Status
Not open for further replies.

Fleetlord

New member
Joined
Jun 19, 2008
Messages
4
Reason
Learn about ALS
Country
US
State
Florida
City
Orlando
I'm a little frustrated as I either cannot find a clear answer as to what type of twitching I'm having, or I don't understand the answers...

I am experiencing the following...

Random slight contractions of muscle that are focused in one spot of the muscle. It can contract once, or it can go on like a blinking light. I cannot see any rippling under the skin. The muscle just jumps. It can happen in my bicep, tricep, shoulder, thumb and side of hand(those move the finger). They feel like a centralized "flex" of the muscle, like a POP inside my bicep or tricep...Feels like my bicep is flexing its bicep...

Are those fasicualtions or myclonus?

I have some twitches that I CAN SEE in my calfs. They don't ripple, I can see the muscle flex and release slightly. I don't feel them as much in my calves...less intense, but they happen more frequently..

So, I've been to the Neuro. Had the MRI's, EMG, NCV.

Legs showed some abnormalites in thighs on EMG correlating to a "spinal issue" at L3/L4 MRI is showing a congenital canal narrowing at that level. Spinal cord involvement is suspected, but not clear. Radiculopothy is the diagnosis. Neuro said other "fasiculations" are benign and anxiety related..

Seems fasicualtions is just a generalized term for "muscle twitch", but the definition I see everywhere specifies visible, rippling muscle under the skin. I don't seem to have that anywhere but my calves, even then it doesn't ripple...

I'm having a back ache (intermittent), thigh weakness (both), buring down both legs from knee down, intermittent numbness in both legs, and the "twitching".

Another doctor suspects I have MS, however. Reason being I'm having some "Carpal Tunnel" like troubles in my right hand, but the NCV loss wasn't severe enough. I was about .04ms too latent on the nerve conduction. Slight sensory, dexterity,pain issues.

MRI showed no lesions for MS.

My focus on twitching is that MS doesn't have rippling fasiculations like ALS. It has Myclonus, but I don't really know what they mean by that, or what type of twitching I'm having...:confused:

Any help is appreciated..
 

awieleba

Very helpful member
Joined
Apr 28, 2008
Messages
1,023
Country
US
State
michigan
City
oakland twp
twitching explanation

I can relate and was thinking about posting the same questions on fasc. and twiching.

I do get single fire twiches that feel like twitching. But I get that muclse contraction also. It feels like the muscle is flexing it self or it will kinda tighten then relax quickly in one spot. Afew times on my thighs it was like 5-6 times and I could see. But I dont have rippling twitching that i can see. I can see the little single twitches. I aldo have a thing where my arm or leg or hand will just jerk slightly like when you fall asleep but I am awake, I thought that was myoclonus? I have no idea. it would be nice if someone who has these or knows the difference would explain! I know that i dont have cramps or the spasms that hurt. But is your muscle jumping or moving on your thigh a kinda spasms? it does not hurt, just startles me a little.

anyone who can explain, please do.

april
 

wright

Very helpful member
Joined
Jan 12, 2008
Messages
1,160
Country
US
State
xx
City
xxxx
Fasics versus twitches

They are in essence the same thing: contraction of a group of muscle fibers that make-up a motor unit (a motor unit is a single axon and the muscle fibers that it innervates). Sometimes people and physicians use the term fasics when talking about ALS and not the term twitches, so it can be a matter of semantics.

I believe the reason some use the term fasics with ALS and not twitches, is because of what the small contractions feel and look like. I think that most of the time they "ripple" or feel like worms (i.e. vermiform twitching) with ALS or at least that is what I have read and what seems to be the general consensus on here. I believe they feel and look that way because they are so constant and occur in so many motor units. Having said that, I have read posts on here where some PALS don't have the vermiform twitches but rather your "simple" twitches. There are always exceptions to the rules, especially when it comes to ALS.


Myoclonus

Myoclonus is a larger contraction than a twitch and typically causes limbs and body parts to move uncontrollably. It can be due to some type of dysfunction of the brain or spinal cord but can also originate peripherally. There are a lot of different types. Other times it's simply due to a release of muscle tension. I think the two most people are familiar with is "sleep myoclonus" which causes someone to startle right when they're about to fall asleep and the other is hiccups.

I actually developed myoclonic jerks when I was really stressed and it probably had something to do with the muscle tension I had because of my anxiety and the subsequent release of that muscle tension, manifesting as myoclonic jerks. They got much better and more or less disappeard when my stress levels diminished. That might be something a lot of you want to keep in mind.

Other types of myoclonus signify something pathological: palatal, essential, cortical, action (I think that's considered the worst one) and a few others I can't think of right now. With all of them, muscles are contracting involuntarily and can signify something is wrong with some part of the nervous system.

