Interpreting neurologist comments & actions

Thank you for your time & input.

Talked to my doctor in late October about my right leg giving out & spasming on occassion.  She got me into a neurologist within a week since she wasn't happy with what she saw.

Neurologist mentioned I had lost 1.5 inches of muscle mass in my right thigh & my reflexes in that leg were over active.  He said the leg was clyinically weak.  However, the EMG was normal which surprised him.  He ordered a full abdominal & pelvic ultrasound as well as an MRI.  He said he thought we caught "it" early but he never said what it was.  

I now have visible twitches in my right thigh, calf & foot (other people can see them).  They come & go at random times in the day, they do not go away if I change the position of my leg.

This all happened so fast that I didn't ask many questions when I saw the neurologist.  Now that I've started to read about the symptoms, I see they could be something very minor through to something like ALS.  

I am trying not to drive myself crazy using search engines.  Is there any way to determine how likely the various possible outcomes are?

Thank you!

[Dr. Kokil Mathur]

Hi!
I am sorry to hear about your condition. 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.
In your case since the EMG was normal, other conditions should be looked into. Focal inflammation of the muscle or muscle myositis can also be a cause. Involvement of a single nerve or mononeuropathy due to diabetes, vasculitis, infection (leprosy), trauma, or entrapment can also be a cause. Please discuss with your treating doctor. Take care!

[Dr. Kokil Mathur]

Hi!
I am sorry to hear about your condition. 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.
In your case since the EMG was normal, other conditions should be looked into. Focal inflammation of the muscle or muscle myositis can also be a cause. Involvement of a single nerve or mononeuropathy due to diabetes, vasculitis, infection (leprosy), trauma, or entrapment can also be a cause. Please discuss with your treating doctor. Take care!

[WilliamToronto]

Thank you Dr. Mathur for your prompt & very personalized reply.  It's reassuring that the symptoms could be the result of so many different things.  

I will discuss everything with my neurologist when I see him in a few weeks.  By then he will have the MRI & ultrasound results.

Over the past few days, my wife has noticed twitches in my face.  They are on the lower left jaw line.  I don't always feel them when they are happening but I sometimes feel a numbness in that area similar to when you get a filling done at the dentist's office.  It kind of feels like that side of my tongue is too big for my mouth if that makes any sense.

I have this on my list of things to discuss with the neurologist.  I hope this list of symptoms I've been keeping helps him reach his diagnosis as soon as possible.