Early Signs of ALS: What You Need to Know

Q: Early Signs of ALS: What You Need to Know

Hello： Your symptoms may warrant consideration of a brain disorder. <br>The condition you are concerned about, commonly known as amyotrophic lateral sclerosis (ALS), primarily involves issues with motor neurons. <br>Motor neurons control muscle movement; generally, the motor neur

Early signs of amyotrophic lateral sclerosis (ALS)?

Hello Doctor: Recently, I suddenly noticed something unusual with my body; it feels as if my limbs are not completely my own.
I can say there is a bit of weakness in my limbs, but it's not entirely that.
After a day, this strange sensation disappeared.
It was a very odd feeling.
However, in the past two days, I have also started to notice muscle fasciculations in my limbs.
Although I have experienced this before, it seems to be more frequent this time.
Additionally, I have a persistent sensation in my legs that feels like an electric current running through them.
I am very worried that this might be a precursor to amyotrophic lateral sclerosis (ALS).
Most information online mentions symptoms like limb weakness, muscle atrophy, or inability to perform tasks such as using chopsticks or buttoning a shirt as signs of ALS.
However, I have observed that my strength is still intact over the past two or three days, although I have noticed that my right hand feels less dexterous when performing certain specific tasks (like washing dishes or folding clothes).
Could this also be a precursor? I have already seen a neurologist at the hospital, but the doctor did not assist in this direction.
I have been scheduled for an EEG and evoked potential tests, but not for an electromyography (EMG) test.
Should I request this from my doctor?

Mr. Huang, 30~39 year old female. Ask Date: 2021/02/27

Dr. Jiang Junyi reply Neurology

Hello: Your symptoms may warrant consideration of a brain disorder.
The condition you are concerned about, commonly known as amyotrophic lateral sclerosis (ALS), primarily involves issues with motor neurons.
Motor neurons control muscle movement; generally, the motor neurons in the brain are referred to as upper motor neurons, while those in the brainstem and spinal cord are called lower motor neurons.
When motor neurons become damaged, our muscles may not receive adequate nutrients and chemicals, potentially leading to muscle death.
This is a chronic muscle-wasting disease that can cause muscle atrophy.
If upper motor neurons die, abnormal signal transmission may result in muscle twitching.
Typically, there are no sensory symptoms.
It is advisable to wait for the test results and discuss the possible causes with your physician.
Wishing you good health and peace.
Dr.
Jiang Junyi, Department of Neurology, Taoyuan Hospital, cares about you.

Reply Date: 2021/02/27

More Info

Understanding the early signs of Amyotrophic Lateral Sclerosis (ALS) is crucial for timely diagnosis and management. ALS, also known as Lou Gehrig's disease, is a progressive neurodegenerative disorder that affects motor neurons in the brain and spinal cord, leading to muscle weakness, atrophy, and eventually paralysis. The symptoms can vary significantly among individuals, and early signs may be subtle and easily overlooked.

From your description, it seems you are experiencing some concerning symptoms, including a feeling of weakness in your limbs, muscle twitching (fasciculations), and a sensation akin to electric shocks in your legs. While these symptoms can be alarming, they do not definitively indicate ALS. It is important to note that many conditions can cause similar symptoms, including anxiety, stress, peripheral neuropathy, or other neurological disorders.

Early Signs of ALS:
1. Muscle Weakness: This is often one of the first signs of ALS. It may manifest as difficulty in performing everyday tasks, such as buttoning a shirt or holding objects. You mentioned feeling less dexterous with your right hand during specific tasks, which could be a sign of weakness.

2. Muscle Twitches (Fasciculations): These are involuntary contractions of muscle fibers and can occur in various conditions, including ALS. However, they can also be benign and related to stress, fatigue, or caffeine intake.

3. Cramps and Spasticity: Some individuals with ALS experience muscle cramps or stiffness, which can be uncomfortable and may affect mobility.

4. Changes in Speech or Swallowing: Difficulty in speaking or swallowing can occur as the disease progresses, but it is not typically an early sign.

5. Sensory Changes: While ALS primarily affects motor neurons, some patients report unusual sensations, such as tingling or electric shock-like feelings, which may not be typical for ALS but can occur.

Given your symptoms, it is wise to pursue further evaluation. You mentioned that you have already consulted a neurologist and have been scheduled for an EEG and evoked potential tests. These tests can provide valuable information about the electrical activity of your brain and the function of your nerves. However, an electromyography (EMG) test is particularly useful in diagnosing ALS, as it assesses the electrical activity of muscles and can help identify any abnormalities in motor neuron function.

Next Steps:
1. Discuss EMG Testing: It is reasonable to request an EMG if you feel that your symptoms warrant further investigation. This test can help determine if there is any ongoing muscle denervation or other neuromuscular issues.

2. Monitor Symptoms: Keep a detailed record of your symptoms, including their frequency, duration, and any activities that exacerbate or alleviate them. This information can be helpful for your healthcare provider.

3. Consider a Second Opinion: If you feel that your concerns are not being adequately addressed, seeking a second opinion from another neurologist, preferably one with experience in neuromuscular disorders, may provide additional insights.

4. Stay Informed: Educate yourself about ALS and other potential conditions that could cause your symptoms. This knowledge can empower you to engage in meaningful discussions with your healthcare provider.

In conclusion, while your symptoms are concerning, they do not definitively indicate ALS. It is essential to continue working with your healthcare team to explore the underlying causes of your symptoms. Early diagnosis and intervention can significantly impact the management of any neurological condition, so advocating for yourself and ensuring thorough evaluations is crucial.

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