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Neurology (Expert Forum)
need clearing up
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need clearing up
by mav01, Feb 28, 2001 12:00AM
Dear Doc,
I have been diagnosed with BFS. I have twitching now and then sporadically throughout the day. Arms, legs, buttocks, face, and once in a while by my eye. But other symptoms I have include a tingling feeling in my fingers, mainly left hand. Also I have noticed a bit of a tremor in my left thumb that occurs every now and then. I have also had brief mild pains that last just a second in my arms and forearms. These pains may come just a couple of times a week. I've also been known to have a brief or flash headache. These also occur maybe a couple of times a week. I'm in my young 20's and in good health. NO weakness, ON, numbness have been observed. So to sum up do these symptoms make sense for BFS? Another area I'm asking my neuro about is Lyme disease. And another question, does twitching occur in MS in early symptoms, late, or is the twitching usually accompanied by some weakness. I've heard many different thoughts on that subject. Thanks for your respected opinion
I have been diagnosed with BFS. I have twitching now and then sporadically throughout the day. Arms, legs, buttocks, face, and once in a while by my eye. But other symptoms I have include a tingling feeling in my fingers, mainly left hand. Also I have noticed a bit of a tremor in my left thumb that occurs every now and then. I have also had brief mild pains that last just a second in my arms and forearms. These pains may come just a couple of times a week. I've also been known to have a brief or flash headache. These also occur maybe a couple of times a week. I'm in my young 20's and in good health. NO weakness, ON, numbness have been observed. So to sum up do these symptoms make sense for BFS? Another area I'm asking my neuro about is Lyme disease. And another question, does twitching occur in MS in early symptoms, late, or is the twitching usually accompanied by some weakness. I've heard many different thoughts on that subject. Thanks for your respected opinion
Doctor's Answer
by CCF Neuro[P]-M.D.-RPS, Feb 28, 2001 12:00AM
Dear Mav01:
From what your telling me, I think the diagnosis of benign fasciculations is reasonable. Lyme disease is possible, but I am assuming that you do not live in an endemic area or have traveled to such an area. Twitching is usually not the initial symptom of MS. There has to be muscle disease or peripheral neuron disease for fasciculation to appear and MS is basically an upper motor neuron or brain disease. If seen, it is usually late in the disease. Paraesthesias or sensory changes can be an early symptom.
Sincerely,
CCF Neuro MD
From what your telling me, I think the diagnosis of benign fasciculations is reasonable. Lyme disease is possible, but I am assuming that you do not live in an endemic area or have traveled to such an area. Twitching is usually not the initial symptom of MS. There has to be muscle disease or peripheral neuron disease for fasciculation to appear and MS is basically an upper motor neuron or brain disease. If seen, it is usually late in the disease. Paraesthesias or sensory changes can be an early symptom.
Sincerely,
CCF Neuro MD
I apologize for trying to get a CCF neuro doc to respond to a thread. However, I have tried multiple times to no
avail to get to be an original post.
I have been a runner for 23 years and have had similar progressive symptoms - gradual exercise intolerance during
the last year. Fasciculations and brisk reflexes started 7 months ago - all over my body. Fasics are, however, most
pronounced in my calves and soles of my feet. Had an LUE EMG in August of 2000 - normal. Went home thinking
this is all anxiety. Started meditation, breathing, etc... Then in October cramping starts in quads. Still thinking this is
anxiety. OK until November 6, 2000 - I look down and see new onset focalized atrophy about 3 cm x 1 cm in
upper surface of lateral gastrocs/lateral soleus left leg. Needless to say, I emotionally lost it.
I made a trip back to my neurologist who was concerned - this atrophy was definitely new and not noted during
August exam. He did a detailed emg using what I believe to be very good technique. Except for fasics in left thigh,
the EMG was absolutely normal - even when he stuck needle in atrophied area. EMG is again repeated one month
later - on December 4, 2000. Again completely normal. He suggests that I see an ortho doc - even though there
was no trauma or tenderness in area.
Orthopod really gets me worried when he looks at my leg. "This is not orthopedic - do you have a family hx of
ALS?" He orders an MRI of left leg. Mysteriously - the MRI on Dec. 12 is unremarkable. Shows no sign of
atrophy. Ortho is baffled by this - because we can all (neuro, PT, me, ortho) feel a definite indentation and graininess
in musculature. He suggests that I go to a regional neuro center such as Medical College of Wisconsin or Mayo.
Mayo rejects my request to be seen. MCW agrees. Neuro at MCW decides to skip any more EMG's. She decides
to have a muscle and nerve biopsy performed. To my suprise, this procedure is ordered for the right Vastus
Lateralis and rt. sural nerve. (Atrophy is on left side). Biopsy results have just returned. They are absolutely normal.
One more note: Despite strenthening and stretching exercises for the left gastrocs/soleus, in the four months since the
presentation of the atrophy it has not filled in. In fact, the atrophy appears to have slightly extended - the musculature
around it has flattened out and the soleus is definitely palpable as much smaller than the right leg. There is no
measurable weakness anywhere - though this does not surprise me in such a strong muscle group.
My questions are:
Can the absence of neurogenic changes on right thigh really give me a sense of reassurance that the left leg is
probably not the result of ALS? I know that there are no guarantees...
If the atrophy were the result of ALS - would it be most probable that the emg performed one month after atrophy
presented would have been abnormal in some way?
Thank you. My thoughts and prayers go out to the many other people who are worrying about similar symptoms.
With the three combined symptoms, it has been quite an emotional time for me. Though I am thankful for all of the
normal results, I am still quite concerned. My exercise tolerance is down to nothing. At best, I can run 1/2 - 1 mile
very slow. Fasics are profound after this "jogging", as are crampy/achy sensations in bilateral quads.
Your site is a true blessing.
Sincerely,
Julie Klug
Try posting at 9 a.m. EST, this seems to be the best time. Keep trying and I hope everything turns out okay!
On a positive note, other than the atrophy, this could all be BFS. Just wish I had some reasonable explanation for the dent in my leg....