EMG, fasciculations, fibrillation

[combray]

For about 4 months I have been experiencing constant fasciculations, primarily in my calves and feet and recently in my thighs also.  About a month ago I had an EMG and a nerve conductivity test.  The EMG showed fasciculations in both calves and feet.  Also one fibrillation in one muscle of my right calf.  The rest of the test was clean.  I am an otherwise healthy 39 year old male.  I also had a normal neuro exam about 2 months ago.  The doctor doing the EMG felt the one fibrillation could be the result of injury/trauma as I am a runner.  
I am also having cramping/tightness and some very slight fatigue and soreness in my legs.  However, thus far, I do not appear to have any noticeable weakness in my legs and no atrophy.  I am able to perform all normal activities including running 12 to 15 miles a week.

Like many with unexplained fasciculations, I am worried about ALS.  The doctor said he could not totally rule out early onset of ALS, but that this would be an extremely unusual presentation.  What I suppose I am primarily concerned about is the one fibrillation, could this be an incidental finding or an injury?  Also, the doctor said it would be unusual for benign fasciculations to appear only from the knees down, is this true?  And do benign fasciculations register on an EMG, I am confused on that particular point.  My doctor wants me to have a lower spine MRI.  I have had lower spine x-rays which were normal.  I am a bit reluctant to have the MRI done.  I am at the point where I want to get on with my life and not worry about this as long as there continues to be no noticeable weakness.  All blood work to this point has been normal, including checking thyroid.  
Thank for your time.
CK

[Dr Vinod]

ALS, Amyotrophic Lateral Sclerosis - a form of motor neurone disease and the onset of ALS may be so subtle that the symptoms are frequently overlooked. The earliest symptoms are obvious weakness and/or muscle atrophy. This is followed by twitching, cramping, or stiffness of affected muscles; muscle weakness affecting an arm or a leg; and/or slurred and nasal speech.
No cure has yet been found.
So it is always good to go for an MRI and as your diagnosis do not point towards ALS, and if negative also in MRI you can carry on with your life with more confidence.
Take care and come back to us on further queries.

[roncart]

the reason for the mri of the lumbar is to see if there is nerve root compression in your lumbar. I know this because I have the same problem. I would not hesitate to get the mri done. First and foremost you know your body and it is telling you that there is something going on. I know first hand that you can have fasciculations from the knees down. I have had them for about a year and a half now and they started out as a once or twice a day thing and they have progressed to be constant now in both legs and I recently noticed them in my right buttock. (not constant there but a few mins. 5 or 6 times a day.) In my case they have progressed over time. My neuro guy told me that they mean that there is a problem with the spinal cord. the thing I find interesting though is that my old neuro guy told me that an emg could rule out als. he gave me the test a year and a half ago and said thank God you don't have als because that is what I was worried about. Now I am certain I don't have that because it is a fairly rapid disease and I would know for sure right now if I had it. On another note, I have developed severe burning and pins and neddles in my legs over time now which I did not have when this first started. I have no problem walking. I just have alot of pain. good luck.

[roncart]

I was wondering if anyone out there knows if you have a metal plate in your neck from a previous surgery and have a myelogram done with a catscan are they going to be able to get a picture of the spinal cord behind the plate? I have had a mri with and without contrast and all you see at that space is the metal plate. Now my neurosurgeon told me yesterday that I need a mylogram. Now having had one 20+ years ago and suffering with that headache I don't want to suffer through that again only to be told oh we can't see because the plate is in the way. I have to make a decision soon so I am looking for answers and to be honest when he said myelogram my mind went numb and I didn't ask him the ? Thanks.