Muscle Weakness and Pain: A Neurology Perspective

Q: Muscle Weakness and Pain: A Neurology Perspective

Hello： If you have undergone multiple neurophysiological examinations that have all returned normal results, you generally do not need to worry excessively about the possibility of motor neuron disease and may want to consider other potential causes. <br>I recommend discussing th

Hand pain with a sensation of weakness?

Hello Doctor, I have been experiencing muscle twitching since the end of April, and it continues to this day.
Initially, it was a persistent twitch in a fixed location, but after a while, it became random, with occasional twitches that vary in intensity.
I have been regularly visiting outpatient clinics to investigate the cause.
There were no significant issues found in my EEG or nerve conduction studies, and I have had nearly four blood tests with no abnormalities.
I have consulted many doctors, from general hospitals to Taipei Veterans General Hospital, and many believe I may have autonomic nervous system dysregulation, anxiety, or nerve damage.
They have not prescribed medication but advised me to exercise.
After completing a month of medication, I was prescribed another three months of medications including Enatcaps 50 mg, Chuangli sugar-coated tablets 50 mg, and Rifuxin 0.5 mg.
My hands continue to feel sore, and I feel increasingly weak in my hands, although I can still lift objects.
There is a strange sense of weakness.
When I run, my legs feel much weaker than before; I used to run 20 laps without issue, but now I feel like I might cramp after just 2 laps, unable to reach the finish line.
Walking also feels abnormal.
I am really worried about motor neuron diseases and concerned about the possibility of delaying treatment.
I have considered whether I should see a psychiatrist, but I feel lost.

Xiao Fu, 20~29 year old female. Ask Date: 2020/08/19

Dr. Hong Weibin reply Neurology

Hello: If you have undergone multiple neurophysiological examinations that have all returned normal results, you generally do not need to worry excessively about the possibility of motor neuron disease and may want to consider other potential causes.
I recommend discussing this further with your physician.

Reply Date: 2020/08/19

More Info

Understanding muscle weakness and pain from a neurology perspective can be quite complex, especially when symptoms like muscle twitching, weakness, and fatigue are present without clear diagnostic findings. Based on your description, it seems you have been experiencing muscle twitching (fasciculations) and a general sense of weakness, particularly in your hands and legs, since late April. Despite undergoing multiple tests, including EEG and nerve conduction studies, no significant abnormalities have been found. This can be frustrating and concerning, especially when considering the possibility of neurodegenerative diseases.

Muscle twitching can occur for a variety of reasons, and while it can be associated with neurological disorders, it is often benign. Common causes include stress, anxiety, fatigue, and overexertion. In your case, the mention of anxiety and autonomic nervous system dysregulation suggests that your symptoms may be related to these factors rather than a primary neurological condition. Anxiety can lead to muscle tension and twitching, and it can also exacerbate feelings of weakness and fatigue.

The sensation of increasing weakness in your hands and legs, along with the difficulty in running and the feeling of cramps, may also be influenced by psychological factors. The mind-body connection is powerful; stress and anxiety can manifest physically, leading to symptoms that mimic neurological disorders. This is where the role of a psychosomatic approach becomes relevant. Conditions like functional neurological disorder can present with neurological symptoms without an identifiable organic cause, often linked to stress or psychological factors.

Given that your tests have not indicated any serious neurological conditions, it may be beneficial to explore the possibility of a functional disorder or to consider a multidisciplinary approach to your treatment. This could involve working with both neurologists and mental health professionals. Cognitive-behavioral therapy (CBT) and other forms of psychological support can be effective in managing symptoms that arise from anxiety and stress.

Additionally, physical therapy can help improve muscle strength and coordination, which may alleviate some of the feelings of weakness and improve your overall function. Engaging in regular, moderate exercise can also be beneficial, as it helps to reduce anxiety and improve physical fitness, which may counteract some of the symptoms you are experiencing.

In summary, while your symptoms are concerning, the absence of significant findings in neurological tests suggests that they may not be due to a primary neurological disorder. It would be wise to consider a holistic approach that includes psychological support and physical rehabilitation. If you continue to feel uncertain, seeking a second opinion or consulting with a specialist in functional neurological disorders may provide further clarity and direction for your treatment. Remember, addressing both the physical and psychological aspects of your health is crucial for recovery and well-being.

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