Stress-Related Tingling in Feet

It all started back in February. I was stressed out about a few things and I had just spent a sleepless night worrying. At work I noticed my hands and feet felt cold and tingly. I took a day off work to ease the tension. After a couple days my hands felt normal again, but my feet still felt "asleep" - although I had no trouble walking on them, unlike when they're actually "asleep" after I've sat on them funny or something. The tingling sensation gave way to a buzzing or vibrating feel, as if I had a pager taped to my toes. This went on for a week solid, and the distraction made it difficult for me to sleep.1. Maybe I have diabetes?I first went to the doctor a week or two after the toe tingling started, worried about possible diabetic neuropathy (I didn't have diabetes that I knew of, but it runs in the family; my mother was just diagnosed earlier this year). The blood sugar test came back normal, which was a relief. They drew more blood for other lab tests, and they said I'd get the results in a few days. The doctor did some basic neurological tests (strength tests, monofilament, the vibrating thing) said it could be a vitamin B12 deficiency, among other things, but was probably not serious.2. Whew, it's probably just a B12 deficiency. I can take vitamins.The phone call came with the results, and the nurse told me everything was perfectly normal. One might expect to feel relief upon hearing that blood tests were normal, but I felt a surge of anxiety--oh no, there must be something _seriously_ wrong with me. This was about the time I Googled my symptoms and became convinced I had MS. Late one night, I felt like I was shaking from deep within my body--in retrospect, I believe I had a "thumper" type fasciculation in my back--and this threw me into my first (and so far only) panic attack. I felt a tremendous pressure in my head; my ears went numb; I felt like I couldn't breathe. My wife called 911.3. Oh noes, I just had a brain aneurysm rupture and I'm going to die.The paramedics showed up quickly, and they hooked various wires up to me, but mostly just talked to me, I presume asking questions to keep me lucid. After awhile, they said "Your heart rate is dropping. You've had a classic panic attack. You're not dying. Make an appointment with your doctor and he'll see what he can do about your anxiety."4. It's just anxiety...The doctor examined me a bit, had me fill out some questionnaires, and told me my anxiety was off the charts but there probably wasn't anything physically wrong with me. He said my symptoms aren't consistent with the usual presentation of MS, but that disease is a chameleon, so if my symptoms change or worsen, make another appointment. He sent me off with a prescription of Xanax and a referral to a psychologist. Meanwhile, I'm thinking "Yeah, I know I tend to worry, but my anxiety hasn't ever done _this_ before." I had trouble convincing myself there was no underlying physical cause. But the doctor said that an MRI or nerve conduction study wasn't warranted at this point.5. Today's Vocabulary Word: "Fasciculation"About two months passed, and my symptoms eased up. Not 100% gone, but not often bothersome. I was still occasionally distracted at bedtime by buzzing sensations in my feet and legs. But then one morning I felt as though someone was repeatedly poking me in the leg. I looked and saw it twitching, right through the clothes. This went on repeatedly for several minutes, and I started to panic. Up to this point I had not noticed any motor symptoms, just vibrating/tingling sensations, so this visible twitching had me worried. After this event, I didn't notice any more fasciculations for two weeks, so I figured it was just an isolated thing--but then the fascics started coming regularly, all over my body. 6. I probably have MS after all...After about a week of random repeating twitches every day, I went back to the doctor, and in sharp contrast to my last visit, he seemed very concerned this time. I overheard him talking to a nurse about "widespread fasciculations" in a serious tone of voice. He ordered a brain MRI to rule out the possibility of MS, and he referred me to a neurologist. He did say that, since I had no loss of strength, and my fascics came and went rather than sitting in the same place all day, that I probably did not have ALS, but that my symptoms are not common and I should definitely see the neurologist.7. **SThe brain MRI results came back normal. By this time I had discovered this forum and I was almost certain I had BFS, but I went through with the neurologist appointment to make sure. The neurologist performed clinical tests, including poking and prodding my feet with various implements that the doctor had used before. He tested my reflexes, which were mostly absent, but he didn't say anything about it. After these tests were done, he said "It could be motor neuron disease. I'm going to order some nerve conduction tests, and if these come back normal you're fine." Gulp. Hearing a neurologist mention MND, and not in the dismissive way my GP mentioned it, sent my anxiety levels through the roof. They set me up for two NCV/EMGs, one of the arms and one of the legs, with a follow-up appointment a week afterward.8. A glimmer of hopeThe EMGs were performed by a physical therapist, not by my neurologist. At the first EMG, he was evasive about the results of the test, saying he needed time to analyze them, and he had to report the results to the referring physician, and he couldn't diagnose me or give a prognosis. At the end of the test, he said he found fasciculations in just one muscle (in my right hand), and he'd see me next week for the legs. Still, he didn't say anything about the other results, and I left the test more stressed than I entered it. I was dreading the return appointment, knowing I felt fasciculations in the legs much more often than in the arms. The test bore this out, with fascics present in at least four or five muscles. I asked whether he can see fasciculations in normal people, and he said yes--that fascics by themselves are benign, and "I can tell you right now that I'm not seeing anything else wrong, but your neurologist will give you the full results at your follow-up appointment". Whew.9. Benign fasciculationsI just saw the neurologist today for the follow-up appointment. It was a very short appointment. He said my fasciculations were not pathological, but benign. The EMG was normal. The nerve conduction was 100%--no evidence of neuropathy. Take magnesium, come back if your symptoms change. I was a little frustrated to have waited a week for the appointment, half an hour in the waiting room, and a $30 copay for what should have been a phone call the day after the EMG... but I guess, in retrospect, if the test had shown something wrong, then I would really have needed to see the doctor. But after that frustration wore off, I realized... "Hey. That's it. I'm not dying of some weird disease. I have a benign diagnosis backed by hard evidence. I can finally stop worrying now."... except about my job, and the economy, and swine flu, and ... yeah, I still have anxiety. But I don't need to freak out every time I see my arm or leg twitch anymore.Thanks to those who have helped me here already. I'll keep tabs with the forum. One thing I will _not_ do is come back here worrying and doubting my benign diagnosis. If I do that, you have permission to hunt me down and beat me with a stick. That is all.

