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Dr. Frank
Dr. Frank, Board Certified Physician
Category: Neurology
Satisfied Customers: 9000
Experience:  Board certified general Adult Neurologist, with experience in experimental neuroimaging and neurodiagnostics.
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This is related to my last question(Please see below). The

Customer Question

This is related to my last question(Please see below) . The fact that i am twitching throughout my body ( after stopping baclofen) , can this be a symptom of ALS . In ALS also twitching and fasisculations are a symptom . I do not feel any weakness in my
body or muscles . the current symptoms i have are : My lips feel heavy . Sometimes i have a burning , tingling sensation in them . 2. My nostrils are sometimes painful while taking breath . 3. I have twitching and fasisculations throughout my body sometimes
thumping one's including my face ( over my nose too) ----------- Dear Doctor , Here's my long case history : 1. In April 2015 , i had a dental work for Deep Teeth cleaning (Root Scaling and Planning i believe ) . For the dental cleaning , the dentist thorougly
anesthesized me and as a consequence I felt no pain during the cleaning . 2. A few days post cleaning , i started having jaw pains and also heard clicking noises while opening jaw . could not chew food without pain especially hard foods . My PCP said that
it was probably TMJ and asked me to visit TMJ specialist . 3. The TMJ Specialist ordered for an MRI-TMJ which i took . Based on the MRI . the specialist said that i don't TMJ disorder . She said that had fluid in my facial muscles as a consequence of the dental
procedure(strain) and diagnosed tendonits . 4. I visited another specialist in Cleveland-clinic who took an facial XRAY . Said it was not TMJ and said that it was probably related to nerves . He asked me to visit ENT Doctor and then a neurologist. By this
time , the jaw pain has resolved . However i have twitching of eyelids , tingling and sometimes burning pain in lower and upper lips , inside of cheeks , teeth and gums 5. The ENT Doctor said everything was fine . 6. Over the net i read eyelid twitching can
be resolved by anti histamine eye drops . I apply them and eyelid twitching disappeared though sometimes i do get them sporadically . 7. First Neurologist saw me barely for 5 minutes . Asked me questions like whether i could swallow . He then said that i need
to visit a movement specialist because i could have dystonia . He also ordered for metabolic panel blood work and Brain -MRI . 8. The metabolic panel blood work was normal except Homocysteine ( 21.2) . Creatinine is 0.98 and Albumin is 4.9 (Normal) The neurologist
prescribed Vitamin B12 ( 1000mcg) 9. I visited another Neurologist who ordered Brain MRI as well as Cervical-Spine MRI . Brain MRI was completely normal Cervical Spine MRI showed 1 or 2 disk protrusions . He recommends Back surgery , but does not offer any
suggestion for facial pain . 10 . I visit another neurologist and ask him if i could have Serious diseases like Mysthenia Gravis or ALS given that my Homocysteine level . He said that he does not think so . He checks for whether my tongue is fasisculating
. Observes that the worms like fasisculation involving the whole tongue is not there even though there is transient fasisculation which comes and goes . Babinski test is negative . I can easily perform I also tell him about another symptom involving my right
cheek . when i attempt a half smile from my right side of my mouth , the facial muscles twitch a lot . However with full smile , they do not . We do not observer this in my left cheek (when i attempt a half smile from that side) . He thinks that the symptoms
i am having may be due to injury sustained to the facial nerves when the dentist injected anaesthesia . He has prescribed a light dose of baclofen ( 5mg/day) . I was taking this for about 10 days and then i discontinued them . I am concerned that i may be
having early symptoms of bulbar als based on the following : 1. My lips feel heavy . Sometimes i have a burning , tingling sensation in them . 2. My nostrils are sometimes painful while taking breath . 3. I have twitching and fasisculations throughout my body
sometimes thumping one's including my face ( over my nose too) Can these be early symptoms of ALS . Please let me know
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Frank replied 1 year ago.

Hi. I tried to answer your question earlier. If you want another opinion that is fine and i will step aside. Dr frank

Customer: replied 1 year ago.
I am sorry Doctor .. I was trying to get an ancillary question answered by you . One of the things i want to know is what could be causing the twitching through out my body post stopping baclofen . If baclofen withdrawal is not the cause as you stated , can als be causing this ...Also what's the treatment for burning pain in my lips which is my dominant and most uncomfortable symptom now . Does ALS cause tingling or burning pain in the face ...
Expert:  Dr. Frank replied 1 year ago.

ALS causes neither burning sensations in the peri oral area of your face nor tingling in the extremities. Therye is one condition called hyperventilation syndrome where hypocarbia from hyperventilating causes a respiratory alkalosis which excites sensory nerves. That is seen in stressful situations and the treatment and diagnostic test is the same which is to rebreath the exhaled co2 by using a paper bag to breath into. Another possibility is burning mouth syndrome which comes again from dental procedures and your dentist should be advised. There.are newer treatments for burning mouth. I hope that answers your question. Please get back to me or rate me if satisfied dr Frank

Expert:  Dr. Frank replied 1 year ago.

I hope I was able to answer your questions. Please remember to rate my service as that is how I am compensated for my work. Click on the stars. Thanks Dr Frank