Questions posted in the
Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
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Subject: Re: Another question on Fasiculations I know this is an overworked subject, but I have read in a couple of articles that generalized fasiculations can be a presenting feature of ALS. I have read here that fasiculations occur ONLY after weakness and in focal groups. Are there two types of the disease?? Also a previous poster made the remark that someone here had said speech and swallowing problems were most often seen together and one would not present without the other. Is this also the case?? Thank you.
Dear George: Isolated fasciculation with a normal neurological examination by an experienced neurologist, specially if followed up by a similar normal examination in a few months, is almost NEVER ALS. An EMG examination is frequently requested, however, to confirm the diagnosis of benign fasciculation syndrome, and to calm the worries of the patient. AND Speech and swallowing difficulties in ALS tend to go together, although occasional dissociations occur. The difiiculties are from a combination of pseudobulbar (upper motor neuron) and bulbar (lower motor neuron) involvement.
Widespread profuse fasciculations are the hallmark of ALS. Most ALS experts will agree that the diagnosis of ALS is in doubt if no fasciculation is found, clinically and on EMG. 2. If the fasiculations are not accompanied by atrophy or weakness, what is the probability A normal neurological exam (except for fasciculations) by an experienced and good neurologist makes ALS a very unlikely diagnosis. "Symptoms" are what the patient reports, and "signs" are what the physician observes. Your last sentence is correct if it reads "in the absence of the 3. How many people suffer from benign fasciculations, and how often do they last on average? Sporadic fasciculation is incredibly common, occurs in the majority of normal individuals off and on. Some individuals are more perceptive to these twitches and tend to report them, sometimes from fear of having a serious neurological problem. Most experts agree that a subset of individuals have more prominent, widespread, and persistent fasciculation than should be seen normally. These people often diagnosed to have the benign fasciculations syndrome. This syndrome is obviously quite common, but a prevalence figure is not available. One hundred and thirty seven individuals with benign fasciculations were identified and studied at the Mayo Clinic over a period of 28 years. Of these, 121 were available for a follow-up interview after a mean of about seven years; none had developed ALS, and about half had had a significant improvement. Interestingly, about 16% of the cases have a viral infection preceding onset of symptoms, and about 20% have emotional stresses. 4. Other than ALS and "nothing", what else could explain fasciculations? A long list of causes - root disease, nerve entrapments (such as carpal tunnel syndrome), specific forms of neuropathy (specially demyelinating), radiation injury to nerves, other forms of motor neuron disease (SMA, Kennedy's disease), the cramp-fasciculation syndrome, syringomyelia, thyroid disease, caffeine, some other drugs, etc. 5. How do you define weakness? How do I think about this vis-a-vis soreness, stiffness, aching, Weakness is loss of strength. Specifically, on history, an inability to execute specific actions (such as lifting heavy things, opening jars, turning keys, climbing steps, rising from a chair, getting feet into the car, walking on heels/toes, getting out of bed, etc.) due to a lack of strength. Numerous individual muscles are tested for strength during a neurological exam. 6. If someone is experiencing twitching, along with muscle soreness and fatigue, but can still go out Not necessarily. Needs a good neurological exam. One hand may be a little weak, for instance. 7. What percent of ALS patients experience symptoms in one limb first, versus multiple limbs? My ALS usually starts in one limb (or else, in the bulbar- face/swallowing/tongue muscles), and then spreads to other areas. 8. If the twitches are primarily in the calves and eyelids, with some roving twitches elsewhere, is Yes, in most cases this pattern suggests a benign problem. I hope this is useful to you and to others. +++++++++++++++++++++++++++++++++++++++++++++++++++++++++
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