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Adam123

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Dear Forum,

Thanks to all of you who take time to read and respond. Like many , i seek advice from others on my case. I have read the stickies before joining and posting.

I am 45, male. A year and a half ago i observed fasciculations in my left calf. They have been since constant. They are not painful nor painless. I see and feel them like tiny electrical zaps from a small battery. I experienced some cramps at the time but they went away. I noticed some infrequent twitching in my right calf, but rare compared to my left calf (24/7). I have infrequent twitching elsewhere (arms, back, fingers, eyelids) like 30 seconds or so every one or two weeks.

I have been following up with 2 neurologists and these are their findings and conclusions so far:

- EMG (2 months after symptoms):
- Left calf showed many fasciculations and large motor unit amplitude and duration
- All other tested muscles (all limbs and back), normal
- NCS was normal
- Clinical exam normal
- MRI showed L4-L5-S1 disc degeneration and suspected radiculopathy on left side
- My blood tests were normal with low'ish vitamin D but within the norm
- I do not exhibit clinical weakness or atrophy

Both my neurologists suspect radiculopathy and ruled out anything else. They state my EMG shows chronic neurogenic changes consistent with an old nerve damage (months or years). Over ten years ago i slipped my L5 S1 discs. One of the neurologists believes anxiety could be contributing. I have never suffered from anxiety as far as i know and if i do now, i am sure it followed the twitching not preceded.

My questions / concerns:

- As with many, i am concerned the fasics could be early signs
- I read that new diagnosis criteria treat the combination of Fasics and large motor unit in same muscle as a sign?
- Can radiculopathy cause all this and is it correct that large motor units are a sign of an older damage?
- I am not sure how radiculopathy on left side could explain my right calf twitching
- I am concerned my right calf twitching is gaining momentum in frequency and will be similar to my left calf soon.

Any feedback from the ladies and gentlemen on this forum, and anyone who has experienced similar symptoms, would be much appreciated.
Thanks and bless you all.
 

lgelb

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If you could post the full report/data, that would be helpful. However, from what you say, there is no sign of diffuse active denervation so that would take ALS off the table. Large motor units are common after remodeling has taken place, and the fascics in the same muscle group, but not others, adds weight to that hypothesis.

As for your right calf, as you know from reading the stickies, twitching alone means nothing. And it's not unjust to say that if your left calf is twitching, you might experience some hypersensitivity in your right. The mind is very powerful.

Literature suggests that subclinically low vitamin D may merit treatment, and you might want to treat possible electrolyte imbalances empirically with diet as well, to help address the twitching, and even try a few drops of Mg lotion. I would also ask if PT or a new home exercise regimen for the old injury could have any benefits.

Best,
Laurie
 

Vincent

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The big issue in ALS being clinical weakness, you having none puts you in the clear. There is something going on as noted by your neurologist, listen to him/her. As this is a site that deals exclusively with ALS, you are free to go.
Vincent
 

Adam123

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Dear Vincent and Laurie,

Thank you so much for your quick and informative replies. I really appreciate it.

My main concerns really come from the "new" diagnostic criteria that seem to state fasics as denervation signs, i think its called the Awaji criteria. This is what got me concerned as they refer to the combination of fasciculations and motor unit amplitudes as a diagnostic criteria as they represent denervation and re innervation in same muscle (at least thats how i read it).

I appreciate though diagnosing is probably more complicated than that.

Laurie, not sure how to upload documents but here is a cut and paste - i hope it helps. The EMG table itself only shows Fasics and large Motor units (amplitude and duration) in my left calf. Please read below notes from the report.

"This is a mildly abnormal EMG. Chronic Neurogenic MUAPS were noted in left gastrocnemius with spontaneous activity (fasciculations). These findings in appropriate clinical context represent remote left S1 radiculopathy. No evidence of diffuse anterior horn cell disorder like motor neuron disease was noted"

Thank you again for any insight or feedback.
Adam
 

Nikki J

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As it says in your summary no evidence of ... motor neuron disease

The Awaji criteria do not refer to any old fasciculations but to a specific type of fasciculation potential. From the criteria “Evidence of chronic reinnervation as above ,with evidence of acute denervation in the form of fasciculation potentials, preferably of complex morphology, or instability when studied with a high band pass filter and trigger delay line, which suggests their origin from reinnervated motor units.”
 

Adam123

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Hi Nikki

Thanks for your reply.
I cannot tell from the report the specific nature of the Fasciculations whether they are complex or not. The only description in the report table was that they are many.

When I discussed with the doctor the feedback was the soUrce is most like radiculopathy and subsequent anxiety.

Hence my concerns and why I reached out to the forum.

I guess your combined feedback to me is to trust the neurologists feedback and take comfort in the lack of any clinical signs of weakness.

Unless you or any other members have any poInts to add, I will do that and appreciate all this and for you and other members taking the time to respond.

Thanks again and my very best to all
Adam
 

Nikki J

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I am quite sure your doctor would have noted in the report if they were of the worrisome variety. They are fully aware of diagnostic criteria and know the difference. Complex would have been specified. Best of luck and a long and happy life
 

Adam123

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Thanks Nikki.
We had agreed to have a repeat follow up EMG now that its been more than 18 months. Am a bit scared to be honest but i guess thats only natural...my doctor is saying its up to me to do it or not but does not see a clear need as there are no new symptoms. ...
 
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