ALS s

hello,  I have been having severe muscle cramping in my calf muscles, global twitching that you can both see and not see, and muscle fatique and burning.  I feel these things even when I am not exercising, however, when I do exercise they seem to get worse.  Nothing helps, not even rest.  I feel worse at night it seems.  I went to a neuro and he said he was 99.9 % sure that it wasn't ALS after his neuro exam.  He is sending me for an EMG next week, but he said it's mostly so I can get some good news.  I don't understand what is going on with me.  It's frustrating because I feel he's not really paying attention to the severity of my symptoms.  The truth is, my body isn't doing what I need it to do.  I am a 38 year old female with a young daughter and I've never experienced anything like this in my life.  This has been going on for a few months now.  My GP thinks there is something going on, but doesn't know what.  He thought it might be a virus, but I didn't really respond to the antibiotics.  I know in my heart there's something going on, and I can't help but think it is ALS.  

[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.

There are several causes for calf cramps and muscle fatiguing and burning associated with muscle twitching. Muscle cramps are not an uncommon manifestation of a systemic viral illness, however, this seems less likely since you don't have other symptoms of a viral infection and this has been going on for a while. Muscle cramps with twitching may be due to myopathy. A myopathy is basically a generic term for a muscle problem. Myopathies can be inflammatory, as is the case with a disorder called polymyositis which is an autoimmune disorder. Also, there are genetic myopathies, of which there are several, each with its own characteristics and features. Finally, and probably most commonly, metabolic causes such as thyroid problems or low potassium can be the cause of muscle cramping. The latter 2 can be diagnosed with simple blood tests.

While calf cramps can occur in the setting of ALS, this is not common. Your muscle twitches could be due to benign fasiculation syndrome, though this is less likely if your twitches are associated with muscle pain. 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. 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. 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.

Many of the above disorders can be diagnosed/exclude with an EMG, so it sounds like your diagnostic workup is on the right track. EMG in addition to simple blood tests such as a CK level can assess for the presence of myopathy, and can also diagnose/exclude ALS. If your testing is negative, fibromyalgia could be another possibility, this is a medical condition in which muscle pains occur without a specific identifiable cause, and there is treatment that can improve the symptoms. I recommend continued follow-up with your neurologist.

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