Muscle Twitches: ALS Concerns and Neurological Insights

Q: Muscle Twitches: ALS Concerns and Neurological Insights

Hello： The electromyography (EMG) examination for patients with amyotrophic lateral sclerosis (ALS) may vary in standard procedures from one hospital to another. <br>If you feel that the examination is not thorough enough, you can seek opinions from other physicians. <br>There ar

Amyotrophic Lateral Sclerosis (ALS) muscle twitching?

I am Mr.
Huang, referring to #159787.
I have a few final questions for the doctor.
I had an electromyography (EMG) test on August 19, which only involved needle insertions in my left forearm down to my palm and in my left calf near the sole of my foot.

1.
Can the examination of only these areas determine if I have amyotrophic lateral sclerosis (ALS)? I felt reassured after my last consultation, but starting around August 27, I began experiencing involuntary muscle twitches throughout my body.
I was aware that muscle twitching can occur with ALS, but during the examination, I did not have any twitching in my cheeks, arms, calves, thighs, eyelids, fingers, etc.
Now, I am experiencing these twitches intermittently.
I have been staying up later than usual, but I also sleep in, so I feel well-rested.
Sometimes, I notice my heart rate suddenly increasing at night, and I can feel it in my left arm (though I'm not sure if it's my arm twitching or my heart).

2.
I also noticed that when I clench my fists, both hands tremble, with my right hand shaking more noticeably.
Could this be an early sign of muscle atrophy?
3.
Should I still be concerned about ALS? Is it possible that the previous tests did not detect anything, and now that my symptoms have worsened, the earlier tests were inaccurate?
4.
Additionally, could my symptoms indicate autonomic nervous system dysfunction? I have been very anxious about these issues lately.
I hope the doctor can explain each question to help me understand, as I am genuinely worried.
My mother and I rely on each other, and I am concerned about what would happen if I were to become ill.
Thank you, doctor.

Mr. Huang, 20~29 year old female. Ask Date: 2020/09/03

Dr. Hong Weibin reply Neurology

Hello: The electromyography (EMG) examination for patients with amyotrophic lateral sclerosis (ALS) may vary in standard procedures from one hospital to another.
If you feel that the examination is not thorough enough, you can seek opinions from other physicians.
There are many types of muscle twitching, including muscle fasciculation, muscle myokymia, muscle spasm, and muscle myoclonus, among others, which can be difficult to translate into Chinese.
The causes are numerous, with the most common being stress, electrolyte imbalances, lack of sleep, dehydration, excessive caffeine or stimulant intake, certain medications, fatigue, kidney disease, and diabetic neuropathy, among others.
The conditions that are much less common include ALS, Isaac syndrome, serotonin syndrome, and multiple sclerosis.
In addition to muscle fasciculations, ALS patients may also experience muscle atrophy, increased muscle tone, swallowing difficulties, and speech impairments.
Clinically, a diagnosis of ALS is not made solely based on muscle twitching; other related symptoms will also be evaluated.
The vast majority of isolated muscle twitching cases are due to the conditions described earlier.
If your English is good, you can refer to the following resource for a more detailed understanding, which explains the causes of muscle twitching and spasms: https://www.webmd.com/brain/ss/slideshow-twitches-spasms-causes.
Thank you~~ If you are very concerned, it is advisable to consult a neurologist for assistance.
It is normal for your hand to tremble when you grip tightly; this is a physiological response.
If muscle strength is insufficient, it can lead to trembling during exertion, which can be improved by strengthening the muscles.
I believe there are many possible causes, and ALS is a very unlikely possibility.
Do not worry excessively.

Reply Date: 2020/09/03

More Info

Understanding muscle twitches and the concerns surrounding them, particularly in relation to conditions like Amyotrophic Lateral Sclerosis (ALS), can be quite complex and anxiety-inducing. Let's address your questions one by one, providing clarity and insights based on medical knowledge.

1. Can ALS be diagnosed with only the areas tested during the EMG?
Electromyography (EMG) is a crucial tool in diagnosing neuromuscular disorders, including ALS. However, the areas tested during your EMG (left forearm to palm and left calf to foot) may not be comprehensive enough to rule out ALS entirely. ALS can affect various muscle groups, and symptoms can manifest differently in each individual. A thorough examination typically includes multiple muscle groups to assess for signs of lower motor neuron (LMN) and upper motor neuron (UMN) involvement. If your symptoms have progressed, it may be advisable to discuss further testing with your neurologist, including a more extensive EMG or additional diagnostic imaging.

