Q: For the past year and a half I have been very unsteady on my feet, leading to a couple of falls. I have seen two neurologists who have run multiple tests (MRIs on my brain and back and blood tests) to rule out any blood disorders. All the tests have come back normal. They have concluded that it is a combination of arthritis in my lower back and neuropathy in my feet. I don’t have diabetes. What, if anything, can be done about this? The only thing either of them has suggested is physical therapy.
A: Peripheral neuropathy results from nerve damage that causes, pain and numbness in the hands and more commonly in the feet. Symptoms may include a lack of coordination, stabbing and or burning pain, tingling, and a sensitivity to touch. Causes include having diabetes, infection, trauma, exposure to insecticides, and such autoimmune disorders as rheumatoid arthritis, lupus and other generalized nerve diseases. . You don’t indicate symptoms other than unsteadiness so it is difficult to determine if you fit the criteria for being diagnosed with peripheral neuropathy but perhaps the history you presented to your physicians along with complete examinations they performed has been sufficient to rule out some of the potential causes mentioned.
I would feel more comfortable if you were to make an appointment with an ENT (ear-nose-and-throat) specialist to pursue or eliminate still other possibilities. For example, unsteadiness and falling could result from disturbances that include but are not limited to inflammation or infection of the inner ear or from direct pressure on the balance nerve. The inner ear is encased in bone and filled with fluid that bathes nerve endings of the hearing and balance mechanism. Movement of fluid within the balance chambers sends impulses to the brain that interprets them. In turn, the brain reacts to either normal or abnormal impulses and responds in a manner that may make an individual feel as though he or she is falling or unsteady.
Neuritis is a physiological change that occurs in nerves following a traumatic injury, virus, vascular compression or an autoimmune disease. Balance is impaired and the result may be dizziness that is followed by unsteadiness. Fortunately, the balance malfunction usually subsides with time and often does not recur in most cases. The treatment may be medication to combat the dizziness.
Stress and anxiety may result in unsteadiness and a feeling of falling. It may be difficult attempting to walk because of an incorrect perception the floor or ground is vibrating or moving. This can be controlled by addressing the issues that have occurred and taking action to correct them.
While you indicate you have had and MRI and lab testing, speak with your doctor(s) to determine if thyroid testing and specific vitamin deficiencies have been investigated. Thyroid abnormalities can contribute to metabolic changes within the body, as can abnormal levels of vitamins B1, B6, B12, E, and niacin. Ask if a repeat MRI of the brain is appropriate for comparative purposes to be assured no benign tumors or other abnormalities have been overlooked. Further, the diagnosis can be confirmed with nerve conduction studies, which would eliminate the need for an ENT specialist. If peripheral neuropathy is confirmed, your physician might consider protein electrophoresis. Then if you are dissatisfied with your progress following this, ask for referral to a top-notch center such as Mayo or Cleveland Clinic so you can get to the bottom of the problem and get on with your life.
Readers who are interested in learning more can order Dr. Gott’s Health Report “Ear Infections and Disorders” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.
