Worried about ALS

Hello,

I am fearing my symptoms might be due to ALS.  I know no one can give a definitive diagnosis, but would please like some insight as to symptoms in relation to ALS.  I am 26/m.

Reasons I am concerned about ALS:

1) Muscle twitching which has been relatively constant in both feet and legs for roughly one year.  Steady twitching in my hamstrings and calves over the last two weeks.

2) Slight weakness in legs over last two weeks.

3) My Dr. today noticed weakness in toes, fingers, and arms that I had never noticed before. (Didn't indicate any in legs)

4) Reflexes seem brisk in legs and hips recently.

5) Very slight speech problems recently.

6) 2 MRIs and blood work done (for headaches) about 2 years ago.  All came back normal, so no indication of MS, thyroid condition, etc., at that time.


Reasons I hope point away from ALS:

1) Muscle twitching came well before any obvious weakness.

2) Constant tingling and cold feelings in extremities (mainly feet), not ALS symptoms.

3) Neither twitches nor weakness are isolated to one side of the body. Understanding is ALS usually starts in one area.

4) I am 26, and I understand that MOST cases of ALS don't show symptoms until 40-70.

5) Still largely functional in my muscles, despite weaknesses observed by Dr. and myself.  Can open jars, type fine, run on a treadmill at almost 6 mph, run up steps two at a time, stand on either foot, bench press 45-lb. bar with a bit of extra weight, etc.

6) Have never been strong in toes as long as I can remember, which may explain weakness observed in that area by Dr.


Dr. would like to do more testing to determine what is causing my symptoms.  Was scared to ask too deeply about ALS, as did not want to interfere with Dr.'s exam/diagnosis in person.  Would just like feedback as to whether or not my concern of ALS is valid based on above factors while I wait to finish testing and for results.

Any and all input is appreciated.  Thank you!

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

It must be emphasized that in the majority of cases muscle twitches are benign meaning that they are of no consequence and are not resulting from a serious cause. In such cases, the twitches may be related to anxiety/stress, caffeine, and often occur after recent strenuous activity or muscle over-use. It is important in such cases to reduce stress/anxiety levels and to reduce caffeine intake. Tremors of the hands can be physiological that is exacerbated by stress/anxiety and caffeine.

Benign fasciculation syndrome is a condition in which there are involuntary twitches of various muscle groups, most commonly the legs but also the face, arms, eyes, and tongue. If the diagnosis is confirmed and other causes are excluded, it can be safely said that the likelihood of progression or occurrence of a serious neurologic condition is low.

When this syndrome is present but not particularly bothersome or disabling, treatment is not necessary. If severe and it requires treatment, there are a few medication options though this condition is not very common, and the research that has been done on its treatment is limited. Minimizing caffeine and stress, and treating anxiety if it is present, will improve your symptoms.

However in general (and please understand I am not trying to imply I feel this is the case in you), when fasciculations (i.e twitches) occur in the setting of associated symptoms such as progressive loss of sensation, tingling or numbness, weakness, trouble swallowing and other symptoms, the cause may be due to a peripheral nervous system problem. In general the symptoms would not be episodic and triggered by certain things but would be more constant/frequent without consistent triggers. The location of the problem could be the anterior horn cells, the area where the nerves that supply motor innervation to our body comes from. These are the cells that give off the nerves that allow us to voluntarily contract our muscles. The diseases that might affect the anterior horn cells include ALS (also called Lou Gherig's disease), a condition called spinal muscular atrophy, polio-like viruses, west nile virus, and other infections.

Often these symptoms may also reflect emotional/psychiatric problems related to stress (what is called somatization disorder). The latter is a true medical condition whereby instead of a patient experiencing depression or anxiety, they experience physical symptoms, and once the stress is addressed, the symptoms resolve. Fibromyalagia is another medical condition that leads to whole body pains, and is best treated with medications such as lyrica and neurontin, exercise, and physical therapy.

Your symptoms do need to be evaluated further. I highly recommend that you be examined by a neurologist. You would benefit from an EMG/NCS to evaluate the activity/integrity of your muscles and nerves. Only after a thorough evaluation can the diagnosis of ALS be made or ruled out.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[treadac]

Thank you for the feedback Dr. Newey.  I have a follow-up scheduled with a neurologist that should hopefully get to the bottom of everything.  It is worth noting that I do normally have high anxiety levels.  BP measured yesterday at 150/90, and I have taken Zoloft and Risperidone for anxiety as recently as 13 months ago.  So I am hopeful that most or all of these symptoms are the result of anxiety.

Thank you again for reviewing my post and for the detailed response.