SOUNDS LIKE ALS??

Dear Doctor
I am 22 years old and female.After having some symptoms such as cramps and bilateral pain i was diagnosed 1 month ago with an emg of bilateral cervical and lumbar sacral radiculopathies....Only my right arm and leg were tested...Howevern i noticed now for 3 months widespread fasciculations and there is a point in the thenar muscle where there is atrophy...
I saw another neurologist who noted brisk reflexes and the atrophy in my hand...I have fasciculations in that spot also.The second neurologist wants to obtain the first EMG before performing another one on my left hand.
I asked her if she suspects ALS and she said yes...I know you dont have the chance to examine me but...1)Can ALS be misdiagnosed as rediculopathies???
2)can the hand muscles be atrophied and fasciculating at the atrophied point from something else?(its the thenar muscle next to the thumb, like a big chunk is missing)also the entire hand looks wrinkly
3)She hadndnt noticed any tongue twitches in the exam however i do have weird sensations in tongue..Could that be twitches??
i really need your input
Thank you

[Christopher R Newey, DO]

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 obtain a history from you and examine you, I can not comment on a formal diagnosis or treatment plan for your symptoms. However, I will try to provide you with some information regarding this matter.

It must be emphasized that in the MAJORITY of cases muscle twitches 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. Tremors of the hands can be physiological that is exacerbated by stress/anxiety and caffeine.

Benign fasciculation syndrome 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.

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.

However in general (and please understand I am not trying to imply I feel this is the case in you), when fasciculations occur in the setting of associated symptoms such as progressive loss of sensation, tingling or numbness, weakness, trouble swallowing and other symptoms, the cause may be due to a peripheral nervous system problem. In general the symptoms would not be episodic and triggered by certain things but would be more constant/frequent without consistent triggers. The location of the problem could be the anterior horn cells, the area where the nerves that supply motor innervation to our body comes from. These are the cells that give off the nerves that allow us to voluntarily contract our muscles. The diseases that might affect the anterior horn cells include ALS (also called Lou Gherig's disease), a condition called spinal muscular atrophy, polio-like viruses, west nile virus, and other infections.

Another nervous system problem, neuropathy, may also lead to fasciculations. There will again be associated weakness or sensory changes. Perhaps this is what you may have given the history of back pain


Often these symptoms of twitching, internal movement, etc, may reflect emotional/psychiatric problems related to stress (what is called somatization disorder). The latter is a true medical condition whereby instead of a patient experiencing depression or anxiety, they experience physical symptoms, and once the stress is addressed, the symptoms resolve.

I suggest follow up with your primary doctor and you may benefit from evaluation by a neurologist as your primary doctor feels fit. It is important that you discuss your concerns with him/her. You may need basic lab work to ensure your blood chemistry, particularly your potassium, sodium, and calcium, is normal. Further workup such as EEG, EMG/NCS, or MRI would have to be decided upon by your neurologist depending on the clinical examination and historical findings.

Thank you for using the forum, I hope you find this information useful, good luck.