Is This ALS

[Intel_Maxx]

Hi,
I know that I am sounding terrified but I am....
I am a 27 Years old Guy. I have been having Fasciculations that started in Mar'07. It started in my Right Eyelid. Within two months, I started having Fasciculation all over my body... I consulted a Neurologist and he conducted a NCS and EMG.This was in June'07. I had some blood tests/ Thyroid profile / MRI done...Everything came normal... The Doctor said that it is BFS and gave me some Clozapam... He said that it is hyper Excitability of the nerves... In the meantime I have consulted 2 other Neurologists... Both of them did some basic Neurological exams and said that everything looks fine... I Feel weakness in my Left arm since March... The Tremors are still persistent...

Is this ALS...Is there anything to worry... Please Help..
Thanks

[Abhijeet Deshmukh, MD]

Hello.

I am sorry for the delay. It is actually difficult to say when muscle wasting starts. The two processes can go hand in hand also. While some parts of the muscle are in the process of denervation ( disturbed nerve supply ), others may have already progressed and wasting may have started.

The key is to not even the slightest of weakness and a regular neurological examination. I can understand you are quite anxious at this moment. I can only suggest you to keep a positive outlook. Thinking right does matter a lot.

Regards

[Intel_Maxx]

Hello Sir,

I had an EMG/NCV last week and that came out normal. Also my neuro did a neurological exam and thought a slight APB weakness. He performed a EMG and said that everything is fine.
Can you please suggest how long does it normally take between the start of Fasciculations and  Muscle wasting/weakness?

Thanks a ton for your time
Regards

[Abhijeet Deshmukh, MD]

Hello again.

It is not necessary that muscle wasting should start when having fasciculation. Fasciculation is a result of denervation ( no/cut off nerve supply to the muscle). The EMG may come normal. But a normal EMG does not rule out the possibility of ALS.

Muscle wasting normally does take that much time. A repeat EMG now may again come back normal. You may repeat it after a few more weeks.

Regards

[Intel_Maxx]

Hello Sir,
I have a Query.. I had an EMG when I had widespread Fasciculations... I have heard that by the time Fasics start, Muscle wasting is already there and is indicated in the EMG... Is that true?? In the meantime my EMG/NCS was completely normal.. That was in June. One of my Neurologist said that in Six-eight months an ALS patient normally loses a Muscle... How true is it and is it worth going for another EMG??

Thanks

[Abhijeet Deshmukh, MD]

Hello.

The weakness in your left arm needs to be watched for. Even a small change could be significant. I am not at all pointing towards ALS. But you need to judge for yourself, if the left arm strength has reduced. DO not compare it with the right arm. Do you feel your left arm is any weaker than before ?

Do you have weakness in fine movements of the hands, or gross movements of the elbow or the wrist ?

Some weakness and pain are common with weight lifting, especially if a muscle tendon is pulled.

How is your twitching now ?

And about the anxiety part; do you have significant anxiety provoking situations (other than the fasciculations) ?

No single test can be said to be the confirmatory test for ALS. It is the Neurologist's clinical examination and series of tests that allow us to diagnose ALS. So, you can relax, as your Neurologist does not think it is ALS.

Hope you have a great year ahead.

Regards

[Intel_Maxx]

Thanks for your comments... I can do 30 - 40 Pushups and can Lift weights, Though I find that my right hand is weaker than the right one...( probably because I am right handed)... other then that not much.... I asked for an EMG but my Neuro said that it is not required at all.... You are worrying too much and stop visiting ALS sites on the internet..:)

Please suggest

[ohioprof]

That sure sounds like BFS to me . . . and if you presented with weakness in your arm and an EMG was done and was clean, then it isn't ALS (EMG is a defining test for ALS).
How weak is your arm?  Do you lift weights and found that it's weaker in the gym?  Sometimes we can hurt a limb and not know it (sleep on it funny . . . or there might have been something you were doing over a long period of time and it was more or less a "straw that broke the camel's back" thing, and something very minor caused the injury).  If you're still worried, get another EMG.  If it's clean again, you don't have ALS and most likely have BFS, which is more annoying than anything.  It is not life threatening at all.  Take care.