worried nurse/medical student

[dorado]

Since the age of 16 years old, i've been experiencing right hemi-body spasm i.e from the foot to the face. i believe the appropriate word for it is kinesogenic paroxysmal dyskinesia. this symptom could happen 10 to 30 times a day and lasted 2-5 sec no pain or deficit followed the spasm. the spasm would occur only if i did a sudden mouvement. between the spasm i would feel what i believe Doctors call an aura sensation in my whole hemibody. since that term is fairly vague i will add that i never felt weakness or numness or pins and needle in the right hemibody.

from the age 16 to 21 i never condulted for this problem. however before passing my drivers license test i decided to see a doctor just to be cautious. thats when i got my first encounter with the word MS. He refered me to a neurologist who was not impressed at all with my feeling and said there was no sign of ms in my condition. i didn't like him so i saw anothe neurologist who although he was a lot nicer agreed with the first one. i had a head ct without contrast that was normal.

reassured i continues my life feeling these symptoms on and off knowing that i dont have ms. at age 24 i saw my neurologist in a panick because i started feeling this in my left side again he dismissed what i felt as anxiety. reassured i started to live again with these feeling on and off sometimes on left sometimes on right with the spasms gradually decreasing in frequency. actually there would be period when the aura sensation disturbed me more than the spasm themselves.

present days i'm 28 i've been feeling this aura sensation in my left side for 6 weeks. i saw my neurologist twice in the last 6 weeks. each time he told me that i was too anxious and that if he had the smallest doubt that this could be MS he would have sent me fot an MRI. he prescribed BUSPAR!!!!!. i decided to see another neurologist, he said he could not rule out MS right now but that it was unlikely since this has been going on for 12 years and only one type of symptom and that i needed an MRI. i agreed with him but informed him that i was the impatient type and i was not going to wait 9 months( i live in CANADA long waiting lists) and was ready to pay for it. HE responded that it wasn't worth it, that my result is certainly going to be normal and that i could wait. for the last week the aura sensation seems to alternate sides every 5-10 minutes, i do feel it sometimes in both sides but never for long. this is the rational part of my problem but the following part is also important.


i have an obsessional anxiety disorder diagnosed last year but i've been living with it for at least 5 years. when i started feeling this on my left side, i succeeded to resist going on the net for 2 weeks, after that i could'nt resit anymore.... i went on the net. during the following weeks i started feeling a lot of the symptoms i read:


part of my skin that felt weird cold and changed location (arm face)
shivering (goosebumps sensation) that i felt after my mom told about one of her friends with ms who felt this
warm sensation at different parts of skin and changing location
frustrating unability to be able to say if i feel weakness or not (weird feeling in my legs)

I never felt any of these symptoms before reading them on the net


finally i should add that i tested my strenght at many occasions


my grip is symetrical and not decreased
my strength in my legs doing barebell squat ( squat with 180lbs on my shoulders) is the same
calves strength is the same
shoulder, bicep and tricep is the same
dorsiflexion is the same
i've always had low tolerance to abdominal exercise (i get cramps very easily since the age of 18) strenght did not change, endurance the same

i would like to know your opinion about my experience. i have to say that i am very freaked out because i read an article saying that although it is quite rare paroxysmal kinesigenic diskinesia can be an onset symptom of MS.

thank you in advance

truly

Dominic Noel
BSN, future med student at AUA school of medicine start september 2009

[MG (Admin)]

Thanks Dominic,

Well I will allow myself to be more technical than usual given your background.

It sounds likely that you have a movement disorder which may actually be a type of dystonia. I cannot commit to this without seeing you but it may be worth seeing a movement disorder specialist for this.
In terms of investigation, we always exclude Wilson's disease (by checking liver function, the eyes and ceruloplasmin levels) and also (if dystonia is a possibility) then we always try L-dopa containing meds given the possibility of dopa-responsive dystonia.

MS can cause tonic spasms but this is a rare presentation. In fact dystonia is a grey matter problem whereas MS is a white matter problem.
In other words MS is a remote but highly unlikely possibility
It is clear that you do need an MRI as your symptoms are more on one side than the other and therefore a structural lesion must be excluded...in all likelihood nothing of any worry will be found but it is important to do in any case.
Bottom line:- you should get seen by a movement disorder specialist
Hope that helps...
let us know how it goes

[dorado]

i'm not sure if my reply was entered but if it has i'll edit this one


i'm pretty sure that it is my anxiety talking but if you dont mind can you explain me the rationale in my description that ables you to qualify (to my great joy and happiness may i add ) my risk of MS as highly unlikely*. also i am anxious about the status of this movement disorder. By that i mean would it be primary (like the hereditary form of PKD) or secondary (due to another disease like huntington's disease or MS). i think my greatest strength in this situation is also my achille's heel. my knowledge and understanding of my symptoms is altered by my constant anxiety and i always end up thinking that i have MS or another debilitating disease. did AVM, cysts or tumors (benign or malignant) have been ruled out by the head ct without contrast? i noticed you did not mention the symptoms that i linked to my anxiety does it mean that your impression* is that they do probably originate from my anxiety?


thank you in advance


*i know you're impression is not a diagnosis

[MG (Admin)]

There is no doubt that anxiety explains many of your symptoms as you suspected....this is common and should not stop the investigation of your movement disorder.
CT would pick anything big up but subtle lesions can only be picked up on MRI..

