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Neurology (Expert Forum)
Still Worried
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury.
Still Worried
by GGKK, Aug 07, 2006 12:00AM
Hello.
First of all I would like to thank you for your kind attention.
I am 30 years old. On april 2005 I ran my first marathon. One month later (may 2005) I felt muscle twitches in my rigth knee. I was scared (because I knew muscles twitches could be a neurologic disease) and went to a doctor specialized in neuromuscular diseases. He did a neuro clinical exams and the results were all normal. Blood tests all normal. He said me I was 100% fine and the twitches were benign, normal. After a few days I was with widespread fasciculations (legs, shoulders, forarms, abdomen, back,...). On june 2005 I back to my doctor and asked to him a EMG. He told me it was unecessary. After I persisted a lot he did one (4 limbs). All normal. The fasciculations didn't go away and on september I back to my doctor. He did all clinical exams again , all normal. I asked to another EMG and after I persisted a lot he did it again. All normal again (just rare fasciculations was showed but he told me it is normal). On december I back to him again and he told me I was fine. He disapproved to do another EMG and told me to forget about it. Nowdays I still fell the widespread fasciculations. Since april 2005 (marathon) I stopped all kind of exercises. My weight up from 220lbs to 275lbs.
1) Should I be worried?
2) Could it be the early signs of ALS?
3) What is the difference between benign twitches and twitches in neuromuscular diseases?
4) If the twitches were about ALS, the EMG's I did last year would pick up it or it was too earlier yet to pick up something?
Sorry for my english. Thank you a lot.
First of all I would like to thank you for your kind attention.
I am 30 years old. On april 2005 I ran my first marathon. One month later (may 2005) I felt muscle twitches in my rigth knee. I was scared (because I knew muscles twitches could be a neurologic disease) and went to a doctor specialized in neuromuscular diseases. He did a neuro clinical exams and the results were all normal. Blood tests all normal. He said me I was 100% fine and the twitches were benign, normal. After a few days I was with widespread fasciculations (legs, shoulders, forarms, abdomen, back,...). On june 2005 I back to my doctor and asked to him a EMG. He told me it was unecessary. After I persisted a lot he did one (4 limbs). All normal. The fasciculations didn't go away and on september I back to my doctor. He did all clinical exams again , all normal. I asked to another EMG and after I persisted a lot he did it again. All normal again (just rare fasciculations was showed but he told me it is normal). On december I back to him again and he told me I was fine. He disapproved to do another EMG and told me to forget about it. Nowdays I still fell the widespread fasciculations. Since april 2005 (marathon) I stopped all kind of exercises. My weight up from 220lbs to 275lbs.
1) Should I be worried?
2) Could it be the early signs of ALS?
3) What is the difference between benign twitches and twitches in neuromuscular diseases?
4) If the twitches were about ALS, the EMG's I did last year would pick up it or it was too earlier yet to pick up something?
Sorry for my english. Thank you a lot.
Doctor's Answer
by CCF-Neuro-M.D.-SH, Aug 09, 2006 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes. From the symptoms you describe I suspect you do have benign fasiculations. Fasiculations (muscle twitches) are not specifc to any neuromuscular disease, but are seen in normal individuals after strenous exercise, as a benign syndrome, in electrolyte abnormalities and associated with some neuromuscular diseases (most notably ALS (amyotrophic lateral sclerosis or motor neuron disease).
When patients present with muscle twitches the concern is always to rule-out underlying neuromuscular disease. Patients that do have ALS generally present with weakness and atrophy, and may have associated muscles twitches (but this is not required or specific for the disorder). Without weakness or atrophy the diagnosis of ALS is very unlikely. However given the severity of ALS an EMG should always be preformed on someone concerned about ALS reguardless of the presentation to see if any early signs are present. It sounds like you were treated appropriately and had 2 normal EMGs.
Most people with fasiculations have a benign syndrome. Sometime the fasiculations start after a viral infection and can last for 6months-2 years. Some occur due to imbalance in electrolytes, mostly calcium or magnesium and this should be checked (was probably included in your blood work). They can also occur after excessive exercise (possibly related to your marathon).
