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Fasciculations - concerned about ALS

Muscle twitches and fasciculations may raise the fear of a neuromuscular problem such as ALS

Fasciculations - concerned about ALS

New postby StevenVP on Wed May 21, 2008 8:30 am

In Dec-07/Jan-08 i suffered a herniated disc at L1/L2, which was diagnosed by MRI in Feb-08. Saw an orthopedic surgeon who prescribed conservative treatments (i.e., oral steroids and subsequently physical therapy). Over the past few months, while my functionality has improved quite a bit, i still feel as though i am suffering from nerve-related issues.

Most recently, over the past 1-2 months, i have been suffering from fasciculations, which started in my right foot (instep), but i now experience in both feet and calves. My initial thinking is that this is related to the herniated disc - nerve root compression. Is that possible? However, on occassion i get fascics in my left hand. i now am concerned it could be ALS. I have no muscle weakness or atrophy that i am aware of. My sense is that the fascics started/increased in frequency at the time i began PT and greater physical activity.

Because of the nerve-related issues, i got a consult with a neurologist who had me get an MRI to rule out MS and then a EMG/nerve conduction test ...these tests came back fine but showed the fascis. i am concerned that i am demonstrating early symptoms of ALS. Should i be concerned?

i am seeing the ortho again next week...the neuro mentioned the possiblity of having a myelogram done.

What do you think? thanks!
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Re: Fasciculations - concerned about ALS

New postby pizovic on Fri May 23, 2008 10:40 pm

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Re: Fasciculations - concerned about ALS

New postby MG (Admin) on Mon May 26, 2008 8:25 am

I have to say that ALS does no seem at all likely.

You may want to look at a page dealing with this issue of BFS.

Please forward us the precise wording of the EMG report.
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Re: Fasciculations - concerned about ALS

New postby StevenVP on Mon Jun 02, 2008 8:29 am

Thank you for responding. The write-up of the EMG is below. i should note that since the EMG (May 7, 2008), the fasciculations have spread somewhat so i now experience them fairly constantly in the feet and calves and then periodically in the following locations: eyelid twitch, biceps, triceps, quadricep. Again, i am not sensing that i have any muscle weakness. I am in the process of recovering from a fairly significant disc herniation. i met with my orthopedic doctor last week, and after examining me and reading the EMG (see below), the thought it more likely to be benign. He did not believe it was related to any nerve root compression associated with the disc herniation. He did suggest that i take a few months off from taking a Statin for high cholesterol, which i started in mid-january of this year.

I would greatly appreciate any light you could shed on this. obviously, i am concerned about the possibility of ALS and would feel better if i could get some reassurance that it would be highly unlikely to be ALS and more likely benign. i will also be happy to make a contribution to this helpful site.

EMG Report (May 7, 2008)

EMG of the upper left extremity shows a few fasciculations in the left abductor digiti minimi muscle.

EMG of both lower extremities shows a few fasciculations in the gastrocnemius muscles bilaterally and in the left abductor hallucis muscle. There was also chronic denervation i the iliopsoas, quadriceps, tibialis anterior, peroneus longus and gastrocnemius muscles bilaterally, left worse than right. No active denervation is seen.

Nerve conduction study shows borderline left ulnar motor conduction across the cubital tunnel. This could be within normal or might suggest a very mild irritation to the left ulnar nerve.

There was mild chronic denervation in the L4, L5 and S1 nerve root distribution bilaterally, left slightly worse than right and especially at the L5 nerve root.

There were sporadic fasciculations seen in the lower extremities and in the left upper extremity, mainly in the distal muscles. These were not associated with active denervation. These could be part of the lumbar radiculopathy or they could be benign fasciculations. Follow up study in 3 months is recommended.
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MS Symptoms?? Negative Brain MRI

New postby StevenVP on Mon Jun 09, 2008 11:39 am

I have a concern that maybe what i have is MS.

The neuro i saw about 2 months ago had a brain and cervical MRI done that was entirely negative ( a slight bulging disc in the neck). the neuro had these MRI's done prior to the EMG to "rule out MS". i have since learned that you cannot rule out MS with a negative MRI.

