Frequent twiching in PALMAR & THENNAR area. EMG/NCS.

Resolved question:
Hi,
I am a 41 year old female from Northern Ireland.
In 2006, I started having twitching and buzzing which started in my feet and calves. I saw a neurologist who felt it could be post viral and would subside as clinical exam was normal. The twitching progressed and became fairly frequent in my left thenar, palmar and forearm area. I sought another neurologist exam which was normal. I had EMG/NCS in 2007 on the thenar and forearm (if I remember correctly), it noted contract fasciculations but as there was no weakness/atrophy a benign diagnosis was given. The twitching eventually subsided, for years.
In Dec 2012, I felt my left hand was losing dexterity and then twitching became very persistent in my left elbow area. It kept me awake at night and caused at lot of anxiety. I saw 2 different neuros in Jan 2013, who completed full neuro exams which were normal. I pressed to have another EMG/NCS to alleviate my fears. The EMG was done on all four limbs and carried out in Feb 2013. It came back completely normal.
Fast forward to April 2014, I felt the odd twitch in my first dorsal interosseous muscle. This twitch is still very localised to the Left FDI area but has been twitching constantly, non stop, 24/7 for the last 12 weeks!!!! I notice much less bulk in this left FDI compared to the right. I have not noticed any weakness. I saw the original neurologist from 2006 on 23rd July 2014, he did not even want to do an exam and basically said that I have a relapsing and remitting benign condition. I asked him to do a neuro exam, which he did, but I felt it was rather rushed and superficial. He said he detected no abnormalities and that my left hand was strong. Unhappy with this consultation I made another consultation to see him 6th Aug 2014 and asked for an EMG/NCS, which I am still waiting for.
The annoying thing is that on both ocassions I saw the neuro the twitching in the FDI stopped for a very brief time so he did not see or feel the twitching. I have since seen my GP who was able to see and feel the twitching. My neuro is convinced that these current symptoms are associated and related to my twitching history, however, I am not so sure based on the fact that this twitch is relentless, persistent and always there in the FDI muscle. It has become less 'strong' and less annoying, in that I can't feel it unless I place my right index finger on it, in fact, it currently feels like a pulse but is much much faster. If i place my palm out flat on the table I can see it too.

Questions:
Basically I would like advice on whether this twitch could still be benign even with such a persistent presentation?
Could this episode be unrelated to my twitching history, ie the start of ALS?
Am I right to push for another EMG?
Going out of my mind with worry.

Submitted: 4 Days
Category: Neurologist, Medical

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