Since November, I have had internal tremors almost nonstop upon waking on my right side. For the last couple of weeks, thankfully, I have had relief where there have been almost no internal tremors however, all along, my upper eyelid on the right side has been twitching off on and on and now there is a noticeable drooping difference to the left lid. The drooping is more below the eyebrow, not the immediate upper lid covering the eye. Could this be a sign of ALS? It comes and goes sometimes lasting for a few days and then goes away. Please advice. . .I was so happy that my tremors have gone away but now am worried about ALS since I saw that eyelid twitching can be a sign. I have seen 5 neurologists thinking it was Parkinsons or MS and had a clean MRI. WOuld they have noticed if it was ALS?
A negative MRI though reduces the likelihood of MS, does not rule it out. Diagnosis of MS is complicated as no single diagnostic test is confirmatory. However, more than 90 percent people are diagnosed based on MRI only. Neurological examinations reveal weakness and other signs. Vitamin D and B12 deficiency also produces symptoms like MS, and hence these are ruled out. Evoked potential tests are done to diagnose nerve weakness. Lumbar puncture is also confirmatory.
It is very difficult to comment whether your have ALS or not. To confirm that a doctor has to find signs of both upper (muscle weakness, decreased motor control, inability to perform fine movements, increased spinal reflexes, and positive Babinski sign—great toe going up) and lower motor (muscle weakness, abnormal EMG etc) neuron signs in one limb. Symptoms of many of these diseases do mimic ALS. ALS like symptoms can be due to fibromyalgia, chronic fatigue syndrome, severe anemia, spinal nerve compression high up in the cervical spine, ankylosing spondylitis, osteoarthritic changes of the vertebrae, calcium deficiency, low Vit D, electrolyte disturbance, peripheral neuropathy due to diabetes or hypothyroidism or due to bad posture. Lyme and lupus are the other possibilities.
Electromyography (EMG), nerve conduction velocity (NCV), muscle biopsy, etc are done to confirm diagnosis or rule out ALS. Do discuss this with your doctor and get yourself examined. Take care!
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