Does this sound like initial issues?

[cer3223]

Two months ago I started having random twitching (no weakness), mainly in my lower legs, and became concerned enough to schedule a neurology appointment. I had an EMG done in all four limbs about 2-3 weeks after the onset on the symptoms and he said that my EMG was completely normal. About a week after this, my right leg (mainly in the calf) started stiffening and now my entire leg from the knee down feels completely stiff. He also said my neuro exam was normal, but that was about a week before my leg became symptomatic with stiffness.

Could the neuro test and EMG have been done too early? I trust more that the EMG wasn't done too early since I was having some type of twitching, but am concerned about the neuro exam portion.I have seen discussions on here saying that an EMG can show issues before you before very symptomatic, but what about the neuro exam? If I had a normal exam would that be sufficient, even if a week later I potentially developed an UMN symptom?

 

[Atsugi]

I don't know why you would have a stiff leg. Stiff legs don't point toward ALS in any manner. Why would you think about ALS?

EMGs can pick up problems before you see symptoms. This is because the first thing that happens in ALS is that certain motor neurons in the brain and brain stem are destroyed (this is found on EMG) and THEN you would see symptoms appear in the muscles.

So no, your EMG wasn't too early.

What did your GP medical doctor say? That's where you need to be. A neurologist knows the nerves, but a GP is trained to lead medical investigations to whichever specialty might be needed.

 

[cer3223]

Hi Atsugi, I tried to rewrite my question but Nikki J deleted it. I have started experiencing muscle cramps as well which is why I am now worried. If I have muscle cramps now but didn't have them 4-5 weeks ago when the EMG was clean, do you think it was done too early?

 

[Atsugi]

Again, no. The EMG was not done too early.

What do you mean by a stiff leg? Can you flex your foot up and down? Can you bring your calf up forward and then backward? Or is it mainly a feeling, like it feels tight?

 

[cer3223]

Yes, I can flex my foot up and down, it just always feels tight. The cramps are also worse in that foot. The only reason I even have concern is because I feel like I developed a new symptom after the EMG. Cramps are a LMN issue, right? So something would have probably shown on a EMG even it was a few weeks earlier?

 

[Atsugi]

How old are you?

Why did you think "Maybe I'm dying of an incurable disease" instead of "Gee, my legs are stiff lately"?

 

[cer3223]

I am 25. No it's because I have been having pulsing twitches, cramps and the stiff leg. Also, if the cramps in my feet were due to nerve damage, but they didn't EMG my feet, I have no way to tell if the cramps are from nerve damage or not...Sorry I am just confused!

 

[Atsugi]

Well, first, you leapt from a common symptom, cramps and twitches, to a rare disease. There are a lot of more likely explanations than ALS.

Second, ALS is a disease of 40-70 yro people. There are a few 20s who get it, but that's even more rare.

Did your GP medical doctor send you to the neurologist because she thought you might have a neurological disease, or as a results of pressure from you?

 

[cer3223]

I had already gone to the neurologist 6 months ago for possible MS issues which my GP referred me to, so when all of this started I just recalled them and explained my symptoms and they told me to come in. I guess really I am just worried about the EMG being too soon since the only symptom I had when the EMG was done were some twitches, not the cramping.

 

[cer3223]

Also, would cramping typically occur in multiple limbs at once early on?

 

[Atsugi]

No.

This is the way ALS works. It is a brain disease, not a muscle disease. In the brain and brain stem, ALS destroys a motor nerve, so that nerve cannot send the 'go' signal to its corresponding muscle to contract. So that muscle no longer gets the go signal, and it no longer contracts. It lays limp, useless, paralyzed. Usually this occurs first to a hand or a foot. As a result, you can't use that hand or foot properly. Note that you don't feel anything. The muscle doesn't feel weak, fatigued, or burning or weird or anything. It just doesn't go. Then the ALS destroys the next nerve, and so on.

Sometimes there are cramps, spasms, or twitches associated with ALS. Not always, for sure. My wife never had a cramp or a twitch--her muscles just stopped working, one by one.

Sometimes people say the cramps and twitches occur all over, usually it occurs in only the next muscle to be lost, and sometimes those symptoms never occur.

 

[Atsugi]

CER, by directing your own investigation into your health, you've got an uneducated, passionate worry-wart running your health investigation, looking at ALS instead of looking for the right clues to find out what's going on. This is a waste of money, time, and worry.

And no one on the Internet can possibly diagnose you.

GP medical doctors are especially trained to know how to run a health investigation, using the appropriate specialists at the appropriate time.

 

[cer3223]

Ok thank you for answering all my questions. So, if I started having cramps that were ALS related a few weeks after I had a clean EMG, should I take it that those cramps are probably not ALS related? My EMG would have shown something?

 

[cer3223]

I am extremely sorry about your wife. Thank you for taking the time to talk to so many people on this forum.

 

[Atsugi]

Ok thank you for answering all my questions. So, if I started having cramps that were ALS related a few weeks after I had a clean EMG, should I take it that those cramps are probably not ALS related? My EMG would have shown something?

Right, Exactly.