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  : : Excellent Forum!! I have read that there is a certain type of fasciculation which is caused by lack of sleep and stress. Mine started about three months ago during a period of high stress and several months of insomnia. They are almost perfectly symmetrical in the muscle groups affected.(Inside if feet, calves,lower thighs,and at times general.)I have subjective weakness on days that I don't sleep well but can still climb four flights of stairs and walk on heels/toes. They are not "fine" by any means,areas of muscle as long as 3 to 6 inches will contract. This is worse in the morning(almost constant) and seems to subside as the day progresses.I have no cramps, spasms or hypereflexia of the knee-jerk, just dull soreness in the affected muscles. Two GP's and my neurosurgeon have done standard strength tests and found no deficit.Sorry for the long post but I am very worried this might be ALS. Thanks for your time and input.
  : Dear Craig,
  : Fasiculations are spontaneous or involuntary contractions of the motor unit.  The contractions cause a visible dimpling or twitching under the skin.  The precise source of fasiculations is still contested.  Benign fasiculations occur in normal peopl, particularly affecting the calves, hands and muslces around the eye and nose.  They can be constant for days or weeks on end, or even years in some patients.  These fasiculations occur without atrophy or weakness.  The fasicualtions are usually breif and have a consistent firing pattern.  In contrast, fasiculations that occur with  great frequency in a chronic, slowly advancing, destructive pattern (with weakness and atrophy of muscles that does not wax and wane) occurs in diseases of the anterior horn cell(in spinal cord).  This occurs in diseases such as ALS and spinal muscle atrophy.  Occasionaly fasiculation potentials occur in chronic nerve entrapments but since your symptoms are occuring on both sides, this is unlikely. After three normal physical exams and subjective weakness (?fatigue??) after your tired, the probablility that your symptoms are  indicative of ALS is less likely.  If not already completed, routine lab tests checking electolytes (eg potassium, calcium) should be done.  If fasciulations persist and other objective symptoms (weakness-consistent, cramps, progressive pattern etc) appear further testing such as EMG may prove beneficial.  If ever you are interested in getting an evaluation at CCF call 1-800-CCF-CARE.  Good Luck.

  Thank you for your prompt response; A few more questions if I may.
  First; is it common for ALS to present in a symmetric pattern?
  Second;is it common for fasciculations to precede weakness?
  Third;Is chronic insomnia/stress a known contributor to fasciculations?
  Fourth and last;Could a c-5/c-6 diskectomy with fusion or a l-5/s-1 laminectomy(both of which I've had in the last 4 and 8 years respectively have anything to do with this? I appreciate your opinion.
Dear Craig,
ALS in its most typical form usually affects the hands first (difficulty with fine finger movements, stiffness, cramping and atrophy of hand muscles. The symptoms usually begins on one side.  As time progresses further symptoms develop in different region of the body.  Fasiculations occur after the muscle weakens. Fasiculations are almost never the sole presenting feature of ALS.  Fatigue is known to increase fasciculations. Your prior surgeries probably are not related to your symptoms.  If there is nerve root involvement; the fasiculations/weakness would occur in the muscles innervated by that nerve.  The fasiculations that occur are slightly different that those in ALS because they occur in a repetitive fashion during muscle contraction and are absent at rest.  I hope this answers the rest of your questions.  Good Luck.

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