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Dr. Bob
Dr. Bob, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5641
Experience:  Neurology & Int Medicine (US Trained): 20 yrs experience
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Past year, I have had unexplained daily 24/7 numbness,

Customer Question

For the past year, I have had unexplained daily 24/7 numbness, cramps, stiffness, pins and needles, fatigue and difficulty exercising. The first neurologist said 'functional neurological disorder', the second said 'likely conversion disorder with possibility of cramp fasciculation disorder'. The second neurologist sent me for bloodwork, MRI's and EMG with nerve conduction study. The former two came out negative. When I saw the consultant neurophysiologist, I explained my symptoms and told her that all the doctors think my symptoms are caused by stress. While conducting tests, she shook her head and said no this is not caused by stress and she asked me if I had heard of 'cramp fasciculation syndrome'. I said no and she told me to go home and read about it and that my consultant would write to me. I then spent the next month thinking I had 'cramp fasciculation syndrome' and felt sad but relieved that it did seem to fit and explain my symptoms. I have now received a letter from my consultant saying 'there is no evidence currently of a detectable problem with the muscles or nerve that might explain some of the symptoms- I am pleased to say that neurophysiology tests were reassuringly normal'.Now I don't know if a) the neurophysiologist interpreted the results incorrectly, b) the consultant disagreed with the results reported by the neurophysiologist. Are neurophysiologists able to tell results during the EMG exam or do results need to be analysed by a second person? Many thanks.
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Bob replied 1 year ago.

Hi there. It is very reasuring that your MRI and nerve conduction tests came back normal. Unfortunately, this does not rule out "cramp fasciculation syndrome" or "benign fasciculation syndrome." These things normally do not show up on either MRI or nerve conduction/EMG tests. So both pieces of advice you received might be right. The good news is that if you have one of these syndromes they are not life or limb threatening and often improve over time with improvements in one's psychosocial situation. On the other hand, there might also be a low grade, ongoing autoimmune or autoinflammatory condition resulting in these symptoms (and not a primary neurological condition). I would suggest you have your CRP and ESR tested first. These are both blood tests that look for evidence of overactivity of the immune system. If elevated, I would suggest you ask your doctor for a referral to a rheumatologist. These are the doctors that specialize in autoimmune and autoinflammatory conditions. If the levels are not elevated, I would see a mental health professional to see if you can get any underlying stress or anxiety disorders under control. This might result in dramatic improvement of your symptoms.