Worried about ALS

[marylou807]

Brief history:
4 1/2 months ago while at work felt that I wasn't pronouncing s sounds properly, in that they were elongated.  this was a feeling as opposed to a reality as noboby else noticed and I couldn't determine any difference when I taped myself and listened back.  This went on and is still ongoing but as nobody notices I think it might be blocked ears or somthing..  However, over the past month of so additional worrying symptoms  have presented as follows:
- tongue twitches and tingling - these are not constant but are there - they look like a little pulse on my tongue that will pulsate a few times and then stop.  I obviously dont get to look at my tongue each time this  happens but I can certainly feel them.  happens up to 10 times per day.  Also  have tingling on the surface of my tongue.  I have looked at my tongue for long periods in the mirror where I havnt detected any twitches.
- Twitches on the sole of my foot.  This is going on a while - the twitches are usually just at the arch and are right thumpers - I also experience tingling and a slight burning sensation in my foot alot.  Twitches aren't constant but would occur a lot during the day.
- All over body twitches - front of thigh, shoulder, hands, abdomen - again infrequent but daily.
- Again this could be a sign of my sinusitis but when I drink liquids I feel that it  is coming down my nose, or that I need to blow my nose - have a bad post nasal drip most of the time so am thinking this is probably coming from that, but put it with the rest of the symptoms and I am getting ALS everytime.
As can probably be seen from the above post I am very anxious and am sure that is adding to my stress.  I suppose the tongue thing is bothering the most.  I have a very scalloped tongue also, but again it is very clearly scalloped from where it lies in my mouth against my teeth where I have one or two gaps.

I am really stressed about this and would appreciate any insite on my symptoms.

[Christopher R Newey, DO]

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.

It must be emphasized that in the MAJORITY of cases muscle twitches 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. Tremors of the hands can be physiological that is exacerbated by stress/anxiety and caffeine.

Benign fasciculation syndrome, which I will abbreviate as BFS, 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.

When BFS is present but not particularly bothersome or disabling, treatment is not necessary. If severe and it requires treatment, there are a few medication options though this condition is not very common, and the research that has been done on its treatment is limited. Minimizing caffeine and stress, and treating anxiety if it is present, will improve your symptoms.

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, such as in ALS. Also, in some people with neuropathy, fasciculations may occur.

Often these symptoms may reflect emotional/psychiatric problems related to stress (what is called somatization disorder). The latter is a true medical condition whereby instead of a patient experiencing depression or anxiety, they experience physical symptoms, and once the stress is addressed, the symptoms resolve.

You should follow up with your primary care doctor for evaluation.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[marylou807]

Should have added - I dont have any weakness anywhere