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Neurology (Expert Forum)
Muscle stiffness, voice and speech concerns (ALS or something else?)
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Muscle stiffness, voice and speech concerns (ALS or something else?)
by jraymar, Apr 06, 2005 12:00AM
In June 2004, I began to have symptoms of muscle fatigue all over. After MRI of brain and cervical spine, no problems found. Saw a neurolgist in Dec 2004 after having increased muscle fatigue and stiffness on the entire left side of body (even face), and brief muscle twitches all over. After a full neuro exam (but no EMG) I was told everything looked fine and I had good strength. Since then, the stiffness in the left leg has been much worse, usually after a period of sitting. I have also noticed stiffness and slight pain in both knee and hip joints. My left shoulder and tricep feel stiff and the base of my left thumb gets stiff when I do things like type. Also, since August, I have noticed that my voice feels deeper and gruff, and I have the urge to clear my throat a lot. Recently I have also had problems pronouncing some words correctly, usually words that end in the letter "r". I once thought this was all stress, but now I'm not so sure. I am a 25 y/o male with good health history & still quite active (biking, weight lifting, etc.) Here are my questions:
1. If this were ALS, would it progress this slowly? (I can still do cardio at 80% max HR for 20-30 mins and feel fine) Should I have seen atrophy starting by now?
2. Would the twitches have grown more constant? (Now they come and go... sometimes gone for a day or two, they are large parts of a muscle and I always feel and see them)
3. Could hypothyroidism cause these kinds of "neuro" symptoms? Any other symptoms I should watch for or steps I should take?
I am very stressed and worried. Thank you for your time.
1. If this were ALS, would it progress this slowly? (I can still do cardio at 80% max HR for 20-30 mins and feel fine) Should I have seen atrophy starting by now?
2. Would the twitches have grown more constant? (Now they come and go... sometimes gone for a day or two, they are large parts of a muscle and I always feel and see them)
3. Could hypothyroidism cause these kinds of "neuro" symptoms? Any other symptoms I should watch for or steps I should take?
I am very stressed and worried. Thank you for your time.
Doctor's Answer
by CCF-Neuro-M.D.-PW, Apr 08, 2005 12:00AM
ALS progresses slowly over several months, usually starting in one limb then spreading to others over weeks to months. Rarely it can start with the swallowing or breathing muscles.
Fasciculations occur when there is damage to the muscle fibers from lack of innervation - without objective evidence of muscle weakness and wasting they are unlikely to be due to ALS
Fasciculations can occur for many other reasons also - after exercise or exposure to cold, certain medications, pinched nervesm and benign syndromes with or without cramps too. A normal EMG is not suggestive of ALS, especially if the symptoms have been going on for a while.
More benign fasciculations are usually more widespread and would come and go less than ALS fasciculations
Other causes are probably more likely and you should be investigated for eg endocrine problems, arthritic disease, and connective tissue disorders
Fasciculations occur when there is damage to the muscle fibers from lack of innervation - without objective evidence of muscle weakness and wasting they are unlikely to be due to ALS
Fasciculations can occur for many other reasons also - after exercise or exposure to cold, certain medications, pinched nervesm and benign syndromes with or without cramps too. A normal EMG is not suggestive of ALS, especially if the symptoms have been going on for a while.
More benign fasciculations are usually more widespread and would come and go less than ALS fasciculations
Other causes are probably more likely and you should be investigated for eg endocrine problems, arthritic disease, and connective tissue disorders
