Question: To Dr XXXXXXX Panwar,
I have to tell you that the term paroxysmal pains or and attacks in multiple sclerosis was extremly very helpful, and is consistant with all medical research and journals.
I am contacting you again because I forgot something important in our review, this is the last view, We had a XXXXXXX 28, 2016, and this one of Feb 9, 2016, The customer service of HCM said for me to ask you to review both of them, dash board, please. I will be asking a new question of a class 2 type Headache, is an underlying disease of such to be diagnosed, ,intermitting paroxysmal pain, my additional and latest paroxysmal pain,or atttacks, or altered sensations of what seems to be again paroxysmal minor attacks.
THIS IS AN OLD REVIEW OF FEB 19, 2016
To Dr. XXXXXXX Panwar, can you give me additional in the term of or description of the pathophysiology, or a medical science rational description of the underlying cause that was most likely was the cause of the description of the intermitting pain which we agree non-vascular inter cranial disorder of my multiple sclerosis, I shall enclose previous decisions.how does it connect to it with a rational of medical science........                                   Asked by                              Me               , Fri, 19 Feb 2 2016
Doctor's reply to your question above...
"conversation doctorReplied" Brief Answer:Intermittent pains are common with MS.
Detailed Answer: -Hi xxxxxx,Thanks for being here on HCM again. I am Dr XXXXXXX Panwar,here with you,once more. Of course,I agree that intermittent paroxysmal pains are common in Multiple sclerosis,which may last for short duration(even seconds)as in your case. If MRI picture was suggestive of Multiple sclerosis,which is obviously a non-vascular intracranial disorder,I would rather say that these short duration intermittent pains are a part of disease process. If your therapy is not responding,you may switch to alternative disease modifying therapy.We have several options out there for MS like interferons,BG-12,Fingolimod or Tysabri. You need to have a discussion with your treating specialist regarding this. Hope this helps.If you have some further questions,I shall be glad to have you in follow-up.Regards Dr XXXXXXX Panwar,MD,DM(Neurology)                                   Replied by                              Dr. XXXXXXX Panwar               , Fri, 19 2016
New Concern -date- 8/04/2016 I had originally complained of frequent mid brain headache pains for durations of a few seconds, year 1978 and 1979, and as recent today neurology progress note at VA.DEL, dated of complaint, 01/05/2016 complaints of ongoing electrical vibrations in patches in his skin, lasting 3 to 5 seconds, switching sites intermittently....,but not present at last neurology appointment in July. This has been comming and disapearing for many, many, many years.
RESEARCH OF NEW ENGLAND JURNAL OF MEDICINE DEFINITION - MEDICINENET,,ADDRESS:WWWMEDICINE.COM/SCRIPT/ART.ASP?ARTICLEKEY=13487, MEDICAL TERM RESEARCHED =HEADACHE AND SECONDARY HEADACHES
RESULTS= there are basicly 3 types of primary headaches, they are migrane, tension, and cluster headaches...Then there is secondary headaches, All headaches are considered primary headaches, or they are considered secondary headaches. The New England Journal of Medicine clearly states in this article " only secondary headaches are caused by other diseases. The associated disease may be minor or major. Sub section connection, such as Inflammatory Disease as multiple sclerosis.
Dr XXXXXXX Panwar, please give to me an additional medical statement of your opinion so I can discuss this with my neurologist,
question 1
Please tell me when I complained of mid brain pains, intermitting and frequent headaches, at the beginning in 1978 and 1979, as we discussed a,- non vascular- intracranial disorder,-paroxysmal pains that are common with m.s., can you please the me if the headaches are primary, or if they were secondary headaches, associated by disease.
Just to refresh or update, there was no other medical possibility at the time whatsoever.
part 2, or question2
would you say the ongoing electrical vibrations in patches in skin, intermitting and lasting 3 to 5 seconds are altered sensations of multiple sclerosis, and or from a medical term point definition apperently was is common in ms patients and is considered paroxysmal pains, or attacks, I call them kinda attacks. AND FROM MEDICAL EXPERIENCE CAN YOU PLEASE TELL ME IF IT IS ALL CONNECTED, IN YOUR OPINION. Seems the symptoms XXXXXXX on and over, and what I stated to you is all true and medically documented in my progress notes.
Thankyou Dr. XXXXXXX Panwar
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And also on my July 5, 2016 neurology report additional to feeling ongoing electrical electrical vibrations in patches in his skin, lasting 3 to 5 seconds, switching sites intermittently,[[ not noted here in note, it may go on for several minutes or a couple hours, even a couple days then disappear for months, and reappear several months later in different locations, or sometimes very close to the same location.
Dr XXXXXXX also on the report as this may be helpful is that a light feeling of "electric shocks or " Lehrmite's " that comes and goes at variable frequencies. Naturally this has been present for very many years.
I shall ask if there is a new cure or medicine, but it seems I am getting one of the best medicines,available, "copaxone"

Thanks Again
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Dr. XXXXXXX
I am enclosing 1 slice, pic, of an M.R.I., that other physicians have viewed and noted it is consistant with diagnoses with M.S. of other exams.
I have noticed that all altered sensations of paroxysmal pains from start in years 1978, and 1979 MID BRAIN pain, or then I called frequent headaches, to present Lehermitts,of year 2016 are consistant in time length, 3 to 5 seconds in my case.
and 01/05/2016 complaints of ongoing electrical vibrations in patches in his skin, lasting 3 to 5 seconds, switching sites intermittently....,but not present at last neurology appointment in July.
Only if you wish you may also comment of 1 pic, or slice of M.R.I.
I hope this gives you a more definitive view of medical knowledge of my case so you can assist in answering my question.
The End. 8/07/2016 12:16 pm US est
Thankyou,
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Thankyou for your reply Dr. XXXXXXX
Yes, I do have a full set of MRI's, additional to that reports of medical reports about my limbs to thumb and index finger, numbness, burning, weakness, and paresthesias. That was kept for record stating further diagnosing to the multiple sclerosis. Naturally all test,, and I do mean major test and exams were completed, and ofcourse multiple sclerosis was reconfirmed and confirmed again.
I do understand not all patients have the same symptoms of MS, and not all people have the same initial clinical symptoms of MS, or results,"" I do have a report from a co-worker and my pains in my head"", I went to the physicians, and was told those pain were that I have initial symptoms of multiple sclerosis, they were very correct. That report is missing from my medical files. My benifits for treatment and medications, maybe even more advanced medications, ect.,which to be fair I am entitled to.
Thankyou for explaining your thoughts and expert review about the secondary headaches, and that it is not common for it to be classified as to be common.
The reason for this request is I complained that I had headaches at a physical, they did not have on the list paroxysmal pains, or multiple sclerosis, or send me to a followup to Neuro. So I have a meeting I must attend, and explain to them that the pains were paroxysmal ms pains I had in head. Then the chief neurologist will review.
Thankyou
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I will accept and close, thankyou very much Dr XXXXXXX Panwar

xxxxxxxxxxxxxx 8/8/2016
My last and follow-up question is,,, the term paresthesias mean more additional studies should be conducted of symptoms, or does it mean in my case from before
there is an additional some type of a possible neurological disorder or disease that may exist.

The End, 8/8/2016
actually only a brief general description of the word is needed for a basic understanding, then I shall close. I am pretty much done, paroxysmal was the main overall concern, an has meet my real need, thanks Dr. XXXXXXX XXXXXXX c.