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A little advice, please

Hi everyone,

I’m sorry to bother you but I’ve been trying to research on my own and getting nowhere.

I went to the doctor yesterday because I’ve been having problems for the last couple of weeks with numbness, pins and needles and tremors in both hands, as well as weakness in my right arm and a monstrous headache, my first in years. The symptoms aren’t there all the time, in fact most of the time I feel fine, but whenever I get hot they seem to start. I had a similar thing a few months ago when, for a couple of weeks my right hand would get tremors intermitently when I tried to grip things, not when I was hot, just randomly throughout day. During that same time I found I was completely losing words, where I’m normally pretty articulate.

The doctor shone a light in my eyes and did a quick neurological test (reflexes in my arms, walking heel to toe, touching my finger to my nose and then to his finger). He basically said that he was ruling out any kind of permanent physical nerve damage and ruling out carpal tunnel and that my eyes and neurological responses were fine (yay!). But then said it could well be nothing or could be something serious like MS, but that he wasn’t qualified enough to say and was refering me to a neurologist. But the whole consultation was pretty rushed and I just left feeling a bit confused and like perhaps I was overreacting to nothing if my neurological responses were fine.

So, here are the questions I can’t find answers to, if anyone could help I’d be hugely grateful. If my neurological tests were fine, wouldn’t that rule out MS as it would suggest no lesions/scars on the nerves? And from what I have read since, my symptoms right now could fit heat intolerance. But could intermittent hand tremors and losing words a few months ago really count as an MS attack? Seems like a bit of a stretch to me. Anyway, any answers would be much appreciate. Sorry for the essay! Thanks.

MS is diagnosed by, what is called The Mcdonald Criteria.

This criteria are those required for an MS diagnosis and they were first published in 2001, and revied in 2010.

Although the Mcdonald criteria say it is possible to clinically diagnose MS without any tests, they recommend that investigations are carried out so test results can provide further evidence of MS.

Diagnosis of relapsing remitting MS rests on - 2 relapses, seperated by more than 30 days, OR, 1 relapse and an MRI scan 3 months later that shows new lesions.

To determine if a person has secondary progressive MS they must have - had relapses in the past, shown a steady increase in disability for at least 6 months, whether or not they continue to have relapses.

Primary progressive MS is diagnosed if there havebeen no previous relapses and there is - aprogression of disability over at least a year, an MRI scan that shows lesions consistent with MS, evidence of MS detected by examining the spinal fluid collected during a lumbar puncture. Many have a lumbar puncture if other tests aren’t conculsive.

I hope this is some help for you. At the momment you are at the very first part of the problem with a MS diagnosis, so not jump the gun just yet, it could be other things.

Andy

Hi Phin,

MS is a comparatively rare disease, and has more than 100 lookalikes, so the chances are not high you will come out of this with an MS diagnosis. It could be nothing, or nearly nothing - something readily fixable.

Your doctor appears to be dotting all the 'i’s and crossing the 't’s though, by admitting he’s not qualified to say, and wanting it checked out, just in case. What’s the alternative? To be told it’s “probably nothing”, and to go home and wait to see if anything else happens?

I think your doctor is erring on the side of caution, but that’s no bad thing, as many here have had the opposite experience, of GPs being very dismissive of symptoms, and reluctant to make a referral.

With the most common form of MS, relapsing remitting, early attacks are often characterised by good or even complete recovery in between times, so it is possible to have a normal or near normal neurological exam, if recovery has been good enough. However, there could be other conditions from which recovery is also possible, so it doesn’t mean to say you definitely had an MS attack.

Hope this helps,

Tina

It is a rare GP who regards her or himself as an expert when it comes to testing for subtle signs of neurological trouble. That is why they - wisely - tend to hand it over to the experts the minute they feel that there is something not quite right, even if their own tests haven’t let them put a finger on quite what. Personally, I would rather have this kind of GP any day of the week than the over-confident type who is too quick to dismiss as harmless problems that he or she doesn’t quite understand. The days when GPs referred thoughtlessly just to get a patient off their backs are long gone (if they ever existed) and you can be sure these days that the GP is not referring you for fun. Which doesn’t mean that there is anything serious wrong. But which does mean that you will have an expert taking your history and having a good look at you to see what is to be seen, and that can only be a good and sensible thing to be happening. So don’t panic. But don’t think you are wasting anyone’s time either - you aren’t.

Good luck with it all.

Alison