Re: Twitching question

Posted By CCF Neuro MD MJD on November 25, 1998 at 14:26:02:

In Reply to: Twitching question posted by Bob on November 25, 1998 at 12:27:31:






: Is it generally true that muscle twitching caused by ALS gets worse and not better? I've had muscle twitches for about four months that have affected my eyelid, one foot, chest occasionally, arm, etc. They happened fairly often the first couple of months but less-and-less frequently and now maybe only a half dozen times a day. I've even had a couple of days where I haven't been aware of them at all. They've also gotten "softer" meaning the ones I do have now are a lot less pronounced. It's almost as though my muscles were irritable and upset and now they're calming down. I have no other "symptoms" like weakness or atrophy, or fatigue -- in fact, except for my fear of ALS, I feel pretty good. I know that ALS twitching eventually goes away but I thought I read that it's because the muscles atrophy and there's nothing much left to twitch. Your opinion please...



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It is true that the muscle twitching in ALS called "fasciculations" tend to become more frequent and widespread but later in the course lessen or even disappear.  But the main issue here is your concern over ALS - Amyotrophic Lateral Sclerosis is a disorder that causes weakness with normal sensation, loss of muscle bulk, and problems with issues such as speech and swallowing.  While the initial presentation of ALS can be variable (and occasionally somebody does present with fasciculations), most patients have other symptoms first.  Even if a person first notes fasciculations they are soon after followed by fasciculation.  Note that there is a syndrome of Benign Fasciculations where fasciculations are the only feature - this syndrome does not progress.  You sound like you're very healthy otherwise - Please get evaluated by a neurologist because there is a good possibility (even though your description is limited) that your concerns of ALS is unfounded.



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Sorry about the typo..What I meant was basically that it is a rare case when ALS presents with fasciculations.  So we don't tend to look at patients with only fasciculations and judge their course or whether they are worsening or not.  How frequent fasciculations are in Benign Fasciculations is quite variable.  If yours are lessening that's wonderful.  I would still get them evaluated (sometimes muscle twitches as described by patients tunr out to not be fasciculations after all), but given that you have no other symptoms, this does not seem at this time like ALS.