Great post, JPS!I'm surprised ANY physician would associate "widespread fasciculations" with MS, considering that isn't a symptom at ALL, but I suppose your regular family doctor isn't always going to remember all of the symptoms of all the NMD's. The tingling of your feet and hands could have been related to MS, but in general, an exacerbation occurs in one limb. With MS, symptoms are initially FOCAL and are characterized by acute exacerbations followed by remissions lasting weeks, to months, to years. Anyway, I'm glad to hear that you got your BFS diagnosis and that you are so determined to cherish and enjoy it. ) Blessings, Sue

Really...a stick??!!!! I think that is a little harsh. YAYAYAYAYAYAY!!!! Awesome but not suprising news! Congrats on your bengin diagnosis...that sounds weird doesnt it? You are in a GREAT place right now....run with the momentum and dont look back!

Good for you!! I am a little surprised about the concern of widespread fasiculations and then making a jump to anything bad but ok...the end result is still awesome ) YAY you! I have already set aside the big stick...we all come back with some doubts after the happy dance stops....but it is ok it is just they way we are I shall "gently" remind you to happy danceSmooches,Kit

I'm so glad for you! Your story re-inforced a valuable lesson I learned. While trying to figure out what was "wrong" with me all those years ago, I had an OB who heard me say I twitched and said "Maybe you have MS?" Also had a GP who while extremely skilled, had never heard of BFS and didn't completely believe my neuro that it was benign. Going through the testing is awful and anxiety inducing, but if you are prone to health anxiety, I think it is an essential party of coping with this stuff.

congrats on your benign diagnosis I have had a benign diagnosis as well..but am not completely reassured...awaiting brain mri...done about everything else.

just read this.awesome post.I had basically the same early-on experience with some extreme fatigue and panic attacks - i also thought I was dying of several other things including mad cow disease and a host of other super-rare disorders. I am surprised, however, that your doc said "it could be NMD" that is awful. It can't be NMD until it can't be anything else its a diagnosis of exclusion! Did you press him for this answer? It seems a bit unprofessional and uncompassionate to tell someone who likely has BFS (you had no evidence of clinical weakness and no clinical UMN or LMN signs right?) that it "could be" ALS.