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Leg twitching, muscle weakness, throat clearing, swallowing lump, stiff jaw, popping ears. Could I have ALS?

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Practicing since : 2001
Answered : 502 Questions
Hello. I am very concerned about ALS.

Here is a little background about why I am here. About 3 months ago I was laying at the pool. All was well. I looked at my leg and noticed these twitches. They were all over my calf muscles and looked as if something was jumping around in there. I googled "calf muscle twitching" and boom, you guessed it, ALS was the first thing to pop up. As I read more about the disease I got concerned but not too worried. The look like this:

Here I over 3 months later and both calf muscle's have been twitching and jumping pretty much non stop. I am now more concerned. I also randomly twitch in other areas of the body, (arm, neck, etc..) but that comes and goes immediately where the calf muscle never stops. I have no CLINICAL muscle weakness. I ran a mile and a half today…. sometime my legs do feel like jello though.

I am more worried about a possible bulbar onset of ALS. I have been clearing my throat for a week straight and feel like I have a lump in my trachea. Not a physical lump, just a lump I can feel when swallowing. I believe it is harder to say words now although no one has noticed any speech problems but I think I sound very naisly. I feel like I have a stiff jaw. When I exercise my jaws and ears have a popping sensation. When this is happening it is hard to get words out properly. I feel like I have to open my mouth to get my jaw to stop feeling this way. This has been happening for a while but is getting worse.

Could I have ALS, or a bulbar onset of ALS?
Posted Tue, 3 Jul 2012 in Brain and Spine
Answered by Dr. Shiva Kumar R 1 hour later

Thank you for sending your question.

Your question is a good one and I will work on providing you with some information and recommendations regarding the problems you are experiencing.

From the details given to me it looks like you are suffering from "Benign Fasciculation syndrome" rather than ALS. On the video I can see fasciculations over the limbs. Fasciculations can also be due to other causes like thyroid problems, calcium abnormalities, Magnesium deficiency, Radiculopathies, excess caffeine intake, neuropathies and use of medications.

Benign fasciculation syndrome (BFS) is a characterized by fasciculation commonly seen in the eyelids, arms, legs, and feet. Rarely can be seen in the tongue. Twitching may be episodic or may go on nearly continuously and is usually triggered by muscle movement. As BFS is a diagnosis of exclusion, one needs to exclude other causes including ALS before making the diagnosis.

My recommendation would be for you to wait to see your Neurologist for a good clinical examination and consultation. ENMG is required to exclude the possibility of ALS. You need to undergo couple of blood tests to exclude other causes. You need to be on close follow up for at least an year with clinical and electromyographic exams at about 6-month intervals before we make the diagnosis of benign fasciculation syndrome.

I want to reassure you that the fasciculations looks to me benign and you are not suffering from ALS. ALS usually presents with muscle weakness, atrophy and fasciculations which are usually focal to start before becoming generalized. This is certainly not something that is not life-threatening at this point of time.

I thank you again for submitting your question. I hope you find my response to be both helpful and adequate.

If you have any additional concerns regarding your question I would be happy to address them.


Dr Shiva Kumar R
Consultant Neurologist & Epileptologist.
Above answer was peer-reviewed by
Follow-up: Leg twitching, muscle weakness, throat clearing, swallowing lump, stiff jaw, popping ears. Could I have ALS? 12 minutes later
Thank you for the fast answer doctor!

I tend to agree with you since I have no issues with falling, tripping, and have not lost the ability to do anything at all in the past 3 months.

Do you believe the jaw issue may be TMJ and the throat tightening possibly just anxiety? I have been given lorazepam 1mg for anxiety. Is it common for BFS to cause fasciculations in one area for such a long period of time?

Would you say I have nothing to worry about unless I have actual muscle weakness and/or lose the ability to do a simple task?

Answered by Dr. Shiva Kumar R 30 minutes later

Thanks for the query

Regarding the jaw stiffness and pain I feel it could be due to problems in the tooth or the TMJ. Often TMJ problems are seen in people suffering from arthritis, elderly and in people suffering trauma to the facial region.

Yes benign fasciculations can be sometimes localized to a region of the body and is a definitive sign indicative of BFS. Fasciculations usually start focally and become wide spread over a period of 3-6 months in ALS.

So get a ENMG test done to exclude the possibilities and confirm the diagnosis of BFS. Clinical examination and ENMG will be normal in BFS.

Wishing you good health.


Dr Shiva Kumar R
Consultant Neurologist & Epileptologist.
Above answer was peer-reviewed by
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