Bulbar onset?

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Jusarius

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Hello all! I'm 38-year old male. I have been in good physical condition and doing strength and endurance training 3-5 times per week. However, after a stressful period in September 2020, I started feeling "bubbling" and weird electrical feeling in the soles of my feet. After a couple of days, I woke up with body wide muscle twitches (single contractions) including inside the ear. Over the next few weeks, during the day, the twitches would flare up suddenly and then subside as quickly as they came - sometimes within 15-20 minutes. I could feel them mostly when sitting or lying. Now I have a constant one (since November) in my inner elbow area and occasional hotspots lasting minutes or even hours mainly in my thighs and arms plus single contractions here and there all over the body.

Since December other worrying symptoms have started to emerge: tightness in legs (mainly hamstrings) and now also in both calves - usually after sitting for some time. This is almost every day now. Also, legs and both arms occasionally become very easily fatigued by just doing the dishes. I have also felt "electric buzzing" in the ankles and hamstrings, this has been 4-5 times during the past 6 weeks, lasting hours at a time.

In November, I had intermittent lump feeling in the throat and in January, food started get stuck to the lower esophagus and had some occasional heartburn. It has now progressed over the past 5 weeks so that food would first get stuck right about where my Adam's apple is located. Now, however, bits of food get stuck at the back of the throat every day and swallowing becomes strenuous towards the end of the meal and I can feel tightening of the jaw, face and neck. I continue to have intermittent heart burn and pain in the chest after meals. I have little to no difficulties with liquids. However, during the past week, my nasal cavities have become irritated when drinking juice or coffee for example and e.g. banana tends to get stuck to that area. I think this might be nasal regurgitation. Recently, I have frequent eyelid and lip twitching. Tongue twitches are not frequent but I can now induce loads of them by flicking it with my finger - this happens also with my lips.

I had an ENMG in mid January (from both sides: thigs, legs, arms, forearms, hands, abs and upper trapezius). Apart from fasciculations, no lower motor neuron pathology was apparently detected (didn't receive the paperwork yet). Also no signs no neuropathies. NCV showed mild "damage" in the peroneal nerve in my left ankle. I don't recall having had any injuries there at any point of my life. Around the same time I went to ENT and they did an endoscopy but did not find abnormal reflexes or movements during the swallowing tests. However, I had not eaten for the past 14 hours before the test and tongue + face did not feel tight and fatigued at that moment.

However, do you think this is consistent with bulbar onset ALS? No proper bulbar muscles were tested in EMG which are the ones showing dysfunction at the moment. In addition to swallowing, I feel that I have more trouble pronouncing some words but my wife says she does not notice it and this might be due to monitoring it and becoming too conscious about it.
 

lgelb

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If your wife doesn't notice speech changes, they're not changes.

An EMG will show limb damage in bulbar onset ALS (or any other kind), especially as you describe limb fascics/feelings, were they reflections of an illness.

GERD, allergies, new food allergies, sleep, stress, overall nutrition and exercise are all worth considering, and issues often have more than one cause over time. I see no reason to worry about ALS.

Best,
Laurie
 
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