Advice

[DJL]

I am a 40 yr old male who began experiencing some disturbing symptoms 3.5 months ago.  It began as a soreness (mostly in quads) in my legs that I noticed cause I became fatgued after standing for a time(other standing around were not).  I saw my Dr and he had me take Ibuprofin for a week and did some blood work (came back normal for pk).  After about 1.5 weeks my legs felt more fatigued when I attepted to do any typical things - walking or yard work, and after any exertion were very sore for 2-3 days.  I went back to the Dr. he did the blood work again and addl thyroid blood test (normal again).  With this I went home and things did not improve so he ordered an EMG / NCV which was done on one leg and one spot on my lower back at a major university hospital -- came back normal.  I have had a fair number of muscle twitchs during this time as well.  Now I feel like my left arm is getting weaker as well, with a pain in my elbow when exerted or leaned on in certain ways, and a pain in the tricep if I grip things hard.  My feet also seam to fall asleep easier then previously.  The doc checked my pulse in my ankle and said that was fine and he had me do some leg strength things (as did the dr. who did the EMG)and made no comment.  Due to the normal EMG he has referred me to a PMR dr which I see next week.  I can't help but think this is neuro and am pretty worried.  What could this be ?  What tests should be done at this point?  Does the normal EMG done on one leg (that was already feeling fatigued and weak and twitching) rule out ALS? Any advice comments would be appreciated-than

[CCF-Neuro-M.D.-JT]

The normal EMG is somewhat reassuring that it's unlikely to be ALS if done at a reputable facility by a well-trained physician, especially if that leg is symptomatic. However, this needs to be taken into clinical correlation with your symptoms and neurological examination. Also, the EMG exam for ALS is quite extensive and includes one arm, one leg and different muscles along your spine to be complete. The major blood work should consist of muscle enzyme proteins such as CK and aldolase, as well as routine electrolyte studies. Depending on what they find with your exam, an MRI of the spine may also be a consideration. In addition to or in lieu of seeing the rehab doc, you may consider a second opinion by another neurologist with a subspecialty in neuromuscular diseases. Finally, a more invasive and sometimes more definitive test would be a muscle biopsy, again depending on what your doctors find. Good luck.

[DJL]

As a follow-up to the above I do not notice a change in the way my legs / arm look (atrophy?) and I am not experiencing tripping, falling, foot drop or inability to button, or do similiar tasks.  Hope the dr. can read this bit as well.

[jicommon]

I am not a doctor, but I have been researching neuro issues for quite a while and I think it is highly unlikley you have ALS.  ALS is characterized by progressive weakness - parasthesias - the feet falling asleep are not a hallmark of ALS.  Any number of far more benign conditions can casue you symptoms.  I am sure Dr. JT can shed some more light on what might be causing your condition.

Ian