What Causes Loss Of Muscle Mass Through Out Body?

Posted on Tue, 6 May 2014

Question: I have been experiencing the following bizarre symptoms. At first, I thought these were related to my thyroid condition but my Synthroid dose was adjusted and the thyroid is stabilizing. I have been through a battery of tests which have not revealed anything. These worrisome and debilitating symptoms are however continuing - I am in need of urgent advice on what could possibly be causing this. - Feeling loss of muscle mass through out body (eg behind, knees, shoulders.._ - Some muscles are now so fine, they feel like threads - Constant (24x7) gurgling sounds in stomach - Sensation of ligh punches to stomach area, sides of hips, and abdomen - Some electrical sensations lasting 5-10 seconds in various spots in the body - Muscle twitches, especially in the neck and throat areas - Muscle knotting in weak and wasted muscle (eg hands, knees, hips)

Answered by Dr. Sudhir Kumar (22 minutes later)

Brief Answer: My reply is below. Detailed Answer: Hi XXXX, Thank you for posting your query. I have noted your symptoms. You require a detailed evaluation by a neurologist to determine the diagnosis. First of all, we need to exclude a primary muscle disease such as polymyosistis (inflammatory muscle disease). In addition, we also need to exclude deficiency of vitamin B12 and vitamin D. Finally, we need to exclude a disease of anterior horn cells (motor neuron disease). To exclude above diseases, you would require: Blood tests- serum CPK, LDH. Vitamin B12 and D levels. Electromyography (EMG) studies. I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information. Wishing you good health, Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist Apollo Hospitals, Hyderabad, India Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar My BLOG: http://bestneurodoctor.blogspot.in

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (1 hour later)

Thank-you for helpful response. It is much appreicated. The following are details on where the muscle mass loss has occurred. With this information, are you able to help narrow things down any further and/or provide additional advice? MEDICAL HISTORY This problem initially started when I received a stem cell of cord matrix cells (derived from the umbilical cord) in late September, 2013. This stem cell treatment did not help me and subsequently my thyroid readings became abnormal (eg 5.71 when reading was taken late January). Since March, we have been correcting the thyroid and it is coming back into normal range. A thyroid ultrasound test was also done and is normal. MUSCLE MASS LOSS Muscle mass loss started occurring within a few weeks of the stem cell treatment. The information on this is as follows: - Started in knees, feet, ankles, back of lower legs (October, 2013) - Next moved to muscles along the vertical spine (late December, 2013) - Next moved to hips, shoulders, elbows (January 20th, 2014 forward) - Next moved to arms and hands - Lastly the thighs Some muscles were completely wasted in the knees - could not move anymore. I went for another stem cell treatment for knees (using my own adipose tissue this time). This helped partially with the knees but they did not fully recover due to other ongoing deterioration. As a result, knees are not yet functioning normally. The muscles that are holding up the knee are very weak / feel like threads. There is muscle knotting and popping regularly in the knees. TEST RESULTS TO DATE I have the following recent test results: - Deficient in vitamin D3 (I started supplementing mid-March and am continuing) - Sufficient in vitamin B12 (>1475) - CK is in normal range (42) Please let me know of any other insight / help you can provide. I have been going to doctors without any success diagnosis and am running out of options. Thank-you very much for your help.

Answered by Dr. Sudhir Kumar (8 hours later)

Brief Answer: Needle EMG would help. Detailed Answer: Thank you for getting back and providing more information. It is unfortunate that a diagnosis has not been made despite consulting several neurologists. At this stage, we need to do a needle EMG to diagnose the underlying cause of muscle wasting (muscle disease versus anterior horn cell disease). If a doubt remains after that, then, a muscle biopsy would be required. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (31 hours later)

Thank-you for your answers. We will be requesting the tests that you recommended next week. It can take several weeks to schedule these tests and hence I am asking the next question. The goal of this next question is to ensure we get all the relevant testing done up front and not go through a serial / longer time process as the medical condition is deteriorating quickly. In the event both blood test and needle EMG tests are within normal ranges, what should our next step be? EG. What other illnesses would need to be ruled out and what additional tests would be needed? Kind Regards

Answered by Dr. Sudhir Kumar (6 hours later)

Brief Answer: Muscle biopsy would be the next step. Detailed Answer: Thank you for getting back. If both blood tests as well as needle EMG are normal, then, the next step would be a muscle biopsy from a moderately affected muscle (we should avoid selecting a normal muscle as well as a severely affected muscle for biopsy). Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (2 days later)

Hello Dr. XXXXXXX Thanks again for your previous reponse. I have made an appointment with a neurologist but the earliest date I could get one is in XXXXXXX and so in the meanwhile would like to ask another set of questions: Regarding the muscle biopsy, is the neurologist able to take the biopsy or does this occur in a lab? If multiple areas are affected, as in my case, how is the collection done? Is the procedure invasive and is it painful for the patient? Is it safe to try medication (eg corticosteroids) for a very short period of time to see if this improves things versus waiting for completion of testing? Thank-you again for your help.

Answered by Dr. Sudhir Kumar (6 hours later)

Brief Answer: Usually neurologist does the biopsy. Detailed Answer: Thank you for getting back. The muscle biopsy is usually done by the neurologist. Sometimes, a neurosurgeon attached to the neurologist may also do the procedure. In any case, it is done by a doctor and the muscle tissue is sent to laboratory for examination. Usually, a moderately affected muscle is selected for biopsy. So, a muscle which is almost normal or one that is very severely affected are not chosen for biopsy. It is an invasive procedure as about 2.5 by 2.5 cm tissue of muscle is cut for the biopsy, done under the local anaesthesia. There is little pain during the biopsy. I would not advise corticosteroids without confirmation of diagnosis in view of possible side effects. (In India, you would be able to see a neurologist on the same day!) I hope it helps. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar