Need your help. Leg weakness twitches

[canukr]

Good day, society. I express my respect to everyone and thank you for your time and attention.

English is not my first language, so please accept my apologies for any unclarity and mistakes.

I have been holding myself from publishing here for several months, but I feel that cannot withstand it anymore. I need your help to look into my case and give any advice.

I’m a Caucasian white male 39, an amateur runner, and a fit person. At the end of December 2023, I underwent a mild cold with nose congestion for a week, after which all my troubles began. One day (1-2 weeks since I got better) I started to feel pain in my chest, higher than normal heart rate when walking, doing chores, or even dishwashing. In a few days, I got to ER with complaints, they examined me thoroughly and found that my heart was in good condition. But the symptoms remained, so in 2 weeks I went to ER again and they again did not explore anything wrong with my heart. I felt dizzy and had shortness of breath, so since then I had to stop walking and exercising as I used to. I was reading about heart failures and cardiomyopathies, which spoiled my sleep and made me anxious. At the end of February, I started to feel some subtle lack of confidence in my legs, subtle weakness and tremors in my wrists, and weird palpitations in my chest. In early March palpitations spread to the rest of my body and I googled that those were “fasciculations”. After visiting ER, I was sent for a brain MRI which came back clean. Then I asked my family doctor to refer me for EMG. At that time my hotspot was the right wrist, however, twitches were all over my body from face to butt and legs, though not intense. I got my EMG/NCS on April 17. The doctor poked my arm and leg once and reassured me I had anxiety and the twitches were more likely BFS.

I came out a happy person having all life ahead. But during the next 2 weeks, some weird things started to happen – first panic attacks, then blood pressure surges. I went to the walking clinic and got the prescription for Sertraline (SSRI Zoloft) which I have been taking now for 5 weeks or so. Then at the beginning of May, the fasciculations increased in my legs (first thighs, then the rest of the legs) and I started to feel like both legs became weaker like jelly. I still can walk and do all the things, but I used to be a runner and am sensitive to my body, so I’m noticing that something is wrong. I have random twitches in my arms, lips, back, and stomach, but most twitches are happening in my legs now. The twitches are short and some of them are subtle and they happen at rest and not while the muscle is active, especially after using the muscle. But the weakness in my legs is driving me crazy and urging me to move less. I feel like even visiting a WC in the office requires effort, though I still can walk 5-10 km when it is needed. I was in ER 2 weeks ago and underwent a short physical exam by an ER neuro. No clinical weakness was found. CK was 42 then 58 the second time (a week ago). Thyroid and all other bloodwork is ok, although D and Lyme are pending.

But I’m wondering how the clinical weakness is developing. Could the first EMG have been made early or in the wrong spots? Could my lower heart rate variability and higher HR than before my weird disease be a sign of dysautonomia? I also feel fatigued all the time.

 

[ShiftKicker]

Hi there-

You list a few things that have nothing to do with ALS. Please make sure to have a read here: Read Before Posting, as it explains why things like dysautonomia, chest pain and dizziness point towards something else. I would also direct you towards Covid19 and Neurological Symptoms, as there seems to be new research published daily about how this virus affects various systems- sometimes long after initial even mild or asymptomatic infection.

In the various muscle twitching/BFS and long covid discussion groups across many social medial platforms, there are many threads about twitching and dysautonomia, muscle pain, etc. While I am not stating definitively this is the issue, what you are posting sounds much more something like this than anything affecting motor neurons.

Please take care

 

[canukr]

Thank you for your kind reply. I also consider COVID as an underlying reason, however, increased leg weakness does not align with my theory. Could Sertraline cause this? Should I request another one EMG? The first was done on April 17. Sorry for being annoying, but a neuro appointment is a big deal here in Canada.

 

[Nikki J]

Post viral symptoms do not always appear right away nor is worsening for some months unusual. If a neuro is concerned re als and wants a second emg ( which doesn’t seem to be the case for you anyway) the usual interval is 6 months , sometimes 3 months.

This totally sounds more like postviral and not like ALS as shiftkicker said

 

[ShiftKicker]

Feeling weak isn't quite the same as diagnosed clinical weakness. If you are concerned, you can return to your family doctor. Another way to get a full physical assessment is to visit with a physiotherapist with a goal to work on conditioning and strength. That way you will get baseline and continuing measured strength measurements. If there are issues, you have the observations of a trained physio to provide.