Hello,
Thank you for your query at DoctorSpring.com
I am pleased to assist you.
The good thing is a thorough clinical examination has already been done, and there is nothing suggestive of ALS. In fact with the recent awareness about ALS, a lot of patients are coming with such symptoms, and they are scared of ALS. The anxiety is natural, however in your case there is absolutely nothing suggestive of ALS.
There is no obvious muscle atrophy, or progressive weakness in the limbs. In Bulbar onset ALS, as you rightly said the first symptom is that of difficulty in swallowing, however it is almost always associated with speech issues and loss of tongue movements.
Mostly if there was any minute features of ALS, EMG would have been conclusive. A normal EMG on both limbs rule out ALS completely. Anxiety can itself lead to a lot of symptom manifestations. So you can be rest assured you have nothing to worry about. If anxiety is persistent you can meet your local physician who will prescribe you anti-anxiety medicine for a couple of weeks.
Regards.
Patient replied :
Thank you for your reply.
So since my EMG was done on both legs and arms something would have shown if it was ALS related right?
Also you said that BULBAR ONSET starts out with tongue or slur speech right? My issue is something putting enough energy to swallow my saliva. But than other times everything is fine and swallowing also is sometimes fine
So if it was ALS RELATED IT WOULD BE PERSISTENT AND NOT SOMETHING THAT COMES AND GOES.
My face is trembling when I smile
My lips are trembling
Sometimes I feel like there is to much saliva in my mouth.
But I read the saliva issue isn't that your mouth is making too much of it. It's that you can swallow so a lot of it gather inside your mouth. My problem isn't that. My problem is my mouth is making too much of it but other times it's really dry inside my mouth
So again it's not persistent
Is Trembling Part Of ALS
My left hand also trembles when it's at rest or when I lift it it's still shaking
Thank you again for your help
Thank you for getting back.
Yes, EMG would have shown changes in legs and arms, if it was ALS.
Yes, the symptoms in ALS would be persistent and would not come on intermittently.
Trembling is not a symptom of ALS, and it is unrelated. It could be related to anxiety or a condition called as essential tremors.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist
Patient replied :
Okay thank you very much for your help. Just one last set of questions
I visited a neurosurgeon yesterday in my city in Pakistan and he said he don't see aNY symptoms
he sent me to a neurologist who did the physical. I want to know if he did everything or should I get another EMG.
He asked me to roll up my sleeves and take off my pants for a physical
He hit me with a small hammer on my joints, ankles, elbows, and under my lip
he said he did notice some hyper activity but he said it's minor and it's mostly due to my being so full of anxiety. My question is can anxiety cause some hyper muscles
he said he didn't notice any jaw jerking so he said that pretty much rules out bulbar onset. He said if I had bulbar than when he tapped my lip my jaw would have jerked.
he flexed my muscles when he asked me to relax and I was laying down. And said everything was good
He basically gave me a clean bill of health and said my tremors wee because of what you said earler.
he said in Pakistan when they do an EMG they do it on arms,legs and tongue so should I go ahead and get an EMG again or no is my question to you?
Also could als symptoms progress as fast as within weeks? Mine started with lump feeling I'm throat to tight throat and trouble swallowing and now I have stiffness around my neck and face. I also have tremors and or twitches around my face and throat. But he told me that tremors,stiffness,numbness,tingling,burning feelings are not part of ALS
He said people with bulbar have nasal speech and I have had a bad sinus problem since this thing started. I always have running nose,always coughing or clearing my throat.
He also said that in bulbar your tongue shrinks and you can whistle or your tongue is so small that it can't touch outside of your lip.
In your opinion after everything we have discussed should or can I rule out ALS completely?
Does a EMG on tongue hurt? Also do they have an EMG for thorat. I feel like my face muscles are rearly stiff and tense
Thank you for your help
Thank you for getting back.
I am very impressed with your neurologist and he has done a thorough clinical examination. This has ruled out ALS, and I agree with his opinion.
I think you need not go for another EMG.
I usually include needle study of tongue and chin muscles in my EMG, however, since you do not have any features of ALS, you can wait for that.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist