What should my diagnosis be?

I was tested by EMG using Tahmoush's original 1991 article which defined Cramp Fasiculation Syndrome as a guide.  The result was negative.  That is, the Neurologist doing the test on me could not reproduce Tahmoush's results on me. Yet I still have fasiculations, burning, stiffness, cramping, muscle fatigue, all over, but much worse in my legs.  This is pregressively worsening.  What should my diagnosis be?

Thank you in advance for your assistance,


Kay

[CCF Neuro[P] MD, RPS]

Dear Kay:

It is always difficult to tell patients what they may have when we are not able to see the previous workup, examine the patient, and analyze the test ourselves.  I would tend to believe that you do not have cramp fasciculation syndrome if there were no EMG correlates.  The question, as you asked is what is the diagnosis if this entity is not happening to you.  I am assuming that ALS has already been thought about, and the EMG together with the clinical history as ruled out ALS.  In severe myopathies, one can see fasciculations with cramping, but the physicial exam and laboratory tests would rule this out also.  Problems with electrolytes, and endocrine function might also cause fasciculations and by lab test, these should be able to be ruled out.

By all the exclusions, it sounds that you have what are called benign fasciculations.  These events are noted by fasciculations that come and go or can often be continuous.  The fasciculations are usually made worse by fatigue, lack of sleep, and anxiety.  They are not harbingers of ALS or other muscle disease.  However, they are really psychologically draining.  Watching your muscles twitch (fasciculate) is really bothersome.  We have patients that have had these for years and some only a few days.  It is very individual dependent.  Some patients respond to low dose benzodiazepines, but many do not.

I hope this helps.

Sincerely,

CCF Neuro MD

[Mark]

I too twitch.  I think that it's very important that you don't allow yourself to become obsessed with twitching as it is very easy to do.  Believe me.  I have allowed it to be very consuming in my life and it's not going to change anything.  Just know that your Emg results are a source of hope and that your future is not known yet your not dx with a fatal illness.

[CCF Neuro[P] MD, RPS]

Thanks for your comments.

CCF Neuro MD