Thanks so much, today is off to a good start! I am off work today. I got a good nights sleep and that always helps. My tingling started in February of 2008. It's called parathesia from Peripheral Neropathy. I found at at that time that I had pre-diabetes. I have lost 62 pounds since then and my blood sugar is much better. I also have nerve damage in my feet and some up my legs. My neurologist says the parathesia and the nerve damage in my feet and legs is from the pre-diabetes. The parathesia came on very suddenly one day in February and the tremor started a couple of days aong with the intense tingling and feelings of pins pricking me from the inside out (Parathesia) All this started at the same time as the symptoms of MG. It all happened at the same time we think I may have had a mini-stroke. I had an episode at work - I nearly collapsed and had a grey area of vision and lost my balance. My balance has been off ever since as well. The topamax has helped with the parathesia, the imbalance, and the tremor. I do get twitching too but I have had that since then as well but I have noticed it more lately since I have been on the Mestinon. Thank you so much for the ideas and encouragement, it means so much! I don't feel as alone in this. I have found those who can relate! Thank you, Thank you!!