Concerned about ALS

[SPD45]

6 months ago I started with leg pain in quadriceps, arches of feet with cramps and fasiculations of muscles of both arches(right greater than left). Also had calves tight and twitches. Also had bicep pain mainly right arm. The signs progressed to almost all leg muscles, shoulder, arm and hand muscles and had muscles twitches all over my body even my abdominal muscles and back muscles. Saw my internal medicine doctor who found no muscle weakness or Neuro signs. This was about after 2 weeks from initial signs. He ran full blood Chem., CBC, ANA, rheumatoid factor, sed rate, lyme titer, thyroid panel and electrolytes. All came back normal or negative. He put me on Aleve and muscle relaxors which did not help. He referred me to neurologist in august(2months into symptoms) and said my neuro exam was normal but wanted to run an EMG and NCT on my right hand, arm, shoulder and right foot, leg and hip since signs worse on right side at that time. The test were completely normal and said I showed no signs of neuromuscular disease and said I met none of the requirements for ALS except generalized muscle twitching and diagnosed my problem as benign fasiculations. I was then referred to a neurosurgeon for possible back issues 1 month later. His neuro exam was normal and the MRI of my whole spine from neck down was normal. Had recheck with neurologist 4 weeks ago and neuro exam still normal and I  about 50% better for my leg and arm twitching and muscle pain is a lot better. My concern is now my tongue has started twitching about 2 weeks ago and I feel like I have excessive salivation. My tongue appears strong and can move all directions and I am still swallowing and speaking fine but I am worried it may be slightly atrophied on the sides with tooth impressions in it. I am extremely worried about ALS and is this a concern with all my test so far and what the doctors have told me. I am a 45 year old male so I fit in the age range for ALS. Should I be worried with all that has been done. Please help.

[SPD45]

My question was is tongue twitching something to be worried about since I have already had body wide twitching for 6 months but just started tongue twitching in last 4 weeks. I have already had 3 normal neuro exams and clean EMG and NCT on right arm and leg 3 months ago. Also already had the test you suggested ran and were normal. The neurologist diagnosed them as benign twitches but my question to you was should I be concerned of the new tongue twitches that have started or are they benign as well and not more likely ALS?

[Dr. Kokil Mathur]

Hi!
Symptom-wise, yes there are many which overlap ALS. However for confirmed diagnosis other causes need to be ruled out. Electromyography (EMG), and nerve conduction study (NCV) need to be carried out.  Also clinically there will be hyper-reflexia of the muscles when the neurologist examines you.
Dehydration and electrolyte imbalance, muscle fatigue, pinched nerve due to wrong posture could be the cause of your symptoms too. I would suggest you get the blood levels of the following checked if they have not already been checked: potassium, calcium, sodium, magnesium, vitamin B complex, or vitamins B1, B3, or B6 and Vitamin D. Generally deficiencies of any of the above can cause muscle twitching and spasms in localized or generalized areas of the body. Get your kidney function, parathyroid gland function and adrenal function tests done because these affect the electrolyte balance in the body. Stress, alcohol, caffeine and fatigue all cause similar symptoms. Hence if you take alcohol or coffee then cut this down. Sleep at regular hours and see if it helps. Certain sleep disorders and peripheral nerve disorders due to diabetes or hypothyroidism (probably ruled out in your case) can also be the cause.
Since I cannot examine you and know other related conditions you may be having, nor is a detailed history possible on net, I have listed the various possibilities that should be looked into. Please consult your PCP for primary examination followed by proper referral.
Take care!