30 year-old Male with Constant Twitching in calf muscle without any weakness. Very worried!

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AbChak123

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Hello Everyone

This is my first post on this forum and I'm glad I chanced upon this while desperately looking for a bit of reassurance that I don't have the dreaded disease. My anxiety isn't exactly helping things and it has skyrocketed over the past few days so I'd get into the details without beating about the bush. Please bear with me on this one cause I'll try my best to put everything succinctly in one place.

So I'm from India and I'm an otherwise fit and active guy who's totally into outdoor activities like running and football. I had a disc bulge (L5-S1) diagnosed a couple of years back but through a proper rehabilitation program, I could get back to sports after a few months without any trouble. Recently, a couple of months ago, I noticed my calf muscles (on my left leg) twitching uncontrollably after a 30-minute run. I chose to ignore it but over the next few days, I could sense that it wasn't exactly something that could be brushed aside. The twitching would come and go but it never would stop. Dr.Google compounded my anxiety on this by suggesting the worst possible diagnosis as one of the possible causes. I quickly scheduled an appointment with a Neurologist in my area and when I got there, he checked my reflexes, asked me to walk on my toes and heels, inspected my leg muscles in a supine position. All these went pretty well and I didn't (still don't) have any 'clinical weakness', so to speak. He suggested a few blood tests (TSH, T3,T4, Vit B12,Vitamin D and CPK). It turned out I was deficient in Vitamin D (cause I was in Sweden for a year and didn't take any supplements despite the lack of Sunlight, which I was not used to). My B12 seems normal (but on the lower side) so my neurologist suggested me to take a few Vit D and B12 tablets for the next 2 months. I skipped the B12 tablets (not a good idea) and one month into this time span, I started panicking about it cause the fasciculations had increased in intensity, with near-cramp feelings. I still didn't have any kind of clinical weakness as I would wake up every morning and attempt walking on my toes and heels (I still do it twice or thrice a day for checking any signs of weakness). This time, when I went to him (which was yesterday), he decided to go for a NCS/EMG test. So , yesterday, I finally got my NCS/EMG done and here are the results:

NCS: Appears perfectly normal with no abnormalities recorded in the motor nerve, F wave, and sensory nerve studies. (This was done first so I was relieved)
EMG: This is where my primary concern is now and my anxiety is taking it's toll on me. My neurologist conducted the test on only one leg (the affected left leg) on two different spots (Vastus lateralis) and gastrocnemius muscle (this is where the twitching happens all the time). The results are as follows:

Vastus Lateralis: MUAP Amplitude , Duration seems normal, Recruitment and Interference both seem normal. However, for the gastrocnemius muscle , the recruitment was delayed and interference was incomplete. The impression: "EMG findings were neurogenic pattern in left Gastro muscle"

The doctor said everything else is normal except the fasciculations recorded on the EMG and I don't have any visible signs of clinical weakness or muscle-wasting. There's absolutely no cause of concern. He asked me to follow-up after two months though cause he opined that I might have other autoimmune responses (unlikely, he emphasized though) that could be investigated. "You don't have to worry about anything else cause we still think this is Benign" ..This is what he said as I was about to leave his chamber. He also asked me to continue with my B12 and Vit D tablets for 2 months. Furthermore, he has prescribed two medicines to allay my anxiety problems and help me get some good sleep at night.
As usual, I googled up "abnormal EMG but clean NSC" when I got back home from work and my fears returned again.Since morning, I've been thinking that had it been BFS, the EMG wouldn't have been abnormal, right?
So I want to ask the respected members of this forum a couple of questions:

1. Can an abnormal EMG (I'm not even sure if its abnormal cause for one spot on the same leg, everything seemed okay) rule out BFS and point to something sinister? I'm asking this cause my neurologist said "we have those fasciulations clearly visible on your EMG but nothing else". I read on the internet that BFS wouldn't show any abnormalities on EMG , right? Did he say this just to allay my anxiety so that I don't sweat over it or was he saying this with certainty? Also, are "abnormal" EMG findings commonplace and if these findings don't point to ALS, what else could it possibly be?

2. I still don't have any visible signs of weakness and I can do my daily jobs without any issues. I'll be going for a run today as well in the evening after a 3-week hiatus. I've read on the internet that by the time fasciculations start appearing in ALS, the patient would already show signs of clinical weakness and visible muscle atrophy and this is true for 99% of the cases. Is this true?

