Timing of fasciculations and EMG in ALS

[Ico]

I have heard it said that fasciculations appear in ALS some time after the muscle has been damaged due to denervation. As a result, I have been told that an ALS sufferer would experience profound weakness in any muscle before they feel any fasciculations in that muscle. In addition, I have been informed that, if you are feeling twitches in certain muscles, these would be certain to appear on any EMG taken if they were as a result of ALS. My queries are as follows:

1. In ALS, would a person notice profound weakness before noticing any fasciculations?

2. Once a person has noticed muscle twitching in certain areas of the body, would these show up on a EMG that covered these muscles or is there a chance that they just didn't occur during the EMG?

3. After fasciculations have appeared, does a completely normal EMG rule out a diagnosis of ALS and, if not, how much time should one leave?

3. In ALS, do fasciculations come and go (being more regular on certain days than others)or do they increase consistently?

4. Is there a certain type of twitch/fasciculation that is associated with ALS that is distinct from a benign twitch?

5. What is the usual progression of weakness and atrophy in ALS?

I have not set out my own precise symptoms because I realise that this forum is an educational tool. However, I would be grateful if you could answer these points as I have heard conflicting information about them.

With Best Wishes

[CCF-Neuro-M.D.-SH]

Please keep in mind that I am unable to diagnose you since I am unable to examine you, this forum is for educational purposes only. Concern over fasicualtions (twitch in a group of muscle fibers that does not cause movement across a joint) is a common referal to neurologists for concerns of motor neuron disease(MND).  Fasicualtions are often normal responses of muscles to exertion or less use in a previously atheletic person.  They are also found after viral infections and called benign fasiculations.  Fasiculations do occur in motor neuron disease (MND), but are not specific to this disease, they can also be seen in any lower motor neuron lesion (below the level of the spinal cord).  Motor neuron diease diagnosis is made on the basis of history, weakness, atrophy and characteristic EMG findings.  The presence or absence of fasiculations would not change a diagnosis.  Fasicualtions are not an "early indicator" of motor neuron disease and are only an associated finding.  Therefore, if you do not have EMG findings characteristic of motor neuron disease, does not mean you will not develop MND in the future, but means none is detected at this time. If characteristic changes are seen to suggest MND we also often see widespread fasicualtions.  MND can present in many different ways, but a classic presentation is a foot drop, followed by progressive leg weakness, dropping things, wrist drop and atrophy noticed on exam. This generally progresses to complete paralysis and inability to breathe without assistance within 2-5 year (although some cases extend much longer). EMG does not always catch fasicualtions and they are often missed on EMG, because of their intermittent nature. This does not impact the result like other changes such as fibrillations and motor unit changes. That being said, EMGs are very subjective and if you are given a diagnosis such as MND a second opinion is expected.  In addition, if you suspect MND you should seek out a neurologist with an established reputation in MND EMG. I hope this has been helpful.

[kealoha17]

I started twitching in March one week after having the stomach flu.  It frightened me so I saw a doctor twice, and a nuerologist.  They all said I didn't need to have any sort of test done that I was fine and Diagnosed me with having begnign muscle fasiculations (all over my body with some cramping).

The twitching had happened for two months before I couldn't stand it any longer so even though I am young and have always been very healthy,  I decided to change my life style.  I stopped drinking coffee (Which I only used to drink one cup a day).  I stopped drinking alcohol (even though I only drank about a glass of wine once a week at the most), I started taking a multivitamin and started to do some light excercising.  I also made sure to hydrate myself with water (smart water is great because it has electrolytes)which I found one of the most important things to do.  I had always been in great shape and I am only 29.  Oh, actually the most important thing is that I said a prayer and left it in Gods hands.  Within 2 weeks the twitching had almost completely stopped.  I only start twitching if I have a cup of coffee every now and then (It's hard to resist Starbucks frappacino's in the summer), or if I have a glass of alcohol.  Even though I only have one cup I know that I will twitch for a couple of days..

To all of you who feel alone and afraid because of these muscle fasciculations, I just want to say don't let it overcome you!  You have the power to make yourself feel better, especially if your doctor has diagnosed you with begnign muscle fasciculations, you can make them stop for the most part and begin to live a normal life with them.  Good Luck and God Bless.

[SJSmith]

Sorry, this one is a long one, hang in there please!

I was 37 years old and first started seeing a Dr. in May of 1998 for a persistant twitch in my left forefinger/thumb, it didn't hurt but would involuntarily pully them towards each other in a fairly rapid succession of twitches. I lived in Utah at the time. My Dr. referred me to a neurologist but due to a long appointment wait it was November
of 1998 before I was seen. By this time I had deleloped VERY pronounced random muscle fasciculation

[ajg5446]

What brought on your twitches?  Viral infection?  Stress/anxiety?  Did it start in one area and move to other areas, or did it start with twitches all over the place?

Mine started with twitching in a hand (back in Aug/Sept 2005) and during a high stress/anxious time, the twitches kicked in full force around April of this year and basically haven't subsided since.  However, over the past month they do "come and go" and the frequency of them appears to be slowly declining, however there's no limitation on where I have these twitches.  Absolutely all over the place.

I have no signs, whatsoever, of weakness or atrophy, and my doctors have said that they are more than likely related to stress.  Just a bit tough to believe since I had nothing like this for 35 years...and now, all of a sudden, they are a part of my life.

Thanks...

[Ico]

I was fairly stressed from about October last year and did develop a virus. For a while afterwards I had a very foggy head and had trouble concentrating and reading. This in turn increased my stress. I'd say I first noticed the twitching in Jan/Feb this year but only became concerned in about April. I'm worried because I'm convinced my hands are showing weakness but I have seen a neuro who thinks otherwise. I don't remember where the twitching started but now it occurs mostly in the thigh, arms and, to a lesser extent, the abdomen. In truth it occurs all over. I am taking medication to lower my anxiety and am hoping this will work.

[ajg5446]

If possible, to "supplement" the great questions asked above, what if someone is having twitches all over their body (arms, legs, hands, back, eyes, ribs/abdomen, etc.) and have been for a number of months (3 to 5) with no signs of weakness/atrophy, etc....no EMG performed, but neuro checks by family doctor all are fine including reflexes, coordination, etc....would this duration of twitches (more times than not) rule out ALS or most other serious motor neuron diseases?  Your time and response are greatly appreciated...