Question: Hello

I am contacting you regarding some symptoms I have been having lately. I am a 30 year old male, I take no medication, my height is 181 CM, my weight is 133 kg and I am generally overall healthy.

In end of 2020 (Nov-Dec) I had several episodes of muscle twitching. The muscle twitching was in spontaneous and seemingly random parts in the body. So one day my left upper forearm could twitch for couple of hours, only to dissappear, then 5 days later my right thumb could twitch intermittently for some minutes/hours and to dissappear again. After that my shoulder muscles could twitch with the same frequency and dissappear. The frequency was very intermittent, so the episodes could last all from 15 mins to 4-5 days. The twitching would switch places so for some period it could be my right quad leg muscles, another period could be my face, like eyebrows, cheeks and at other times my arms/hands/fingers. So it was never really localized in a particular area in my body, it was seemingly at random places.

I talked with a doctor at that time, and the doctor told me not to worry as this most likely could be because of stress/anxiety etc. And verily from Dec 2020 until Nov 2021 the twitching dissappeared completely. I did still notice some weird things in the toes of both of my legs. Sometimes whenever for example i lift my left leg and place it on my right knee (when sitting) the toes of my leg very subtly contract. This happens also seemingly at random, and does not happen on all movements. I would say if I was to estimate it only occurs 5-10% of the time of each movement related to my left leg.

The contraction of the toes happens very fast (<1 second) and does not hurt nor cause any hinder to my daily life. Its just a weird peculiarity that I discovered.This has lasted across all of 2021. The twitching began to come again at Nov of 2021 after have dissappeared for a whole year. The nature of the twitching was very similar to that of end of 2020; it was at random parts of my body and lasted intermittently, was never on a particular part of my body. Episodes just like in 2020 could last all from 15 min to hours. This lasted for 3 weeks in November, and have again dissappeared completely since then.

So by the end of 2021 (Nov) I decided to contact my doctor in regards to this. Reading about this on the internet I read something about ALS and ofcourse as you can imagine, I began to be really scared and anxious of this. So I went to the doctor and explained all my history of symptoms (of the twitching I wrote above) and told him everything and that I am worried about that its a more serious underlying neuroligcal issue.


The doctor proceeded to make a very comprehensive physical evaluation when I was at his office. He did many tests, a summary:

-) Tested my reflexes on my knees, and lower ankles (I think also elbows, but not sure if I remember correctly)

-) He told me to lift my hands horizontally and tried to press down to see my strength

-) He told me to do some squats

-) He told me to walk stright to see the way I walk

-) He told me to walk on my toes

-) He then told me to look at his fingers with my eyes while he moved them around

-) He then told me to lye on the bed and lift my legs and he ripped the bottom of my feet to test the reaction of my feet etc


These among many other tests he did. It took around 45-60 minutes and he told me that it was extra ambitious from his side. The results from the physical evaluation was normal he told me and he told me that he could not see any particular abnormality/deviations. However, he still could not explain my twitches.

Given this, my doctor sent away my profile along with the symptoms my twitches to the neuroligcal department of Stockholm for a consultation remittance. After a neuroligist have read my symptoms and my entire history, this is the answer they gave back to the doctor, and I translate:

" Dear colleague,

Thanks for the remittance. I have examined and read all of your notes in detail. And, I agree with your assessment that in the absence of spasticity, muscle weakness and atrofies the suspicion of a motorneuroligcal disease is very low. Since patient have had a lot of unexplained issues however I think its still of value to do an EMG. MRI for the brain and cervical spine is also of value, MRI for the entire back is not necessary."



So it seems that both the doctor and the neurologist have no suspicion of any motorneuroligcal disease. I have went and made the MRI for my cervical spine last week, but they could not fit my head into the apparatus completely so unfortunately they could not do an MRI for my brain. I am still awaiting to get a time slot for the EMG test.


So given now that you have had a complete overview of my symptoms and my background, whats your assessment of this? Should I be worried about a motorneuroligcal disease? The reason I am asking is because everytime I google twitching ALS comes as one of the possible casues, and I loose sleep over this. Given my symptoms and everything I wrote, should I be worried?

The thing is I have become very out shape since corona, I have not exercised since 1.5 years ago because of the restrictions. And I have gained almost 15 kgs. So when I read about muscle weakness I almost become hypocondriac because every activity I do I begin to question myself "is this because I am out of shape or something underlying motorneuroligcal disease?"

For instance if I am cooking food with a frying pan my muscles can slightly burn because I am using the same motion over a long period of time. After rest they completely recover. Every activity I do I become hypocondriac. Am I overthinking this? I mean I did a comprehensive physical evaluation with my doctor and he told me its normal, am I overthinking this?



Please give me some clarification about this, should I be worried at all?

Hello

The doctor already tried to prescribe to me high concentractions of Magnesium of which I took for 1 month 2 times a day, but that did not seem to make a difference.

Given my detailed description above, is my symptoms something that I should worry about?

I was not refering to the eelctrolyte imbalances because as I mantioned above the doctor already suspected that and he gave me high concentrations of Magnesium supplements along with vitamins/minerals tablets for 1 month but to no avail.


I was more refering to the symptoms I was having, is it something to be worried about? The reason why I am anxious and asking is because everytime I google "twitching" ALS pops up at the top, and that makes me really anxious.

So what I want to get from you, is given the history of my symptops, tests and all I wrote above, does it entail a potential ALS root? Or its very unlikely that that is the case?

Please elaborate