About 3 1/2 months ago I began seeing fasiculations in my calves and ankle area. I wasn't too concerned because they didn't seem to be causing any other symptoms. I had an EMG done and had my potassium and calcium levels checked, which were all normal. That was approximately 3 weeks ago. Now these fasiculations have become very pronounced. They are almost constant in my lower legs and also now in my feet. I have sporadic periods of them in my shoulders, arms, hands, abdomen, eyes, and these are frequently accompanied by a tingling sensation and patchy areas of numblness. When I touch these areas I can feel the sensation, but when I am walding or doing something they feel numb. I also now have cramping in the fat area below my thumb and in my feet even at rest. The fasiculations are really bad when I first get up an the morning and at night when I am not active. I am currently taking synthroid .5mgm. and premarin .9mgm and daily vitamins. I had my TSH checked in Jan. and it was within normal range. I am concerned about the increase of these fasiculations, and the cramping. I am not experiencing any "real '" weakness. I walk every day and climb stairs.My arms feel weak at times,but it does not prevent me from activities. Could this be ALS or does it sound more like fibromyalgia? I truly appreciate your time, you offer a wonderful service!
Sorry to hear about your fasciculations. Good news is that since you have no real muscle weakness and your EMG is normal, the most likely etiology of your fasciculations, cramping, and anxiety is a condition called benign fasciculations. For the majority of cases we do not know what causes them. In about 30% of the cases it is viral in nature. But the other 70% we do not know. The things that make them worse are fatigue and anxiety. They can come and go, last for hours, days, or even years. We do not think they cause any lasting muscle damage. They are not associated with ALS down the line. Some treat with a benzodiazepam but many do not find relief with medication.
Sorry, there is no real treatment. The psychological issues are the worst since we assume that it must be ALS but rest easy it is not ALS. I understand your condition as I get fasciculations myself.
Technically no, as there are strict criteria for EMG diagnosed ALS as one has to have 3 different muscle groups showing denervation without sensory conduction loss. But for all practical purposes, a normal EMG indicates that the cause of fasciculations is not a bad muscle undergoing death.
How about a drug-related cause? I know there are lots of medications that cause muscle pain and cramping, tendon pain, and miscellaneous neurological problems (SSRIs and quinolone antibiotics come to mind -- both of which have lots of low-incidence-rate side effects), but I haven't heard of anything that specifically causes fasiculations.
For what its worth, I started a regular walking program last February. After every walk I get fasiculations. During a brief round of taking Zoloft (an SSRI) I had intense calf muscle pain and near-constant fasiculations. I'm off the SSRI (and all other antidepressants) and my fasiculations are getting better. Just to show how complex these things are, I took two weeks off from walking and the fasiculations nearly disappeared. I decided that cardiovascular health is more important than discomfort and started walking again, and the fasiculations are back, although not nearly as strongly.
Thanks so much for your prompt and informative response. The service provided here is wonderful!
Regarding my second question:
Would an EMG done 3 weeks prior to fasiculations find ALS?
I have been told by a Neurologist that yes, it would have shown up on the EMG. The reasoning given is because ALS is present long before fasiculations and there would be damage by the time a person is twitching.
Any clarification of this would be greatly appreciated.
I am not sure what your trying to imply. Nothing was stated that you were a medical professional nor was there implications that what was stated to be for a medical professional. We do not understand completely what causes muscle fasciculations. As previously stated some come after viral infection but for the most part the etiology is not understood. Many medications can cause tremor, but most do not cause fasciculations. Some diseases cause fasciculations such as ALS, toxins, myopathies etc. The medications you mentioned by lead to tremor but not fasciculations. Sorry you got so offended.
Rick was the poster you thought you offended. Rob was the original poster. I think Rick(second poster) was just making a comment to Rob and prefacing it by saying he wasn't a doctor but that Rob might consider the theory that his fasciculations had a drug related cause. I don't think you offended anyone. In fact your answers are usually among the most tactful and compassionate ones posted.
