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What causes constant twitching in the calf muscles while having amyotrophic lateral sclerosis?

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Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3650 Questions

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Posted on Sat, 3 Sep 2016 in Brain and Spine
Question: yes- I'm a 55 year old Male, and for 6 months or more I have had continuous twitching/fasciculations in both of my calf muscles. I didnt think much about it until i looked it up on the internet, saw it could be BFS, or could be much worse, and now it has my attention. I went to my general practitioner who did a blood panel and determined it wasn't a metabolic imbalance. I have an initial neurologic consult scheduled as a result, but that isn't available until mid-october, and the more I'm reading about this online, the more frightened I'm becoming about having MS or ALS or something severe. I do also occasionally have tingling/numbness in my hands as well, and the occasional tingling on my tongue.

Are there any "self-tests" i can try while waiting to see the neurologist that could perhaps give me some peace of mind? and/or what are signs beyond the fasciculations I should be aware of, or look for, which may be clues as to my situation? what is the likely hood/percentages this is BFS versus something more? could waiting until october be harmful in the long run?
I also have a bulged disk - C4 or 5, I believe- in my neck , any chance thats related?
thanks for your consideration,
-XXXX
doctor
Answered by Dr. Olsi Taka 2 hours later
Brief Answer:
Read below

Detailed Answer:
I read your question carefully and I understand your concern.

To start with MS, those symptoms you have are not indicative of MS at all, that should be the last of your concerns. Furthermore at 55 you do not have the age for one to develop MS, it typically starts at a young age before 45, cases over 50 are very exceptional (personally have never seen one with an onset after 50 in 8 years in the Neurology field).

Regarding ALS, while the age is not an argument in this case I still do not think it to be likely. The primary feature of ALS is motor weakness, weakness which is usually of an insidious onset in one limb, developing over months years involving other regions. Fasciculations are a feature but they develop on top of the weakness and the atrophy, the muscle wasting. So those are the signs you should be looking for, the self test, weakness causing difficulty performing daily activities. The fact that you have only fasciculations starting on both lower limbs at the same time and spreading so quickly to involve the hand and tongue without any evident weakness or muscle wasting is an argument against ALS.

The tingling as well is not a feature of ALS, it is called otherwise motor neuron disease because it involves motor nerve cells sparing sensory ones, so sensory symptoms like tingling go against it and in favor of anxiety (which is commonly related to BFS).

So the likelyhood of it being BFS is very high though it is difficult for me to speak of percentages in a patient whom I have never examined, but I would still say over 90%.

As for the bulged disk, it can cause symptoms in the lower limbs when compressing the spinal cord, but again more in the form of weakness. Also the disc bulging in the neck can't cause symptoms in the tongue.

I hope to have been of help.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Olsi Taka 44 hours later
Thank you for your response, very helpful.
I would like to follow up by saying I drink a pretty fair amount of alcohol, and as Ive continued to read, I'm getting more concerned about alcoholic neuropathy as a possible scenario?. could that cause the BFS? or are they different? I function well, dont have shaky hands, in general, but I do have the tingling in my arms and legs, beyond the fasciculations, and have experienced some muscle weakness as of late, mostly noticing that my muscles are cramping a lot more than normal. For the last few years i have had 3-4 drinks a day, and occasionally more, is that enough to cause nerve damage? I drink whiskey only. If i have a really heavy night it might entai aas much as a 1/2 a fifth,. I never drink in the daytime, and most of the time i have 3-4 whiskeys at night between 6-10 pm. I am now going alcohol free to see if this makes a difference in my condition,. I am suddenly concerned/curious about the possibility of alcohol, and wondering if it cold be 1- a contributing factor, or 2- a causal factor. and if so, is this reversible, curable?..
doctor
Answered by Dr. Olsi Taka 4 hours later
Brief Answer:
Unlikely

Detailed Answer:
Thank you for the additional information.

Technically alcoholic neuropathy can cause your symptoms. However usually that happens in people who consume large amounts of alcohol for many years. There is not a cut off value for the amount of alcohol, but I do not think that your type of consumption justifies that. It is a case usually of much larger amounts, in patients who are malnourished and there is debate on how much it is due to alcohol itself or the vitamin deficiency due to malnutrition in alcoholic patients.

So I do not think it is a causal factor, unlikely to be a contributing factor either. From a practical point of view the only cure is interruption of alcohol and vitamins, so nothing wrong with you going alcohol free.

I still think BFS is more likely though. One way it may be related to alcohol is because BFS is related to anxiety and people who consume alcohol tend to have anxiety issues (alcohol alleviates anxiety and it may be a factor why alcohol is used in the first place). It is an association which doesn't mean alcohol is the cause though, I hope you understand the difference. Just mentioning it because you should be careful with interrupting alcohol cold turkey as it may cause an increase in level of anxiety.

Let me know if I can further assist you
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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