33 yr old ALS concern

On June 11, 2009, I woke up with hands that felt kind of clumsy with a buzzing feeling in my forearms.  They felt like they do when I am nervous.  For  month before that, I had noticed that I was dropping things a little more.  I went to see my GP who spent about 5 minutes looking at me and said it was Carpal Tunnel. I didnt agree, so I decided to see my chiropractor.  He did a full evaluation and couldnt find any problems with my reflexes etc.

On June 25th,  I noticed I was little less steady on my feet due to my calves feeling tight and weak.  My legs also hand a tingly, static electricity type feeling over them, and I would feel little tickles all over them. I saw a nuerologist about a 3 weeks after I woke up with nervous hands.  He did a full examination and didnt find any problems with strength or reflexes etc.  I told him about the tickles and he said, you generally cant feel fasciculations.  He scheduled a EMG.  About a week after that, I noticed my face muscles felt weak. My nuero had me come back in but couldnt determine any facial weakness.  

7 weeks after my initial hand symptoms, I got a EMG and NCV of my left arm and right leg.  Everything came back normal except border line carpal tunnel of my left hand.  The nuero said that he was fairly certatin it wasnt ALS or MS. He said that I probably felt carpal tunnel and my mind took the ball and ran with it.  In other words, my tight calves and weak face are somatizations due to anxiety.  I was feeling happy for about 2 hours, until when I got home, I started to watch my calves and noticed fasciculations in my calves that I couldnt feel.  This was the first time I actually saw one. My forearms now also have that static electricity feeling that preceded the fasciculations in my calves.  


#1 Is it possible that I didnt have fasciculations during the EMG and that is why I passed

# Could this all really be due to somatization?
  

[Neuro Forum]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.

It sounds like you have a lot of different symptoms, and in the setting of a normal EMG and what sounds like a normal examination based on your neurologist, a serious neurologic disorder becomes unlikely. Sometimes, when there are multiple symptoms that really have no clear explanation, a diagnosis of stress-induced symptoms is made. This is a diagnosis of exclusion, meaning appropriate tests were done to exclude other causes. It sounds like you had tests and an evaluation done, and after normal results, the possibility of stress-induced problems was raised. It is very possible that the minor symptoms caused by carpal tunnel scared you and your body responded to the anxiety, and amplified all your symptoms, and you became more aware of even minor symptoms that would not have otherwise concerned you, and stressed you out even in more in addition to other life stresses.

In response to your question, yes, it is possible that you have fasiculations that were not picked up on EMG. However, it is not the presence of fasiculations on EMG that support the diagnosis of ALS. i.e. it is not the absence of fasiculations that allowed you to "pass" the EMG. There are other, specific, findings that suggest the diagnosis of ALS on EMG (evidence of dennervation, meaning loss of muscle innervation by the nerves), and it is likely on that basis that your neurologist told you there is no evidence of ALS.

One possible cause to your twitching is benign fasciculation syndrome, which I will abbreviate as BFS. This is a condition in which there are involuntary twitches of various muscle groups, most commonly the legs but also the face, arms, eyes, and tongue. If the diagnosis is confirmed and other causes are excluded, it can be safely said that the likelihood of progression or occurrence of a serious neurologic condition is low. In such cases, the twitches may be related to anxiety/stress, caffeine, and often occur after recent strenuous activity or muscle over-use. It is important in such cases to reduce stress/anxiety levels and to reduce caffeine intake.

Continued follow-up with your neurologist is recommended. Treatment of the carpal tunnel (usually with a brace, and with avoidance of manual activities that exacerbate it, and sometimes with physical therapy) is recommended. For mild carpal tunnel, surgery definitely is not indicated. Follow up with your primary doctor, and treatment of anxiety or depression if it is present, is recommended as well.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.