A few questions about symptoms

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Theot

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I have a few questions regarding some symptoms that I experienced over the past 10 months. I have read the stickies and realize that the bulk of my story involves muscle twitching and not much else, and so it points away from ALS. I have also had a relatively clean EMG - fasciculations in two muscle groups being the only things noted.

The start: I developed some random twitching in my upper abdominals last year in May. I’d never felt such a thing, and as they felt like heart palpitations, I told my PC about it and he had me wear a holter monitor for a day: nothing significant was found.

Fast forward to October and I was able to tell that this was muscle twitching as it had spread to my calves, shoulders, shoulder blades, and now everywhere. I was alarmed at first and took a trip back to my PC, when I was then sent to the Neurologist. Neurologist did a clinical exam and didn’t note any weakness or atrophy or reflex issues. He then scheduled me for an EMG with another neurologist as he did not have any neuromuscular diagnostic training. He told me the EMG was to rule out ALS (I took a deep breath on that one because it hadn’t been on my radar).

He asked me if I’d been under any stress or had a history for anxiety. The answer to the former is yes, it was during a particularly stressful time in my life that this popped up. I don’t have a history of anxiety; though I suppose “we use the EMG to rule out ALS” could evoke an anxious response from anyone. I was given a diagnosis of BFS and sent on my way with some blood work that I haven’t gotten back yet. I read briefly that with BFS, action of the muscle should overtake the “twitching” - that does not happen with me, I keep twitching right through any additional activity.

Now, a month after my EMG, I have significant twitching that seems to be exacerbated by exertion, particularly in my shoulders. triceps, and calves: lifting my arms over my head in the morning to stretch - anything really: weed-wacking today and my right arm is intensely twitching at the shoulder and my left triceps is doing the same. Additionally, if I’ve just shaved and brush a cloth against my face it will start twitching around my mouth. The concerning part of this is that the twitching has only gotten worse and worse and it seems easy to unintentionally evoke twitching, pushing on a muscle (crossing my arms) or resting my arms on my knees…

My questions are as follows: when a symptomatic muscle is tested during the EMG, in my case a muscle where I’ve noted significant twitching for quite some time, will the EMG always show abnormalities consistent with ALS when ALS is present? Does anyone think it advisable to pursue a second opinion with a neuromuscular specialist?

Respectfully - T
 
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Hi T. I’m glad you’ve read the stickies. Twitching is common, nonspecific, and meaningless in the absence of muscle function failure which you have not described. It doesn’t matter how much you twitch, when you twitch, where you twitch, etc. Whar matters is that a neurologist didn’t notice any “weakness, atrophy, or reflex issues”.

I’m also assuming your EMG was normal. If it was done in an area where you’ve noted twitching, then it would show ALS if ALS were present. A normal EMG along with a normal neuro exam definitively rules out ALS.

So I don’t feel you need a second opinion with a neuromuscular specialist unless you believe that’s what it will take for you to stop obsessing about this.
 
Hello Karen,

Thank you very kindly for your response to my question. I don't know that this has met the level of obsession for me, though I'll submit that twitching is obviously an uneasy personal negative feedback loop; I guess it was the odd (to me) presentation of twitches that had me wondering about their genesis. I appreciate your taking the time respond and wish you the best. I'll move along.

Regards, T
 
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