Hello Doctor,For the past one year I have been suffering from seemingly unexplainable symptoms, which have been getting progressively worse.I have been through a series of medical examinations which did not find anything. My doctors are clueless and I am desperate. I hope you may have some suggestions.Symptoms:Persistent unbearable fatigue which is worst in the morning and afternoon, worsens after eating a meal, after standing up and after drinking coffee. It gets better after lying down with legs raised and after stretching the neck and after drinking alcohol. Otherwise the fatigue prevents me from doing most normal daily activities. I can barely sit and watch videos, eat and use the toilet. I am not able to do any other work. While sitting I fall asleep during the daytime.Resting and intention tremor (while rotating the wrists).Sluggish memory, fairly frequent memory lapses (forgetting my friends names). Clumsiness - when pressing buttons on the computer or microwave I often miss the button and while opening drawers or doors I grasp air instead of the handle, etc.Eye coordination problems - while reading my eyes jump over words thereby making me misread words for something else or just omit words.Cognitive difficulty - with mental arithmetics and planning and I often mispronounce words or use different words than the appropriate one in a sentence during speech.Post-void urinary dribbling and frequent defecation.Flashes of past memory like dreams while awake, euphoria turning into nausea and extreme tiredness afterwards.Pain in the neck, muscle cramps and stiffness in the neck and TMJ area. (I have had orthodontic treatment for the past 2.5 years for correcting underbite). Slightly dislocated coccyx.Pain and pressure behind the eyes, urge to blink often.Tests done and reports:MRI scan of the brain: normal.Thyroid function tests, Liver Function Tests (LFT), serum electrolytes, vitamin B12, kidney function tests: normal.Glucose blood test: normal.Lyme disease: no abnormalities.Gluten intolerance: no abnormalities.Complete Blood Count: no abnormalities.Urine microscopy: no abnormalities.Psychiatrist: no abnormalities, except worry about my health.No hypotension or orthostatic hypotension.Sleep study: no hypoxia or sleep apnea.No papilledema and nystagmus.Plantar reflex - flexion, negative Romberg\s sign.Symmetrical reflexes.No family history of any disease, no childhood history, no epilepsy, no drugs ever taken.Serum C-reactive protein level, serum vitamin B12, serum ACE level, serum folate, complement C3, complement C4, ESR (Erythrocyte Sedimentation Rate) are within normal range.Could all of these be caused by anxiety disorder/ depression?What all tests would you recommend to rule out all possible underlying neurological conditions? What is the most probable condition I am suffering from?
Hi. All the symptoms which you have mentioned cannot be explained on the basis of anxiety disorder or depression. The points against anxiety and depression are resting and action tremors, problems with eye coordination and the memory lapses that you are experiencing. You have already undergone almost all required tests in neurology. But a few more tests are necessary: Complete neurological examination by a neurologist - this is the most important test. Screening for heavy metals. At this stage, I am not able to make a provisional diagnosis for you but there is a possibility of Synucleinopathy (group of disorders associated with abnormal deposition of synuclein), if your age is beyond 50 years.Revert back with the reports to a neurologist online 