2. Is the shaking in your hands when making a fist indicative of early muscle atrophy?
The shaking or tremors you experience when clenching your fists could be due to several factors, including muscle fatigue, anxiety, or even benign essential tremor. While muscle atrophy is a concern in ALS, it typically presents with weakness and muscle wasting rather than just tremors. If you are experiencing weakness alongside these tremors, it would be important to bring this up with your healthcare provider, as it could indicate a need for further evaluation.

3. Should you still be concerned about ALS given your symptoms?
It’s natural to worry about ALS, especially with symptoms like muscle twitching. However, muscle twitching (fasciculations) can occur for many reasons, including stress, fatigue, or benign conditions like benign fasciculation syndrome. The absence of significant weakness or atrophy in the areas tested during your EMG is a reassuring sign. If your symptoms have worsened since your last visit, it’s essential to communicate this to your doctor. They may recommend follow-up tests or a referral to a specialist in neuromuscular disorders for a more comprehensive evaluation.

4. Could your symptoms indicate autonomic nervous system dysfunction?
Your experiences of rapid heartbeats and muscle twitching could suggest some level of autonomic nervous system involvement, especially if they coincide with periods of anxiety or stress. Autonomic dysfunction can manifest in various ways, including heart rate irregularities and muscle spasms. Stress and anxiety can exacerbate these symptoms, leading to a cycle of worry and physical manifestations. It might be beneficial to explore stress management techniques or consult with a mental health professional to address the anxiety stemming from your health concerns.

In conclusion, while your symptoms are understandably concerning, they do not definitively indicate ALS. The best course of action is to maintain open communication with your healthcare provider, report any new or worsening symptoms, and consider a comprehensive evaluation if necessary. Remember, many conditions can cause muscle twitching and related symptoms, and a thorough assessment is key to determining the underlying cause. Your health and peace of mind are paramount, and seeking clarity through professional guidance is always the best approach.

Similar Q&A

Understanding Muscle Twitches: Could It Be ALS or Just Anxiety?

I have been experiencing continuous muscle twitching all over my body for a month (in the soles and tops of my feet, backs of my hands, arms, elbows, shoulders, back, and face). A few days ago, my left calf twitched continuously for an entire night, causing significant pain. The ...

Dr. Jiang Junyi reply Neurology
Hello: The condition you are concerned about, commonly known as amyotrophic lateral sclerosis (ALS), primarily involves issues with motor neurons, and most patients do not have a family history. Motor neurons control muscle movement; those in the brain are referred to as upper mo...

Understanding Muscle Twitches: Could They Indicate ALS Symptoms?

I have recently been experiencing muscle twitching in various parts of my body, particularly in my arms. The twitching occurs intermittently, and it seems to stop when I change positions. After some research, I found that muscle twitching can also be a symptom of amyotrophic late...

Dr. Hong Weibin reply Neurology
Hello: There are many types of muscle twitching, including muscle fasciculation, muscle myokymia, muscle spasm, and muscle myoclonus, among others (which are difficult to translate into Chinese). The causes are numerous, with the most common being stress, electrolyte imbalances, ...

Understanding Muscle Twitches: Concerns and Neurological Insights

Hello Doctor, I have recently been experiencing muscle twitching. The twitching occurs in specific areas after significant movements; for example, after sneezing, the muscles around my ribs twitch a few times. The twitching is more noticeable when I lie down in bed, especially in...

Dr. Hong Weibin reply Neurology
Hello: There are many potential causes for muscle twitching. In addition to muscle fasciculation, there are muscle myokymia, muscle spasm, muscle myoclonus, and others that are difficult to translate. The causes are quite diverse, but the most common ones include stress, electrol...

Understanding ALS: Symptoms and Concerns About Muscle Weakness

Hello, doctor. Recently, I have been experiencing muscle twitching all over my body, and after some research, I found that it could possibly be amyotrophic lateral sclerosis (ALS). I am becoming increasingly worried and would like to ask you what the feeling of weakness in ALS is...

Dr. Jiang Junyi reply Neurology
Hello Mr. Wei, You mentioned that "the soles of my feet occasionally feel a twitching sensation, and my feet easily become numb." These symptoms are more indicative of peripheral nerve compression, as motor neuron diseases typically do not present with significant sens...