The symptoms of peripheral nerve hyperexcitability.

The primary symptoms caused by peripheral nerve hyperexcitability (PNH) is involuntary muscle fibre activity in the form of muscle twitches(fasciculations), cramp and cramp like feelings, along with muscular aches, pain, soreness and discomfort.

Sensory symptoms such as pins and needles, numbness, tingling and burning sensations might also be present to a more or lesser degree. Secondary to these, sleep disturbance, fatigue and an intolerance to exercise may also be experienced, though these might not become evident until a period of time after the onset of the main symptoms. Excessive sweating (hyperhidrosis) is also reported in some patients with PNH which could be as a result of an increased metabolic rate linked to muscle overactivity.

All these symptoms can vary in terms of severity with good and bad periods lasting days or months. Normally the twitches are always present while the other symptoms can wax and wane. A feeling that the symptoms are worse while at rest may be also observed.

The Muscle Twitches.
Usually the first symptom to be observed. They can be variable in terms of size, type and duration and also migratory, habitually moving from site to site. Therefore, they are not limited to any specific area of the body so they can be experienced anywhere from head to toe, nor do they follow any particular pattern.

However, they commonly affect the limbs with the calves and or thighs being a favourite area and these sites may well become the predominant area, with random activity appearing elsewhere occasionally. Quite often they might be sensed, but not be visible and the reverse can also apply. Variations that can be expected include short bursts of rapid muscle twitching affecting a small area, with an interval between each burst, to a slow rhythmic pulse that causes the whole muscle to move, which can last for hours.

From experience, constant muscle twitching may well be observed which is focused in and around a particular muscle on a daily basis. One particular type of muscle activity that is hard to define, is often described as a rippling or undulation of the muscle with the reference to it feeling like having to worms under the skin. In most case's twitching/muscle activity continues during sleep and general anesthesia

The Cramp
Probably the most painful of the symptoms and usually triggered by movement. It can be persistent and when it does subside, the affected muscle may remain painful for quite some time. Another common occurrence is the feeling that the muscle is about to cramp up, but never actually turns into the full blown version.

The Aches and Pain.
These symptoms may occur due to a prolonged period of muscle activity. Despite the fact that some of these twitches can be very small, over time they can have a cumulative effect. This can result in symptoms of the type caused by exercise, namely aches, pain and soreness including area's that are tender to the touch. During periods when these symptoms are not evident a tender spot may well appear without any apparent reason. Quite often first thing in a morning is a time when this is observed, this could be due to one very specific area being subjected to constant muscle twitching activity throughout the night. Typically these aches and pains vary depending on the severity of the muscular activity, however, a constant sense of background discomfort may well be present on a daily basis, noticed as burning or tingling sensations.

The Fatigue.
Fatigue can also be a component of PNH. It often persists on a daily basis and is not relieved despite periods of sleep or rest. Furthermore, it is not necessarily dependant on the severity of the symptoms as one might expect. Patients with mild symptoms of muscle twitching are equally likely to experience fatigue as those where the muscle activity is more intense. Given the physical nature of PNH then constantly overworked muscles could result in fatigue, further to this, PNH can be mentally arduous which also places demands on the body and as with any long term illness some form of permanent tiredness might be expected. Studies of chronic fatigue syndrome have indicated a possible link to the autoimmune process, so fatigue in relation to PNH could be caused as a direct result of immune dysfunction.

In my particular case fatigue is present on a daily basis despite 6 or 7 hours of undisturbed sleep and I often wake feeling more tired than the previous night. Mid afternoon is also a time when the effect of fatigue becomes a problem with the urge to sleep difficult to ward off.

The exercise intolerance.
Exercise intolerance may also be observed as a physical aspect of PNH. This might become more evident when constant twitching is focused in and around the larger muscle groups. This persistent activity would in essence, subject the muscles to a form of perpetual self exercise, uninterrupted by the required rest that is necessary for the muscles to function normally. Therefore this would leave little capacity for the extra workload in the form of physical exertion. Add to this the problem with fatigue in the form of permanent tiredness and it would seem natural that the body was unable to tolerate exercise.

At rest.
It is often noticed that the symptoms appear to be worse while resting. One plausable explanation for this could be the fact that the muscle is relaxed, so any twitching it was subjected to would be more pronounced thus giving a perception that the symptoms are worse. Another line of thought that could also explain this observation is a decrease in blood circulation when the muscle is in a relaxed state. Quite often if I impart some form of movement, however slight, into a muscle then invariably the symptoms affecting that muscle become less apparent.

Stressful times.
Stress and anxiety can also impact on the symptoms and will undoubtedly elevate them. It is oftent thought that stress is the cause of the symptoms, and this is frequently the view of Doctors, but as far as I am aware their is no evidence to support this. However, it is often reported by people that their symptoms started after a particular stressful period, so it may play a role as an activator in some cases.

Various others.
Occasionally random symptoms may be observed that are dissimilar to those experienced on a day-to-day basis. This type of activity tends to come and go over periods of time. Examples that I have experienced include movement induced cramp affecting the calf muscles when stretching out first thing in a morning. Another was a period of months when my thumb would constantly twitch down towards the palm of the hand. Hamstrings that become so tight that it can be difficult to fully extend the affected limb.The most unnerving and strangest symptom I've suffered is best described as a sudden abrupt convulsive movement or jolt directed at the back of the thigh muscle, immediately followed by a shiver or "flow of current" like feeling that terminates with a buzzing sensation at the tips of the fingers.

Taken overall, whenever a new symptom appears, or a familiar one but in a different area on the body previously unaffected, then as long as it is muscular in origin and can be atributed to PNH. I don't let it concern me.