ALS Muscle Weakness Question

Hi,

I'm 19 years old and female. After going for a walk last week, my right leg felt very numb and painful. It's no longer numb, but since then I've felt cramp-like pain both above the knee and below the knee. I also experienced twitching muscles in that leg. A few days ago, I started experiencing aches and twitching in my other leg, and in both of my arms. My right leg now feels stiff and weak- I keep expecting it to buckle under me, but it never does. I can still go up stairs, walk, and etc., but whenever I do that one leg feels painful and weak. Also, I feel the twitching, but I can't see it- it's not visible looking at my leg. It's like the muscles under the skin are clenching or something.

I saw the doctor yesterday, and she had me get an X-ray and a blood test (to check for enzymes, to rule out muscle disease or something). She also said that if those are negative, she will schedule me for an EMG. She didn't mention MS or ALS or any other neurological diseases. I think that she is focusing on my right leg. Maybe I didn't emphasize enough that it is spreading, or something. She also bent my leg all the way, to check that I could.

I also have a history of anxiety disorder, but I am not currently on any medications.

So, my questions are:
1. Does the pain and weakness I am experiencing sound like the muscle weakness that is a sign of ALS? I am not really sure what that kind of weakness feels like.
2. Does cramping pain usually come before weakness in ALS?
3. Will the EMG test for ALS even though it's probably going to only be of my right leg?
4. What else could this be? My doctor suggested that I may have pulled something in my leg, but that doesn't explain my other limbs aching. The X-ray technician also told me that that's unlikely, since I didn't fall or sustain any other kind of injury. Could it be anxiety? I've had twitching from anxiety before, but not pain.

Thank you very much

[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.

1) Weakness is a description of power of a muscle. It is tested when a person exerts full effort. It is graded on a scale of 0 to 5 with 5 being full power. Without the ability to examine you, I cannot tell if you have weakness. People can have slight weakness who can walk up and down stairs. Some people will describe weakness when it is actually a sensory problem.
2) Cramping can be associated with ALS. This cramping is called volitional cramping. It may occur as the patient turns in bed during the early morning hours. It is a sign of lower motor neuron disease. It should be stated though that cramping can be a manifestation of a systemic viral illness, myopathy (i.e., a muscle problem), or metabolic such as thyroid or potassium abnormalities.
3) An EMG/NCS would be appropriate to test for a myopathy, neuropathy, upper and/or lower motor neuron disease such as ALS. Depending on the results the examiner finds on the EMG/NCS of the leg, he/she may do additional body parts.
4) The differential for your constellation of symptoms is broad and includes radiculopathy (compression of nerve roots caused by structural abnormality of the back), fibromyalgia (diffuse muscle aches and pains), metabolic (as already mentioned), lifestyle (too much caffeine, anxiety/stress), etc.

You should be evaluated by a local neurologist to have a complete neurological examination focusing on upper and lower motor neuron findings. The neurologist will want to test your strength, reflexes, cranial nerves, gait, and your sensation and coordination. After the examination, it would be much easier to provide answers on possible etiologies for your symptoms. If not already done, basic metabolic workup should be performed including examining your thyroid. Lastly, neuroimaging such as of the lumbar spine would be helpful to evaluate any herniated discs causing either nerve root compression.

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

[susan_m460]

I don't mean to be annoying, but please, could a doctor answer me? I'm really very worried. Thank you...