Widespread fasiculations and bulbar onset?

[mari c]

Several months ago I began having mild muscle cramping in the  the legs and forearms.  Then the legs began to tighten up & get sore.  About 6 weeks ago I began to notice fasiculations in the feet, calves, upper legs, back, shoulders, & upper arms.  About 4 weeks ago I started to notice cramping in the hands.  During this whole time I have been clearing my throat a lot with a bit of mucus.  I have had the muscle under my chin cramp up on me about 4 times while yawning.  I had to massage the muscle a little to relieve the cramp.  Now the muscle under the chin just feels a bit crampy - not right.  Also while completely relaxed in bed before falling asleep I'll feel a shaking feeling in my throat, upper chest area.  I'm not sure if this is a throat fasiculation, an esophogeal spasm, or if the portion of my tongue that is in my throat is shaking?  Sometimes I sound a little hoarse and have to clear my throat.  I also thought I had a little trouble swallowing steak and pork ribs a few days ago.I had a normal EMG in early June that included my arms, legs, back, & 1 muscle in the neck (not the tongue and no facial muscles).  Normal Neuro exam.  Neuro thinks I have benign cramp fasiculation syndrome.
1 Can you have widespread cramping and fasiculations with Bulbar onset of ALS?  One fasiculation in the leg was picked up on the EMG.
2 Have you heard of this shaking feeling in the throat area when completely at rest?
3 Is cramping under the chin a symptom of bulbar onset?
4 Does my normal EMG rule out bulbar onset even though it didn't include the tongue or face?
Thank you.

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

1) usually not, it usually starts in a segmental fashion (one limb, or bulbar only). Widepread symptoms near onset are more suggestive of a benign syndrome. One Fasciculation on an EMG in the leg is within normal limits. Fasciculations in the absence of objective muscle weakness or wasting is unlikely to be ALS

2) I'm not sure what you mean by shaking, is there actual shaking or just a feeling. A feeling of a lump or sensation i that area when there is none is called glomus, and is usually an anxiety related symptom

3) Not witohout other evidence of bulbar dysfunction like swalloqing/breathing/speech difficulties

4) EMG is not a good test for bulbar ALS because of the technical difficulties in testing those muscles - the diagnosis is more based on clinical history and examination.

Good luck

[mari c]

I should also mention that I have hypothyroidism diagnosted about 6 months ago and have been taking synthroid at gradually increasing dosages (currently at 137mcg).