ALS Fear

[Dee566]

Dear Dr.  ALmost a year ago to the day, I had awoken with violent internal tremors on my right arm and leg.  Since then, although not as violent, I have had them almost 24/7 with brief periods of reprieve.  My eyelids have had visible twitching.  I had an EMG about 5 months ago and it was clean.  I have seen a movement disorder specialist for the last 8 months every few months and he has found nothing however, for the last three weeks, I am now experiencing visible twitches on the other side upper arm and calf.  My upper eyelid has drooped this past year to the point that my eyebrow looks lower and also, I now sporadically have a twitch in my eyebrow.  When I emailed my doctor and asked if the emg would rule out als, he did not address that question, only asked if I have a video of the twitch.  It is hard to get one since they don't last that long and come infrequently. Questions - does a 3 limb emg rule out als and how long are the results good for, would als present suddenly like that a year ago, would als take a year to diagnose and numbness in a hand a symptom.  I really am having a hard time moving forward and don't want to live like this.  I look forward to hearing from you as soon as possible.  

[Dr. Kokil Mathur]

Hi,
I am sorry, did not mean to worry you. If your tests have been negative for ALS, then other conditions which present like ALS (mentioned in my post) should be ruled out one by one. At times the ALS scare is due to these conditions. Hope this eases your worry! Take care!

[Dee566]

i have had many clinicals and have passed all of them.  would that make a difference in your answer?  i have seen that you are more positive with other responses so your response worried me a bit.

[Dr. Kokil Mathur]

Hi!
It is very difficult to comment whether your have ALS or not. To confirm that a doctor has to find signs of both upper (muscle weakness, decreased motor control, inability to perform fine movements, increased spinal reflexes, and positive Babinski sign—great toe going up) and lower motor (muscle weakness, abnormal EMG etc) neuron signs in one limb. Symptoms of many of these diseases do mimic ALS. ALS like symptoms can be due to fibromyalgia, chronic fatigue syndrome, severe anemia, spinal nerve compression high up in the cervical spine, ankylosing spondylitis, osteoarthritic changes of the vertebrae, calcium deficiency, low Vit D, electrolyte disturbance, peripheral neuropathy due to diabetes or hypothyroidism or due to bad posture. Lyme and lupus are the other possibilities.
Electromyography (EMG), nerve conduction velocity (NCV), muscle biopsy, etc are done to confirm diagnosis or rule out ALS. A clear EMG alone may not be diagnostic. Do discuss this with your doctor and get yourself examined. Take care!