Worried about ALS, twitching

[Onemore]

Hi. I write from Spain. Sorry for my bad english.



From some years I have been experiencing twitching in diferent areas of my body. Six months ago i noticed fatigue in my right arm, and pain in my right arm and my shoulder. I went to a neuro that, after making usual test, walking, touch nose, etc, told me that he thinks all was related to stress. He didn't think that a EMG was neccesary.



The pain continued, so I went to a traumatologyst. He ordered an cervical MRI that show important foraminal narrowing in right side of C3-C4 due to arthrosis and osteophites, and mild foraminal narrowing in both sides of C6-C7 due to osteophites.



He thinks that my problem can't be caused for this, so he thinks too that it is related to stress.



I went to a phisio that told me that my right arm (biceps) was with less muscular mass than the left, but he thinks that it is related to a non use of this arm due to the pain. After that, i went to the gym to test my biceps. If I take 20 pounds with left arm, i can lift it aprox. 20 times. When I use right arm I can only lift it 17 times.



But lately, I have observed a change in the twitching. It only last for a second of two, once in an hour or in two hours, but only in my right arm (sometimes in triceps, sometimes in elbow, sometimes in forearm), but mainly in the triceps. Other times only stayed in a place for two or three days, but this twitching in the arm I am now coming for my 5th week.



Besides this twitching there are a few in other part of my body, but less frecuent.



Do you think I have to worry about ALS?

[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 that you describe, pain in the shoulder/arm, weakness in the arm and muscle twitches are non-specific and could represent several disorders.  ALS is often difficult to diagnose, because the presenting symptoms can be found in other disorders.  It is typical for ALS to present with hand atrophy/incoordination, and foot weakness/often as a foot drop.  There may also be twitches (fasiculations) and painful cramps/stiffness.  

   That being said, it is uncommon for ALS to present with pain that is not related to cramps and stiffness.  Other diagnoses that may be considered include neuralgic amyotrophy (immune related disorder), radiculopathy(nerve root compression), and CIDP (chronic inflammatory demyelinating polyneuropathy).  The twitches that you describe, are not specific for ALS, but are often seen in a benign syndrome, due to electrolyte imbalance, or after a viral infection.

   I would recommend that you get an EMG to evaluate for the above diagnoses.  Also ask your neurologist if there is any sign of atrophy in your hands.  I would recommned a neurologist that has expertise in the ALS/neuromuscular disease (EMG is subjective, and should be done by an expert).

   I hope this has been helpful.

[johnflox]

Have you taken any medicine up to one and a half years prior to the onset of your symptoms?

There are many drugs that cause the symptoms that you describe and you should rule out first that you are not suffering a toxic effect of a drug.



Many of those drugs cause the symptoms normally 6 months after taking them, but it is not uncommon that the symptoms appear in force up to 18 months after discontinuing the treatment.



So, there is no wonder that almost all patients start years of search for a solution, without knowing the real cause behind their health problems.



Just as an example, fluoroquinolone antibiotics (ciprofloxacin, marketed in Spain as Baycip and with more names, levaquin, floxin, tequin) cause permanent and irreversible neuropathies in severe cases, and very systemic neuropathies that mimick Lyme, Multiple Sclerosis, Gulf War Syndrome, Sjögren`s, Reactive Arthritis and others.



Other medicines with similar toxic profiles are those taken for rheumatic conditions, cancer treatments, and others.



Suerte y le deseo que sus molestias curen pronto y no se trate de una reacción tóxica.

[Onemore]

Thx for your answer.

The thing that scares me is that those new twitching in my right arm are completely diferent from others I had in the past.



First, others had last for two or three days, and the ones in the arm has no end.



And the fact that are in my right arm scares me more... because even the doctors didn't found me clinical weakness, i have muscular pain, and feel it sore after a little exercise.

[Onemore]

Thank you for your post.



I can´t remember taking any pills. Only last september i had a flu vaccine. Is the only medicine i can remember.

[Onemore]

I forgot to tell:



After the phisio told me about less muscular mass in my arm, I started to use it more (I have a little baby that I used to carry with my left arm) and I think i improved in muscular mass in my right biceps.



A patient with ALS can improve in muscular mass?

[mike1105]

you may have something as simple as myofascial issues with trigger points, which can cause ALL the symptoms you describe, especially the soreness, stiffness and pain. I would suggest purchasing a book by Clair Davies on trigger point release. At the same time, you'll need to learn how to properly stretch associated muscles. For instance, the scalene muscles in the neck, if tight and shortened, can cause weird symptoms of pain, numbness and twiches in the shoulder all the way down the arm and even into the hand.....

[Onemore]

Thank you for your advise.



I will try to find this book.

[Onemore]

Thank you