Hey JP-- actually body-wide twitches are pretty uncommon in ALS. There is a misconception here, too. Twitches and fasciculations seen in ALS aren't really the same thing--as there are different causes.
Hyperexcitiability can cause twitches. So, things like anxiety, stress can even be causes of the body-wide twitches. Heck, even too much caffeine an be a cause.
When ALS strikes the nerves, they begin to die, and other nerves try to compensate for the loss--this 'trying to compensate' can cause some to feel or see the jumps in the muscle (fasciculation) Once those muscles are dead--those fasciculations stop, as there are no more nerves available.
So--technically, fasciculations seen that are part of ALS are seen when the nerves are already damaged, thus, they show up on EMG. Benign twitches can still be present--that are not the same kind of twitch, if that makes sense.
I believe you'd said you'd been under a huge amount of stress? While of course I can't say for sure--it is possible your twitches were related to that.
ALS normally affects all areas, of course, but not all on DAY ONE so to speak. So, generally, bodywide twitches are not what is seen--they will generally be localized in the muscle that is being affected--that foot, that hand, that arm, the tongue--whichever area is the first victim of this insidious disease.
It's important to clarify here that clinical weakness and perceived weakness are very different things. You may not FEEL any weakness--but very often, a doctor can test and find it. That's clinical weakness--and clinical weakness is what is needed to diagnose ALS. Along with a whole host of other things.
Normally when one sprains an ankle--even severely, foot drop isn't the result. It's sore, swollen and tender for sure..but the muscle isn't 'dying' it's 'injured'. In foot drop--the muscle is dead and/or dying. It can no longer perform it's rightful task--keeping your ankle up. Now, if your sprain was severe enough to require medical intervention and a doc said you tore or damaged ligaments or tendons--then it's certainly possible to cause foot drop -- but an injury that severe would usually require surgical intervention.
The thing with ALS is this--there is simply a lot that no one knows. But just like someone with a heart attack can get ALS -- it doesn't mean that all that have one will develop ALS. Same with Benign Fasci Syndrome. Not all with BFS will get ALS--in fact, very small percentage will.
There are two main areas involved in ALS-- UMN Upper Motor Neurons and LMN Lower Motor Neurons. LMN changes--weakness, fasciculations, atrophy eventually-- are seen on EMG. The specific pattern seen is reinervation and denervation.
In UMN -- the symptoms are clinical only-- spasticity, hyper reflexes, hypertonia, weakness, positive hoffmans or babinski, clonus -- all things a doctor sees on clinical exam.
A diagnosis of ALS requires both types of issues. There are folks here with mainly UMN issues--like me--with no diagnosis. There are some with mostly LMN--like Helen-- who has been diagnosed because the LMN shows on EMG--UMN does not.
As in any medical condition, the signs and symptoms are a list--because not all are seen in every patient. I know PALS that never saw a twitch. Others have no pain--still others have severe pain. Some progress very slowly--some very quickly. Nothing is certain with this crap condition. Just the fact that deterioration will inevitably continue. There are more than one MND. ALS is only one of them.
Did I clear that up or make it more confused? You'll note the first line of my quote 60% of patients. Not all notice that initial weakness because the other nerves are able to compensate or we are able to without realizing it.
