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Pamhill83

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So I've had a slew of variety of symptoms over the years first being on and off all over muscle twitching. The started about two years ago and subsided probably in a matter of a couple of days. Always seems to come and go. I was just seeing by to neurologist for headaches and some other symptoms, however nothing came up about any nmd type issues.

I had two neurological exams 2 weeks ago, and the doctor who gave second opinion wants me to have an MRI because of new onset headache.
She spent alot of time on my arm reflexes, but said nothing about it. The first Neuro breezed through his exam about 5 mins in total.

I have been having increasing cramping in my hands when using them, and twitching in my thumb. The cramping seems to be happening right in the middle of my hand where my palm is. My thumb seems to favor curving inward.

Now I'm also having cramping in both my feet and muscle spasms in my thighs when I'm relaxing, or in bed. They burn from time to time.
Twitching is happening at night.
About a month ago I was walking off my front porch slipped fell and broke my ankle.
Should I ask for further testing at this point to rule out ALS?
 

lgelb

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Since you are already headed for an MRI, I would see what if anything that shows before discussing the indications that may exist for an EMG. But the wax/wane nature, 2y duration, and variety of your symptoms does not suggest ALS.

Best,
Laurie
 

Pamhill83

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How likely is it both doctors missed signs in the Neuro exam? Is the Neuro exam even a good indicator of motor neuron issues?
 

Nikki J

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Likelihood they missed something? Very very very low. They do these exams all day every day. It may seem that they breeze through but whensomething is abnormal it is a red flag

The modern neurologic exam has been developed to test efficiently and thoroughly for neurologic problems. Each component looks for specific deficits. If your exam was normal then you do not have signs of ALS
 

Pamhill83

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Thanks Nikki.
It was just unusual that the 2nd Neuro kept going back and forth testimg my arms with the hammer over and over. I didnt have a reflex on my left arm. But ahe didn't say anything about it! I didnt think to ask!
 

Atsugi

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Pam, remember that each of those neuros has kids they need to get through college, and so they REALLY don't want to misdiagnose any fatal diseases.

They do this so often that it can be fast and over with before you know it.


My wife, a doctor for 20 years, used to call patients herself, so she could see them get up in the waiting room. She said she had most people diagnosed before they got to the exam room!

Don't worry about ALS. But good luck with whatever it is that causes your symptoms.
 

Pamhill83

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Isn't a absent reflex a sign of ALS? Coupled with fasiculations a red flag?? I feel the Neuros has dismissed this! All the textbooks and articles I read say absent reflex is sign of motor neuron disease. I am lost...
 

Nikki J

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People with ALS generally have hyperactive reflexes. When absent reflexes are found in ALS it would be a late finding coupled with significant weakness if not paralysis and muscle wasting.
 

Bestfriends14

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No, absent reflexes are not a sign of ALS. You've been told by professionals you don't have it and told by members here that you do not have ALS. So why are you trying so darn hard to find reasons that you do? Does that not give you a pause?

Pam, go and live your life. You do not have ALS, so be grateful for it. If you cannot accept the fact that you do not have it, and continue to search for reasons to try and get a diagnosis, then you should perhaps seek counselling as to why you are not accepting a clean bill of health. I'm sorry if I sound blunt, but any member here would trade you places in a heart beat.

Good luck to you and hope you can focus living the best life you can in 2019. Take good care.
 

lgelb

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Pam, think about it. If absent reflexes were a sure sign of ALS, why would we need EMGs? There can be many reasons for those, and not all of them are sinister. If anything, at onset, reflexes in ALS are more likely brisk than absent. The MRI will look for things like spine problems that can certainly relate to the issues you report.

Best,
Laurie
 

Pamhill83

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I am sorry for these posts. My biggest fear is of course that I will develop weakness in the near future. That there are a few patients who started with the twitching and eventually had weakness. It's hard right now to cope thinking that could be my reality. Trying to live being in the moment. It's not easy.
Thank you all though for your time you've taken to reply.
 

MVFinVA

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Pam, By the time my husband had the twitching he already had the weakness, he just hadn't noticed it yet. Two weeks after we noticed the twitching a neurologist gave him an exam and the first thing he said was he was concerned my PALS had ALS. Further testing, EMG, etc followed. There were things he was looking for in the exam that told him ALS was a possibility. To us, watching the exam, there was nothing particularly concerning. He was the professional and knew what he was looking for. If the neurologist didn't see anything in your exam, there was nothing to see. Trust the doctor and the folks here.

Mary
 

Pamhill83

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I forgot to add- in early November I had a baby- 4 days before she was born I slipped on my steps and fell and broke my ankle-slight avulsion fracture. 3 weeks later I fell again in the yard after my dog pushed me and I lost my footing. I have not fallen since or lost balance but I do "knock around" into things like doorways. I didnt tell the Neuro because I forgot. Should I mention it again?
 
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Nikki J

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Tell the doctor anything that you worry about but none of that sounds remotely concerning
 

Pamhill83

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One question- is bulbar ALS subtle? The last few weeks I've had some episodes of choking on saliva, and also excessive drooling at night? My voice is scratchy throughout the day and when I wake up. My husband has commented on noticing my voice changes. Could this possibly be signs of a slow bulbar onset?
 
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