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Having Widespread Twitches With Difficulty In Swallowing. Positive Hoffmans, Reflex Negative Babinski Hyper Reflexia. Suggest?

Posted on Wed, 21 Aug 2013

Question: 53 year old woman with widespread twitches difficulty swallowing seen by 4 neuros. 2 normal limb EMG's within 8 months. Saw ALS specialist at NYP in NYC didn't even want to do testing. Positive hoffmans reflex negative babinski hyper reflexia. Sure I am not suffering from ALS. Finally got different neuro to give me permission to have tongue EMG due to my fear of Bulbar onset. Normal swallowing study. This fear is consuming my life

I have been told by AlS specialist I don't have but he didn't order EMG can he tell by neuro exam. EMG were done by another neuro

Answered by Dr. Pratap Sanchetee (1 hour later)

Dear Ms

I have gone through the details provided by you. Neurological signs and symptoms in you does no suggest motor neurone disease and I tend to agree with ALS specialist.

Can you tell me what inference neurologist have drawn for widespread twitching based on clinical examination and EMG. I am sure thyroid function tests and to exclude any systemic disease have been done and they are normal. You should be reassured and wait for improvement or deterioration of symptoms. You should be under medical supervision (regular visits) of your doctor

Regards

Pratap

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Pratap Sanchetee (2 hours later)

Possible BFS. Possible virus. Should I do EMG of tongue I have bugged them to do. They tested me for auto immune all normal so scared that I develope symptoms that may just be anxiety

Answered by Dr. Pratap Sanchetee (21 hours later)

Dear Ms,

Apologies for the late response.

Well, before we examine and investigate you fully, it will be incorrect to attribute symptoms to anxiety only. In my opinion tongue EMG will not help much in arriving at a diagnosis.

I repeat my earlier observation: I would like to know what was your neurologist inference for widespread twitching based on clinical examination and EMG. I am sure thyroid function tests and to exclude any systemic disease have been done and they are normal. You should be reassured and wait for improvement or deterioration of symptoms. You should be under medical supervision (regular visits) of your doctor.

Regards

Pratap

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Pratap Sanchetee (7 hours later)

No twitching noted on EMGs. Opinion of neuro not ALS. BFS is what they are saying. Do to my fear of bUlbar als wouldn't tongue g rule that out

Answered by Dr. Pratap Sanchetee (2 hours later)

Hi,

I am sorry for repeated enquiries. Was benign fascicular syndrome the diagnosis? Or does BFS stand for something else.

I hope you do not mind clarifying.

Dr. Pratap

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Pratap Sanchetee (18 hours later)

ALS Specialist didn't really say just said twitching happens. He gets twitches. Previous neuro said no fasiculations on EMG. Read as normal EMG. With further emails regarding to this doc who did EMGs he said no ALS maybe benign fasiculations. I've been worked up for lots of stuff. I still fear bulbar ALS and he said I can have an EMG to test tongue

Answered by Dr. Pratap Sanchetee (14 hours later)

Dear Ms

As the situation clears, it looks you have benign fasciculation syndrome which has a good prognosis. Two important causes are anxiety and thyrotoxicosis. Later can be ruled out by doing blood test for thyroid functions. You need to be reassured. There is no ALS or fear of bulbar palsy. Your doctor will reassure once again and if needed may prescribe treatment for anxiety.

Regards

Pratap

Above answer was peer-reviewed by : Dr. Prasad