MS or ALS??

Hi Quixotic,

I'm a 34 yr old male and I've read several of your posts and you seem exceptionally knowledgeable about MS and ALS, so I hope you don’t mind me asking your opinion on what I’ve been experiencing.

I've been suffering from intermittent back pain for nearly 2 yrs now, which is generally accompanied by nausea (but no vomiting).  Recently (~3 weeks ago) the back pain began to subside but I started to experience fasciculations all over my body and I've developed pain/cramping in my left arm (with no noticeable weakness) and occasionally in the knees, calves and left foot.  I saw my internists last week and he thinks it's all related to my back but suggested I get an EMG to eliminate conditions such as ALS or other diseases affecting the CNS.  My coordination is great (i.e., no tripping/falling), my reflexes are all okay, but the unexplained pain along with the fasciculations is strange and concerns me.  Does what I've described sound anything like ALS or MS to you?

Thanks in advance for your opinion.  I appreciate your help.

Best,
Todd36

[sllowe]

Hi Todd,

Welcome to the MS forum.  I'm not Quix of course but wanted to welcome you and say hello.

Have you peeked at our health pages yet? They are wonderful and do describe those tests associated with what Drs look at to dx MS.

I hope you get to feeling better very soon. 2 yrs is a long time to suffer w/the back issues.  Maybe you can get your Dr to run an MRI or something.

Wishing you well,
Shell

[jensequitur]

We also have a 'Ask The Doctor' forum here on Medhelp, just created.  It's perfect for medical questions such as yours.

Fasciculations are caused by damage or inflammation of the nerve.  It can certainly be caused by back problems, along with the pain you're experiencing.  I think your next step is to get an MRI of the spine to see what's going on in there.

[Quixotic1]

Hi, there!  Welocme to our home.  

One of my first questions is whether you have had an MRI of your neck to see if there is a reason there to blame your back for all of these symptoms.  If not, you should have one.  34 is a young age to blame all symptoms on the back.

You are worried about these symptoms being ALS or MS.  I will give you my opinion, but you should see a neurologist for an evaluation.

Nothing you have mentioned suggests ALS to me.  Now ALS can be very hard to diagnose, and I was never a neurologist.  However, ALS is not a painful disease.  It is a disease of progressing weakness without significant pain or sensory problems.  It certainly does not begin with pain.

The fasciculations always make people worry about ALS, but the fasciculations do not occur real early in the disease nor do they occur all over all at once.  The fasciculations occur late in the disease and occur as each muscle undergoes wasting away and severe weakness.  So you are having fasciculations without weakness and that does not suggest ALS.

All-over fasciculations can occur after several kinds of infections, especially viral infections.  Once they start they can go on for many months and be extremely disruptive to your peace of mind.  One infection that you should be thoroughly tested for is Lyme Disease.  A couple of our people here with Lyme disease did complain of all-over fasciculations and frequently of pain.

Now, MS.  Back pain is not uncommon in MS, but it usually has other symptoms happening also.  The different areas of pain and cramping certainly could fit with MS, but your history is not very typical of it.  MS requires a pretty thorough workup which would include a good neurologic history, a very thorough neuro exam, and if, there was suspicion, an MRI of the brain and spinal cord.  Since your PCP has blamed your back, then an MRI might be in your future anyway.

The EMG is an electrical study of the inside of the muscles.  It is also done along with a study of the nerve signal speed of the sensory nerves.  Both of these tests should be noraml in MS, but they can give clues to the presence of ALS (which I think is unlikely in you).

Now you have to realize that I am not a neurologist and I am NOT here in any official role as a doctor.  I have only given you a semi-educated opinion.  From what you told us, neither ALS nor MS seemed likely to me.  But, I think you do need an MRI of your spine and while you're at it your doc might include the brain.

I hope this helps.

Quix

[Todd36]

thanks everyone for your feedback.  as you assumed, I’m a medhelp neophyte and haven’t explored the other features the site offers yet.

although i know you're not drs, your input definitely puts me at ease for the holidays until my EMG appointment.  the intensity and frequency of my pain/cramping and fasciculations have been fluxuating (strange, eh?).  i'm a bit perplexed as to why my dr wants me to have an EMG before an MRI, as the vast majority of my pain/probs originated in my back.  the reason i suspected ALS is b/c my dr wants me to get an EMG.  otherwise, I probably wouldn't be concerned with it.  my babinski reflex is normal, which i think would argue against ALS.  who knows what drs think sometimes.  I guess that’s why they say they “practice” medicine ...errrr!  Well...time will tell.

thanks again and happy holidays.

best,
todd