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Muscle Twitching
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Muscle Twitching

About 9 months ago I suffered a brief illness (maybe viral) during which I started suffering pronounced muscle twitching in my left tricep and both calves. These twitches soon spread body wide. During my first visit to my Neurologist he conduct standard neuro-exam and strength testing all of which appeared normal. This was followed up by an MRI of my neck and an EMG. MRI showed some minor arthritis and the EMG was also normal. Blood creatinine kinase was also normal. Six months later I had a follow-up visit with my neurologist who repeatedly asked about any loss of strength - all I can say is that I have not been limited in any physical activity I normal do. I still suffer from fasicualtions which can and go in intensity - some day I hardly know they are there, others day they drive me to distraction and most of the twitching is not visible on the surface of my skin - however, some are. I have a follow-up visit in about 8 months - my neurologist doesn't seem to think it is ALS, also does not seem to want to rule it out yet. I am very concerned about ALS - should I be - should I get a second opinion?

Thanks for your time
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Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.

It is true in general that in the evaluation of ALS, an EMG may initially not show major abnormalities. However, with ALS, as crude and unscientific as it sounds, one of the key diagnostic aids in such cases is time: an ALS patient, over a 8 month period, would develop some features to suggest ALS even if initially all that was present were fasiculations. If weakness, spasticity, swallowing difficulties, or other problems have not newly developed in recent months, the probability of ALS is extremely low, and as long as new symptoms do not develop, re-evaluation or continued evaluation is likely unnecessary.

One possibility that would explain your muscle twitching is benign fasciculation syndrome, which I will abbreviate as BFS, which is a condition in which there are involuntary twitches of various muscle groups, most commonly the legs but also the face, arms, eyes, and tongue. If the diagnosis is confirmed and other causes are excluded, it can be safely said that the likelihood of progression or occurrence of a serious neurologic condition is low. It must be emphasized that in the vast majority of cases fasiculations are benign meaning that they are of no consequence and are not resulting from a serious cause. In such cases, the twitches may be related to anxiety/stress, caffeine, and often occur after recent strenuous activity or muscle over-use. It is important in such cases to reduce stress/anxiety levels and to reduce caffeine intake.

When BFS is present but not particularly bothersome or disabling, treatment is not necessary. If severe and it requires treatment, there are a few medication options though this condition is not very common, and the research that has been done on its treatment is limited. Minimizing caffeine and stress, and treating anxiety if it is present, will improve your symptoms.

While fasiculations can occur in other neurologic disorders, again, it would be reassuring that over several months, in the presence of fasiculations, other symptoms have not developed.

Continued follow-up with your neurologist should new symptoms arise, or if otherwise indicated is recommended.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
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