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I just turned 70. I was diagnosed with Parkinsons Disease in…

Hi. I just turned...

Hi. I just turned 70. I was diagnosed with Parkinsons Disease in August 2005. I've also had lumbar sacral fusion and L3 laminectomy. 3 years ago. My PD is very slow moving in terms of getting worse. I have severe hip, buttocks, and leg pain. I have a spinal stimulator which hasn't done much good. I now have tingling in my legs when I stand up. I know tingling is a sign of MS. Could my luck be that bad as to have MS too?? my pain is pretty intense and is slowly getting worse.

Doctor's Assistant: What seems to make the symptoms worse or better? Any redness or swelling in the leg?

No redness or swelling. Pain and tingling in both legs. Sitting a lying down help, standing and walking make it worse.

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

I don't have any neurological issues in my family of origin. All my doctors, especially my PD doc continue to say my symptoms are neurological, not muscular. But no treatment for neurologic pain has brought me any relief, So I wonder if I have a dystonia? or MS??

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Answered in 1 hour by:
3/10/2018
Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 6,122
Experience: American Board Certified Neurologist, Internal Medicine
Verified

Hi, I am an American Board Certified Neurologist with vast experience in diagnosing & treating all neurological as well as all other health/medical conditions, and I am very glad to help you with your health concerns.

I am sorry to hear about your health as you have described above. As a Neurologist I frequently diagnose & treat this type of health situation, and I can certainly help you in this regard.

Let me discuss the health issues and concerns you have been having & their management point by point below here;

First of all this new onset tingling does not appear secondary to MS

This is because it is extremely uncommon for ms to start presenting around age 70

Also the tingling you have described seems starting or worsening when you stand up or walk and this pattern is not suspicious for ms

The symptoms of ms such as tingling or any other symptom are expected to be constant rather than related to any change in position etc, so it should equally bother you while lying down or sitting etc too

Also with ms certain other symptoms too are usually expected to occur such as - severe blurring of vision or loss of vision in one eye, paralysis like or stroke like symptoms on one side of the body, facial droop, double vision etc, and you have not mentioned any such symptoms so I assume you are not having any such additional symptoms so again this implies ms is unlikely the cause for the new onset tingling you have been having.

This type of tingling can be due to one of the following causes;

1) Pinched spinal nerves in the lower back/lower spine region, with or without spinal stenosis

2) Peripheral neuropathy (primary nerve damage in the legs itself)

3) Circulation problems too can rarely cause tingling sensation in the legs

4) Other health conditions that can present with tingling in the legs include the following;

a) Vitamin deficiencies

b) Thyroid disease

c) Diabetes

d) Prediabetes etc

The worsening pain appears muscle related and some of the possibilities to explain this type of pain include the following;

1) Dystonia

2) Muscle spasticity

3) Muscle rigidity

4) And the earlier mentioned causes for the tingling sensation in the legs can also cause severe and progressively worsening pain in the legs too

As you see there are several possibilities to explain this type of new onset of tingling sensation, as well as severe & progressive pain - and this will require a thorough clinical examination followed by certain relevant investigations that may include some of the following;

1) MRI scan of the brain

2) MRI scan of the spine and spinal cord (if any contraindications for mri scan is present then CAT scan can be done)

3) EMG/Nerve conduction study of the legs – this is a nerve and muscle test

4) Circulation tests such as Doppler Ultrasound of the legs

5) And certain blood tests such as the following;

a) Comprehensive metabolic panel that includes electrolytes, blood sugar, liver and kidney tests etc

b) Blood vitamin level estimation

c) Muscle enzymes such as CPK, Aldolase, LDH

d) Inflammatory markers such as ESR, CRP, ANA, RA factor

e) Thyroid tests etc

Not necessarily all the above investigations may be necessary, your clinic doctors including the neurologist will be in a position to decide which ones among the above mentioned investigations are required in your case after conducting a thorough neurological examination in the clinic. If the current neurologist is not helpful then please consider seeing another one for another opinion. And also if any of the above investigations have already been done, especially recently, then there is no need to repeat them. The precise & specific treatment plan will depend upon the results of the above mentioned investigations and in the meantime you may try some of the following therapeutic measures to help with this new onset tingling sensation and the pain;

Nerve-pain pills such as Gabapentin, or Amitriptyline

Muscle relaxants such as Baclofen, or Tizanidine

Steroid Iontophoresis

Cannabinoid CBD Hemp oil oral or sublingual preparations

Narcotic pain killer such as Lortab or Percocet

Physical therapy

Massage therapy

Hydrotherapy

Trigger point therapy (if any trigger points are present)

