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[JNRusty]

I have experienced bilateral calf atrophy over the past few years and have essentially lost all muscle mass in both of my medial gastroc muscles.  I have had 2 EMG's with the one performed at mayo suggesting a neuropathy.  My CPK has been in the high 300's and MRI did not reveal any problems in my back or legs.  Since my most recent EMG about 6 months ago I have been noticing multiple fasciculations each day.  The majority of them have been in my lower legs with a few noticed in my arms.  I am confused and questioning what may be causing this.  One neuro had felt it may be myoshi myopathy however by ATHENA test for dysferlin came back normal.  Since visiting mayo I have been concerned about ALS and the fasciculation have been worriesome.  Not sure if I just notice them now or if they have been going on for a long time.  Please help with any suggestions

[JNRusty]

Regarding the Bilateral calf atrophy and fasciculations I have had an MRI on my back and there is no concerns in my back.  The MRI on my calves showed significant atrophy in the medial gastrocs and some atrophy in the lateral gastoc.  My nerve conduction scores were completely normal and my EMG showed non length dependent and fibrillation potentials were seen only in the medial gastoc and lateral gastroc with sparse changes noted in the posterior tibials.  How concerned with ALS would you be?  I have been having multiple fasciculations daily and wondered if this could be due to the fact that the muscle is no longer present in the gastroc to respond?  No babinski reflex is present.  CPK remains in the high 300's.   I work in a very high stress job that is production related so I work all three shifts here and there.  ALS is very concerning and I wondered how consumed I should be with this a possible diagnosis?  Thanks

[PaulMD]

These symptoms may indeed by due to ALS, however this would usually present with one sided symptoms.  Other possibilities would include autoimmune disorders that can be attacking the nerves or the muscles.  Localized problems such as local impinged nerves which can likewise cause muscle atrophy should also be ruled out by MRI.   The next time you consult with your neurologists, you may discuss these option and possibly be worked up for such.  It really sounds like your situation is quite complicated and I hope the diagnosis can be clinched soon.