Given the symptoms and histoy you provided I would recommend that continue to follow with your neurologist, but do not need anymore EMGs unless you develop weakness or atrophy (muscle size shrinking). I would make sure that the blood work he/she ordered included Na, K, Cl, C02, BUN, Cr, Glucose, calcium, magnesium, phos (electrolytes), and CPK, aldolase (muscle enzymes). I would also encourage you to continue exercising. I hope this has been helpful.
When patients present with muscle twitches the concern is always to rule-out underlying neuromuscular disease. Patients that do have ALS generally present with weakness and atrophy, and may have associated muscles twitches (but this is not required or specific for the disorder). Without weakness or atrophy the diagnosis of ALS is very unlikely. However given the severity of ALS an EMG should always be preformed on someone concerned about ALS reguardless of the presentation to see if any early signs are present. It sounds like you were treated appropriately and had 2 normal EMGs.
Most people with fasiculations have a benign syndrome. Sometime the fasiculations start after a viral infection and can last for 6months-2 years. Some occur due to imbalance in electrolytes, mostly calcium or magnesium and this should be checked (was probably included in your blood work). They can also occur after excessive exercise (possibly related to your marathon).
Given the symptoms and histoy you provided I would recommend that continue to follow with your neurologist, but do not need anymore EMGs unless you develop weakness or atrophy (muscle size shrinking). I would make sure that the blood work he/she ordered included Na, K, Cl, C02, BUN, Cr, Glucose, calcium, magnesium, phos (electrolytes), and CPK, aldolase (muscle enzymes). I would also encourage you to continue exercising. I hope this has been helpful.
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It's difficult to put it out of my mind.
Here's my story;
I was 37 years old and first started seeing a Dr. in May of 1998 for a persistant twitch in my left forefinger/thumb, it didn't hurt but would involuntarily pully them towards each other in a fairly rapid succession of twitches. I lived in Utah at the time. My Dr. referred me to a neurologist but due to a long appointment wait it was November
of 1998 before I was seen. By this time I had deleloped VERY pronounced random muscle fasciculation’s that were all over my body with no specific problem area, this included my tonque as well. These twitches/faciculations were observed by the Dr. at the time of my visit. Over the next 6 month I had 2 different unremarkable MRI's, and 2 different needle EMG's which were basically normal but he did comment that they were "a little slow" (he did not share much info with me which was frustrating). When the MRI's came back he noticed a small white area (pea sized) in my left frontal lobe area near my speach center which he felt was a small benign brain tumor, I had a second opinion and the second Neurologist dissagreed and said that it was instead a venous annomoly (naturally swollen or odd sized blood vien in my brain) He said it appeared "safe" and should not be the cause of my symptoms or future worries, following MRI's showed no change. He concluded that my twitching was caused by benign muscle fasiculations.
Another year passed and by fall I had basically the same symptoms which came and went but did not worsen. I did have a new symptom that was a surprise. As a teen I had a couple instances of migraine headaches, typical retna dialation, color flashes/light sqiggles, and dead blotches in my vision field, then a powerful headache for a couple hours, then everything was fine. I had a few of these over a few month period and none since, seemingly unrelated to my twitching problems. After being seen for this my Dr. suggested a routine of injections of vitamin B-12 to help with the twitching, after 6 months of this there was no noticeable change in frequency or severity. Another year passed and still no dramatic changes, no muscle loss or noticeable weakness anywhere, no foot drop or trouble swallowing, etc. Then in 2003 I went in for another test, this time a lower lumbar punture (spinal tap) was done. The results were inconclusive as I had an unusual result of an "unusual looking" presence of oligoclonal bands (poorly defined as he described it) which were also found in my blood serum. He suggested it showed a defensive process in my cerebrial/spinal fluid but it was not specific enough (in the bands and due to the blood serum also having it) to determine the cause.
Now 3 years later: (7 plus years from my first thumb twitching symptoms) I now live in Spokane Washington.
