ALS symptoms?

Good morning. I will try to explain this the best I can. About a year ago I started having weird pain in both my legs. it is completely random (happens anywhere on my legs at anytime) and feels like someone is poking me with their finger. then about a week ago I woke up to a feeling of heaviness in both my legs, as though they were about to fall asleep. I got up and was able to walk around on them without any problems and it hasn't happened again. now for the last couple of days I have been having large twitches in my feet and legs (also at random places and times). I fell in my bathroom last year and hit my lower back on the edge of the shower tub but I cannot remember if that was before or after the leg pain started. now I'm afraid that maybe the leg pain has really been small cramps this whole time and i just wasn't paying attention and the reason I fell in the first place is because I have ALS. does this sound like ALS to you? I called in sick to work today and am waiting to see if my doctor can see me today. I am so scared. thank you.

[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 a doctor.

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

It must be emphasized that in the majority of 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.

Another nervous system problem, neuropathy, may also lead to fasciculations (i.e., twitches). There will again be associated weakness or sensory changes.

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.

I agree that you should follow up with your primary doctor and you may benefit from evaluation by a neurologist as your primary doctor feels fit. It is important that you discuss your concerns with him/her. The differential is broad as you can see from the above (and these are just a few possibilities). You may need basic lab work to ensure your blood chemistry, particularly your potassium, sodium, and calcium, is normal. Further workup such as EEG, EMG/NCS, or MRI would have to be decided upon by your neurologist depending on the clinical examination and historical findings.

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

[implodingspace]

If I might contrinbute, only because I too was in angst and stress for much time with what I finally found out was fasciculations. First of all thought, as it seems important on a site like this, this is experiential and honestly the best thing you can do is PUSH for MRI's of everything until you have imaged all of the potential problem areas. I think, think ALS may show atrophy on mri??? but other potential causes may show also...also my neru had mentioned if the mri came out negative he'd do an EMG to further eliminate causes. I'm pretty sure ALS shows on an EMG along with other motor neuron diseases.

I had a doc, who had it stuck in his head it was "brain MS" or bust, he imaged the brain and cervical spine and nothing...i felt sad actually because my legs twitched night and day, I had some sensory weirdness, vibrations and electrical shock feelings,  and it was starting to cause spasticity (hyper-tone in muscles) and it was painful, my legs would stay contracted at rest for 2 straight days. the twitching moved up my trunk and was then (in winter) behind shoulder bladed causing them to move. still receiving chiropractic care. Finally my GP sent me to a neuro because of the obvious weakness on left side (both sides to me but more visibly noticeable on left) and I had the thoracic imaged....i had a very long syinx most of thoracic spine and 3 degernated/herniated discs. (I also had a vice grop pain around left rib since fall 2009 I didn't complain about until summer of 2010)

upon imaging the cervical and lumbar they found 2 more degen/herniated discs one in each section and bone spurs and in the cervical since the september one (now March) another syrinx

I wanted to respond because honestly it could be benign, but the best thing you can do is make sure to push for MRI'sin the location of symptoms and not retreat if it progresses. I retreated and let that chiro keep adjusting me which is contraindicated with syringomyelia, and the entire time I was with him, while he told me anecdotes of achilles (implying my full body twitching was my achilles heal) the pain and fasciculations were moving up my body. I understand he is like anyone else who gets stuck on an idea, I honestly was expecting thoracic MS lesions to show, but the best you can do is advocate and be open minded. I really did ask my current counselor if there was any way i could cause this with anxiety because at least if you know you can do something about it. If you are open minded and have investigated other avenues and if it progresses or you deteriorate, just keep seeking help until you find it. I hope all goes well for you!