Possibly ALS?

[TFarren]

Hello, and thanks so much for this opportunity to ask a question!  I am 30 years old, and about a year ago I noticed muscle twitching or fasciculations in both legs.  This came and went.  About this time, I had also been on a steady Starbucks diet about 1 espresso per day.  I though this might be the cause, but after laying off for a week notice no changes.  Recently, on 7/21 after drinking a supposed decaf drink, I felt strange and nervous for NO apparent reason.  I went to the restroom and discovered that my facial muscles were very unsteady.  I tried to exert my face muscles to see what would happen (scowl) and discovered my eyebrows, etc. were quivering wildly.  I couldn't keep my face still! I decided that day that I would have no coffee - and haven't touched caffein at all since.  This symptom has disappeared, but I am still having fasciculations at varying degrees everyday, insomnia (possibly due to worry) and my hands feel unsteady and shake at times.  I don't think I have lost strength, I can still lift my 30lb dumbells with no problems.  Something else that worries me.. I have severe white-coat anxiety.  Blood tests make me so nervous that I almost vomit.  Is it reasonable to take some sort of sedative before tests etc?  I haven't seen a doctor due to fear - where should I start?

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

You should seek the advice of a neurologist about this. Without weakness it is unlikely that this represents ALS. Other conditions which can give you fasciculations would include benign fasciculation syndrome, anxiety, excessive excercise, and electrolyte abnormalities. Caffeine could also exacerbate this. The neurologist will review your examination and make the appropriate recommendations. Good luck.