I have been in Spokane Washington for nearly 20 months since leaving Utah, my symptoms have come and gone over that period but never really worsened. I have no trouble swallowing or speaking; I have not had any difficulty tripping, etc. and do not notice any loss of muscle. I was a power lifter as a teen and am still a pretty strong guy but have not lifted weights for years so my muscles are out of shape and get sore after a short weight lifting session (typical of being out of shape) but have not "wasted" or anything, I do get tired a bit quicker than I used to but this could simply be due to age (43 now).
Lately the twitching in my left forefinger and thumb has been more active and I have had my typical fasciculation’s, randomly over my body, but more so in my extremities, most in my calves and thighs, and arms, pretty much as before, just more frequently. My calf muscles also sometimes have that twitching best described as a “Corn popping” feeling under the skin, it doesn’t hurt but it’s annoying and disturbs my sleep, this seems to worsen with excersize. I also have more fasciculation’s in my tongue than I used to have (I had them when I first visited you but they are a little more noticeable now) the difference now is that rather than a twitching/tingling feeling, these muscle faciculations feel more like multiple "mini-cramps" they don't hurt like a cramp but seem to be affect the function of my tonque slighlty which they had not done before, again, no slurred speach, or swallowing/speach problems, just different and more noticable.
Here’s what’s new:
A new sensation began in my left foot about 6 months ago, it comes and goes but has been more and more frequent, it is a pulsing feeling of the nerves in the core of my instep, sort of a tingle, no pain or true "numbness" just a electrical feeling that pulses on and off, no stretching or exsorcize seems to effect it in any way. Now for the past several months I get frequent cramps on the insides of both hands between the little finger and the wrist which seems to be brought on by doing simple tasks. I get similar cramps on the soles of my feet but less frequently, either cramps can be worked out pretty easily but they seem to re-cramp if I continue whatever I was doing. The final problem I’ve had is that when I run more than about 3 miles on unevern ground (outdoors, hills, trails, etc.) my calves swell up and feel tight, it does not cause my feet to swell but this gets to the point that blood to my feet gets slowed and they go numb forcing me to stop running, I have not noticed this when running on flat ground or a treamill. I have noticed this off and on for about a year.
Of course I’m dreading that I may have ALS as I can find no other disease that these symptoms match. I have an appointment with a new neurologist in Spokane but since his appoinment time won't allow my first visit for 6 more weeks I thought I'd ask you forum members for some input.
NO STRICTLY ANSWER YET! I'm twitching since March 2004. Starting in eyelid fasciculations spread all over my body. My legs are twitching 24/7 (like popcorn) almost two years. I can run. Two/three times per week I run 5 miles within one hour. I have 50 years.
At least 5 (five!) Neuros here in Croatia said that I have not ANY fatal desease. I have done 7 (seven) EMG; five on my own choice. All good and normal except mild radiculopathy L5/Sl. Some kind of metabolic disorder is still on suspect because I have dx tetany (diagnose in my left hand).
Crams in my calves were described as benign. Magnesium (sublingual) helps me. Drink water (not too much 2-3 litres) with little bit salt and no sugar (or suplements like aspartame). Eat fresh tomatos & bananas (rich of potassium).
Greetings.
S.B.
P.S.
I am dee jay on radio station and congas (percussions)player as well. I can play on conga skin by my fingers, handling with equipment, CD's... With ALS I shouldn't do it.
Some medicines cause both fasciculations and muscle wasting, without realeasing amiotrophic lateral sclerosis (ALS).
One of the class of drugs more frequently prescribed that cause fasciculations in a great percentage of people is the fluoroquinolone antibiotics (cipro, levaquin, floxin, tequin and the like).
You should spend a few minutes ruling out that you took any of those antibiotics up to one and a half years prior to the onset of your symptoms.
The only consistant syptom (symptom) I have is the twitching in my left forefinger/thumb, it's been there off and on for about 7 years now, it almost seems like some sort of permanant nerve or brain damage because it's always there. If I strain the muscles there intentionally the thumb and forefinger will begin to twitch and spasm after I relax even if it had been resting/not twitching prior to the excorcise. Other parts of my body do not react in the same manor after excorcise. I don't recall any specific event in my life that may have caused this damage(?) it just started twitching one day out of the blue and slowly became more noticable/stronger/frequent over time.