Brief Answer:
Yes- ALS should not be on your mind anymore

Detailed Answer:
Good afternoon. My name is Dr. Saghafi and I am happy to answer this important question for you.

First, a few words on what we refer to "Juvenile ALS" This is taken to be ALS which has its onset prior to age 25. In the literature this appears to occupy about 10% of all described cases. However, these young onset cases are almost always associated with a family history of ALS which I don't sense you have. They almost all have tongue fasciculations (or twitching) at the time they present to medical attention and all cases which have had EMG studies done are ABNORMAL. The percentage of cases of Juvenile ALS since the beginning of when they were described in 1850 to the 1950's was in the range of 50% of all affected persons.

However, over the next 3-4 decades that percentage dramatically DECLINED to 10% or less. It is not clear why this dramatic decrease in case reported incidence, however, that is what the numbers show.

At present, the average age of onset for ALS is taken to be 65 years.

There is a very comprehensive and nice review article on the pure epidemiology of ALS as it has come to us through the past 2 centuries that you may be interested in reading. I don't know if you can open the article up at this link but it talks extensively about the characteristics of Juvenile ALS:

http://brain.oxfordjournals.org/content/early/2012/06/01/brain.aws144.full

Personally, based upon what you have presented I believe you may have a condition known as BENIGN FASCICULATIONS and this is not that uncommon. You'd be surprised to know how many have muscular twitching underneath their clothing that you wouldn't even imagine!

Talkin' about Smoking Hot Women takes on a whole different meaning when you have a visual of all this muscle twitching happening in their arms and legs, underneath their clothing and such when you just see them walking down the street, doesn't it? HAHA!

At any rate, so long as your neurological examination was deemed normal as well as the EMG and head CT and you've got a NEGATIVE FAMILY HISTORY of ALS then, I would trash the notion of having ALS no matter how much twitching your muscles were doing and talk with your primary doctor as to what else could be causing these movements. If it's BENIGN FASCICULATIONS it is treatable but I'd do the full workup first before jumping into medications.

If the information I've provided has been of use to you I'd appreciate a bit of written feedback so that I may know how well I hit the mark at answering your questions. Also, if there are no further questions or comments on this issue would you be so kind as to CLOSE THE QUERY on your end so that the network may archive this case for the future as necessary?

I would also like to let you know that if you'd like we can continue these discussions on this network if you specifically direct questions to my attention (DARIUSH SAGHAFI, MD) or if you'd like to even do a live WEBCAM telemedicine chat please look me up at www.healthTap.com. I am in the state of OHIO. I am on shifts from 3a-7a Wed-Sat. That way you may be able to show me what the fasciculations look like as well as their distribution.

All the best to you.

This query required 39 min. physician specific time for review, research, and final draft documentation and envoy.

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Brief Answer:
Hoffman's in your case very nonspecific

Detailed Answer:
Hoffman's sign is best interpreted as a reflection of hyperactive reflexes without saying really what is the cause. When one looks at the clinical picture of the patient then, one can understand what it is showing. In your case, you have no evidence of any of the BAD things for which this sign is present such as cervical cord impingement or deterioration, no evidence of hyperthyroidism, or other evidence of upper motor neuron dysfunction or limb spasticity. Anxiety syndromes are well known to be a cause of positive Hoffman's signs.

I would also have expected the EMG to have detected problems anywhere in the left upper extremity in the way it is done since surveys are always performed which do general testing and then, if things are abnormal more specific testing is done in other parts of the limb. If everything is clean then, that suggests that the limb is clean. Does that make sense?

Good luck with everything.

Once again, your written feedback with a STAR RATING of this conversation would be greatly appreciated and if there are no further questions CLOSING THE QUERY from your end will signal the network that I've satisfactorily answered your questions so we can archive and reference this in the future as necessary.

This query required 43 min. physician specific time to review, research, and document final draft for envoy.

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