results of neurology report- point to ALS?

I am a 56 year old female.Have had pins & needles sensation off & on in hands and feet and restless legs for 10 years. Pain like an ache in legs last year off & on. Last May had twitching noticable in pinky & thumb of left hand, continues to come & go. Painful sternum spasm on 4 different occassions past three years. Had muscle cramps after biking last summer and noticed twitching all over body off & on. In January this year had some kind of I can only describe as an attack: muscles very tight especially back and lower back pain bad by end of the day. Whole body felt like nerve endings sensitive. Pins & needles sensation increased and twitching. Still continue with constant fasicilation in arch of left foot and toe moves. Most noticable at rest. Saw neurologist and had EMG. Blood work normal but low vitamin D. Neurological exam unremarkable but have severe loss of vibration sense in lower legs and numbness in toes. EMG: Nerve conduction & EMG study within normal limits except for chronic, mild, right-sided ulnar nerve denervation. They think this is due to a compressive peripheral injury because nothing showed up on MRI of head or cervical spine. No polyneuropothy or radiculopathy or muscle disease. They say I do not have ALS currently. The denervation is worrisome. I can still bike but only do about 10-12 miles. Muscles don't feel strong. I have not been diagnosed. Do these findings point to ALS?

[Christopher R Newey, DO]

I have been struggling with random twitches,etc. I am an otherwise healthy late 30 soemthing female. Over the past 6 months I've had a twitch here and there which has self resolved (eye twitch, lip twitch). I wrote it off as stress.

Over the past month things have escalated. I've had slight tingling feeling in extremities, and one finger quivers slightly when held still. It is very slight to the naked eye, but I feel a sensation of numbness. I notice the numbness more on my left side, but not exculsively. On top of this I have a pulsating twitch (I'd say a few seconds) that occurs now and then all over my body. Not contstantly but consistently. I've felt in in my arm, leg, back, side. This occurred for the first time a month ago, subsided but now is back.

What is this or what could it be? Help

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 your doctor.

Without the ability to obtain a history from you and examine you, I can not comment on a formal diagnosis or treatment plan for your symptoms. However, I will try to provide you with some information regarding this matter.

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, which I will abbreviate as BFS, 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 BFS 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 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.

Another nervous system problem, neuropathy, may also lead to fasciculations. There will again be associated weakness or sensory changes.

You mentioned also having tingling sensations too. If symptoms migrate (move from one place to the other) as you describe and are intermittent, causes might include seizures, migraine disorder or metabolic problems such as low calcium.

Often these symptoms may 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.

I suggest follow up with your primary doctor and you may benefit from evaluation by a neurologist as your primary doctor feels fit. It is important that you discuss your concerns with him/her. You may need basic lab work to ensure your blood chemistry, particularly your potassium, sodium, and calcium, is normal. Further workup such as EEG, EMG/NCS, or MRI would have to be decided upon by your neurologist depending on the clinical examination and historical findings.

Thank you for using the forum, I hope you find this information useful, good luck.