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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 34678
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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Your website was referred to me re: internal

Customer Question

Your website was referred to me re: internal tremors/vibrations in my torso, arms and head. Gets especially bad at night and wakes me up. Have had numerous symptoms related to MS but MRI and Lumbar Puncture are negative.
Do you know what these internal tremors/vibrations could be?
They started about a week after I had a vertigo episode followed by many weird sensory symptoms that were frightening. I have had double vision for 15 years (never could determine why) incontinence issues for 10 years, memory loss and brain fog, etc. Very fatigued most of the time. Thanks for your help!
Submitted: 1 year ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 1 year ago.


I am Dr. Arun and will be helping you today.

I am sorry that your question was unanswered for long.

Neuropathy of polyneuropathy can be a possibility of the diagnosis.

Following investigations are done for ascertainment of the diagnosis (some of which had been done for you);

1) Electromyography/nerve conduction studies (EMG/NCS)

2) MRI of the spine and brain

3) blood glucose and glycosylated hemoglobin

4) serum B12 level with methylmalonic acid (with or without homocysteine),

5) serum protein electrophoresis

6) Anti-nuclear antibody

7) Lyme testing

8) Rheumatoid factor

9) Sjogren's syndrome testing (Anti-Ro, Anti-La Antibodies)

10) Serum thiamine (vitamin B 1 ) level

11) Pyridoxine (vitamin B 6 ) level

12) Serum folate levels .

13) Urinary excretion of N -methylnicotinamide

14) Cyanocobalamin (vitamin B 12 ) level

15) Pantothenic acid: Excretion is less than 1 mg/d.

16) The serum α -tocopherol (vitamin E) level

17) Serum phosphate level

18) Biotinidase levels

19) Aminolevulinic acid synthase in urine (porphyria)

20) Arylsulfatase A and B (leukodystrophies)

21) Hexosaminidases

22) Urine oxalate levels

23) Serum lactate, ammonia, and pyruvate

24) Urine myoglobin

25) Muscle histochemistry

26) Enzyme assays of muscle, blood, and fibroblast

27) Leukocyte glycogen levels to detect acid maltase deficiency

28) Leukocyte, DNA analyses (McArdle disease)

Skin and nerve biopsy are recommended after the results of these investigations.

This is likely to give the diagnosis and guidelines for the management.

It is privilege assisting you.

Please let me know if you have further queries or unanswered questions.

Please consider a positive rating if this interaction has been satisfactory, as this is the only way we experts are credited and compensated for the time and work. You are not charged again for giving a rating.

Thank you.

Wishing you all the very best in life.

Expert:  Dr. Arun Phophalia replied 1 year ago.

Thank you for the opportunity to answer completely your Question. Please make sure to rate me because that is how I am credited for my work.

Now, I will provide an Additional Service offer so that you have this option available on your question list to get a hold of me directly in the future.

This additional service offer can be used for

- if you would like to schedule a new, private email session or to ask me directly a new question. It's up to you.

Thank you.