Hot fomentation

Short wave diathermy

Infra-red light therapy

Ultrasound therapy

TENS (Transcutaneous Electric Nerve Stimulation)

Interferential therapy

Laser therapy (Cold laser therapy or Low Level Laser Therapy)

Acupressure Mat and Pillow Set for the relief of pain

CES (Cranial Electrotherapy Stimulation) treatment

ESI (Epidural steroid injection)

Botox spinal injections etc

In addition to the above treatments the following natural or herbal treatments too can help;

Limbrel (Flavocoxid)

Nettle Root extract

S adenosyl methionine (SAMe)

Glucosamine + Chondroitin + MSM combination

Methyl Guard Plus (which is a combination of active forms of vitamin b12, vitamin b9/folate, vitamin b6, vitamin b2) etc

The above are the various treatment options to consider, but please see not all these above mentioned treatments may be required in your case; I am trying to provide a list of the various treatment options like this so that you are familiar with several treatment options that are available for helping with your severe, refractory & progressively worsening muscle pain, as well as the new onset tingling sensation, and you may try to use them as necessary. If you see any of the above treatments you have already tried please disregard them and you may explore the treatment options which you may have not yet tried.

To summarize once again;

1) As mentioned earlier above there are many different underlying causes for the symptoms you have mentioned.

2) A thorough evaluation and clinical examination in the clinic by a neurologist followed by certain relevant neurological investigations as mentioned earlier above (certain specific/relevant blood tests, Scans, Nerve & muscle tests etc) can help us in ascertaining the precise cause for your symptoms

3) The specific treatment will depend upon the particular diagnosis that is made after the above investigations and in the meantime please consider trying some of the above mentioned treatments to help with obtaining relief from these bothersome symptoms you are suffering from.

4) And very importantly please see this type of health situation can be diagnosed & successfully treated, so please not to lose hopes; please ask your current neurologist/pd specialist for the above mentioned further evaluation, neurological/medical investigations as well as the therapeutic modalities mentioned earlier above, if the current neurologist/pd specialist etc not helpful then please try to see another one to receive another opinion. And I also can strongly reassure you, the new onset tingling certainly does not appear secondary to MS, it is due to one of the other causes as I had mentioned earlier above but certainly not due to MS, so please not to be scared.

Wishing you a quick & complete recovery! And also Wishing you the best health!

All the very best!

Please let me know if you have any additional questions or if you want to discuss this further.

Assuring you the best services!

Best Regards!

Dr Subbanna MD

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Customer reply replied 1 month ago
Thanks Dr Subbanna!! You must have spent some time pulling info together. You’ve given me relief from my panic feelings about MS. I will be back in touch. What’s your take on cauterizing the sacral brain bound sacral nerves. I’m nervous about doing it but I’ve got to find something to deal with my pain. Thanks again. I got more than I expected,Kent

You are very welcome Kent! My pleasure! I am very glad you found the above information helpful! And I am sorry I could not reply earlier since I was away from the computer and just returned.

If you are inquiring about RFA or Radiofrequency ablation, then it is another treatment options that is available for getting relief from the leg pains. This procedure is also called by various other names such as the following;

Radiofrequency neurotomy or

Radiofrequency neurolysis or

Radiofrequency neuroablation or

Radiofrequency rhizotomy etc

During this procedure radio frequency waves are used to produce heat, and the heat is generally applied to an area called as DREZ (Dorsal root entry zone), and this is the region of the spinal cord where the pain signal carrying sensory nerve roots enter the spinal cord. By generating heat in this region this region of the spinal cord gets ablated thus destroying the ability of this region to transmit pain signals to the brain.

This is a minimally invasive procedure without the risk of any major complications and is also found to be effective in treating severe pain in the legs etc

So if you remain refractory to other treatment modalities then this type of rhizotomy or ablation procedure in the region of sacral spinal cord/sacral spinal nerves too can be tried.

And once again, there is certainly no suspicion for MS in you, and I earnestly hope you find the above information & list of treatments helpful to you.

Please let me know if you have any additional questions or if you want to discuss this further. And please take a moment and kindly click a positive rating (preferably 5 Star/Excellent) to credit for the time & effort put by me in answering your health question, and this is the only way I will be credited for my service to you. Rating me now does not close your question and if you have follow-up or additional questions you can ask them after the rating too!

Assuring you the best services!

Wishing you all the very best!

Best Regards!

Dr Subbanna MD

Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 6,122
Experience: American Board Certified Neurologist, Internal Medicine
Verified
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Dr Subbanna MD
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Category: Neurology
Satisfied Customers: 6,122
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Experience: American Board Certified Neurologist, Internal Medicine

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