broad diagnosis. The causes are as wide-ranging as disease, trauma, repetitive stress injuries, endocrine disorders, infections, cancers, overuse of alcohol, side effects of certain medications and environmental factors.
If your doctor suspects peripheral neuropathy, then the next step is a neurological examination. Also relevant is a detailed medical history, information about work and home environments as well as family medical history.
The neurological exam will include testing muscle strength as well as assessing the ability to detect changes in temperature, vibration, light touch and body position. These simple tests can indicate what types of nerve fibers are affected. Metabolic conditions like diabetes, kidney or liver dysfunction, or vitamin deficiencies can be detected through blood and urine tests. Additional tests, like an MRI, may be called for.
During any type of medical exam, you are your own best advocate. Be prepared to tell your doctor where, exactly, the tingling and spasms occur. Describe them in detail. Are they associated with a time of day or night, with an activity or a specific movement? When it comes to your medical history, give complete details, even if they seem unimportant to you. Infections like shingles, Epstein-Barr or West Nile virus can cause neuropathy. So can Lyme disease and other tick-borne infections.
By observing and accurately recording the details of your symptoms, you can give your doctor the vital information she or he needs. And by understanding the nuts and bolts of the diagnostic process, you can become an advocate for your own behalf.