Need opinions

armaansd

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Hello Everyone,

I'm 30 year old male living in India. I have hypothyroidism been taking thyroxine 100mg since 2018.

From past couple of months I've been facing these weird symptoms that I'm trying to make sense of.

Here the full context:
late April: felt weakness in lower limbs and postural tremor (whenever I extend my index finger or little finger) in both the hands, went to see a neurologist. He performed peformed MMT and checked reflexes, both were normal except hyporeflexive in Achilles tendon. He suggested to follow-up after one month and gave me some multi-vitamins.

early June: tremors and perceived weakness in legs still there along with I started experiencing widespread muscle twitching (calfs, tighs, tricep area, back and sometimes in hands). He ask me walk on heels and toes which I was able to do. Neurologist prescribed me anticonvulsant (Phenytoin) and asked to meet after one month.

early July: tremors and twitching still there, I also feel weakness in left hand (non-dominant). Till now my neurologist was not able see the twitches but that day they were visible. He performed NCV/EMG (all four limbs left FDI, right APB, right deltoid, right tibialis anterior, left gastrocnemius) which came out normal. He suspected that I might suffering from anxiety and depression and prescribed clonazopam and escitalopram for one month. During EMG he noticed my left hand FDI is little smaller than right one but he does think it's significant to consider as atrophy.

2nd August: tremors have subsided little bit twitches are still there. He performed MMT for upper limbs, noticed that the limbs shakes violently under resistance, but was able to sustain the resistance and consider it normal. Asked to me come again next month. Also suggested to continue clonazopam and escitalopram for one month more.

Questions:
1. Are tremors same thing as fasiculations? (I know fasiculations without clinical weakness or visible atrophy doesn't hold any significance w.r.t MND).

2. Is clinical weakness observed in ALS is gradual or sudden? ( could it be possible that the tremors or limb shaking under resistance is a sign of gradual muscle weakness)

3. Observed these shakiness in arms and legs while yawning in the morning or while stretching, could this be a early sign of weakness?

4. Do you thinking my symptoms are related to early onset of ALS? (I know clean EMG = no ALS)

Apologies for the long post, I believe this context should be necessary for you folks to answer my following questions.

I really appreciate this community and people who are either suffering from this horrible disease or providing support to a loved one and despite they are helping people to clear their doubts.

Thank you all
 

lgelb

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No/no/no/no.

An SSRI and benzodiazepine, both powerful and with tradeoffs, are not indicated for someone who "might" be suffering from depression and/or anxiety, nor subject to an arbitrary "one more month" duration. Anticonvulsants are much overprescribed for conditions other than seizure disorders, and have their own side effects as well. I would find another doctor to work with you on feeling better from both a physical and mental standpoint, including possibly titrating the thyroxin up or down, and also review your diet, electrolytes, and hydration.

Best,
Laurie
 

armaansd

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Thank you Laurie for your response. I'm thinking of getting a second opinion from an another more experienced Nuerologist along with seeing a Psychologist to evaluate depression and anxiety.
 
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