Hi, I have had internal tremors for 2 years now (like an annoying vibrating feeling inside which is more noticable when I am resting) but 2 months ago I noticed my tongue was twitching all over. I wasn't worried at first until I googled twitching tongue and now I'm terrified I have ALS. I have other annoying symptoms but no muscle weakness. I have an appointment in a months time with a neurologist but cannot sleep with fear. I guess I'm hoping for reassurance?
Well, other than ALS there are many conditions which can cause internal tremors with tongue twitching. Tremors are often associated with drugs, alcohol, smoking, lack of sleep, poor sleep patterns, stress and fatigue. They can be seen in peripheral neuropathies of diabetes, in hyperthyroidism, parasomnia, multiple sclerosis, TIAs or transient ischemic attacks or mini strokes, hypoglycemia, disorders of calcium metabolism, hyperparathyroidism etc. Certain epilepsies too could be the cause. Consult an internal medicine specialist or your PCP. Discuss these possibilities with your doctor. A comprehensive investigation is required keeping all the points in mind. You will need blood sugar monitoring, MRI of brain and cervical spine, T3, T4, TSH, sleep studies, serum electrolytes, brain EEG, etc to reach a diagnosis.
Other than this, 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. Since you have a month before you see the neurologist, ask your family doctor about the other possibilities. Hope this helps. Take care!
The medical advice given should not be considered a substitute for medical care provided by a doctor who can examine you. The advice may not be completely correct for you as the doctor cannot examine you and does not know your complete medical history. Hence this reply to your post should only be considered as a guiding line and you must consult your doctor at the earliest for your medical problem.
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