new and worried

[zac111]

my symtoms started 2 months ago with a twith in my arm and leg and quickly about a week later moved to both legs since then moved to my face off and on and arms off and on but steady in my legs.i went to a neru and he did a emg and nvc the emg was clompletly normal while ths ncv showed slow condution of the nerves i have pain in legs when climbing at work and a lot of fatige.now when i swallow my own saliva it feels like a lump in my throat.i was just wondering if this could be signs of als given the nerve study and emg and if i should have a repeat emg later.my b-12 is low normal as well as magnesium and thyroid is normal also.any help would be great i am very worried now as i have 2 young kids.  

[Forum-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 signs that you describe are non-specific, but should be investigated further.  The twitches that you describe are likely fasiculations (small twitches in the muscle that do not cause movement across a joint).  Fasiculations occur in a number of different scenarios including after a viral infection, with electrolyte disturbances, after strenous exercise and in some neuro-muscular conditions (including ALS).  Fasiculations are not thought to be an 'early sign' of ALS, but are most concerning if they are in the presence of weakness and atrophy.  Having a normal EMG suggests that you likely do not have ALS at this time (at least at our current level of detection).  I think it is reasonable to repeat the EMG in 6months-1year if you continue to have your symptoms.  The symptoms of fatigue, weakness climbing stairs, and difficulty swallowing is concerning for possible myopathy (disease of the muscle, myasthenia gravis, or (less likely) bulbar ALS).  Muscle diseases often cuase weakness in the proximal muscles (the muscles that allow us to stand, climb stairs, etc).  I would suggest that you have a CPK and Aldolase levels drawn (blood work) as an initial step to evaluate for a myopathy, as well as an ANA, ESR and CRP.  The difficulty swallowing (bulbar dysfunction) can be seen in a number of neuro-muscluar disorders including myasthenia gravis(MG).  MG is a disease were the immune system attacks your nerves abiltiy to contract muscles.  I would recommend sending (blood work) for Acetyl choline receptor antibodies (binding, blocking and modulating) and Muscle specific tyrosine kinase (MUSK) antibodies-which are often positive in MG.  There is a form of ALS that presents primarily in the bulbar muscles and can be evaluated by a specific EMG of the vocal cords.  The slow conduction on the nerve conduction study is non-specific, but may indicate some neuropathy(although it is difficult to evaluate with out the acutal data).  I would also suggest that you have your swallowing evaluated with a barium swallowing study.  
I hope this has been helpful.

[JCmcc]

Dear Friend,
Please be advised that I am not responding to you as a physician and that I am not advising you and that what I write is not meant to be construed as medical advice or a replacement from the forum neurologist, et al.

With that said and based on the information that you provide I would say that ALS (Amyotrophic Lateral Sclerosis/Lou Gherig's Disease/Motor Neuron Disorder) is the least likely cause of your symptoms. Each and everyone of your symptoms are variable and non-specific for any one specific condition. Naturally this makes the search for your diagnosis both technical and clinical. You may want to prepare yourself to expect further test batteries.

There could be either a combinatory effect or many possible causes and this is why it is imperative that you find a neurologist that you can trust. I recommend attending a major academic center. There are many possible causes.

I hope that this has been helpful.

Good Luck!
JCmcc.

[zac111]

thanks for yopur input the nvc showed slow condution in a couple of different places im not sure which ones he said it was consistant with neruophaty but he said i didnt have symtoms of it.the twithing is in big and small muscles now and ther skin on my hands look liker im 80 but im just 34 years old.

[JCmcc]

Zack,
  The same previous heading applies.
  With that said, I think that perhaps you are thinking too much. This is common when a person is faced with the possibility of something potentially debilitating or life threatening.
  I cannot judge for you what your level of concern should be. I am not under your skin.
  The remark about your hands does not exactly concern me unless of course your hands went from "normal" to looking like "an 80 year old's hands" in appearance over and immediate timeline post your twitching. This may be something or nothing and if it is something it may be something entirely different, e.g., Exima.
  If your only symptoms are twitching and fasiculations--I am not as worried for you. A more than common rising problem is Benign Fasiculation Syndrome (BFS) and this can cause a great deal of fatigue. If you are worrying yourself to the point of exhaustion-it would be easy to mistake this has a part of what you presume to be happening with your body, such as, ALS.
  Did your neurologist want to see you again? This too would be not uncommon. Sadly in neurology and other specialties, where we stand, is the test of space and time.
  It is important for your own peace of mind to understand that there is absolute no way that you wil receive a pat answer on this website; not from me, not from other contributors and not from the neurologist. You will receive possible clues and answers to help guide you along and hopefully some peace of mind.

I hope that I have been helpful to you,
JCmcc.

[stacielynnw]

This is my first time to post here, and I know this may sound strange, but I read that some people experience muscle twitching and electrical sensations when they have a hormone imbalance. I thought I was too young to be having hormone trouble (early 30's), but I was having a variety of symptoms with no explanation. When I broke out with hives off and on for over a year, I went to an immunologist, and after he performed all the allergy tests without finding a definite cause, he suggested I get my hormones checked. He said both female hormones and thyroid hormones can cause many strange autoimmune symptoms, even joint and muscle pain. I went back to my GP and asked him to check my hormones. He said I was too young to be menopausal, but he checked them anyway. Two weeks later he got the results and called me back to tell me I was in full menopause. (Luckily I had already had my children!). My thyroid was also out of balance. A few cents worth of hormones, and all my problems were gone!I realize this may seem to simple of an answer, but it couldn't hurt to get it checked.

[Annie62]

That's true--female hormone levels definitely can cause an exacerbation of symptoms when one has an autoimmune disease (not sure if you have an autoimmune disease or not); it sounds as if your symptoms came on due to perimenopause.  But with autoimmune diseases some women report feeling worse/better at certain times during their cycle, better during pregnancy, etc., (depending on which disease).  For the past 7 years I've had an exacerbation of my neuro symptoms-weakness, slurred speech, tingling/heaviness, trouble breathing right at the time of ovulation every month just like clockwork.   It would last for 4 or 5 days every single time.  Sometimes I didn't think I would survive it.  Now that I am going through menopause/no longer ovulating (early for me, too, though not as young as you) I thankfully no longer have that predictable hell to look forward to every month.  I still don't understand why it happened, but female hormones definitely play a big role in autoimmune diseases.