ALS Concern

. 32 Year old male with weakness in legs and arms and difficulty with workout recovery after 2 weeks of onset I went to a neurologist on March 10th. They did an ncv of my hands and elbow and found what they diagnosed as motor nerver conductions studies reveal mild moderate prolongation of right left median distal motor latenceys(at the wrists), F wave studies of bilateral median and ulnar nerves are within normal limits, sensory nerve conduction studies reveal mild right median conductiion velocity slowing.. They did a needle EMG of my hands my right tricep and my c7 and c8 left and right paraspinal. Needle electromypgrahpy of the arms and cervical paraspinal musculature is normal. No evidence of ulnar neuropathy or lower cervical radiculopathy.Evidence supports Carpal tunnel Syndrome.The Neurologist team also did an emg on my legs which stated that all f wave latencies were within normal limits, evaluation of left peroneal motor the left tibial motor and left sural sensory nerves were unremarkable. All examined muscles showed no evidence of electronic instability(they did a total of 8 leg muscles).I have continued weakness in my legs and fasicualtions throughout my body 3 weeks later. Could the EMG have missed something?  lately i feel my throat tightening ,my face has been twitching as well  and I have had some difficulty swallowing. Three days ago I was talking to a friend and when I turned I felt a pull in my neck muscle,a pain in the back of my neck and it jerked my jaw down for a quick second; the next morning Iwoke up with a facial tighness  and now I am congested. I have went to two other neuromusular specialists in NYC and both have done physical examinations and have said my strength is fine and they see no sign of ALS.Do you think they tested enough parts of the body to diagnose properly. Would my emg catch bulbar onset?

[Christopher R Newey, DO]

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 obtain a history from you and examine you, I can not comment on a formal diagnosis or treatment plan for your symptoms. However, I will try to provide you with some information regarding this matter.

It must be emphasized that in most cases muscle twitches are benign meaning that they are of no consequence and are not resulting from a serious cause. 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. Tremors of the hands can be physiological that is exacerbated by stress/anxiety and caffeine.

Benign fasciculation syndrome, which I will abbreviate as BFS, 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.

When BFS is present but not particularly bothersome or disabling, treatment is not necessary. If severe and it requires treatment, there are a few medication options though this condition is not very common, and the research that has been done on its treatment is limited. Minimizing caffeine and stress, and treating anxiety if it is present, will improve your symptoms.

However in general (and please understand I am not trying to imply I feel this is the case in you), when fasciculations occur in the setting of associated symptoms such as progressive loss of sensation, tingling or numbness, weakness, trouble swallowing and other symptoms, the cause may be due to a peripheral nervous system problem. In general the symptoms would not be episodic and triggered by certain things but would be more constant/frequent without consistent triggers. The location of the problem could be the anterior horn cells, the area where the nerves that supply motor innervation to our body comes from. These are the cells that give off the nerves that allow us to voluntarily contract our muscles. The diseases that might affect the anterior horn cells include ALS (also called Lou Gherig's disease), a condition called spinal muscular atrophy, polio-like viruses, west nile virus, and other infections.

Often these symptoms may reflect emotional/psychiatric problems related to stress (what is called somatization disorder). The latter is a true medical condition whereby instead of a patient experiencing depression or anxiety, they experience physical symptoms, and once the stress is addressed, the symptoms resolve. Fibromyalagia is another medical condition that leads to whole body pains, and is best treated with medications such as lyrica and neurontin, exercise, and physical therapy.

It sounds like you have had a thorough workup to evaluate for more of the worrisome causes of muscle twitches. I would suggest that you continue following up with the neurologist. If you have any changes such as weakness or true dysarthria or bulbar symptoms, you may want to follow up sooner, but again, it is reassuring based on the information you posted.

Thank you for using the forum, I hope you find this information useful, good luck.

[nyc1334]

can anyone assist?

[nyc1334]

Thank you ,

I am just really nervous and it seems like my left arm is getting weaker and the fasiculations are becoming more widespread. i am starting to experience pain in my bicep now as it twitches as well and have not been able to get a good night sleep in about 6 weeks. I am really scared that the EMG was done to early and it wouldnt have shown whats happening now.

[nyc1334]

Im sorry one more thing,

My neuro also did a EMG of the right genioglossus hypoglossal Root CN xII and it came back saying " this is normal elecrical study, there is no evidence for facial neuropathy or hypoglossal neuronpathy. Needle emg revealed no evidence of spontaneous activity , normal notor unit potential and full recruitment pattern on maximal effort.

but my Biceps and triceps continue to twich, would it matter that the needle EMG wasnt done on those two twiching parts?

I promise that is the last question.