Fasciculations atrophy without weakness

[jwill]

I am 44 year old male with fasciculations that began subtly in my right calf 15 months ago.  They have since progressed to constant in my R calf and foot, + sporatic everywhere else on my body. Two negative EMG's (last one 10 months ago), neg MRI C-spine, L-spine, & brain.  Extensive lab work all neg.  No gross weakness, but "subjective' weakness on & off in all four limbs (not all at the same time).  I also get tremorous when exerting any muscle.  ie: my arm visibly shakes when picking up something substantial.  This affects all my muscles & started around the same time as my fasciculations.  The past several months, noticed some loss of muscle mass medial distal L thigh & medial R forearm.  No injury or other reasons known to explain these findings.  Two neurologist (one is an "expert" in the field) say they don't think it is ALS, since I don't have any real weakness.  They can't explain the atrophy or the shaking, but tell me not to worry.  I am still worried as things seem to keep slowly progressing.  I feel like I've worn out my welcome at the physician's office.  Am I a hypochondriac?  I seem to be obsessed with my condition (not just my own opinion).  I would really appreciate your opinion and advise! Are there other conditions that my cause these symptoms?

I've tried magnesium & quinine without relief of fasciculations.  Quinine has caused tinnitus & hearing loss.
Any other suggestions?  

Thank you for your response.

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

There is a condition referred to as benign fasciculation syndrome. This syndrome involves intermittent fasciculations without changes in muscle strength or mass. This syndrome can come and go overtime. It sounds from your description that you have had a thorough evaluation into this problem, and do not have a clear answer. The fact that your EMG has been normal twice is reassuring, and helps to exclude nerve or muscle damage. Also the fact that your MRI's have been normal is good. I know that you stated you have seen a muscular specialist, was this at an academic center? Without seeing you and going over your tests it is impossible for me to render an opinion. I assume that you have had blood work for the common muscle and nerve conditions? It sounds like you are uneasy with the opinions you have received. Therefore, I think it would be reasonable to have a second opinion. However, I would make sure that this was done at a large academic center with a neuromuscular neurologist. Good luck.