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Physician with fasciculations affecting body fearing ALS

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hi I am a 40 year old GP (Primary care physician) in Australia. since last 4 weeks I have been having fairly regular fasciculations - started with left eyelid, moved to right eyelid then arms, legs, back, thighs and buttocks. I have had these fasciculations in last 6 months - but were completely intermittent and last 4 weeks they have been constant, sometimes associated with sudden finger movements and seems to affect the web space of hands and posterior tibial area of foot. However there are no fixed postions. just after these (3-4 weeks back) I had some ache in my right biceps especially on contraction and also a vague restless feeling in both arms (although not clumsiness). trial of magnesium improved significantly and rest seems to help. no weakness in either arms or legs. I do walking for 4 kms / day with no difficulty. obviously being a physician myself the first concern was ALS however I an convincing myself for BFS . Since last 2 days I have noted being little bit more tired. no previous medical history, only thing I take is vit D and the last levels were therapeutic. sometimes I take 2 tabs / day and was also wondering about vit D toxicity and not sure whether it can cause fasciculations. the reason for consult today was some fasciculations in left mid arm which were pretty consistent for few seconds and then I started having some aches in left arm. I weight 89 kgs and I am generaly fit and furthermore there is no history of ALS in family. no weakness, atrophy noted. The questions were what is your opinion in general with patients diagnosed as ALS in particular what symptoms do they have. I have done heaps of research and the result was more confusion. dont want to get EMG done as I am concerned regarding false postiives / negatives and it can be normal earlier on and obviously will require further recordings. In the abscence of any weakness / atrophy what are the chances of ALS as i know thay can precede other symptoms by months / years. please reply ASAP so that I can answers more questions raised by you. I am a trained phhysician from UK and also doing General practice and Emergency Medicine in Australia. Thanks for your prompt response

Category: Neurologist, Medical

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Hello Dr,

Thank you for posting your query in detail at DoctorSpring.

I am a qualified Neurologist and have experience of about 15 years in treating neurological disorders, and would have seen about 500 cases of ALS so far in that period.

First of all, I would like to reassure you that based on your description, my diagnosis would be BFS, and not ALS.

Also, vitamin D toxicity does not usually lead to fasciculations.

Patients with ALS usually present with weakness and/or wasting of muscles and these symptoms tend to progress over time. Within six months, there is definite worsening. Symptoms begin in one limb and then progress to other limbs over 2-3 years. It does not start in whole body at a time.

I agree with you that EMG is not definitive, in the absence of typical clinical symptoms, and also it would need to be repeated. So, I also would follow up a patient clinically rather that do an EMG if some one came to me with symptoms such as yours. The only time I would do an EMG is if the patient requested me to do in order to be more sure that it is not ALS.

I hope it helps. I would be pleased to answer any follow up queries.

Best wishes,

Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist, Institute of Neurosciences,
Apollo Hospitals

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