m pretty sure that it is my anxiety talking but if you dont mind can you explain me the rationale in my description that ables you to qualify (to my great joy and happiness may i add ) my risk of MS as highly unlikely

MS very rarely (if ever) causes the symptoms you have....that is all.
Also...if you are anxious to the point of this affecting your function then this needs to be treated...irrespective of whatever else is going on.

all the best

[dorado]

hello thank you again for your wonderful service



so i followed your advice.... i'm getting an mri on thursday and i am getting help for my anxiety which is getting better... but my fear of MS is still alive and well and it seems like the only way to calm it down is to research on the net. even my symptom seem better when i do that (weird!!!). i had to postpone my deposit and final answer for med school because of all this. last week i read an article on movement disorders http://www.pubmedcentral.nih.gov/articl ... id=1868381
and the unending spiral of thoughts started again about MS. as stated in my initial post my Doctor did put me on Buspar so hopefully my anxiety will be on check. but concerning this article do you think it could describe my situation???

thank you again for your help

Dominic


ps:

the symptoms on my left side are still the same (kind of an aura sensation no functional weakness noted), this aura sensation initially started on my right side 12 years ago and now its alternating side during the day. example: 20-45 minutes on the right side, 10 minutes both sides 30-45 minutes on the left side (again WEIRD!!!). one last thing physical activity (while doing it) seems to decrease whatever feeling i have when i manage to not think about it left or right.

[MG (Admin)]

This article describes 2 very very rare cases (which is why they were published)!
Both of these patients at some point along the way had some features more typical of MS.
It is also not very clear that their movement disorder was caused by MS although it is possible.
So the short answer to your question is that it is theoretically possible....but highly unlikely...so unlikely in fact that you would probably find yourself written-up in a case report if MS turned-out to be the cause of your movement disorder.
Let us know how the MRI goes and try to stay calm.

all the best

[dorado]

i am trying but hardly am able to stay calm. i am a nerve wreck. and on top of that my symptoms are now mainly on my right side ..... where they usually were for most of the last 12 years. my left side is almost symptom free as if nothing ever happened i also feel a weird feeling (maybe just too scared to say weakness) above my right knee cap i hope its due to the huge anxiety i have now. i'm writing these lines and i'm crying . it may be totally irrational but i feel like it cant be nothing else than MS and this freaks me out. this would mean no more med school, disability ect....

freaked out Dominic

[dorado]

so i got my head MRI and i managed to have it seen by a neurosurgeon and a radiologist... both agreed that there isn't any signs of MS, i have my official appointment with my neurologist today to look at the real report. my symptoms are still there. i figured that if it was indeed anxiety they would have disappeared with the evaluation of both of the doctors who took a look at my MRI.

still worried Dominic

[dorado]

hello!!

i had my appointment with my neurologist who confirmed the radiologist report of no lesion in white matter or ischemic disease. I am very happy about that . however, my symptoms are still present and evoluating now, it feels like an alternating sides weird feeling (very hard to describe, not able to say if its definite weakness as no functional deficits are present), the spasm are not occuring at all though. my questions are, is MS completely ruled out now by this MRI without contrast on a open 1.5T machine or is it possible that i may fall under the possible 5% who have MS without lesions? and besides anxiety is there any other differential diagnosis i should ask my neurologist?

less worried but still worried Dominic

[MG (Admin)]

Yes..it sounds like MS has been completely ruled-out in your case (there are criteria for diagnosing MS and from what you have told me you do not fit-in to these criteria).
And yes..your symptoms can be explained by anxiety however this diagnosis can only be made with confidence if no objective signs are found on clinical examination....I assume the Neurologist examined you...what did he find?

[dorado]

well he thinks its one of those things, certainly didn't look worried at all. he did do neurological exam.. i guess he found it to be normal. i asked him if a full spine MRI would be a good idea to eliminate any possibility and he said no. what do you think?

[MG (Admin)]

If the neurological exam is normal then there is certainly no need to do any more MRI's.

all the best.

[dorado]

hi!

so its another week but i feel the same. i saw another neurologist who confirmed what the other one said: nothing to worry about. i'm trying to get in contact with a movement disorder specialist. i have a question though.... the feeling i have constntly in my left side is like a prespasm... but somtimes i ask myself if i'm just afraid to say it is hemiparesis. so here is my question :
1)is hemiparesis a subjective sensation or a functional deficit?

2)if i can barebell squat the same way, play b-ball the same way besides being annoyed by this disturbing feeling, bench press, shoulder press, jump as high on both legs ect... is it still possible to talk about hemiparesis. and what about the chnging side phenomenon many times during the day is this typical of any pathology?

3)if hemiparesis is present wouldn't it indicate a total spine MRI examination to verify the integrity of the corticospinal tract?

i have to leave for med school and get engaged to my lovely girlfriend but my fear to be sick is paralyzing me. I guess i'm just looking for answers that could convince me i have nothing.

thank you for your kindness and your answers it is greatly appreciated

still worried Dominic

[MG (Admin)]

Hemiparesis means objective muscle weakness on one side.
If the neurological exam did not reveal any weakness then you do not have hemiparesis
Hope that helps

[dorado]

so hemiparesis isnt just a sensation.... its really a decrease in strength which i cant really say i have. But have you ever heard of something like what i'm describing you i.e a constant sensory aura or prespasm sensation?