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Neurology (Expert Forum)
Weakness, fasciculations, ALS?
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Weakness, fasciculations, ALS?
by andamin, Apr 28, 2005 12:00AM
I know that you get a huge amount of ALS questions, but I have been really worried about this for some time now, so here goes:
1.Are ALS fasciculations usually single-fire twitches? The first twitching I noticed was a “rapid-firing” machine-gun-like multiple twitch of my left thigh (which I could easily see and feel.) It happened like this several times an hour for a couple of days, only at rest. Now I have single twitches, usually in the same locations (both calves, both thighs, right thumb, left tricep, right tricep, right forearm.)
2.Since ALS is progressive, would fasciculations also get worse, or could they come and go?
3.How weak is weak? I have felt what I thought was weakness in my left leg and my right arm, but when I put myself to test (stepping up on something high or lifting something heavy) I can do it. Heavy objects do feel slightly heavier with my right arm (I am right-handed.)
4.Is muscle fatigue related to weakness? My right forearm will start to ache like it’s getting really tired with repetitive stress (like holding the lever down on a high-pressure car wash hose.)
5.Are foot arch abnormalities ever related to ALS? My left foot feels like it is flat (it makes more contact with the floor than my right.)
6.If an ALS patient presents with fascics only, how long would it be before weakness or atrophy could be detected by the patient? I realize this is probably one of those “It’s different for different people” questions.
7.How much more common is BFS than ALS?
I know that you are busy and your time is valuable.
Many Thanks
1.Are ALS fasciculations usually single-fire twitches? The first twitching I noticed was a “rapid-firing” machine-gun-like multiple twitch of my left thigh (which I could easily see and feel.) It happened like this several times an hour for a couple of days, only at rest. Now I have single twitches, usually in the same locations (both calves, both thighs, right thumb, left tricep, right tricep, right forearm.)
2.Since ALS is progressive, would fasciculations also get worse, or could they come and go?
3.How weak is weak? I have felt what I thought was weakness in my left leg and my right arm, but when I put myself to test (stepping up on something high or lifting something heavy) I can do it. Heavy objects do feel slightly heavier with my right arm (I am right-handed.)
4.Is muscle fatigue related to weakness? My right forearm will start to ache like it’s getting really tired with repetitive stress (like holding the lever down on a high-pressure car wash hose.)
5.Are foot arch abnormalities ever related to ALS? My left foot feels like it is flat (it makes more contact with the floor than my right.)
6.If an ALS patient presents with fascics only, how long would it be before weakness or atrophy could be detected by the patient? I realize this is probably one of those “It’s different for different people” questions.
7.How much more common is BFS than ALS?
I know that you are busy and your time is valuable.
Many Thanks
Doctor's Answer
by CCF-Neuro-M.D.-PW, May 01, 2005 12:00AM
rapid 'single-fire' twitches sound to me like myoclonus not fasciculations. Myoclnus in the setting you describe is usually benign.
Fasciculations in ALS may fluctaute but would not for instance completely disappear (unless the muscle was totally wasted) and would tend to spread to different areas over time
weak means at least a decreased inability to move the muscle against resistance, and/or a difference from side to side, without other explanation ie pain etc
muscle fatigue is usually not true weakness from a neurological/nerve cause, but a problem with the muscle itself may cause early fatigue (but could be anything from normal to a myopathy)
Foot arch abnormalities could develop later in MS due to severe disability, but would not be an early or only feature
Fasciculations in the absence of weakness or atrophy is not suggestive of ALS
BFS is much more common than ALS
Good luck
Fasciculations in ALS may fluctaute but would not for instance completely disappear (unless the muscle was totally wasted) and would tend to spread to different areas over time
weak means at least a decreased inability to move the muscle against resistance, and/or a difference from side to side, without other explanation ie pain etc
muscle fatigue is usually not true weakness from a neurological/nerve cause, but a problem with the muscle itself may cause early fatigue (but could be anything from normal to a myopathy)
Foot arch abnormalities could develop later in MS due to severe disability, but would not be an early or only feature
Fasciculations in the absence of weakness or atrophy is not suggestive of ALS
BFS is much more common than ALS
Good luck
8. What does atrophy look like in the early stages? Would a patient be able to identify it?
Again, thank you for your time.
-andamin