Most recently i have been experiencing some left eye pain. i thought maybe it was just strain..it appears to be coming from the top of the eye, not really the back of the eye but hard to tell. the pain moments tend to be very brief and appear to happen when i move my eye quickly, but not all the time. question: can you have optic neuritis without experiencing vision loss or problems? i am not experiencing any vision issues at this point. the pain has been on and off for about a week now.

My other symptoms are:
(1) muscle twitches (mostly in the calves and feet but occassional twitches in other locations: eyelid, shoulder, buttocks, triceps, etc.)
(2) pins and needles in left foot

i am not experiencing any weakness, nor other listed symptoms of MS, but i understand that optic neuritis is often the presenting symptom of MS.

thank you for your response to this, and if possible my earlier posting as well.
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Re: Fasciculations - concerned about ALS

New postby clinicalguru3 on Sun Jun 22, 2008 9:26 am

Firstly, I would say that the fasciculations are not compatible with MS...you are due to have a follow up EMG regarding this so please let us know how that goes.

can you have optic neuritis without experiencing vision loss or problems


Well the first day or 2 could be pain only without vision problems but to answer your question we would not even suspect or look for optic neuritis if there is no visual problem.

If you are having new syptoms you should be re-examined even though my hunch is that the exam will be normal.

Let us know how it goes.
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Re: Fasciculations - concerned about ALS

New postby StevenVP on Mon Jun 23, 2008 7:30 am

thank you for your reply. i did see an opthamologist for an eye exam which was fine. Since then, i have not had the eye-related pain.

I still have continued fasciculations (going on for about 2.5 months)...mostly in calves and feet, but periodically/randomly in hand (causing finger to move), buttocks, shoulder, triceps.

Other symptoms and concerns:

1) Up until last week, i had no sensation or feeling of weakness. i have been increasing my work-outs since my back has improved considerably. Last week, i started getting pain and discomfort in my left forearm. perhaps this is related to lifting weights, etc and is just an over-use injury. but i find that i am also having some difficulty typing and am concerned that this could be an initial sign of developing weakness in my arms and hands.

2) i have been feeling light-headed on and off for the past week...like my equilibrium is off. i am not falling down or tripping or anything like that.

Questions:

1) Does my EMG report findings (above) cause you any concern? I am not due to go back to the neuro until August. it kind of contradicts itself ..saying i show denervation, but not active or current denervation. could this be a sign of inital ALS?

2) what about the sense of arm/hand weakness? is it likely that i could have ALS with fascis as the presenting symptom? i don't have any weakness or atrophy in my feet or legs yet i have fascics.

3) is light-headedness a symptom of ALS?

Any insights you could provide would be greatly appreciated. i am very scared that i may have ALS....but i am also concerned that my anxiety over all of this may be a contributing factor to what i am experiencing.

thanks
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Re: Fasciculations - concerned about ALS

New postby clinicalguru3 on Mon Jun 30, 2008 9:04 am

1) Does my EMG report findings (above) cause you any concern? I am not due to go back to the neuro until August. it kind of contradicts itself ..saying i show denervation, but not active or current denervation. could this be a sign of inital ALS?


The results do not point to ALS. The main thing to know is whether your neurological exam shows objective motor problems. An EMG such as yours may be normal...of course it does not exclude the possibility of a problem 100%...which is why you should repeat it as advised..if it is the same or better then the possibilit of very early ALS is even less likely than it is now (which is very unlikely IMHO!)

2) what about the sense of arm/hand weakness? is it likely that i could have ALS with fascis as the presenting symptom? i don't have any weakness or atrophy in my feet or legs yet i have fascics.

It all depends on the neuro exam as mentioned above...let us know what is found please.

3) is light-headedness a symptom of ALS?


No...but it is a symptom of hyperventilation (amongst other causes).

Hope that helps.
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Re: Fasciculations - concerned about ALS

New postby pain in the back on Tue Oct 27, 2009 5:17 pm

Hey I caught the mention about radiculopathy in this thread. Are there any underlying conditions that tend to bring both radiculopathy and fasciculations?
Radiculopathy is a type of pain in the back.
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