Fasciclations and Upper Motor Neuron signs

[TxLefty]

How significant are hyperactive reflexes and up going Babinski reflex and how likely is it that fasciculations and muscle cramping in the same patient are benign?

[budgy]

I have been told that there are reflexes in the 4 quadrants of the abdomen that refer to the upper motor neuro pathways.  I don't have any response to the reflex testing.  I have a response to "tickling" but not to the professional sharp instrument tracing.  The doctor who tested me said it was interesting and didn't say anything else about it.  He said simply that there were supposed to be reflexes there which involve the twitching of the belly button, but that I don't have any.  Is it common for people to not have a response to this type of reflex testing?  What sort of neuro problems would a lack of response indicate?  What do the upper motor neuro pathways have to do with, and how do they relate to the abdomen or abdominal muscles?

[CCF Neuro[P] MD, RPS]

Dear Keith:

Your wife may have carpel tunnel syndrome.  I would seek out a good neurologist and find out if this is the problem.  Although extremely rare, your wife might also have thoracic outlet syndrome.

CCF Neuro MD

[Keith Jenkin]

For over Eight years my wife has believed that she has MND. A clinical physician ruled this out 7 years ago. She has twitches and noticable wasting of the thumb muscles on both hands. Is there any advice you could give me as she is suffering a great deal\of mental anguish

[CCF Neuro[P] MD, RPS]

Dear Jack:

A pronounced herniation or spinal cord compromise could cause fasciculations. The EMG will be telling.  I would wait for the results before making any diagnosis of benign.

Sincerely,

CCF Neuro MD

[Jack P.]

I am a 48yowm with a C6-7 posterior lateral disk herniation which occurred 5 months ago. Treated conservatively it still aches from time to time and prevents full physical activity. I awoke at 1:00AM 10 days ago to total body fasciculations,head to toe. Persistant ever since. Followup MRI...no change.Reflexes normal.EMG next week, but will probably be normal.Could the two be related? Hard to accept the possible diagnosis of benign fasciculations.Benign= we haven't figured out the cause yet. Could it be a direct or autoimmune inflammatory process involving nerve rootlets? Any research or clues?

[CCF Neuro[P] MD, RPS]

Dear Robert:

Fasciculations without muscle weakness is usually benign.  I would see your neurologist just to put your mindset at ease.  I would think that this is nothing worrisome.  But check with your neurologist just to make sure.

CCF Neuro MD

[Robert]

I have had "quick" muscular twicthes throughout my legs,  buttocks,  triceps, and jaw area.  These twicthes occur at the rate of 1-5 a minute. Also have tendon pain in the forearms. I'm under extreme stress thinking about this all day long. Is there something to be looking for or to be worried about?

[CCF Neuro[P] MD, RPS]

thanks for your comments.

CCF Neuro MD

[Thomas Murphy]

I am a 30 year old male and, along with alot of others it seems, I have for the last year or so experenced the same symptoms i.e.
heavy arms, burning feet, extreme fatigue, spuratic numbness in hands and feet, dizzeness, foggy thoughts, ect. My 2nd neurologist has put me on neurontin. My orignial doseage was 1800 mg a day ( 600mg 3 times a day ). That amount of neurontin was overkill it really confused me so I have adjusted to 2 times a day 300mg. The amount I need is directly related to the physicality of the day. I have no idea where to go from here?
However this whole experence really gives me a refined outlook on life. Hang in there everyone!!!

[CCF Neuro[P] MD, RPS]

Dear Lavon Lockwood:

I am sorry to hear about your diagnosis.  Hang-in there, let us know if there is anything we can do.

Sincerely,

CCF Neuro MD

[Lavon Lockwood]

I'm posting to  this as an update.  I just returned from Houston and have been diagnosed with PLS.  Thanks for the support.

[CCF Neuro[P] MD, RPS]

Dear Ms. Davidson:

I would first see what the etiology might be.  Medication is only good if your treatint the cause of the problem.

CCF Neuro MD

[Loretta Davidson]

Lately I have been experiency very painful muscle spasms in my ribcage. I am about to be 65 and waiting for my medicare card to be valid before I make an appointment to see a doctor.  I was wondering what can I do in the meantime to try to keep the pain down?

[CCF Neuro[P] MD, RPS]

Dear Lavon Lockwood:

I think you need to talk to your neurologist, he/she is the one that did the neurological exam and the testing.  Anything from postviral to "we don't know" might be the etiology of benign fasciculations (benign meaning that they are not caused by a specific disease and will not cause lasting physicial harm).  If twitches are benign fasciculations, there is no real treatment.  Fatigue and anxiety seem to make them worse.  Benzodiazepines might help alittle, but not in every case.  They last for variable amounts of time but weeks to months to years have been reported.  They tend to go away on their own.

However, benign fasciculations is a diagnosis of exclusion meaning that all other considerations must be ruled out.  Only your neurologist can do that.

Sincerely,

CCF Neuro MD

[CCF Neuro[P] MD, RPS]

Sorry you doubt my clinical acumen.  Go it on your own.

CCF Neuro MD

[Lavon Lockwood]

I'm quite relieved that the twitches probably have little to do with the other symptoms- now the big question is- how do I get rid of them?  Will they eventually go away?  Any ideas on how to put up with them (along with the poorly functioning hand, frozen shoulder, weak legs, ataxia, etc. this is definitely in "the straw that broke the camel's back category!)  Lavon

[CCF Neuro[P] MD, RPS]

Dear Lavon Lockwood:

Usually these are not good things and they most often have an etiology that is sinister in nature.  Usually together, your symptoms are both upper and lower motor neuron in etiology.  There is one caveat, that is the spasticity and babinski can be due to patient stress and anxiety.  If you had symmetric reflexes with both toes going up then this might be due to the latter.  In some people, the babinski is a difficult sign to elicit correctly as a healthy withdrawal reflex might mask itself as a babinski (especially if you are anxious).  The normal EMG is very compelling that this might not be sinister in nature and only further lab tests will confirm this as benign.  I hope that things turn out normal.

Sincerely,

CCF Neuro MD

[Yea right]

Reflexes maybe, buta positive babinski's reflex caused by anxiety? Doubt it.What lab tests do you suggest for him?

[to responder "yeah right"]

If you have symmetrical babinski, it is not as big of a deal as being asymmetric.  I believe that is what the doctor is trying to stress.  You are about rude to demand of the doctor the way you have.  If the gentleman wanted to know what lab tests he needed he would have asked the doctor.

[Lavon Lockwood]

Thanks for the quick reply!  I do know this may mean some rather serious problems and have been to a neurologist.  The EMG was normal as was an MRI of the brain and spine- I also had an LP this last week with results pending.  I have been pleased with the thoroughness of my care but suspect the whole work up will be normal and was wondering if all of this is perhaps normal wear and tear over a half century of living.

[CCF Neuro[P] MD, RPS]

Dear Lavon Lockwood:

I would say that you need to see your neurologist.  I would suggest a full neurological exam and if warranted, an EMG.  Usually these signs together are not a good sign.  They usually mean something is going on.

Sincerely,

CCF Neuro MD