What should I do?

[Dee]

I am a 36 y/o male. I was dx with Hashimoto's disease 3 yrs. ago. About 3 months ago, my nose began twitching. Then, some days later, the twitching in the nose stopped and I began to have twitches in my elbows, then forearms, and hands. Later on the twitches spread to my trunk and lower limbs. Later, the fraquency of the twitching subsided. After that I began to have stabbing pains in my wrists, palms of my hands, close the finger joints, ankles, and soles of both feet. I felt the pain either along the muscles or nerves but not in the joints themselves. I felt that my feet and hands were slightly swollen and red. A hematologist did bloodwork for lupus, rheumatoid arthritis, immunoglobulins, platelet count, etc, Everything was normal, except for the IGG which was high and "polyclonal."
In the mornings it is sometimes hard to close my hands, but as the day goes by I seem to regain the strength. I recently noticed that separating (abducting) my fingers will make it easy for me to close close my hands and make a tight fist. I still feel lots of pain in my hands and feet, a tingling sensation in my left foot, my leg and hand muscles are tight at times.
I recently saw a neurologist and he scheduled me for an emg and a ncs. I have the following questions: what do these symptoms sound like? Could they mean ALS? Could the twitching be related to my autoimmune hypothyroidism? What may the high IGG count suggest? What would be a reasonable next step to take if the emg and ncs are normal but the symptoms persist?
I would really appreciate your feedback.
Sincerely,
          Dee

[CCF Neuro[P] MDl, RPS]

Dear Dee:

Sorry to hear about your symptoms.  Is your thyroid disease under control?  Assuming that your symptoms are as you stated and there are no others (meaning a normal neurological exam) then it is very doubtful you have ALS.  One has muscle weakness with ALS.  Fasciculations without muscle weakness is not in the differential of ALS.  There are several things that could give you your symptoms, but I hesitate telling them because, without a good neurological exam it would be chasing air.  Things like benign fasciculations, amyloid, diabetes, alcoholism, collagen vascular disease, arthritis, etc can give you your symptoms.  The most worrisome possibility is ALS and that you do have.  

Sorry, I can't be of more help.

Sincerely,

CCF Neuro MD

[Sandy]

Dear doc:

I have no idea what I should do at this point,

For the past 3 months Ive been experiencing muscle twitches that started off in my right eyelid. They can occur anywhere all over my body and I notice them the most when Im trying to fall asleep.They seemed to completely go away when I started taking antibiotics for a infection I had but after I stopped taking them, they returned with a vengeance.

Im 24, . Besides that Im pretty healthy and try to get some exercise.
I had bloodwork done to look for
low blood sugar.
low iron
thyroid disease
diabetes
blood count
EKG,
all were completely normal and I was given a clean bill of health by 2 doctor. But the twitches still persist.I was wondering if it is at all unusual to have body twitches for 3 months, off and on. Im wondering if its anxiety since I lead a very stressful life and sit in front of a comuter for 10 hours a day.
What type of tests should I have done to rule out all possible causes? Im begining to loose all hope of ever feeling normal again, The twitching is quite distracting and its depressing.
Thankyou.
Sandy

[CCF Neuro[P] MD, RPS]

Dear Sandy:

Sorry to hear about your twitches.  Since all your tests are thus far normal, that is very encouraging.  Fasciculation or twitches without muscle weakness rules out the major evil players of fasciculations such as ALS and polyradiculopathy.  Since you have had no problems with eating or weight loss, the bulbar type of ALS is extremely unlikely.  What you have sounds like benign fasciculations.  These are muscle twitches that arise from an unknown etiology.  Things like stress, anxiety, fatigue make them worse.  There are no real treatments for these twitches.  They seem to go away on their own, but that can take many months to a few weeks. I would see your neurologist and talk this over with him/her.

Sincerely,

CCF Neuro MD

[Help for Sandy]

Hi Sandy,

much as these wonderful guys say....get to a good neuro to ease your concerns. I have had muscle "flutters"/twitches for 8 months now. Started abruptly during a stressful period in my life - and when I read they could be a symptom of ALS...I freaked out. I did some research and have since started to feel better since I have no progression and no muscle weakness accompanying the twitches. I also sought out an excellent neuromuscular specialist - the head of the MDA Clinic in San Francisco,  a Dr. Robert miller - who sees possible ALS and ALS for a living. He conducted a neuro exam and said there is nothing sinister going on and he did not even recommend going through an EMG (thankfully). There are all sorts of signs they look for when trying to see if there is even a concern of ALS - signs you and I would not be normally be aware of like reflexes, gait, Babinsky's test, etc.... I think a similar exam is very probable in your case and might help ease your concerns.

[CCF Neuro[P] MD, RPS]

thanks for your comments.

CCF Neuro MD