increase reflex- fasciculation

[sogil]

i'm 36 years old and i have widespread fasciculation for about 12 month without muscle weakness, or muscle atrophy. the fasciculation are mostly widespread exept for several episode of fasiculation in spesipic muscle (including one time of the tip of the tongue)that lasted for up to 48 hours.

i had 2 emg  after 2 and 6 months that showed:
needle emg showed mild neurogenic changes in a
single muscle without evidence of denervation (motor unit potential in this muscle showed increase amplitudes with mild polyphasia).nerve condition was normal

i also had an mri of spinal cord which was normal and a a normal neurological exam exept for increased reflexes in both legs witout signs of pirmidalic change. (no babinski).from what  i undertand that single isolated "unusual" finding is unlikely to be ALS, and is more likely to be either an isolated muscle or nerve injury .

but what about the combination of fasciculation with increase reflex and the isolated "unusual" finding ??

i read that a general rule is that fasciculations in relaxed muscle are never indicative of a motor system disease unless there is weakness, atrophy, or reflex change
my questions:

1. what is the meaning of mild neurogenic changes and of motor unit potential in this muscle showed increase amplitudes with mild polyphasia)

2. is the emg test consider normal ?
3. what are the risk of als with this findings??
4. is the combination of fasciculation and increase reflex can point someting?
5. how long could one say must pass without any change untill als can be ruled out??

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

First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
   The symptoms and findings you describe are non-specific, but are most consistent with benign fasiculations.  Increased reflexes without long tract signs (babinski etc) are a normal finding in young people.  Fasiculations that are not accompanied by weakness and atrophy are a frequent benign finding.  These can occur after a viral infection, with exercise, with metabolic problems and in normal people.  When fasicualtions are in the company or weakness and/or atrophy then concern for Motor neuron disease (MND)(ALS) or other muscle diseases is appropriate.  The EMG findings in MND include fibrillations and positive sharp waves.  Chronic neurogenic changes with changes in motor unit potential, increased amplitude and mild polyphasia, can be seen in disc disese and other chronic, but stable conditions.  I would recommend that you have another emg if you develop weakness or atrophy or other new symptoms develop.
I hope this has been helpful.

[JDHAWK]

Hi,

I have small fiber neuropathy with diabetes and had fasciculations.  I read on the neuropathy website that others who had fasciculations used Magnesium.  I could not believe the results.  In a few weeks my fasciculations were gone.  Now I take 200mg of Magnesium each night.  

All my best,

Hawk1