twiching

[ayan ray]

thanks for providing this wonderful service. It is a great help to lay people like us.
Well my problem mignt not be a problem at all. I experience this strange twiching of muscles. It is not frequent, it is infrequent actually. Sometimes they don't happen for monthes, sometimes they happen almost every day. Any part of the body can twich e.g. the eyelids, the fingers or the calf muscles. Is it a sign of something more serious? Do I need to get a EMG done? Is there any chance it might lead to anything more serious like ALS?

[CCF Neuro[P] MD, RPS]

Dear L.

The diagnosis of ALS early in the disease is sometimes difficult.  But, since he has bulbar signs, there should be paraspinal changes on EMG in the cervical regions.  If these regions are normal, this would be a case against ALS.  However, nothing in medicine is absolute.  Sorry, I do not want to scare you.  There are other things that can cause bulbar or swallowing problems.  Sometimes things need to brew awhile before we can diagnose a problem.  I wish I could tell you that for sure he does not have ALS.  It is difficult because I do not have the chance to examine him.  Also in his favor, if there are no upper motor neuron signs then this is also in favor of him not having ALS.  I wish I could tell you straight away.  Hang in there, love your husband as this is a very difficult time.  It sounds like your a wonderful wife.

Sincerely,

CCF Neuro MD

[Deedee]

I have been following this line of discussion with great interest because one of my symptoms is twitching, also.  In addition, I have a terrible weakness in my muscles, and have even had trouble breathing on occasion.  Rest allows me to function better, but when I get too tired, it takes days before I can walk very far.  So far CK was 76, and Acetylcholine Receptor AB was <0.5, so they have ruled out MG.  However, no distinction was made about what which AB tests were done.  Please, more info on that.  Also am confused about EMG results.  Stated as "normal", but with these variations noted:  some loss in decrease in motor unit, amplitude and duration with some evidence of myopathic recruitment; rare sharp waves in only one location, and early recruiting myopathic units.  The recruitment problem occurred in all nerves tested, and the decreased motor in most.  My Repetitive Stimulation of the Rt ulnar nerve showed no decrement, just baseline wandering.  However, I am concerned because this test was conducted at my wrist, and I have read it is more accurate at the elbow or shoulder.  As my symptoms have not improved overall, I have been considering a second opinion from a neurologist.  Current one has ruled out any neuromuscular problem in me.  Would this be warranted?  Thanks for any help you can offer.  I know you can't Dx, just need to know what direction to go in.

[CCF Neuro[P] MD, RPS]

Dear DeeDee:

Sorry about your physicial problems.  ALS is a frightening disease and most people with twitching or fasciculations are concerned.  The EMG diagnosis includes fibrillations, motor amplitude decreases in three distinct areas of the body, fasciculations, and a normal sensory NCV examination.  The clinical parameters include muscle weakness, no sensory loss, and both upper and lower motor neuron findings.  For EMG diagnosis of MG, one need a loss of amplitude with continued firing of the nerve.  Good news, this was not found on your exam.  There are three antibody types that are associated with MG, although only one need be present.  These are receptor binding, blocking or modulating antibodies.  Yours were really not present so again, this would pretty much tell you that you do not have MG.  

There are several diseases that can give you weakness.  It might be a good idea to visit a neurologist and just have things looked at.  Be sure to bring all your records and films and studies.

Sincerely,

CCF Neuro MD

[Deedee]

So ALS is still a possibility?

[CCF Neuro[P] MD, RPS]

Dear DeeDee:

ALS is not a consideration since your EMG was not indicative nor did you communicate any upper motor neuron involvement.

CCF Neuro MD

[L.]

What is considered upper neuron involvement?