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Sporadic FASICULATIONS in body not responding to SNRI.

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I also have fasciculations now for 5 months. Constant 24/7 in calf and sporadic elsewhere. Clinical examinations show no weakness or atrophy but I feel aching around shoulder%2C biceps and calves. I have had 2 EMG. First EMG after 3 weeks of twitching showing clean except for up to 7mV on both ADM bilaterally. Second one done after 4 months did not test ADM but showed clean except for fasciculations on right calf. I have been told BFS but I am still concerned for ALS. Please help with advice on this%3F.

The first twitching was in right calf and was very occasional but it has progressed and is now 24/7 with twitches pinging all over the calf and down to the anckle. One specific spot as well at bottom of calf that sucks in dramatically on twitching every 50 to 10 seconds on average.

The rest of the twitches in hamstrings, thighs, biceps, triceps, shoulder, neck, bottom of thumb, along ADM and stomach and chest are sporadic throughout the day but becoming more consistant.

I am also getting aching now in the right calf as well as the shoulder and arm on right side.

I have been on SNRI for anxiety but this did not help and am now off this medication. I have klonopin to use sporadically when needed at night.

Also strangely my right knee has been weak and painfull for many months if not almost a year but i had not really given it any thought. I can exercise ok and did 20mins on ecliptical today followed by 20 push ups and some bicep curls with 5kg's.

I collapsed for 1st time in my like in january whilst doing breathing exercises i just froze in position in acute pain through my back and chest and my body seized and shut down and i convulsed down hitting my face on the kitchen island. My wife shook me fully awake and went to hospital. all was ok and all tests for heart etc came back normal and they said just standard vegal thing.

Anyhow i am very concerned of ALS and am 40 years old patientold.

Category: Neurologist, Medical

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Category: Pediatric Neurologist
Dr. Sudhir Kumar is online now

Expert:  Dr. Sudhir Kumar replied 4 Days.

Thank you for posting your query at DoctorSpring.com
I have noted your symptoms and EMG results.
In my opinion, you do not have ALS. In order to diagnose ALS, there should be a combination of lower and upper motor neuron abnormalities. Lower motor neuron abnormalities include wasting (thinning of muscles), weakness and fasciculations. Upper motor neuron signs include spasticity (increased muscle tone) and exaggerated deep tendon reflexes. In your case, wasting and upper motor neuron signs are absent.
Normal EMG also is a point against a diagnosis of ALS.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist

Patient replied :

Dear Dr,
So is my EMG considered normal then with fasciculation shown on recent one and ADM MUPs on the older one. Does the EMG have to show more things like fibs and pos sharp waves etc? Can this be early signs? As i have been twitching for 5 months would i have had other symptoms by now if ALS and would more signs have shown up on EMG?

Expert:  Dr. Sudhir Kumar replied 3 Days.

Thank you for getting back.
EMG would show fasciculations, fibrillations and positive sharp waves in two or more regions (out of bulbar, cervical and lumbosacral) for us to diagnose ALS. Yes, in five months, EMG would pick up ALS.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist

Patient replied :

Dr, Over recent days I have felt that it is strange feeling on right leg that seems to be awkward when walking. It feels as if it is stalling and as if i might trip. Please note that i have not actually tripped to date. What would i need to look out for in this area of the body that could relate to MND. Would it be awkward walking feeling or would it be specific like foot drop that would be nticed etc? Also, the calves are aching now as well in semi cramp like feeling.

Expert:  Dr. Sudhir Kumar replied 2 Days.

Thank you for getting back.
I have noted your new symptoms. These could due to muscle cramps or spasms.
For signs of MND in legs, you could look for muscle wasting (thinning of muscles) and foot drop.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist

Patient replied :

So without foot drop or wasting then its not related to mnd?

Expert:  Dr. Sudhir Kumar replied 1 Day.

Thank you for getting back.
Yes, absence of muscle wasting or foot drop would be against a diagnosis of MND. As diagnosis of MND requires presence of both upper motor (increased muscle tone and exaggerated deep tendon reflexes) and lower motor neuron (wasting and fasciculations) abnormalities.
Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist

Dr. Sudhir Kumar
Category: Pediatric Neurologist
Senior Residency, Fellowship: DM, Neurology, CMC, Vellore, 2001
Junior Residency: MD, Internal Medicine, CMC, Vellore, 1998
Medical School: MBBS, Christian Medical College, Vellore, 1995
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