Anyway, I hope that helps.
 

awieleba

Very helpful member
Joined
Apr 28, 2008
Messages
1,023
Country
US
State
michigan
City
oakland twp
wright

thanks wright.

I do notice my myoclonic jerks more at night when I am trying to relax. I had alot more in day when i was more stressed over all this. Maybe my muscle is trying to relax.

Do think if an area on the thigh (like maybe 6 inches long) jumps/contracts for 5 or 6x then stops is a twitch, spasms, or myoclonus? It feels different than the random twitching and the myoclonic jerk. it does not hurt and does not feel like a twitch. it only happens maybe once a week or every 2 weeks.

thanks

april
 

wright

Very helpful member
Joined
Jan 12, 2008
Messages
1,160
Country
US
State
xx
City
xxxx
It sounds like a twitch to me. The motor units in the leg are large (sometimes as many as 1,000 muscle fibers) so the twitches will be larger.

How often do those twitches happen and do they happen when you are in certain positions? Can you make them go away by changing positions?
 

awieleba

Very helpful member
Joined
Apr 28, 2008
Messages
1,023
Country
US
State
michigan
City
oakland twp
when you mention it, it seems that every time it has happen, I was sitting in my car! I dont think it has ever happen while standing. I can rub it and it goes away, but it may have been over anyway. It only happens like every week or two, not often

thanks for being helpfull to everyone!

april
 

Fleetlord

New member
Joined
Jun 19, 2008
Messages
4
Reason
Learn about ALS
Country
US
State
Florida
City
Orlando
Wright,

Thanks! You've made some sense out of all this for me..

I'm definately having "brisk" twitches instead of the rippling veriform type.


They seem to go away if I move or change positions. Most of them at least..

I don't seem to be getting progressively worse in any one area, but new stuff is popping up. The stuff varies from day to day. One day my hand is worse than my legs and vice versa. Sometimes it's pain. Sometimes it's burning. Sometimes it's weakness.
That cycle seems to be spreading a little, but not one limb getting worse. They are taking turns..I've had this for about a month now...

Interestingly enough, my B12 results were considered low normal. I take Nexium for heartburn and that effects B12 absorption. Three doctors seem to be in agreement that I am low and could use some B12 shots, but to this date, not one can decide who is going to give them to me:confused:
 

planningguy

Senior member
Joined
Jun 5, 2008
Messages
556
Country
US
State
Wyoming
City
Sheridan
Fleetlord - If you have low B12 and three doctors agreed you should probably have shots, then I would recommend that you pick the one you are the most comfortable with and have him/her administer them. B12 shots are pretty straightforward, and if you are comfortable enough, they are easy enough to administer yourself in the thigh. The multi-dose vial and syringes will probably be the cheapest prescription you will ever have filled.

I have pernicious anemia (antibody prevents B12 absorption), and I give myself a monthly shot. Most people who have had low B12 for a significant periof of time notice the difference pretty quickly.

I do have a question for Wright if its ok. I now have both twitchs, and the rippling fasciculations (The ripples are mainly in my calves, which is also where I have considerable soreness and occasional cramping). I asked in another post if their was a significant difference between the two types of twitches. I know a little about BFS from reading, but my question is are there many other conditions that can cause the finer ripples along with weakness and soreness? On the other post CIPD was mentioned as a possibility.

Thank you,

Robert
 

patricia1

Very helpful member
Joined
Sep 18, 2006
Messages
1,149
Reason
PALS
Diagnosis
7/1999
Country
US
State
newjersey
City
lopatcong NJ
Wright,

Thanks! You've made some sense out of all this for me..

I'm definately having "brisk" twitches instead of the rippling veriform type.


They seem to go away if I move or change positions. Most of them at least..

I don't seem to be getting progressively worse in any one area, but new stuff is popping up. The stuff varies from day to day. One day my hand is worse than my legs and vice versa. Sometimes it's pain. Sometimes it's burning. Sometimes it's weakness.
That cycle seems to be spreading a little, but not one limb getting worse. They are taking turns..I've had this for about a month now...

Interestingly enough, my B12 results were considered low normal. I take Nexium for heartburn and that effects B12 absorption. Three doctors seem to be in agreement that I am low and could use some B12 shots, but to this date, not one can decide who is going to give them to me:confused:

Give yourself the injections i do. Get a script from your MD Its 6 dollars a vial.

Pat
 

wright

Very helpful member
Joined
Jan 12, 2008
Messages
1,160
Country
US
State
xx
City
xxxx
Robert

Twitching can be caused by so so so so (did I say so?) many things, including CIDP.

One other thing: vermiform fasics are not exclusive to ALS; they can be seen in any condition that causes a muscle to twitch.

