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Neurology (Expert Forum)
ALS?????
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ALS?????
by KellyMarie, Feb 11, 2005 12:00AM
I am a woman, 38, and am hoping for some advice. 3 months ago I started experiencing severe aching in my legs and arms along with muscle tics (small jerks) throughout my body. The aching is no longer as severe but is still there and the tics have subsided to where I only get them a few times a day. I did see a neurologist back in December (my family Doc sent me thinking it might be MS) and after examining me (one of the things he had me do was walk on my heels and then my toes which I can still do) he came to the conclusion that it was most likely stress causing my symptoms. I was under a lot of stress at the time. I was given Ativan for the anxiety and I am still taking it. I happily accepted that diagnosis until over the Christmas holidays when I began to have fasciculations. These were mostly in my calves and thighs but more recently I have also experienced them every so often in my arms, hands, feet and trunk. The other change is that my forearms, wrists, hands and especially fingers ache (not sure if it is cramps) and my feet definitely cramp often (the kind of cramp that makes your toes point and stay that way). I had a problem with my wrists aching over a year ago but it eventually went away. The fasciculations only happen when my muscles are relaxed. Of course I searched the Internet for causes and ALS is now my greatest fear. Although I don’t feel like my legs or arms have gotten any weaker I do find that I can’t go for long walks any more without my legs really starting to ache and feel heavy. Sometimes to the point where I have to sit down for relief. I have dropped things but mostly because I get a pain in my wrists, which cause my hands to lose them grasp. I have no problem doing every day thinks like braiding my hair or buttoning my clothes. The only thing that happens once in a while is that my left hand will fall asleep while I am sleeping. Not from my laying on it or from it being in a weird position. After moving it around for a few minutes it’s back to normal. My questions are:
1) Are cramps and fasciculations a common first sign of ALS?
2) Can tongue fasciculations be felt or just seen and what do they feel/look like.
3) If I had muscle weakness would I still be able to do push-up and squats. How can I test myself for weakness?
4) Could the Ativan mask or lesson the symptoms of ALS?
5) Do legs, arms, etc ache constantly with ALS?
6) Could stress/anxiety cause muscle fasciculations and cramps?
I do have an appointment with a different neurologist next month for a second opinion but I really need to research this for myself before then. I did have a bone scan done back in October for something unrelated and it was normal. Thank you so much for your time.
1) Are cramps and fasciculations a common first sign of ALS?
2) Can tongue fasciculations be felt or just seen and what do they feel/look like.
3) If I had muscle weakness would I still be able to do push-up and squats. How can I test myself for weakness?
4) Could the Ativan mask or lesson the symptoms of ALS?
5) Do legs, arms, etc ache constantly with ALS?
6) Could stress/anxiety cause muscle fasciculations and cramps?
I do have an appointment with a different neurologist next month for a second opinion but I really need to research this for myself before then. I did have a bone scan done back in October for something unrelated and it was normal. Thank you so much for your time.
Doctor's Answer
by CCF-Neuro-M.D.-CS, Feb 15, 2005 12:00AM
1) cramps and fasciculations alone do not mean ALS. Fasciculations in the absence of weakness and muscle wasting is unlikely to be ALS. Fasciculations can also be caused by exercise, cold, certain medications (like Mestinon), pinched nerves, other disorders of the motor cell in the spinal cord (eg by a virus), or benign fasciculation syndromes with or without cramps. ALS usually presents with weakness and other symptoms in one limb. Widespread fasciculations is more suggestive of a benign disorder.
2) Tongue fasciculations can be seen as rippling movements of the tongue muscles. I'm sorry I do not know what they feel like (but they are unlikely to be painful)
3)Weakness is a subjective measurement and mild weakness is difficult to assess. A muscle power grade is used by neurologists from 0 to 5, 0 being no movement, 5 normal strength against resistance. Mild weakness is between 4 (giveway to resistance) and 5.
4) no, apart from providing some relief from cramps
5) aching may be a feature, but in the early stages only one limb is affected
6) stress is a very powerful precipitant of neurological symptoms, so this is a possibility
I cannot give you a clinical diagnosis over the internet, so a second opinion is a good idea. EMG can also provide evidence of early ALS.
Good luck
2) Tongue fasciculations can be seen as rippling movements of the tongue muscles. I'm sorry I do not know what they feel like (but they are unlikely to be painful)
3)Weakness is a subjective measurement and mild weakness is difficult to assess. A muscle power grade is used by neurologists from 0 to 5, 0 being no movement, 5 normal strength against resistance. Mild weakness is between 4 (giveway to resistance) and 5.
4) no, apart from providing some relief from cramps
5) aching may be a feature, but in the early stages only one limb is affected
6) stress is a very powerful precipitant of neurological symptoms, so this is a possibility
I cannot give you a clinical diagnosis over the internet, so a second opinion is a good idea. EMG can also provide evidence of early ALS.
Good luck
Member Comments (4)
by catr, Feb 11, 2005 12:00AM
Hello - I had the same problems starting November 2001, vertigo, tingling in left leg/foot sometimes pain, numb hand, tingly face mouth and lips. I saw two neurolgists that both said it is anxiety, had MRI's on spine and brain came normal, had evoked potentials which one leg showed borderline slowing but neuro said that was because my leg was not warmed up first but the other leg came normal? Neuro put me on anxiety medication, did not help whatsoever, stopped taking ALL medications and after a few months I felt great my symptoms were almost ALL gone I was so happy but then last Thursday they came back and it has been just over a week now and I am now scared that they came back. My neurologists and doctor said 99% I do not have MS? Then what? Could it be anxiety even though the medication did not help and I felt best when I did not take anything. I am still not taking anything and would rather not. My first symptom started two weeks after I had the flu shot but they say that has nothing to do with it. I have hemangeoma's, buldgin discs, ostreo, etc etc on my spine but they say that is not the cause either. Found out I have fibromaylagia but they said that is not the cause either. Can someone please help me? It's just so wierd the way it came back. I would appreciate any feedback at all thankyou very much and Good Luck to you all. I am also hoping the doctor can respond as well.
by BMNS, Feb 11, 2005 12:00AM
Hi! Just wanted to say that I have had the exact same symptoms (minus the extreme foot cramping) and experiences with my body the last 3 months. I originally thought it might be ALS too because my dad passed away from the disease in 1997. After talking with my mom who cared for him his entire illness, she assurred me that what I was/am experiencing is not ALS. The doctors on this site will give you assistance to put it into perspective, but if you still have concerns, the 2nd neuro will confirm that it is not ALS. I attribute mine to unbelievable stress and/or a flu shot I had late in October which I have made worse by freaking out about my symptoms. Mine are much, much better like yours. Just dealing with leg aches and a few twitches every now and then all over, but mainly feet and legs. ALS does not get better...clinical muscle weakness and atrophy are primary to ALS. Sounds like your forearm/hand/wrist symptoms might be Carpel Tunnel. I'm sure that's what mine is as I have worked on computers for 20+ years. Anyway, I am interested to know what you find out at your neuro appt. and the dr. here. Due to some really bad experiences with my dad, I am not into doctors, as such, and am just going to wait it out. One last thought, check out www.aboutbfs.org. You might find some similarities to and comfort about your symptoms there. I wish you the best of luck!
by BMNS, Feb 11, 2005 12:00AM
Oops! The web site is www.aboutBFS.com, not .org. Sorry!
