25 year old med student, fasciculations and cognitive changes

[mwill100]

Ah my dear friends, thanks in advance for your support. I'm sending much love to all who spend their time in service to others here.

Navigating the medical world is scary, even (especially, perhaps) for a med student. There's still stigma to being ill in this field. :/

I'm a male med student in Chicago, just now recently on a leave from school. This has been a journey for me.

I just want to say I don't think I have ALS, but am not ruling it out at the moment due to the fasciculations and weakness. Still, my issues seemed to start with severe cognitive changes before the physical problems.

About 12 months ago I got hit with some massive confusion, fatigue, and depression out of the blue, but no antidepressants touched it-- I even did TMS with no luck. Mainly I was just zoned out all the time and really apathetic-- major anhedonia and memory issues. We ran the gamut and some stuff is off (WBC, platelets, lymphocytes, monocytes have been at the high end for almost a year now), but not high enough to think leukemia or anything. Catecholamines look ok too. My total protein and SGOT were a little above the high index.

MRI C-spine normal, MRI brain showed a vascular lesion in the right frontal cortex, likely a telangiectasia, and I've been told it's unrelated to my symptoms. I was really hoping it was cancer so that I would have an answer. The depression and fatigue have been severe.

Then 4 months ago I started experiencing fasciculations in all my limbs, and that hasn't stopped. I will get an EMG soon. I have certainly noticed weakness in my muscles, but I don't think it would jump out at me because I haven't been working out for a year and have been depressed.

No mono (EBV). I spent all my life in Arizona, and did a one-year job near NYC last year, spent a lot of time outdoors. But my Lyme Western blot only had 2 bars reactive: 30 and 41. I was really hoping Lyme because it seemed to fit everything! At any rate, I am taking Minocycline now for acne, so I've hoped that might cover things just in case.

With the fasics, I guess there is just no real way to know for sure until you start noticing major physical issues. For me, my biggest problems have been extreme confusion, depression and fatigue, so I'm likely to try ECT if that doesn't improve.

I just wonder if anyone here with ALS had cognitive issues and fatigue/depression show up first.

 

[mwill100]

I do want to add that this month I have especially experienced weakness in my fingers a bit. It seems to be worse in the morning, though. I used to be a very fast typer, but now have some trouble.

I also was diagnosed with mild sleep apnea a year ago. I never had noticed issues before, but pretty suddenly was finding myself waking up choking. I choke quite a bit more just out of the blue, sitting at my desk, and while eating now. I thought I was just forgetting to swallow correctly or was eating too quickly. These issues haven't gotten a lot worse. Sometimes it has felt like my tongue is a bit big in my mouth, but no one has pointed out changes in my speech.

 

[Atsugi]

Thanks for including lots of details, Mwill. There's no reason to think you have ALS.

First, you don't describe FTD. <Corrected>.

Second, you're 25. This is a disease for 40-70 yro. Although there have been some 20 yro patients documented to have ALS, those outliers are rare.

Third, fasciculations and twitching are common to many conditions, so they are not diagnostic of anything, esp ALS.

Fourth, the weakness you described as worse in the morning: In ALS, the weakness does not come and go. Once it happens, it stays forever, all day, for the rest of your short life. This is because the weakness is NOT muscle weakness, it is a destroyed nerve. The nerve is not giving the "go" signal to the muscle, so the muscle lays there limp and useless, paralyzed, waiting for a signal that's never going to come.

Finally, while reading through your post, I never once thought "My gosh, could this guy have ALS?" Instead, I was impressed--not in a good way--by how rapidly various medical problems are coming your way. It's as though...HEY, there it is...you're a med student. Yup. You might want to consider the possibility that you're suffering from a common affliction that med students often get. (My wife was a doctor.) Often, med students will "get" lots of the symptoms of the diseases they study. They get better later, of course.

Healthy people twitch. People under stress twitch. Anxiety twitches.

Your primary problems seem to be blah on the brain. Confusion, slowness, depression, slow thinking and typing--all around blahness. Sounds like you need better quality sleep, better diet, good friends and happy times to get your brain back on track. Avoid alcohol. But I'm not a doctor, so take my opinion with caution. I am, however, fairly knowledgeable about ALS, since my wife had it and I've been dealing for years with people who have it. You don't have ALS to worry about.

 

[lgelb]

M,
ECT is a major step. I certainly wouldn't consider it (and I'd hate to think who would order it) w/o failing on a host of antidepressants, total dysfunction, etc. which if you're in med school would be hard to fathom.

So if you have OSA, are you on PAP? Seems like improved oxygenation/more consolidated sleep could only help the constellation of sx you report.

ALS, no.

Best,
Laurie

 

[mwill100]

Thanks so much for the replies, to you both. This helps a lot. I agree with the above. Fasciculations are scary when they come up out of nowhere. None of my blood tests show a reason. Maybe they'll go away with time, maybe not. Lyme still seems like a good explanation. It can make psychiatric issues much worse.

The main problem with me is that my father had a history of depression, which came on in his mid-30's and was treatment-resistant. This is kind of late for severe depression to show up first time around, so I wondered about FTD. He was a family doc and died of an accidental overdose at age 37. No signs prior to that.

I've had major depression most of my life, and it was well controlled until this past episode. Unfortunately I've failed all the meds on the market in the past year, and TMS didn't work. I'm also a trans male, but I don't think it's psychologically related to that because I came out 5 years ago and have great therapists. It's felt very biological, if you will. We checked endocrine stuff.

I slept through my neuropsych testing today. It's been hard to stay awake for more than a few hours at a time. I think that's just the depression.

I have 9 months to figure out what might help, so now might be a good time to see if ECT will be my answer during the worst episodes. This will be a lifetime condition, but I don't have ALS and I can find hope! Cheers and thanks again.