Your neurologist is correct, Gracie, although most cases start with localized twitching that then spreads. I was one of the atypical pALS whose first symptom was body wide twitching, with no functional failure. As Al said, it is more rare than localized twitching that spreads, but it does occur. Published literature indicates that this all over the body initial presentation seems to be more prevalent in men over age 50, like me, but it can and does occur.