I have been twitching sporadically for about 3 months now in various parts of my body. Some days are worse than others. I have had two neuro exams and two EMGs (one on 3 of my limbs; the other on the bulbar region). The bulbar EMG was just a few days ago. Both EMGs were "clean". One fasciculation was detected in my back on one EMG, but no deinnervation potentials were detected in either EMG. Both the neurologist and phsyiatrist told me that any fasciculations I am experiencing are of a benign nature, and no fasciculations or other abnormalities were detected in the bulbar EMG. They also told me that my reflexes were "normal" though perhaps slightly brisk (either +2 or +3). Babinski sign was normal--as is my gait. I can still run 2 miles without stopping at a decent pace, and I can surprisingly still benchpress 300 pounds. I have no noticeable weakness or atrophy--though I do periodically get tingling and numbness in my extremities.
Problem is that about two weeks ago I started having difficulties in my speech. I'm not sure that it is quite a "slurring", but it is noticeable. It ebbs and wanes over the course of the day. In particular I am having trouble saying words that start or end in the letter "S". Most people don't notice, but a few have. In the morning I typically experience very little trouble. After lunch I have more difficulty--with my words coming out a bit fuzzy. Evenings are hit or miss. Unless I repeat it several times, the "S" just doesn't come out quite right. I definitely do better after I rest my voice for awhile. When I speak for an extended period of time, I have start getting tightness and pain in my throat just above the adam's apple. I always get a sore throat after speaking for more than a minute or two.
I am not having difficulty swallowing though I have (mildly) choked on liquids a couple of times in the last month. I have severe reflux that I control via aciphex.
So, here are my questions:
1. Is bulbar onset still possible after a clean and recent EMG of the bulbar region? I had two sticks in the tongue, one in the back of the neck and one in the thorassic region. If there was a problem, shouldn't the EMG have picked it up? Is there a need to do an EMG in the throat itself or is that even possible? What other tests could help to shed light on my recent onset of speaking difficulties.
2. Would speech problems associated with ALS "come and go" in the very early stages of the disease.? Could they be limited to the letter "s" at first and then progress to other vocalizations.
I want to believe after the EMGs and physical exams that I am in the clear. However, the speaking difficulties persist whether I am nervous or calm, so I can not simply write it off as anxiety induced. Any guidance you could provide would be most appreciated.