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ALS symptoms: come and go?

  For the past 2 months I've been having muscle cramps, twitches, incoordination and even muscle weakness (inability to lift things) and muscle fatigue and muscle pain. The symptoms are noticeable for several days then go away only to return again a few days later. Though the symptoms always return there is no noticeable residual damage from the recurrent flares since my strength and coordination return back to normal between the excacerbations. An EMG that I had 2 weeks ago was normal but my doctor has noticed that my reflexes are slightly abnormal (overly hyper reflexes). He doesn't feel that it is ALS but said that it might be too early to tell. Is a common for ALS to present initially in this manner (that is for symptoms to "come and go") with no residual damage between flares? Any info?
Dear Andrea,
ALS usually affects men slightly more than women and most people are usually over 50 years of age.  In the most typical form there is awkwardness in tasks requiring fine movements, stiffness of fingers, and slight wasting of the muscles in the hand.  These are usually the first symptoms of the disease.  Cramping and fasiculations of muscles in the forearm, upper arm, and shoulder also appear.  Before long, the triad of atrophy, increased tone (spasticity) and hyperreflexia affect the arms and legs.  Sensory changes are not present.  There are other variations in the pattern of evolution but the course, irrespective of the pattern of onset, is essentially PROGRESSIVE. EMG is usually decisive if not diagnostic in ALS.  In leiu of a normal EMG and fluctuating pattern of weakness, perhaps other etiologies for your weakness should be explored.  More common examples include cervical spondylosis and multiple sclerosis. An MRI of the brain and cervical spine may be helpful.  Discuss these options with your doctor.  If ever you are interested in getting an evaluation at CCF call 1-800-CCF-CARE.  Good Luck.

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