Widespread twitching plus brisk reflexes and Hoffman sign

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Scaredmamaoftwo

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I’m 40 years old. Mom of two under 4. I’m pretty worried. I started having muscle twitching in early November (4 months ago). It started very randomly in my left upper arm/bicep. By the next day I had twitching in my right arm too. Within weeks the twitching and progressed to almost my entire body (legs, feet, arms, hands, fingers, abdomen, upper back, butt, even groin/pelvic floor. ) They used to happen a few times a day, but have really processed and happen all day long, in multiple muscle groups at a time sometimes. The ones that are most often and the strongest are the ones in my upper arms (deltoid area), upper back and upper legs. You can physically see and feel them happening. Non-painful. Nothing stops them.

I have been tested and all came back normal for MRI of neck, all deficiencies (copper, magnesium, vitamin B12, Folic acid, D, B1, B6, zinc, etc). I’ve also been tested for celiac and any autoimmune diseases. All was negative.

I have a positive Hoffman sign on the right hand and brisk reflexes (3+) all over.

I’m not sure if it’s related, but this started a year ago with a very sudden onset of severe deep cramping in my legs. It felt like I had the flu and was achy. Tylenol didn’t relieve the pain. I would get leg weakness too when these episodes occurred. I had those episodes of cramping on and off for several months along with daily tingling in my feet that was awful. The tingling was worse in the mornings. I have had random hot feelings in my right foot too.

The tingling comes and goes and has been better the past two months. But I still get it occasionally. My legs, feet and even arms go numb very easily and often. Just sitting normally can make my legs go numb.

No real weakness. My arms (forearms) get tied easily. I notice I can’t hold my phone up long anymore, but it’s minimal and it doesn’t seem like it’s progressing.

I’m most worried about having brisk reflexes, a positive Hoffman sign and progressive body wide fascinations for four months. And I’m overly fatigued. I’m struggle to just function day to day. It’s very unusual for me the past few months. I feel as though I haven’t slept in days, but I’m getting enough sleep.

I have an EMG scheduled next week and I’m not feeling positive about it. These muscle twitches are too constant and all over my body.

My neurologist told me if my EMG comes back normal, I don’t need to follow up with him anymore. That’s it’s benign. Does that seem right? Positive Hoffman sign, brisk reflexes, and body wide progression of muscle twitching and if EMG normal then just consider all that stuff no big deal?
 

ShiftKicker

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Hello-

We ask that people read here first: Read Before Posting to learn about twitching and what symptoms would (or would not) cause a doctor to be concerned about ALS. You list a fair number of non-ALS related issues- particularly sensory issues (pain, tingling, numbness, etc) and symptoms that come and go or which improve.

This link may also be of interest to you. You mention a possible viral infection, and covid has been found to cause all sorts of odd symptoms long after acute infection.

Hopefully your neuro might be able to provide you some reassurance with regards to ALS after your EMG.

Please take care
 

lgelb

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Millions of people have a positive Hoffmann sign and no nerve issues. Brisk reflexes can be a normal variant or indicate anything from coffee to anxiety. Widespread twitching in the absence of a problem with doing/moving something argues against ALS and most serious things.

So there is something to your neuro's statement, but it just means that a clean EMG would suggest following up with your internist if you develop any functional impairment. And you could focus on self care from that point, without feeling like you were missing something treatable. Stretching, balance training, diet, hydration, therapeutic massage, swimming, are all examples of ways that you could probably help yourself feel better.

Best,
Laurie
 
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