I'm really worried and anxious and any sort of advice/opinion on this would be highly appreciated.

Thanks and Warm Regards
AbChak123
 

KarenNWendyn

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Please read this if you have not already done so:

The clean clinical exam alone (normal strength and reflexes) along with normal muscle function goes against ALS. The EMG also sounds reassuring if it does not show increased insertional activity or positive sharp waves.

EMGs can show abnormalities for many reasons other than ALS. It’s possible that the old disc bulge may be associated with a few abnormalities on your EMG.

if you can post the actual EMG results along with the summary and conclusions (black out any identifying information), we’d be in a better position to comment.

Keep in mind that what is important when it comes to diagnosing ALS is the big picture: clinical weakness as determined by a physician, characteristic EMG changes in multiple muscle areas, upper motor neuron signs, evidence of disease progression, and ruling out ALS mimics.

That said, I don’t think you need to be worrying about ALS.
 

AbChak123

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Hi Karen

Thanks a lot for your valuable input and the re-assurance you've provided. Much appreciated. I'm hereby attaching my EMG/NCS findings for you to go through. Unfortunately, the EMG findings are not as detailed as the NCS . I'm not sure whether it's a mistake made by the technician who was compiling and preparing the reports or the standard protocol the hospital follows. I'm afraid you'll have to do with a detailed NCS report and an overview of EMG findings germane to the aforementioned two spots.
The fact that the physical or the clinical examination came out clean seems re-assuring. You're right..the l5-s1 disc bulge might have something to do with this cause despite a successful return to sports , it's never ever going to be 100% (My Sports doctor told me this) and I have to continuously keep stretching my glutes, hammies and calf muscles (on the left leg cause that's where the occasional Sciatic flare-ups happen and that's the leg where the twitching started) besides strengthening my core and lower back on a regular basis. These muscles get tight easily after sitting for long hours at the office (I have a desk job) and when I "wiggle my big toe" , I literally can feel a big butt muscle moving (gluteus maximus?). I think it might be my chronic sciatic nerve irritation but it's surprising to know that this could all potentially show up on an EMG.

Warm Regards
AbChak123
 

Nikki J

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Hi the attachment did not open for any of the mods So was removed as it can not be checked ( and likely it can not be read by others). Please try another method
 

AbChak123

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That's quite surprising. I had compiled all the images together (12) into one big PDF file before I uploaded and I think on clicking the attachment, it gets downloaded into your system folder. Nevertheless, I've uploaded all the 12 files separately now. This should suffice I believe

Warm Regards
AbChak123
 

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AbChak123

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..and here are the last 2 images (given the max number of images that can be uploaded in one go is 10)...
 

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KarenNWendyn

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Thank you for re-posting. The EMG is reported in a different style than what we’re used to. Nevertheless, I don’t think it is reporting an ALS pattern.
 
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AbChak123

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Thank you so much for your assurance again! This might be a little out of scope in regard to this forum's conversation, but can an abnormal EMG point out something equally sinister(if ALS is to be ruled out). I've read about muscular dystrophies and while these are extremely rare diseases (much like ALS), these manifest with similar symptoms such as Muscle weakness and wasting..right? They would also show up on a clinical exam...is that correct?

And secondly, are there any self-tests that I can perform everyday or periodically to check for any muscle abnormalities. I know that walking on heels and toes is a reliable indicator, but apart from it, are there any physical examinations I can perform on myself to rule out clinical weakness?

Again, thanks a lot for your valuable input :)

Warm Regards
AbChak123
 

Nikki J

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The emg can show many things. We are not electrophysiologists but I don’t believe the pattern is at all consistent with muscular dystrophy. As Karen stated the format is slightly different but it looks benign and that was the interpretation given.
do not self test! It can become obsessive all too easily. We have actually seen people sustain overuse injury. And only a doctor can say clinical weakness. You had an exam and didn’t have any.
 

AbChak123

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Thanks a ton for your re-assurance! I want to thank you both for this. Have a nice day!

Regards
AbChak123
 

lgelb

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This list might reassure you. We see a fair number of people with isolated EMG abnormalities in that muscle. None returned with ALS.

Best,
Laurie
 

AbChak123

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Thanks a lot Laurie. This was of great help. All of you are doing a wonderful job over here, something that's really commendable. Much appreciated!
 
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