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What Causes Fasciculations?
Question: Firstly, I am a recently turned 26 year old male. For the past couple of weeks I have been having semi-continual fasciculations. I have no prior medical issues, nor history of neuro diseases in myself or family. The twitches started off primarily in a left leg, and have since progressed to the right leg. Primarily in arches of feet and calves, but can occasionally be felt elsewhere. I got curious and looked this up online and immediately became increasingly concerned about ALS. That said, I have not noticed any weakness or atrophy to speak of. My left calf cannot flex to the same extent that my right can, and it may be ¼” smaller; however, the muscle is fairly similar (just not totally symmetrical), and I don’t seem to have weakness when running my 3 miles a day or doing calf raises.
I have gone to a neurologist who did a strength, reflex and balance test. He seemed to be a good neurologist, and he showed no concern about ALS. He thought the fasciculations were from my running and probably enhanced by the fact that I undoubtedly have severe anxiety about this. He did not suggest an EMG- said he would do one, but he thought it was a waste of time because he “knew everything would be normal”. He just suggested that I move on and not worry about neuro disease. He said “come back if you have weakness…. But you won’t”.
My real question is - What are the chances that I have ALS disease? Are they pretty much 100% I do not? Can I move on knowing that I do not have this disease?
I have gone to a neurologist who did a strength, reflex and balance test. He seemed to be a good neurologist, and he showed no concern about ALS. He thought the fasciculations were from my running and probably enhanced by the fact that I undoubtedly have severe anxiety about this. He did not suggest an EMG- said he would do one, but he thought it was a waste of time because he “knew everything would be normal”. He just suggested that I move on and not worry about neuro disease. He said “come back if you have weakness…. But you won’t”.
My real question is - What are the chances that I have ALS disease? Are they pretty much 100% I do not? Can I move on knowing that I do not have this disease?
Brief Answer:
Yes
Detailed Answer:
fasciculations are just a sign of a peripheral nerve disorder and not specific for any kind of disease. there is even a diagnosis called benign fasciculation syndrome you should check out. fasciculations happen
when the nerve cable to the muscle called the axon becomes irritated or disconnected. this can happen for any number of causes, one of the rarest of which is ALS. the hallmark of ALS is weakness so this is not a concern if you are not weak. there are many causes of decreased range of motion at the ankle so in order to help more information needs to be provided.
Yes
Detailed Answer:
fasciculations are just a sign of a peripheral nerve disorder and not specific for any kind of disease. there is even a diagnosis called benign fasciculation syndrome you should check out. fasciculations happen
when the nerve cable to the muscle called the axon becomes irritated or disconnected. this can happen for any number of causes, one of the rarest of which is ALS. the hallmark of ALS is weakness so this is not a concern if you are not weak. there are many causes of decreased range of motion at the ankle so in order to help more information needs to be provided.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thank you for the info doctor. My calf muscle range of motion is rather fine, and strength is fine, so I am really not too concerned there. It more just looks like muscles are not totally symmetrical in size, but very close. I assume this is rather common and not a problem if strength and motion is fine?
And can I take you to be saying ALS is not the cause of my twitching and that I don't really need more follow up or an EMG? Would the weakness with ALS have already shown up by the time my muscles are twitching if it were this disease? I should ask for peace of mind i suppose- if the slight difference in calf size were due to muscular atrophy I just assumed there would be weakness associated with it? I guess I was thinking with common sense that if a muscle is wasting away to the degree that it could be felt then you would notice it while running or working out? I could be wrong, so your answer to this among the prior questions would also be helpful. Thanks!!
And can I take you to be saying ALS is not the cause of my twitching and that I don't really need more follow up or an EMG? Would the weakness with ALS have already shown up by the time my muscles are twitching if it were this disease? I should ask for peace of mind i suppose- if the slight difference in calf size were due to muscular atrophy I just assumed there would be weakness associated with it? I guess I was thinking with common sense that if a muscle is wasting away to the degree that it could be felt then you would notice it while running or working out? I could be wrong, so your answer to this among the prior questions would also be helpful. Thanks!!
Brief Answer:
Correct
Detailed Answer:
loss of muscle size is the result of loss of mass which leads to weakness. clinically visible atrophy is end stage weakness so you would know for sure. it is much more likely that it has always been like that as most people are asymmetric in many aspects or the other side is larger for a different reason. you do not need another emg unless something else happens
Correct
Detailed Answer:
loss of muscle size is the result of loss of mass which leads to weakness. clinically visible atrophy is end stage weakness so you would know for sure. it is much more likely that it has always been like that as most people are asymmetric in many aspects or the other side is larger for a different reason. you do not need another emg unless something else happens
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Okay thanks again. Just to make sure it doesn't change your opinion- I have NOT had an EMG performed, only the physical test that the neurologist did. He did not suggest an EMG because he wasn't worried. Do you still think an EMG is not necessary?
And in closing out, do you agree that with twitching there would typically be other symptoms? Would you say this is a 99.9% chance no ALS? Thanks a lot for the help. I guess the only other additional, and maybe primary question would be- does my having these twitches make me any more likely to have ALS than the next person my age who doesn't have them? If it's not an indicator, I suppose my
Odds are the same as anyone else's at 26, which are almost nonexistent? This is probably the best way to state that question.
And in closing out, do you agree that with twitching there would typically be other symptoms? Would you say this is a 99.9% chance no ALS? Thanks a lot for the help. I guess the only other additional, and maybe primary question would be- does my having these twitches make me any more likely to have ALS than the next person my age who doesn't have them? If it's not an indicator, I suppose my
Odds are the same as anyone else's at 26, which are almost nonexistent? This is probably the best way to state that question.
Brief Answer:
Correct
Detailed Answer:
Hi,
You don't need an emg for ALS. You migt need it for other reasons later but not for muscle twitches. The only known risk factor for ALS is the sod1 mutation which is in familial ALS and super rare. These twitches do not predispose you to anything. Your odds of getting ALS are just like anyone else.
Regards,
Correct
Detailed Answer:
Hi,
You don't need an emg for ALS. You migt need it for other reasons later but not for muscle twitches. The only known risk factor for ALS is the sod1 mutation which is in familial ALS and super rare. These twitches do not predispose you to anything. Your odds of getting ALS are just like anyone else.
Regards,
Above answer was peer-reviewed by :
Dr. Raju A.T
Okay thanks so much for your answers. In closing can you please just explain what you mean by I might need an emg later on? I just got a bit confused because it seemed like you were saying I don't need one in fear of ALS. Do you just mean I might need one at some point in life? Sorry for confusion. Won't take more of your time than needed.
Brief Answer:
No problem, that's what I'm here for
Detailed Answer:
exactly, I just meant that you don't need one now for ALS but it doesn't mean you won't ever need one
No problem, that's what I'm here for
Detailed Answer:
exactly, I just meant that you don't need one now for ALS but it doesn't mean you won't ever need one
Above answer was peer-reviewed by :
Dr. Yogesh D
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