Resolved question:
Thank you for taking the time to look at my e-mail. My 57 year old mother has recently noticed constant twitching primarily in her calves and feet for the past 3 weeks. It sometimes jumps to her glutes and stomach. The twitches are quite strong and visible and seem to jump from muscle to muscle. After doing a google search, she has convinced herself that it is ALS. Her anxiety levels are currently through the roof and it has affected her appetite and she has also become sleep deprived. The thought of having ALS has consumed her thoughts to the point of having a nervous breakdown. When we are able to calm her down, the twitching does slow down and sometimes ceases. She hasn't had any signs of clinical weakness, however, I believe her mind has led her to perceiving weakness.
Her blood tests came back normal and she also had an MRI of the brain where a tiny lesion was found which the doctors deemed to be non-threatening.
She currently does not exhibit any other signs of ALS, just the muscle twitching. The twitching also stops when she contracts her muscles.
With this one symptom, are her concerns warranted? I am of the opinion that she exhibits the sign of BFS, but would like an experts opinion. She has an EMG scheduled in about a month, but I am worried that she can not psychologically handle the wait.
Submitted:
4 Days
Category:
Internal Medicine Specialist
Hello.
Thank you for choosing DoctorSpring.
I understand your concern. With all the ALS news going rounds your Mother's anxiety is understandable. From her clinical history and additional details provided I can most certainly say that this is NOT ALS or anything of concern. These look like benign fasciculation. The diagnosis of ALS should satisfy a set of criteria. You can see it here - http://www.alsa.org/als-care/resources/publications-videos/factsheets/criteria-for-diagnosis.html May be your can refer this to your mother and make her understand that a muscle twitching is not ALS. It is just one symptom and it alone in isolation does not represent ALS. It is important to keep talking about this and give her confidence.
The EMG result might not contribute much to the diagnosis and you need to wait for this to rule out ALS or anything of concern. The current investigation are good enough when coupled with a good neurological examination. Rather than waiting for the EMG you should convey it her now itself that ALS has been ruled out.
Hope this helps
Feel free to ask followup questions. I will be more than happy to answer any additional question you may have
Regards
Deepu
Hello,
This is Chris's mom. I am so thankful that my son took the initiative to seek advice from a knowledgeable person. It has eased my mind in regards to ALS as both doctors I had shown the video of my calf twitching stated they had never seen this before. My son provided you with almost all pertinent information although when he stated I had twitching all over it really has only been in my right calf, then my left and now I have noticed twitching in my foot as well as sometimes in my knees and thighs. Not much for upper body twitching at all. I believe myself to be a fairly easy going person and have never felt this sort of stress or anxiety before. My anxiety stemmed from local doctors not being able to ease my mind regarding ALS which I know they can't, (actually when I asked the on-call doctor what she thought my chances of it being ALS she stated 50/50. Well my heart sank but then the rational side of me took over and realized this was definately not fact based. But that along with "Dr. Google" and the current campaign on ALS awareness , it was a constant reminder which did not help my case. I do find the more stress I have in regards to this the more my twitching is noticeable. But the fact remains it is constant, and although it used to wake me up from sleep, it now prevents me from falling asleep without taking a prescribed sleep aid. Upon waking I do realize that the twitching is hardly noticeable but once I get up and move around it starts. I am now confident with your answer that I do not have ALS but do you have any idea as to why this is happening. I have also felt numbness in my right hand and arm at times but I realize this can also be attributed to stress. I have a consult next week with a neurologist which is exactly what is needed. Do you think I should insist on an EMG because what we were told is that he would do the consult and based on that decide whether or not to proceed with the EMG. Any other advice or information would be greatly appreciated.
Hello,
I am glad that I could talk to your directly. I understand your concern. Allow me to explain what exactly is the twitching in the ALS. The muscle twitching in ALS is caused by dying nerves. When nerves die the muscles loose their power and function (called LMN lesion) . So these dying muscles will exhibit fascinations and fibrillation (seen as twitching). Twitchings can occur from a a LOT of causes (just like fever can be from a flu or ebola !).
The reason for the above explanation is to make you understand that the muscle twitching is a part of the evolution of the disease. So there will be definite associated signs which can be easily identifiable. Since you did not have any of those there is NO reason to worry. Since you have a Neurologist appointment soon he/she will be able to rule out ALS easily. The numbness could be by stress. I can understand why your GP/local Doctors were 50/50 about ALS. This is because they do not see much ALS in daily practice and ofcourse it is safe to be sure. EMG is not really necessary , but your Neurologist will be the best person to take the call. There is no need to insist on EMG.
Hope this clarifies
Feel free to ask followups
Thank you