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Neurology (Expert Forum)
worsening symptoms
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worsening symptoms
by Rob, Sep 12, 1999 12:00AM
About 3 1/2 months ago I began seeing fasiculations in my calves and ankle area. I wasn't too concerned because they didn't seem to be causing any other symptoms. I had an EMG done and had my potassium and calcium levels checked, which were all normal. That was approximately 3 weeks ago. Now these fasiculations have become very pronounced. They are almost constant in my lower legs and also now in my feet. I have sporadic periods of them in my shoulders, arms, hands, abdomen, eyes, and these are frequently accompanied by a tingling sensation and patchy areas of numblness. When I touch these areas I can feel the sensation, but when I am walding or doing something they feel numb. I also now have cramping in the fat area below my thumb and in my feet even at rest. The fasiculations are really bad when I first get up an the morning and at night when I am not active. I am currently taking synthroid .5mgm. and premarin .9mgm and daily vitamins. I had my TSH checked in Jan. and it was within normal range. I am concerned about the increase of these fasiculations, and the cramping. I am not experiencing any "real '" weakness. I walk every day and climb stairs.My arms feel weak at times,but it does not prevent me from activities. Could this be ALS or does it sound more like fibromyalgia? I truly appreciate your time, you offer a wonderful service!
Doctor's Answer
by CCF Neuro[P] MD, RPS, Sep 12, 1999 12:00AM
Dear Rob:
Sorry to hear about your fasciculations. Good news is that since you have no real muscle weakness and your EMG is normal, the most likely etiology of your fasciculations, cramping, and anxiety is a condition called benign fasciculations. For the majority of cases we do not know what causes them. In about 30% of the cases it is viral in nature. But the other 70% we do not know. The things that make them worse are fatigue and anxiety. They can come and go, last for hours, days, or even years. We do not think they cause any lasting muscle damage. They are not associated with ALS down the line. Some treat with a benzodiazepam but many do not find relief with medication.
Sorry, there is no real treatment. The psychological issues are the worst since we assume that it must be ALS but rest easy it is not ALS. I understand your condition as I get fasciculations myself.
Sincerely,
CCF Neuro MD
Sorry to hear about your fasciculations. Good news is that since you have no real muscle weakness and your EMG is normal, the most likely etiology of your fasciculations, cramping, and anxiety is a condition called benign fasciculations. For the majority of cases we do not know what causes them. In about 30% of the cases it is viral in nature. But the other 70% we do not know. The things that make them worse are fatigue and anxiety. They can come and go, last for hours, days, or even years. We do not think they cause any lasting muscle damage. They are not associated with ALS down the line. Some treat with a benzodiazepam but many do not find relief with medication.
Sorry, there is no real treatment. The psychological issues are the worst since we assume that it must be ALS but rest easy it is not ALS. I understand your condition as I get fasciculations myself.
Sincerely,
CCF Neuro MD
What about an EMG done 3 weeks before fasiculations begin, would that still find ALS?
Thanks so much,
Hang in there Rob!
You are not alone, I have very similiar symptoms.
Technically no, as there are strict criteria for EMG diagnosed ALS as one has to have 3 different muscle groups showing denervation without sensory conduction loss. But for all practical purposes, a normal EMG indicates that the cause of fasciculations is not a bad muscle undergoing death.
Sincerely,
How about a drug-related cause? I know there are lots of medications that cause muscle pain and cramping, tendon pain, and miscellaneous neurological problems (SSRIs and quinolone antibiotics come to mind -- both of which have lots of low-incidence-rate side effects), but I haven't heard of anything that specifically causes fasiculations.
For what its worth, I started a regular walking program last February. After every walk I get fasiculations. During a brief round of taking Zoloft (an SSRI) I had intense calf muscle pain and near-constant fasiculations. I'm off the SSRI (and all other antidepressants) and my fasiculations are getting better. Just to show how complex these things are, I took two weeks off from walking and the fasiculations nearly disappeared. I decided that cardiovascular health is more important than discomfort and started walking again, and the fasiculations are back, although not nearly as strongly.
-- Rick
Thanks so much for your prompt and informative response. The service provided here is wonderful!
Regarding my second question:
Would an EMG done 3 weeks prior to fasiculations find ALS?
I have been told by a Neurologist that yes, it would have shown up on the EMG. The reasoning given is because ALS is present long before fasiculations and there would be damage by the time a person is twitching.
Any clarification of this would be greatly appreciated.
Thanks again,
I am not sure what your trying to imply. Nothing was stated that you were a medical professional nor was there implications that what was stated to be for a medical professional. We do not understand completely what causes muscle fasciculations. As previously stated some come after viral infection but for the most part the etiology is not understood. Many medications can cause tremor, but most do not cause fasciculations. Some diseases cause fasciculations such as ALS, toxins, myopathies etc. The medications you mentioned by lead to tremor but not fasciculations. Sorry you got so offended.
Rick was the poster you thought you offended. Rob was the original poster. I think Rick(second poster) was just making a comment to Rob and prefacing it by saying he wasn't a doctor but that Rob might consider the theory that his fasciculations had a drug related cause. I don't think you offended anyone. In fact your answers are usually among the most tactful and compassionate ones posted.
CCF Neuro MD
-- Rick
I want to say you do an incredible job at not only clinically providing in laymans terms things to people, but are extremely compassionate in your responses to all posters. Whoever posted that quinolones can cause fasiculations was correct. One Clinical Pharmacologist who has seen numerous cases
has seen many unusual peripheral and central nervous systems disturbances displayed. His theory and others in the case of peripheral nervous system effects are that chemically quinolones bind to receptor sites on neurotransmitters. Often times drugs like Ativan. Klonapin, Valium, BZ drugs are used to treat this as they compete for the same binding sites. Supposedly to be able to dislodge the chemically bound quinolones. Also people who report muscle cramping, sensory disturbances, burning, twitching, fasiculations, are often told this can actually be caused by quinolone induced subclinical seizures. Apparently the mechanisms that unleash PN from these drugs, differ then those that cause tendon rupture as the tendon ruptures have to do with soluable lipids and have been discussed in papers by AAOS and in numerous studies that appear in Pubmed. Some people given quinolones who have a virus can have even stranger outcomes with even more diffuse atypical symptoms. Since these drugs like Chemo drugs cross the blood brain barrier they are capable of doing a lot of damage to particular people which are often only revealed on petscans and no not show on MRI's or EEG's.
Thanks again for the incredible service you do.