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Avatar universal

Worried about ALS/MS?

38 yr man. Meds: Lipitor 10mg daily (4 yrs), metoprolol 100mg daily,81mg baby aspirin. 2 mos. ago began having symptoms. started with PVCs-heart palpitations and chest/body pains. Then had one day of cold hands/feet followed by tremors (vibrating sensation) (varied depending on position of body) in face and extremities for about week with PVCs. Then felt lightheaded with PVCs for about 1 wk. Clean bill of health from cardio on 3/17/10 after EKG, holter, stress echo and negative CPK (came back normal) test-put on beta blocker. Slight mitral regurg. Beta blocker resolved PVCS. Now symptoms are slight shallow breathing (slight tightness on neck,left shoulder) and muscle twitches and some minor aches pain in body. Muscle twitches at times seems to be concentrated in my lower left leg but I also notice the twitches all throughout my body (for example every day I can feel twitches in my shoulders, chest, face, back, buttocks etc ) so are not isolated to one area.   Even had eyelid twitches.   Also, I can feel the twitches as well as see them so I don't know if I am misusing the term twitch vs spasm etc.  I also have burning sensation in jaw sometimes and I have seem to have a slight difficulty swallowing and I notice that I burp alot after swallowing.  Haven't noticed any muscle weakness yet as I exercise and strength train regularly.  Also, my home scale says my weight hasn't changed.  Thinking I might have a heartburn/GERD issue I've tried taking OTC Prilosec and that seems to help a little.  Perhaps I need a stronger medication?. I also only notice the twitches while at rest and do not notice them while moving, exercising, etc.  Should I be worried about a neurological disease like MS or ALS or might I just have a really bad case of heartburn/GERD that needs prescription meds and the shallow breathing/shortness of breath from the  
heartburn/GERD is causing my muscles to twitch as my body is not getting enough oxygen?
5 Responses
Avatar universal
Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Neurologic disorders are unlikely to explain your palpitations and a primary cardiac cause should be pursued and treated by the appropriate specialist. The same is true for heartburn.

There are several causes for calf cramps and muscle fatiguing and burning associated with muscle twitching. Muscle cramps are not an uncommon manifestation of a systemic viral illness. Muscle cramps with twitching may be due to myopathy. A myopathy is basically a generic term for a muscle problem. Myopathies can be inflammatory, as is the case with a disorder called polymyositis which is an autoimmune disorder. Also, there are genetic myopathies, of which there are several, each with its own characteristics and features. Finally, and probably most commonly, metabolic causes such as thyroid problems or low potassium can be the cause of muscle cramping. The latter 2 can be diagnosed with simple blood tests. In the setting of a normal CK, a myopathy becomes less likely, but medications such as lipitor can certainly cause muscle cramping (though if the cramps are mild, keeping the lipitor on may be worth it).

EMG in addition to simple blood tests such as a CK level can assess for the presence of myopathy, and can also diagnose/exclude ALS.

Fibromyalagia is another medical condition that leads to whole body pains. Its cause is unknown, but it is characterized by diffuse aches, sometimes GI symptoms similar to irritable bowel, sleep abnormalities, low pain threshold, and other features. It is best treated with medications such as lyrica and neurontin, exercise, and physical therapy

One possible cause of your muscle twitching is benign fasciculation syndrome, which I will abbreviate as BFS. This is a condition in which there are involuntary twitches of various muscle groups, most commonly the legs but also the face, arms, eyes, and tongue. If the diagnosis is confirmed and other causes are excluded, it can be safely said that the likelihood of progression or occurrence of a serious neurologic condition is low. It must be emphasized that in the MAJORITY of cases they are BENIGN meaning that they are of no consequence and are not resulting from a serious cause. In such cases, the twitches may be related to anxiety/stress, caffeine, and often occur after recent strenuous activity or muscle over-use. It is important in such cases to reduce stress/anxiety levels and to reduce caffeine intake.

However in general (and please understand I am not trying to imply I feel this is the case in you), when fasciculations occur in the setting of associated symptoms such as progressive loss of sensation, tingling or numbness, weakness, trouble swallowing and other symptoms, the cause may be due to a peripheral nervous system problem. In general the symptoms would not be episodic and triggered by certain things but would be more constant/frequent without consistent triggers. The location of the problem could be the anterior horn cells, the area where the nerves that supply motor innervation to our body comes from. These are the cells that give off the nerves that allow us to voluntarily contract our muscles. The diseases that might affect the anterior horn cells include ALS (also called Lou Gherig's disease), a condition called spinal muscular atrophy, polio-like viruses, west nile virus, and other infections. Another nervous system problem, neuropathy, may also lead to fasciculations. There will again be associated weakness or sensory changes.

I suggest follow up with your primary doctor and you may benefit from evaluation by a neurologist as your primary doctor feels fit. It is important that you discuss your concerns with him/her.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
Avatar universal
Is is true the that you would have to have ALS for sometime (5-10 months) before you noticed the twitching and that twitching occurs later in the the disease course?  Also, it would seem out of the norm from what I read on the progression of ALS to have slight difficulty swallowing, shallow breathing, leg twitching (both legs), facial twitching, neck twitching simultaneously.   From what I read ALS starts in one body part/area frist then progresses.  Is that right?  Also my symptoms started with lightheadedness and heart palpitations which don't seem to be symptoms of ALS.  But I do notice stiff facial muscles and leg muscles with the twitching but no weakness.
Avatar universal
thanks for your prompt reply.  I did visit a cardiologist for my palpitations and was put on a beta blocker and given a clean cardio bill of health.  My ekg was normal except for the pvcs.  My echo showed slight mitral regurgitation and I passed a stress test with flying colors.  Also on 3/24/10 my CPK blood muscle test came back normal as well.  I am able to workout and lift weights normally in fact my upper body strength is increasing. My primary dr thinks all of my symptoms are tied to one medical event/condition as I haven't been symptom free since my symptoms started in 1/2010 with the pvcs.  He thinks unlikely that I have ALS because pvcs and lightheadedness symptoms which I felt initially are usually not associated with ALS as heart is involuntary muscle and lightheadedness is a sensory symptom.  In fact I almost had to go to the emergency room because of the lightheadedness as I felt like I might pass out.  Would you agree with his comments?  I have an appointment with him this week to determine next course of action.
Avatar universal
I live in Wisconsin-should I be looking at rheumatological diseases like lupus or lyme disease?   Also I can feel the twitcingg/spasms besides seeing them and they only occur when my body/particular muscle involved is a rest.  They don't occur while walking moving excerising etc.  Finally just to give you the most information possible I have noticed an increased or changed sensitivity to certain odors (for example urine), have had some eyelid twitching, more throat clearing than normal and noticed sometimes have a slight difficulty finding the right words to say when talking (cognitive issue). No problem in talking or loudness of voice as I am loud talker and my wife is always telling me to talk softer.
Avatar universal
I guess I should add that I even though I mentioned difficulty swallowing.  I don't know if that's really the case.  May just be perceived as I was out celebrating a friend's birthday last night and had no problems eating a 12oz steak and fries.  My GP also thinks I might have stress/axiety related issues.
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