Twitching and Bulbar Questions

[WindyCity]

Dear Doc,

I am a 36 y. old female.  Long story short...I have been experiencing widespread twitching for approx. 2 mos.  I saw a neurosurgeon and neurologist about 6 weeks into my twitching.  Upon my clinical examination, I presented no weakness and had slightly exaggerated reflexes - doctor didn't seem to be worried.  I have had a CT scan of the head, MRI scan of the brain, MRI scan of the cervical spine and an EMG (8 needles in four extremities).  Other than having mild carpal tunnel in the right hand and a right annular tear of the thecal sac (I believe at C5), all tests have come back normal.  A couple of months ago, I felt as though I was coming down with a sinus infection - felt like something was at the back of my throat (only on the left side).  I have noticed that after I drink liquids, I tend to feel like there is a mucous buildup.  Sometimes, the area in the throat (where it feels like there something stuck in my throat) will hurt.  As the day goes on, it gets worse (hardly noticeable first thing in the morning).  I don't believe I've had any twitching of the tongue.  However, I do have occasional twitching in my face and lips.  I have been thinking/worrying about ALS 24/7 for weeks on end.  I have a hard time concentrating, eating or sleeping because of this.  The doctors say that I don't have ALS and that it's benign 1)  With the tests that I have had at this point, should I be worried about bulbar onset? 2)  When lying down, I tend to find that I will move and the muscle will twitch shortly thereafter. Is this normal for benign twitching?

Thank you.

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

As I have not personally examined you nor have I reviewed your diagnostic studies, I cannot accurately comment on whether or not you definitively have ALS. Having said that, the normal neurological examinations and EMG studies should be somewhat reassuring that this is unlikely to be ALS. What I can say is that it would be unusual (but not impossible) for bulbar onset ALS to present with very minimal throat symptoms with pronounced muscle twitching. It more commonly presents with a progressive difficulty in swallowing and slurring of speech followed later on by muscle twitching. The EMG can be normal initially with bulbar onset although we can sometimes see subtle changes in the facial and tongue muscles on the needle portion of the test. Also, the twitching should have showed up on the EMG as fasciculations if you had them during the exam.

Benign fasciculations can occur spontaneuously, after any type of muscle exertion such as that after exercise, stress, and I have seen it with less movement also. If you are still concerned, you could consider a second opinion with a neuromuscular specialist at a major academic center or an ALS clinic if you happen to be near one. Good luck.

[dizz]

my understanding is ALS is diagnosed through a process of elimination and may take several months. Early ALS symptoms may be similar to a number of other neuromuscular diseases. Diagnostic tests include MRI (magnetic resonance imaging), EMG (electromyogram), muscle biopsy, and blood tests. In order for a definitive diagnosis of ALS to be made, damage must be evident in both upper and lower motor neurons. When three limbs are sufficiently affected, the diagnosis is ALS.

I'd stop worrying about having ALS and increase my vitamin intake of B-6, B-12 and Folate (folic acid), or a multi vitamin like B-50 Complex or Centrim Silver would contain these 3 in addition to others.

[WindyCity]

Thank you for the timely responses.  From what I have read, I understand that ALS does not present with sensory symptoms such as a lump in the throat feeling.  I hope that I am right on this one.  I have heard about B-12 and will try that.  I am also going to ask my doctor for blood work.

[Risa]

For almost three months I have had this muscular twitching sensation in my throat.  It is very annoying and is constant throughout everyday.

I just delivered a baby in January and didn't have any of these symptoms until a week after the delivery.  I have seen a family practice doctor, I have seen an ENT doctor, they thought that maybe it was my allergies, but they are now under control and the feeling will not go away.  

My throat is just constantly jumping all day long.  It's not that bad when I first awake in the morning, but at about noon time until I fall asleep at night is it constant annoyance.  Please tell me what you think.  Could this be some neurological.

Risa

[Risa]

For almost three months I have had this muscular twitching sensation in my throat.  It is very annoying and is constant throughout everyday.
I just delivered a baby in January and didn't have any of these symptoms until a week after the delivery.  I have seen a family practice doctor, I have seen an ENT doctor, they thought that maybe it was my allergies, but they are now under control and the feeling will not go away.  
My throat is just constantly jumping all day long.  It's not that bad when I first awake in the morning, but at about noon time until I fall asleep at night is it constant annoyance.  Please tell me what you think.  Could this be some neurological.

Risa

[Risa]

For almost three months I have had this muscular twitching sensation in my throat.  I didn't have any of these symptoms until after I delivered my baby in January.

Could this be something neurological?  I have seen a family practice doctor and a ENT doctor without any positive results.

Please let me know what you think.

Risa