Twitching

[Mark Anthony]

My identical twin and I are both twitching.  Experiecing tremors, essential I think,  laying down, feels like entire arm is on a vibrating bed.  Can be felt but not seen.  The twitching is migratory and felt.  My left eyelid constantly twitches and I can make it twitch by closing my eye hard and releasing . Then eye lid trembles or twitches .   Does ALS affect "EYE LIDES" ?


I have had two EMG ,  one in March and one in Aug of 99.  BOth are normal.  Twitching started three months ago for both of us.
My twin seems to be acting very unusual.  He seems to be paranoid. I had him get a cat scan and its clear.  I am on buspar and it does seem to calm the tremors down some.  The twitching seems to be coming and going.  Now is in one place and not in anyh particular increment.  Would ALS show up in emg, on entire left side of body,  if bulbar onset?  EmG wasn't done on my neck , throat or tongue.  What is the chances of both of twins coming down with sporadic ALS if no familial history?
Is there anything you can suggest as we are identical twins.  I think it's definitely hereditary as we started at the same time.
I am on buspar he is not.  He seems to be paranoid I am not.  We both are stressed as hell though.  My nuero thinks its anxiety related disorders that were inherited.  ANy suggestions would be very helpful.  Do you think this is ALS onset?  Wouls a low platelett count in blood suggest anything?  I am having blood work done as we speak.  Please give your advice on if you think this is anxiety or somthing settiing in.  Twins at same time is very unusal is it not?  Help me please.


Mark

[CCF Neuro[P] MD, RPS]

Dear Mark:

Sorry to hear about your twitching.  Muscle fasciculation or twitching without muscle weakness is not ALS.  The EMG would have shown changes in the muscle without changes in the nerve conduction studies.  You and your twin had normal EMG exams.  This would pretty much rule out ALS.  There are a variety of muscle disorders, nerve disorders that can cause fasciculations but in almost all cases there are abnormalities in the labs or EMG.  That leads us to what could be going on.  I haven't examined you, and actually a good neurologist should have a look at you.  For one, you won't believe me because your symptoms may not go away for awhile (no one can tell).  Second, to have a live body tell you that what you have is a bother but of no long term medical consequence is better than a few words on the internet.  It will be worth the money, believe me.

It sounds like you have what is called benign fasciculations.  In about 30% of the cases the patient can relate a viral illness a few weeks before the onset.  They do not harm except for the psyche, as alot of people think they have ALS.  The duration can be from days to years and as far as I know, no one knows why some last longer than others.  They can move around the body or include the whole body.  Anxiety makes they worse as does fatigue.

I hope I helped alittle.  See your neurologist.

Sincerely,

CCF Neuro MD

[This is mark again , could you answer a]

Would the emg pick up on als if bulpar onset?  If the entire left side of body was tested including the shoulders.  He didn't perform an emg on my face, tongue, head.  Furthermore,  I truly understand that many disorders could cause twitching, however , identical twins coming down with same symptoms at same time,  what would be the likely hood of als (sporadic) if no familial history of als was present?  Please answer this if you can.
My sincerest thanks for this forum.
Mark Anthony

[Mark]

Are you suggesting that I seek another neuro exam.  You mentioned that I should have a good nuero look at me?  NOt saying your suggesting another evaluation however I am not sure if your not suggesting another exam.  I have had two by same nuero apprx four months apart.

[CCF Neuro[P] MD, RPS]

Dear Mark Anthony:

Please see Mark's posting on the same day concerning twins who might have ALS.  I am assuming that it is either you or your twin.  

No, is the answer to your bulbar question.  If you had bulbar signs you would have difficulty chewing, swallowing, and tongue control.  You would be drooling also.  In fact, you would have probably lost many pounds of weight and others would note that you have changed the way you talk.  The EMG would also have found other muscle groups that would be beginning to have changes as pure isolated bulbar motor neuron disease would be by definition not ALS.

Sincerely,

CCF Neuro MD

[CCF Neuro[P] MD, RPS]

Dear Mark:

No, I don't think that you need another neurological exam.  I think you need to follow up with a neurologist over time to give you piece of mind that you do not have ALS.  Since the percentage of familial or inherited forms of ALS is less than 10%, the odds of you coming down with this form without anyone in  your family having it would be very remote.  It would be even more remote for both of you to have ALS that is not familial.  Since you have had multiple EMGs that were normal, have a normal neurological exam (therefore no muscle weakness) it is extremely unlikely that you or your twin have ALS.  I do not think you have ALS.

Sincerely,

CCF Neuro MD