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Can I rule out ALS and MS?
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Can I rule out ALS and MS?

I am a 37 year old male that has had a variety of symptoms for the past 18 months.  My symptoms began with a strange problem with my mouth/tongue which continues to this day off an on.  I have a cramp like feeling in my tongue, which at times makes it hard to speak for a few seconds. It is always preceded by a swollen throat. No one else can tell, but I can. This may happen once or twice a day.  It comes and goes, as do all of my symptoms. It may happen for 2 months and then be gone for 2 months.  I also have muscle twitches all over my body.  I will experience the twitches for weeks at a time and then they will go away for several weeks before returning.  I have joint pain in my hands and knees.  On occasion, I have difficulty with my hands.  They seem to not quite do what I want them to do. It seems to be an effort to pull a credit card out of my wallet for example. That seems to come and go.  I wake up in the mornings with stiffness in my muscles, hands, ankles, and legs that seems to ease a little as the day goes.  I did have a period about 10 months ago where I had difficulty walking. That lasted for about 3 months. I could walk, but it was just a weird feeling.  Finally, the muscle and joint symptoms seem to be worse with cold weather and when a weather front is moving through. I go for weeks where there are limited symptoms, and then they get worse.  This cycle is happening off and on all the time.  I run 3 times a week.  Usually, I have no difficulty with this.
I have been under the care of a PCP and a Neurologist for the past 18 months.  I have had full blood work multiple times, EMG (once), and MRI (once).  The results have been normal.  I have had 3 full neurological exams during that time.   The neurologist says that he can rule ALS and MS out, but I am still concerned.  I know you can
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Avatar_n_tn
Although I have not personally examined you or reviewed your diagnostic studies, I am always hesitant to completely rule out a diagnosis that could potentially take significant time before manifesting itself in a more overt manner. To have all those symptoms at your age would also be concerning to me. ALthough you're a little young for ALS, the twitches (if not related to exercise) could be suggestive of ALS if it becomes more constant and is associated with weakness. MS is also always a consideration in a young person who has focal neurological problems, even with an initial normal MRI. Having said that, there are a number of possiblities these symptoms could represent, even stress. It might be helpful for you to have someone else get a fresh look at your case with the benefit of time and prior studies for comparison. Talk to your PCP and suggest the possibility of getting a second opinion. If you're in the CLeveland area, we'd be happy to take a look at you. Good luck.
5 Comments
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Avatar_n_tn
I thought that ALS is progressive in its onset and the symptoms do not wax & wane over a long period of time.  Can you further explain?  Thanks.
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Avatar_n_tn
Yes, you are correct. That's why I said if it the symptoms become constant, then ALS could be considered.
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Avatar_n_tn
Yes, you are correct. Just to clarify my prior statement, if the twitches as well as the other symptoms become constant, then ALS could be considered.
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Avatar_n_tn
you might want to look into the dystonias especially with parkinsonism (parkinson-like symptoms) it really sounds like you might have a form of dystonia, if not several, ask one of the neurologists here to explain what they are better, but they can cause alot of the symptoms you are listing, if not all of them.
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