Fasciculations all over the body and lump in the throat

bgtr89

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Hello, I am a 35-year-old Brazilian man. I apologize in advance if my English is not perfect. Throughout my life, I remember having fasciculations in my body, like those that commonly occur near the eye.

Currently, after a period of a lot of stress and anxiety, I suddenly developed fasciculations all over my body. I have fasciculations in my face, arms, legs, neck, buttocks, and even on my head. It would be easier to list any point where I don’t have them. Additionally, I have started to experience a tremor, nothing too pronounced (especially in my hands).

This has been going on for about two months. I consulted a neurologist and had an electromyography of the upper limbs—this was because the fasciculations first started in my right arm.

The test was clear and showed no abnormalities. My doctor said everything was fine and did not see the need for another electromyography (I also had an MRI).

This year, I went through a lot of anxiety associated with hypochondria after having to undergo some medical tests. Around the same time the fasciculations appeared, I developed a sensation of a lump in my throat. I saw a doctor, and he detected inflammation in my throat caused by reflux. I am undergoing treatment and have shown improvement; the sensation has migrated from the right side to the left side and is less intense (I have not finished the treatment with the medication yet).

The neurologist and also a psychiatrist prescribed me some medications to cope with the high anxiety. In the first few days of the medication, I felt a bit of weakness in my legs and also a lack of coordination, but this has improved a lot as the days go by (however, I still feel my legs a bit weak).

I also started to have spasms, involuntary movements mainly in my legs that occur when I am starting to fall asleep. At first, these symptoms were more pronounced, but now they seem to be regressing as well.

I have been observing my body for signs of atrophy, but I haven’t found anything significant. I wonder if some asymmetries have always been there or if they are just in my head. For example, I have small indentations on the side of my tongue caused by bruxism and teeth grinding, which was noted after a visit to the dentist to address the issue. However, in this moment of hypochondria, anxiety, and stress, my mind plays tricks on me.

Returning to the fasciculations, they do not have a pattern; they appear here and there and usually last a short time (a few seconds and sometimes just a single twitch). Some limbs go days without showing fasciculations, while on other days I feel them in several of them. I even observe my tongue; I see tremors when it is sticking out, but it doesn’t seem to match the same pattern of fasciculations I see in videos. When the tongue is at rest, I have observed with my phone's flashlight that I don’t see it fasciculating, but I can see an occasional intermittent twitch.

So far, I have not had clinical weakness or problems writing, typing, or getting dressed. I also haven’t had any trouble swallowing (except when I get very nervous and seem to mimic the sensation) and I don’t have problems speaking any words (I am a teacher and have been speaking normally, except for the discomfort from the inflamed throat).

I have been very tense, which has caused me insomnia. I also had a test and my B12 level is low (338.0 pg/ml).

What do you think of my description? Is there anything that could reassure me? I greatly appreciate any opinions. I'm very anxious, and this has been affecting my work and my relationships with my family.
 
Hello-

Please read here: Read Before Posting. It explains why twitching absent clinical weakness points elsewhere. You have a life long history of twitching, you have no weakness and you have been cleared via emg and multiple clinical exams by a neurologist. You appear have a very overwhelming case of health anxiety and report intrusive levels of self testing and hypervigilance.

You appear to have had some side effects from meds the doctor has prescribed, so your best course is to check back with them about adjusting or changing them. ALS is not in the picture here. It seems like you may also benefit from additional support via talk therapy to find some tools to reduce your stress and focusing on your health.

Please take care
 
Thank you very much for your response; it helped me a lot.

I’m new to this “world.” Is it possible for an electromyography (EMG) and nerve conduction study to come back normal in a limb that has fasciculations and/or atrophy due to ALS?
 
From the link I provided you. Please make sure to read it, as your questions may already be addressed there:

EMGs
Does a dirty (abnormal) EMG mean I have ALS?
EMG, properly done, is the gold standard test for ALS. But an abnormal EMG can indicate hundreds of other, non-fatal, diseases. So listen to your doctor.

My EMG was done “too early”

EMGs cannot be done too early. 70% of a nerves fibers die before you feel weakness. An EMG will detect that process long before you can feel it.
Here is a simplified summary:

1. ALS causes nerves to die.
2. EMG detects effects of nerves dying.
3. For ALS, muscles get weak and atrophy when they lose their nerves (no pun intended).
4. Therefore a weak or atrophied muscle due to ALS will absolutely, positively show up on EMG. Clean EMG = No ALS and a clean EMG plus a normal clinical exam = no Motor Neuron Disease at all
 
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