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Neurology (Expert Forum)
Fasciculations/cramps/muscle loss in 19 y/o -- ALS?
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Fasciculations/cramps/muscle loss in 19 y/o -- ALS?
by pose, Jun 03, 2006 12:00AM
I'm a 19 year old male with fasciculations primarily in my right lower leg, starting in mid-March of this year. They're almost constant, and happen in several places throughout my right leg spontaneously, and consistently. It started in my right calf, but has since progressed to happening in other places, such as along the entire right side of my neck (off and on), in my chin/lower lip, occasionally on my abdomen, and as of last night my right bicep,(it woke me up) and forearm. My hands also quivers when I grip.
I also have other symptoms, such as if I flex my right leg, the muscles of my calf cramp up, and/or quiver, and take a while to release. If I raise my foot and flex the muscles in my leg, my foot is held in place and slowly drops as the muscle relaxes. Occasionally, if I point my toes down, they cramp and are stuck pointing down. I also noticed (and measured) last night, that my right lower leg seems much smaller in circumference, and is indeed .5-1" smaller than my left calf.
I have two herniated discs at L4-L5, and L5-S1, with loss of light sensations on the lateral aspect of my right lower leg. I have had an MRI of my L spine, brain, an EMG, and EEG, as well as blood work (including magnesium, calcium, thyroid function, and Lymes disease - no results yet.) No known family history of neurological disease.
During the EMG of my right lower leg, the neurologist inserted the needle into a muscle that frequently twitches, and there was no activity, and he seemed baffled.He then ended the exam. That same area of muscle now seems sunken and soft. Possibilities?
I also have other symptoms, such as if I flex my right leg, the muscles of my calf cramp up, and/or quiver, and take a while to release. If I raise my foot and flex the muscles in my leg, my foot is held in place and slowly drops as the muscle relaxes. Occasionally, if I point my toes down, they cramp and are stuck pointing down. I also noticed (and measured) last night, that my right lower leg seems much smaller in circumference, and is indeed .5-1" smaller than my left calf.
I have two herniated discs at L4-L5, and L5-S1, with loss of light sensations on the lateral aspect of my right lower leg. I have had an MRI of my L spine, brain, an EMG, and EEG, as well as blood work (including magnesium, calcium, thyroid function, and Lymes disease - no results yet.) No known family history of neurological disease.
During the EMG of my right lower leg, the neurologist inserted the needle into a muscle that frequently twitches, and there was no activity, and he seemed baffled.He then ended the exam. That same area of muscle now seems sunken and soft. Possibilities?
Doctor's Answer
by CCF-Neuro-M.D.-PW, Jun 11, 2006 12:00AM
Fasciculations in the absence of muscle weakness and wasting is unlikely to be due to ALS. there are several more common causes such as a benign syndrome with or without muscle cramps, a normal response to cold or exercise or certain medications, an overactive thyroid gland, pinched nerves or some other spinal cord disorders that are rare such as synringomyleia and polio.
Fasciculations that are widepread are more likely to be benign. A smaller calf circumference could also result from a pinched nerve root in the back, or may be a variant of normal particularly if there is no weakness on testing or abnormality on EMG.
No activity on an EMG is normal if the muscle is relaxed and abnormal if the muscle is contracting. One must be sure that the needle is actually in the muscle you are testing/moving to hear that muscles activity. The needle will only 'hear' the muscle activity in the immediate area around the tip. If another muscle or part of the msucle is faciculating, it will still be silent.
There are other primary muscle conditions that can cause cramping with exercise that can be evaluated by muscle biopsy (various muscle enzyme deficiencies or medication side effects), and a blood CK level that is elevated may make these more likely
Good luck
Fasciculations that are widepread are more likely to be benign. A smaller calf circumference could also result from a pinched nerve root in the back, or may be a variant of normal particularly if there is no weakness on testing or abnormality on EMG.
No activity on an EMG is normal if the muscle is relaxed and abnormal if the muscle is contracting. One must be sure that the needle is actually in the muscle you are testing/moving to hear that muscles activity. The needle will only 'hear' the muscle activity in the immediate area around the tip. If another muscle or part of the msucle is faciculating, it will still be silent.
There are other primary muscle conditions that can cause cramping with exercise that can be evaluated by muscle biopsy (various muscle enzyme deficiencies or medication side effects), and a blood CK level that is elevated may make these more likely
Good luck
Thank you.
Wouldn't know if actually Amitriptyline caused your neurological problems, BUT I was prescribed Amitriptylin for nerve pain with disasterous results. After only 15 mg over three nights, I'm left with severe ringing in both ears that is on-going now nine months and am told will be permanent. So this med does have serious side effects! It wouldn't surprise me at all that your problems are due to this med.
He said the muscle loss would be due to the herniation, but didn't have much to say about the loss beginning with the twitches, which are beginning to progress to my upper extremities, and face. He ordered an EMG of my arms -- which, oddly, have the least twitches at this point.
My muscles (many different places) have been kind of stiffish and painful lately, too. I'm not sure if they're muscle spasms and/or related to the fasciculations and such, or if it's just strain from sleeping weird, or something.
I'm so depressed, and I feel sick thinking about everything. I'm beginning to get hopeless, especially with appointments being 2-3 weeks apart.
Terri