Concerned over ALS

Thank you for taking my question. I'm a 32-year-old male who has been experiencing a host of frightening symptoms over the past 2 months. It started with extreme fatigue and an odd heaviness in my left calf. Symptoms which followed have been: bilateral weakness/dyscoordination in the fourth and fifth digits of my hands, weakness in the left leg (particularly the outside - sometimes experience a tingling sensation between the third and fourth toe), increasing widespread fasciculations, swallowing difficulties, fatigue while chewing, tingling/burning sensation on front portion of tongue, voice becoming hoarse quickly, and, in the past week, neck and upper back weakness/pain/burning sensation. These symptoms have me terrified of ALS. I've had two EMG's of my arms and legs (most recently last week), and multiple neurological examinations in which the doctor reports not seeing anything significant, yet the symptoms seem to be increasing/worsening to me. Bloodwork and MRI's of the brain and cervical spine have been unremarkable, with the exception of some mild arthritis in my neck. Due to anxiety over these symptoms, my sleep has been affected, with me only getting 3-6 hours/night (from 7-8).

My questions:
1. Does this sound like ALS?
2. Since the EMGs didn't test the bulbar region, could this be bulbar onset that wasn't picked up by the EMG or neurological exam?
3. Is 10-12 minutes an adequate amount of time for an EMG of two limbs (8-9 muscles)?

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

1) 2 months is a short time to expeorience that rapid onset of symptoms for ALS - this makes it less likely - if you have these symptoms but no objective signs of ALS like muscle weakness when tested by the neurologist, muscle wasting, or EMG evidnce of disease then it is also unlikely to be ALS. Bulbar onset can be more rapid but again objective tests should confirm your symptoms
potentially they are exacerbated by sleep deprivation and anxiety
you were right to seek medical attention and it is encouraging that your tests are clear so far. Fasciculations can occur in many other situations than ALS and are usually benign especially if widespread from early on

2) bulbar EMG is difficult and often does not provide an answer - it is a clinical diagnosis

3) yes, in the hands of an experienced EMGer

Good luck

[S.B.]

During last and this year I have had 5 EMGs by 3 different Neurologists. None of them have checked bulbar section. At least 3 of 5 lasted less than 30 minutes, two limbs minimum.  All were good and normal except mild radiculopathy and L5/S1 lesion.
If you have one normal EMG (you have TWO!) during faciculations sensation (or twitching) you are 100% sure that ALS is not the reason for your problems; meaning twitching.
Don't worry. S.B.

[Buzzy Bee]

Unusual neuro symptoms and especially tremors could possibly indicate lyme disease. Hubby has tremors/myoclonus/seizure-like episodes and diagnosis of Lyme, babesia and bartonella (other tick-borne co-infections). For 1st 1 1/2 years neurologists kept saying Not Parkinson's but just anxiety/depression despite the fact that he shook in his sleep which often woke me up even when he slept through it. He has one normal EMG and several white matter lesions on MRI, but these progressed over the last 4 1/2 years and were not there early on. Despite treatment he is far from well and within last 4-6 months has had some difficulty swallowing -- it's beginning to look like the bugs are starting to try to attack other cranial nerves besides the vagus nerve (G.I. symptoms are just about as bad as neuro symptoms for him).

For more info check out the site   http://www.lymenet.org and go to flash discussion. Also Brain Talk Communities is another active neuro forum   http://brain.hastypastry.net

[mwc04]

Thank you all for the comments. Part of my bloodwork was a Lyme serology about 6 weeks after a tic bite (I didn't have the hallmark rash). The neurologist just ordered blood work for myasthenia gravis.

[PJ31470]

I have recently experienced neck and leg weakness. I take antidepressants and was off them for awhile causing major anxiety and depression. Now I'm getting back up to my regular doseage. Since I had an incident of widespread neuromuscular weakness 10 years ago,and a few smaller incidents since then in times of stress,the neuro doesn't think it's ALS. I don't recall ever having had neck weakness,though. He examined me twice and found no objective weakness and is certain,after consulting with my shrink,that it's just from anxiety and stress. As long as my neck and legs are weak,though,I can't help but feel it's ALS. Brain MRI showed nothing. Neuro won't even do an EMG because he says it will only worsen what he calls my psychsomatic symptoms. He's a pretty well respected neurologist and says that even a normal EMG will not likely keep me from worrying. I 'm just supposed to let the anti-depressants take effect. I feel lousy.