Muscle Weakness and Twitching: Possible Causes and Concerns

Regarding muscle weakness and twitching?

Hello Doctor, I have been troubled by this issue for a long time.
In mid-September last year, I suddenly felt weakness in both legs and my right hand (a burning, sore sensation originating from the muscles, similar to a persistent feeling of weakness in my legs).
However, I was able to walk normally.
A few days later, I suddenly felt better, but at the end of October, I started experiencing muscle twitching.
After a few days of twitching, the weakness returned! (This time it felt more severe, and I couldn't sleep at night).
It lasted for about 10 days (I felt it all day long) and then suddenly improved.
A week later, it flared up again (but during this time, my muscles continued to twitch...).
This episode lasted for half a month.
I researched online and found that muscle twitching combined with weakness could possibly indicate ALS (Amyotrophic Lateral Sclerosis), which has left me in a state of anxiety and fear.
I visited a doctor who performed an electromyography (EMG), blood tests, and nerve conduction velocity (NCV) tests.
The doctor noted the muscle twitching but said there were no issues, and everything else was normal.
I was advised to monitor the situation, and then one day, I suddenly felt completely normal without any weakness, although the muscle twitching persisted.
Then it started again...
In summary, I am really scared that it might be ALS or some serious illness, and I feel like crying every day.
Doctor, could you please explain why this is happening? Is it possible that it could be ALS or something similar? My symptoms include persistent weakness in both legs or my right hand (burning and sore) lasting for several weeks, followed by several weeks of recurrence.
What could this illness be...
Thank you, Doctor.

wish4475, 20~29 year old female. Ask Date: 2017/01/05

Dr. Jiang Junyi reply Neurology

According to your description, the condition commonly referred to as "Lou Gehrig's disease" is formally known as amyotrophic lateral sclerosis (ALS), which is a rare neurodegenerative disease with a prevalence of approximately 5 in 100,000.
The cause remains unknown, with 5% to 10% of cases being hereditary.
It typically affects individuals around the age of 50, with a male-to-female ratio of about 1.5:1.
Most patients initially present with localized limb weakness and a decline in fine motor skills.
In the early stages, it is often misdiagnosed as cervical or lumbar nerve compression, Parkinson's disease, or myasthenia gravis.
A diagnosis is more readily made when treatment is ineffective and the disease progresses to other limbs.
Since it is called a motor neuron disease, if you are experiencing symptoms, it is advisable to first consider more common conditions.
I recommend consulting a neurologist for discussion and examination.
Wishing you good health and peace.

Reply Date: 2017/01/05

More Info

Muscle weakness and twitching can be concerning symptoms, especially when they appear suddenly and fluctuate over time. Based on your description, it seems you have experienced episodes of muscle weakness, a burning sensation, and muscle twitching (fasciculations) in your legs and right arm. These symptoms can understandably lead to anxiety, particularly with fears of serious conditions like amyotrophic lateral sclerosis (ALS), commonly known as Lou Gehrig's disease.

Firstly, it's important to note that muscle twitching and weakness can arise from a variety of causes, and not all of them are indicative of a severe neurological disorder. Here are some potential explanations for your symptoms:
1. Benign Fasciculation Syndrome: This condition is characterized by persistent muscle twitching without significant weakness. It can be benign and often occurs in healthy individuals. Stress, fatigue, and caffeine can exacerbate these symptoms.

2. Electrolyte Imbalance: Low levels of electrolytes such as potassium, calcium, or magnesium can lead to muscle cramps, weakness, and twitching. If you have had changes in your diet or hydration status, this could be a contributing factor.

3. Neuromuscular Disorders: Conditions such as myasthenia gravis or peripheral neuropathy can cause muscle weakness and twitching. However, these typically present with more consistent symptoms and may be accompanied by other signs.

4. Anxiety and Stress: Psychological factors can significantly impact physical health. Anxiety can lead to muscle tension, twitching, and a sensation of weakness. The cycle of worrying about your symptoms can exacerbate them, leading to a feedback loop of anxiety and physical symptoms.

5. Post-Viral Syndrome: After an illness, some individuals experience lingering symptoms, including muscle weakness and fatigue. This can occur after viral infections, and the symptoms may take time to resolve.

6. Medication Side Effects: If you are on any medications, it's worth considering whether they could be contributing to your symptoms. Some medications can cause muscle-related side effects.

Given that your doctor has conducted electromyography (EMG), nerve conduction velocity (NCV) tests, and blood tests, and found no significant issues, this is reassuring. The fact that your symptoms have periods of improvement suggests that they may not be due to a progressive neurological condition like ALS.

However, it is crucial to continue monitoring your symptoms and maintain open communication with your healthcare provider. If your symptoms worsen or new symptoms develop, further evaluation may be warranted. You might also consider consulting a neurologist who specializes in neuromuscular disorders for a more in-depth assessment.

In the meantime, managing stress through relaxation techniques, regular exercise (as tolerated), and ensuring proper nutrition and hydration can be beneficial. If anxiety about your health is overwhelming, speaking with a mental health professional can also provide support and coping strategies.

In summary, while your symptoms are understandably distressing, they are not definitively indicative of a severe condition like ALS based on the tests performed. Continue to observe your symptoms, maintain a healthy lifestyle, and seek further medical advice if necessary.

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