Eye twitching & arm numbness

[3horse]

My right eye started twitching and now has begun to close anytime I move my mouth. This has been going on now for about five months. Now my arms go to sleep all throughout the day and also at night when I sleep. It doesn't really matter what I am doing, they just start tingling and then begin to go numb. The soonest neurology appointment I can get is Dec. 12th. I don't know if the two symptoms are related. The eyelid twitching and closure upon mouth movement is really annoying. Any ideas as to what is going on here?      Thank you, PJ

[LifesAHeadache]

Can I just echo what CCFNeuroMD-JL said about not going to the ER unless you are in a true emergency state.  I'm not on a high horse about not using the ER - but you have to be so careful.  I took my daughter to the ER when she was 11 for a severe migraine.  Big time childrens hospital - told the physician that my daughter could not have IMITREX.  The ER doc came back and said we will not give her IMITREX, we are going to try Sumatriptan and you can follow up with Excedrin Migraine.  1 - Sumatriptan is the generic name of Imitrex 2 - Excedrin Migraine has asprin in it.  Asprin cannot be used in Peds because of Reye Syndrome.  Now, most ER docs are great but don't go hoping to be treated by a veteran specialist for a true diagnosis.  ER docs try to stabilize you until you can get to the specialist.

[3horse]

Thank you for taking the time to answer my question. I really appreciate it.   PJ

[Joyce K Lee, MD]

Dear 3horse,

Thank you for submitting your question.
I will answer your concerns to the best of my abilities, but please be informed that I am unable to offer a diagnosis based on your history and list of symptoms.
I am extremely limited in not having the opportunity to perform a full neurologic examination on you, nor am I able to review the pertinent imaging.
This is solely for educational purposes and should in no way be a substitute for a formal evaluation by a certified physician.

These are all the diagnosis I could think of that are associated with eye twitching:

Aicardi syndrome
Benign essential blepharospasm
Corneal abrasion
Corneal ulcer
Hemifacial Spasm
Primary glaucoma, congenital
Spinocerebellar ataxia
Stiff-Person Syndrome
Torsion dystonia

Based on the limited details you provided, your symptoms seem to point more towards something like benign essential blepharospasm or hemifacial spasms (since movement of your mouth provokes these eye twitches) more than anything else.

Benign essential blepharospasm (BEB) is a progressive neurological disorder characterized by involuntary muscle contractions and spasms of the eyelid muscles. It is a form of dystonia, a movement disorder in which muscle contractions cause sustained eyelid closure, twitching or repetitive movements. BEB begins gradually with increased frequency of eye blinking often associated with eye irritation. Other symptoms may include involuntary winking or squinting of one or both eyes, increasing difficulty in keeping the eyes open, and light sensitivity. Generally, the spasms occur during the day, disappear in sleep, and reappear after waking. As the condition progresses, the spasms may intensify, forcing the eyelids to remain closed for long periods of time, and thereby causing substantial visual disturbance or functional blindness. It is important to note that the blindness is caused solely by the uncontrollable closing of the eyelids and not by a dysfunction of the eyes. BEB occurs in both men and women, although it is especially common in middle-aged and elderly women.

In most cases of BEB the treatment of choice is botulinum toxin injections (there are several formulations; the most commonly used is Botox), which relax the muscles and stop the spasms. Other treatment options include medications (drug therapy) or surgery.

All in all, you need to see both a neurologist (preferably a movement disorder specialist) and an ophthalmologist, seeing that your symptoms could be due to problems localized either to the central nervous system or the eye.

If a local neurologist is not able to see you within a reasonable time, perhaps you should seek help elsewhere.
We would be more than happy to evaluate you at the Cleveland Clinic.

Although my suspicion is that this is not a super-urgent problem given that it has been going on for 5 months so now considered "chronic", I'm sure it is bothersome and that you would rather be evaluated sooner than later.

As a courtesy, please do not do what the other non-physcian responder advised and go to an ER for evaluation of this problem with hopes that you would see a specialist.
ER's are for emergencies.
You may end up with a large ER bill and not even see the right specialist, leaving empty handed.

Thank you,
Hope this helps,
JKL, MD

[3horse]

I live in Southeast Texas. I was hoping a Doctor would answer my question here on this forum. I figured they'd let me know if my symptoms are serious enough to need immediate attention or could wait till my appointment with the Doctor.

[Smak750]

Where do you live that the soonest you can get in is 3 months? Try calling Universities. Also if one place says they can't see you for many years, ask for a referral somewhere else. It might take the better part of a day but you could get something in a week or so.

Your LAST option is to go to a hospital. Usually a specialist will only see you if it is life threating, but you might get lucky, but it will cost you lots of $$$ and there is no guarantee of seeing a specialist.