Hello Doctor, and thank you for answering this question.
For the past several weeks I have been experiencing random muscles twitches (legs, arms, back, midsection, shoulders, feet). These come and go, and pop up randomly throughout the day. I am a 24 year old male, and otherwise healthy. I have had a brain MRI 2 months ago (for an unrelated symptom).
I recently saw a neurologist who performed a physical exam and noted that there were NO brisk reflexes and NO muscle weakness. The exam was normal, and no other tests were ordered.
My question to you is this;
1) after a few weeks of twitches and no weakness on exam, can I stop worrying about ALS and be content that this is benign?
2) also, should I even be worrying about something like ALS in my 20's?
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.
This scenario is always worrisome for patients, because of the concern of ALS. Usually by the time twitches or "fasciculations" develop in ALS, there is some degree of weakness, increase in reflexes and loss of muscle bulk. The fact that you don't have any of these makes me think that this is probably what we call " Benign fasciculation syndrome". The twitches in this syndrome can be focal or widespread, may be accompanied by cramps and long term neruological follow up has shown that there is no increased risk of developing ALS.
Usually ALS tends to start in an older age group , 30's- 40's, but there can always be exceptions.
All in all, from the description you have given me about your exam, I think that this is benign. You should just keep following up with your neurologist. If even after months of twitching, there are no other neurological symptoms, you should be more at ease. If you are still worried, they can perform an Electromyogram (EMG) which also helps with the diagnosis or rule out ALS.
Sometimes drastic changes in diet, dehydrations, new medications can cause the twitching.It can be aggravated by anxiety or activity, but that does not make it any less benign.
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