Comment to Neuro RPS:
I want to say you do an incredible job at not only clinically providing in laymans terms things to people, but are extremely compassionate in your responses to all posters. Whoever posted that quinolones can cause fasiculations was correct. One Clinical Pharmacologist who has seen numerous cases
has seen many unusual peripheral and central nervous systems disturbances displayed. His theory and others in the case of peripheral nervous system effects are that chemically quinolones bind to receptor sites on neurotransmitters. Often times drugs like Ativan. Klonapin, Valium, BZ drugs are used to treat this as they compete for the same binding sites. Supposedly to be able to dislodge the chemically bound quinolones. Also people who report muscle cramping, sensory disturbances, burning, twitching, fasiculations, are often told this can actually be caused by quinolone induced subclinical seizures. Apparently the mechanisms that unleash PN from these drugs, differ then those that cause tendon rupture as the tendon ruptures have to do with soluable lipids and have been discussed in papers by AAOS and in numerous studies that appear in Pubmed. Some people given quinolones who have a virus can have even stranger outcomes with even more diffuse atypical symptoms. Since these drugs like Chemo drugs cross the blood brain barrier they are capable of doing a lot of damage to particular people which are often only revealed on petscans and no not show on MRI's or EEG's.
Thanks again for the incredible service you do.
Interesting Rob, I am 22 years old and I have had the same symptoms for nearly 4 months. I have gone to 3 doctors and they have no clue. I have numbness in my toes and arms and I am scared. i tend to dwell on the negative conditions like MS and diabetes, but my tests have come back negative. Hang in there.
Open Forum Message Follow-Up: RE: Subject: Restless leg syndrone stings
THIS REALLY CAN MAKE YOU EASY MONEY!! ITWORKS!!! BUT YOU HAVE TO FOLLOW IT TO
THE LETTER FOR IT TO WORK!!!! A little while back, I was browsing through
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most of us, I was curious, so I kept reading. Anyway, it said that you send
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your own name and address in the bottom of the list at #6, and post the article
in at least 200 newsgroups (There are thousands). No catch, that was it. So
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I figured what have I got to lose except 6 stamps and $6.00, right? Like most of
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you how this works and most importantly, why it works.... also, make sure you
print a copy of this article NOW, so you can get the information off of it as
you need it. STEP 1: Get 6 separate pieces of paper and write the following on
each piece of paper PLEASE PUT ME ON YOUR MAILING LIST.' Now get 6 US $1.00
bills and place ONE inside EACH of the 6 pieces of paper so the bill will not be
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56, Marion, AR 72364 STEP 2: Now take the #1 name off of the list
you see above, move the other names up (6 becomes 5, 5 becomes 4, etc...) and
add YOUR Name as number 6 on the list. STEP 3: Change anything you need to, but
try to keep this article as close to original as possible. Now, post your
amended article to at least 200 newsgroups. (I think there are close to 24,000
groups) All you need is 200, but remember, them more you post, the more money
you make! ---DIRECTIONS -----HOW TO POST TO NEWSGROUPS------------ Step 1) You
do not need to re-type this entire letter to do your own posting. Simply put
your cursor at the beginning of this letter,then click and drag your cursor to
the bottom of this document. Select 'copy' from the edit menu. This will copy
the entire letter into the computers memory. Step 2) Open a blank 'notepad' file
and place your cursor at the top of the blank page. From the 'edit' menu select
'paste'. This will paste a copy of the letter into notepad so that you can add
your name to the list. Step 3) Save your new notepad file as a .txt file. If you
want to do your postings in different sittings, you'll always have this file to
go back to. Step 4) Use Netscape or Internet explorer and try searching for
various newsgroups (on-line forums, message boards, chat sites, discussions.)
Step 5) Visit these message boards and post this article as a new message by
highlighting the text of this letter and selecting paste from the edit menu.
Fill in the Subject, this will be the header that everyone sees as they scroll
through the list of postings in a particular group, click the post message
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of it, it will take about 30 seconds for each newsgroup! **REMEMBER, THE MORE
NEWSGROUPS YOU POST IN, THE MORE MONEY YOU WILL MAKE!! BUT YOU HAVE TO POST A
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ADDRESSES ARE CORRECT.** Now the WHY part: Out of 200 postings, say I receive
only 5 replies (a very low example). So then I made $5.00 with my name at #6 on
the letter. Now, each of the 5 persons who just sent me $1.00 make the MINIMUM
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OK, now here is the fun part, each of those 625 persons post a MINIMUM 200
letters with my name at #2 and they each only receive 5 replies, that just made
me $3,125.00!!! Those 3,125 persons will all deliver this message to 200
newsgroups with my name at #1 and if still 5 persons per 200 newsgroups react I
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your name is no longer on the list, you just take the latest posting in the
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and see if it really works?? I think so... People have said, 'what if the plan
is played out and no one sends you the money? So what! What are the chances of
that happening when there are tons of new honest users and new honest people who
are joining the internet and newsgroups everyday and are willing to give it a
try? Estimates are at 20,000 to 50,000 new users, every day, with thousands of
those joining the actual internet. Remember, play FAIRLY and HONESTLY and this
will work. Enjoy the money, Rick
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