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s2knet

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Around 3 weeks ago, out of the blue, my left thumb started twitching a few times a day.

After continuing to do so for about 3 days, the twitching became widespread across my entire body over the course of a few days – limbs, trunk, back, face etc

I got referred to a neurologist who did a basic physical exam and found no obvious weaknesses or reflex issues and he said to monitor it, saying it was probably benign fasciculations and they should subside. (I will caveat here that I suffer from health anxiety, so I did continue to worry.)

After a week of the same symptoms, I returned for a follow up and he said that although he was still not overly concerned (due to my age - I’m 39 years old and the nature of the onset), he instructed blood tests and an EMG.

I just saw him for the results today and he was able to confirm that the EMG results were normal and that the bloods looked reasonable, although the creatinine and the thyroid results were on the higher end of normal – so he has effectively diagnosed Benign Fasciculations.

Whilst this has reassured me somewhat, I just examined my forearm muscles and noted that my right forearm now appears to be noticeably smaller than my left forearm – even though I am right handed, so this has set my fears off again. And the fasciculations continue unabated across my whole body.

On the basis of the above history, can anyone please advise whether a return visit to my neurologist to report this new observation of possibly atrophy is warranted. Any feedback is much appreciated.
 
The EMG is the gold standard test. You don't have ALS.
Leave your doctor alone. He has sick people to see.
 
Dear Atsugi

Thank you for your reassurance.

A follow up if I may before I put this thread to bed.

I performed a few strength tests (reverse wrist curls) and noted that the right arm was weaker than the left which added to my concern as I would certainly have expected it to be stronger given my dominant hand.

I'm not familiar with the body locations selected for Emg.

If the right forearm was not covered explicitly in the emg ought i go back to the neurophysiologist and get that explicitly checked out?

Thx again.
 
First, a neurophysiologist knows what he's doing. If your neurologist isn't concerned, you shouldn't be.

Second, the weakness that should concern you would be obvious: Dropping cups because one or more muscles is not working. Don't worry about the wrist curls.

You see, ALS destroys motor neurons in the brain, the ones that tell your muscles to contract. Since the muscles don't get the signal, they don't contract.

If you are still concerned, ask your doctor; there are many other possible conditions. ALS is rare. The issues you're describing are common. Don't leap from common issues to a rare, fatal disease.

We're not doctors here, and so we can't diagnose you. But we do know ALS really well, and I wouldn't worry about it if I were you.
 
Dear Atsugi

Thx once again.

All the best.
 
I have taken a photo here of the difference between my forearms which to me is pretty stark.
The right is smaller than the left and I am right handed - so that is concerning.
Image - TinyPic - Free Image Hosting, Photo Sharing & Video Hosting

The muscles of the right are softer than the left even after hard tensing.
And there is no "fullness" to the muscle bellies on the right forearm.
Strength-wise, the right side is not stronger than the left and may even be weaker in some grip tests I've done

Can I give some detail from the EMG report; (which was produced on the 13th July - just over 2 weeks back)

The detail included ; "Some muscles tested (R Biceps, EDC, Tibialis Anterior) show evidence of mild chronic denervation, but none showed any acute or ongoing neurogenic process. Fasiculations are infrequent and confined to the foot muscles. Axial muscles are normal."

The conclusion was "In summary, the findings are consistent with the possibility of benign fasiculations and there is no evidence to suggest AHCD (Anterior Horn Cell Disease). The mild chronic neurogenic changes seen in the right arm and leg muscles suggest presence of mild background radicular dysfuction"

My neurologist has seen the full EMG report - and also fully physical exam of my forearms and entire body and reflex tests2 days ago and still did not seem to be overly concerned. Would others arrive and the same conclusion of "No evidence of AHCD" based on the same results?

However, after having taken the photo today, i really am beginning to get concerned.
And continue to get fasiculations over whole body.
 
Congratulations on that great EMG report!

You have nothing of concern happening, just like your doctors are telling you. I'm so happy for you, any one of us would trade places with you in a snap.

Gently as a mother of kids around your age I would say to you - you are now obsessing and trying to prove to yourself there is something terribly wrong. This is actually a medical condition so please go back to your doctor and be really honest about your obsessions and ask him to get you immediate help for health anxiety disorder. It's great news that what you do have can be treated.

Do yourself a favour and stop reading anything here as it is making your disorder worse.

All the very best
 
I agree. Good advice, Tillie. You said it better than I could have. --Mike
 
Thanks for the input tillie and Mike.

No need to reply but I am just logging development of my symptoms.
Since yesterday the left thumb is now twitching continuously
And there are two other spots that are regularly twitching in the back of that hand
Furthermore there is now also a regular twitch although less frequent on the lower side of the left forearm.
The more concerning nature of these fasc is that they are now localised and persistent rather than widespread and infrequent. This change happened so quickly.

Additionally I noticed today some loss of mobility of my right thumb when trying to type on my phone.
It just won't move as fast and to the right spot anymore.
And also that the muscle between the thumb and the index is slightly cramping frequently and I have to stretch it out to get some relief. This muscle has also started twitching.

I read that symptoms can present similarly on both sides hence this appears not to be a good turn of events for me.

I have arranged a follow up emg for all affected areas and will let u know how I get on.

Fascs continue unabated thru all other parts of body - legs / arms / and particularly noticeably thru the abdominal area and feel like flutters.

Thx again.
 
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