Brief Answer:
MS is very low on my differential list of possibilities from description

Detailed Answer:
Good evening. I'm the neurologist that sent you the poem on BFS. I still would say that's a likely possibility having to do with all of the twitching you're describing. As far as the tingling sensations and electrical sensations I'm not sure because you never described that stuff to me the first time around.

But I will tell you what stands out from what you tell me that really speaks HIGHLY AGAINST MS.....the clean MRI's. The newest criteria we observe in making the diagnosis of MS (probably at least the last 5-8 years it's been like this) REQUIRES that an MRI either with or without contrast be POSITIVE for at least 1 plaque lesion in either the brain or some part of the spinal cord. If the MRI's are negative but symptoms are present that are consistent with demyelinating disease then, we can make a diagnosis of either POSSIBLE or PROBABLE MS depending on how well the symptoms fit the rubrick (which in your case I would say is mild to moderately fitting at best).

Bottom line, with the symptoms you outlined and clean MRI's of the brain and cervical spine I think the chances of your having MS are extremely low....maybe not ZERO...but not high at all....in my opinion that is....

As far as the EMG goes....that test will NEVER BE SENSITIVE OR SPECIFIC enough to diagnose MS....it can only diagnose the type of electrical disturbance and localize it for you.....it does not look at DEMYELINATING types of diseases. It does detect neuromuscular types of diseases but not MS...never has, never will.

Now, to your questions:

1. Will the spinal tap show any abnormalities that would point to MS if they where not searching for it MS in particular?

ANSWER: If the tap was not being done specifically for demyelinating disease then, NO...they would not have typically sent the fluid for all the tests that we USED TO DO when suspecting MS.

Having said that....recall that previously I told you that it is not considered necessary or even recommended to do spinal taps anymore for diagnosing someone with MS. You must have a positive MRI in order to claim POSITIVE TEST results supportive of MS. In other words, if your MRI's are NEGATIVE and even if you have spinal fluid that shows the tests we used to get as being POSITIVE....get what the diagnosis turns out to be? Who knows but it AIN'T MS....so forget about spinal fluid tests....it's not considered standard of care. Of course, there are many neurologists (and primarily the older ones)....who will do spinal taps...partly because it's a procedure that can be billed and it's definitely a way to keep people coming back...."come back in 6 months and we'll redo the tap..." HA! Right....believe me...I know a ton of docs who play those games.....but as long as the MR is negative....you can have 100 "positive" taps and never be able to fully support your diagnosis of MS strictly on spinal tap results.

I hope I've made the case for why SPINAL TAPS are now considered PASSE in the diagnosis of MS even though many doctors and neurologists even still may wish to do them.


2. I am still worried i have it because my feet are numb and i still have the shocking sensation in my ring finger. Keep in my mind these symptoms all started at the same time as the body wide twitches.

ANSWER: MS does not typically present with body twitches as you've described them. You've already been given the diagnosis of BFS...at least once by myself....but of course, I don't know about how the twitches are combined with some of the other symptoms because you didn't tell me that before. At any rate, I simply refer you back to the MRI's which have all been normal of the brain and the cervical spinal cord and restate what I said in the first question. NEGATIVE MRI's for plaque lesions make the diagnosis at best POSSIBLE and not PROBABLE or DEFINITE MS.


3. I would really appreciate your opinion on my situation. And what course of action i should or should not take. I know this is just a consultation, i made another appointment with my Nuero today but i like getting everybody not just 1 persons opinion on the matter.


ANSWER: I am an adult neurologist and I'll bet your neurologist is, well, an adult neurologist as well. And I'm not sure how many other neurologists you've seen......can you guess what I'm going to tell you NOT to do any more as a recommendation? Don't hire any more Chefs to help make the Soup.....it's going to lose its taste....you know what I mean? In fact, it may not even end up being soup! LOL......

I would recommend you follow the advice and lead of your neurologist who has the advantage of examining you. You are not doing yourself or him/her any favors by soliciting different opinions (especially from the same specialist)....there are many approaches and many ways to apply the same knowledge to making a diagnosis of MS. I believe your neurologist should be given the XXXXXXX and privilege of determining what is best for you in terms of tests, imaging studies, and so forth.

That is my opinion on what you should and should not do. Hope all that makes sense to you.

I hope this answer satisfactorily addresses your interesting question. If so, may I ask your favor of a HIGH STAR RATING with some written feedback.

Also, if there are no other questions or comments, may I ask you CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary?

Please direct more comments or inquiries to me in the future at:

bit.ly/drdariushsaghafi

I would be honored to answer you quickly and comprehensively.

Please keep me informed as to the outcome of your situation.
All the best.

The query has required a total of 97 minutes of physician specific time to read, research, and compile a return envoy to the patient.

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Brief Answer:
MS HIGHLY UNLIKELY with your presentation

Detailed Answer:
There is less than a 5% chance that a person with a negative MRI of the brain has MS. If the spinal cord is also clear from lesions then, that number of 5% goes down considerably to about less than 1%.

If I was certain of my neurological EXAMINATION on you, understood the items you mention in your history and have the MRI studies that you do then, I would look for other causes of your symptoms and basically forget about MS.

Things can always develop in the future therefore, MRI's should be repeated every 6-10 months.

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Brief Answer:
Glad to have been of service

Detailed Answer:
I'm glad to have helped you....I hope you can discover whatever the problem is causing your symptoms. The MRI's of the brain (and spinal cord as well) as well as a neurological assessment and EMG's, etc. definitely all point well away from MS so you should rest more easily. Read that poem on BFS every now and again and let me know if it doesn't describe your situation pretty closely? Then, pass it on to any of your comrades.....you know they're having another ALS Bucket Challenge in August so this poem will come in very handy! HA!

My thanks for your consideration on a high STAR rating. Please don't hesitate to contact me in the future if there's anything else I can do for you.

Be Well!

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