I hope you get your answers soon but as I have said, I certainly wouldn't be concentrating on ALS. You will be in good hands with a neuromuscular specialist and they will most likely get to the bottom of your condition.

Take care
 

rjteach

Member
Joined
Jul 1, 2008
Messages
15
Reason
Learn about ALS
Country
US
State
ny
City
ossining
question for wright

hi wright. I just came back from my second emg. Was clean. 30 days after first symptoms was my first clean one and today 90 days later was my second clean one. He did my whole right side. 9 sticks. from calf to the back of neck.

I still have this problem when i swallow, the ball at the bottom of the throat feel. Im worried about bulbar. does two emgs clean rule it out. Ive read that a good emg on the limbs would detect a problem with bulbar or the throat. The nuero said that trouble swallowing with bulbar is the beginning of the swallow and not the end(bottom of throat feel). Said they also look for speeck problems. Said he didnt seem it necessary to do sticks on tongue or face. told me to get on with my life.
 

planningguy

Senior member
Joined
Jun 5, 2008
Messages
556
Country
US
State
Wyoming
City
Sheridan
Wright - Thank you for the reassurance, I knew it was the case, its just good to hear it(yet again :-D) from someone else.

Robert
 

wright

Very helpful member
Joined
Jan 12, 2008
Messages
1,160
Country
US
State
xx
City
xxxx
Hello RJ

Certainly it's always a good sign when EMG's are clean with lower motor neuron symptoms (twitching and supposed atrophy in your case). Congratulations.

Can an EMG be clean on the limbs with bulbar symptoms: yes it can if lower motor neuron death has not yet progressed to the spinal cord. HOWEVER, from what you have said in your other posts, your symptoms don't appear to be "ALS-like" symptoms. Case in point: you say you think you have atrophy but you don't have weakness: that is definitely not typical of ALS. I'm still not convinced you truly have atrophy.

I certainly can't tell you more than your neuro; his words should give you more solace than mine do. I would do your best to believe what he says and then do as he said: get on with your life. If things change, then give him a call. We're also here to help you if we can. Take care.
 

rjteach

Member
Joined
Jul 1, 2008
Messages
15
Reason
Learn about ALS
Country
US
State
ny
City
ossining
thanks

wright . what do u mean though when you say if lower motor nueron death hasnt gotten to the spinal cord. If an emg clears up your whole body, wouldnt that mean that there is no problems with your lower motor nueron base.

Also, the twitches that ihave in mybody are the same twitches that i felt in my face from time to time. So im guessing that if my twitches were clean in my arm and legs, then they should be clean in my face.

Last question. When they stick a needle in your tricep lets say. The nuero told me that the needle is like an eye and it covers a little area. If thats the case then why do they only do like 6 or 7 needles and not many more. Is it because they know that if there is a problem lets say in your arm that its probably gonna show up now matter where they exactly place it.

thanks again.
 

wright

Very helpful member
Joined
Jan 12, 2008
Messages
1,160
Country
US
State
xx
City
xxxx
I'm almost hesitant to write this, because I don't want to cause anyone undue stress and I hope that it doesn't.

When ALS "begins" it typically begins focally and then spreads radially. If it has begun in the bulbar region, then it is due to death of the lower motor neurons of the brainstem (the brainstem is shaped like a bulb, ergo the name, bulbar) . . . and if it is in the earlier stages, might not have spread to the spinal cord. If there is no lower motor neuron death in the spinal cord (the lower motor neurons of the spinal cord are what innervate your limbs and thoracic region), then the EMG will be clean in your limbs. The EMG of bulbar muscles (tongue, swallowing muscles, facial muscles, etc.) however, would be dirty.

Having said that, typically if you are to the point of having bulbar symptoms, then spread to the spinal cord has more than likely already happened and therefore the EMG in the limbs would more than likely be dirty. It takes time for clinical symptoms to manifest after motor neuron death, so many times you can have a dirty EMG before you even know ALS has begun or before it has spread to clinically unaffected areas of the body. I hope that calms the fears of people that read the above paragraph.

To answer your other question: yes, if you have ALS symptoms or are suspected of having ALS, one or more of the 6 or 7 muscles that they EMG will most likely show signs of denervation on the EMG. They will typically EMG muscles that are innervated from different regions of the spinal cord to be thorough. If you have a particular weakness and/or atophy in a muscle, they will definitely EMG it.

As your neuro said, you are fine. He has evaluated you both clinically and electrophysiologically and there is obviously no sign of motor neuron disease. Do your best to move on with your life and to be grateful . . . BUT . . . don't forget about this disease and do what you can to help those that have it.
 
Status
Not open for further replies.
Top