Brief Answer:
Hey Great News You're telling Me!

Detailed Answer:
Good morning and thank you for the condolences on LeBron's debut back home for the start of the NBA season. They did pull out a squeaker the next night with XXXXXXX so perhaps a little sweet revenge (on somebody)...HA!

That's good news that you've decided to defer the EMG for the time being. I agree with you and I'll tell you why. Let's assume that at some period of time in the future something did happen where you started feeling a loss of strength or power in the arms or legs or what have you. At that point and assuming that these twitches were still present an EMG would be MORE LIKELY to detect something of abnormality that would more definitively point toward one type of problem or another as opposed to this point in time.

So using an EMG test is really best done when as much of the clinical picture of what you're suspecting is present at the same time, twitching, muscle weakness, loss of bulk....none of which you have except for the twitching....so wise move Grasshopper to nix the test at this time. Don't worry there will always be a neurologist standing ready to put you through that particular diagnostic study if you really and truly want it so it ain't goin' anywhere.

As far as your twitches being exacerbated by anxiety or stress....in BFS it absolutely can be that case. Let me share with you a paragraph directly from the Wiki article that you can get online that says this:

"The precise cause of BFS is unknown, and it is not known if it is a disease of the motor nerves, the muscles, or the neuromuscular junction. Though twitching is sometimes a symptom of serious diseases such as spinal injury, muscular dystrophy, Lyme disease, multiple sclerosis or amyotrophic lateral sclerosis (ALS), causes like BFS and over-exertion are more common. Mitsikostas et al. found that fasciculations "were slightly correlated to the body weight and height and to the ANXIETY LEVEL" in normal subjects."

Have you had your blood electrolyte levels checked yet? I don't recall if you've had the full panel of those done. Especially correlated to these twitches is felt to be MAGNESIUM. By the way, magnesium is felt to be deficient in people with unusual or unexplained states of anxiety. I wonder???

I've checked many a person who I never thought would have magnesium level deficiencies and found them, treated them appropriately and magically symptoms go away! Trust me, I'm not a HUGE fan of correcting micromolar concentrations of vitamins and minerals to cure major problems BUT in this case with the twitches, your anxiety levels, and so forth....I'd get a set of levels of magnesium and perhaps a few other trace elements (Zinc, Copper) and just make sure in general that everything else is in order, Thyroids, adrenal glands, Vitamin D, etc.

Now to your question- You are correct to guess that in the condition of BFS we believe that the driving force or progenitor of the problem is in the brain (or central nervous system) and is not a disease process at the level of the spinal cord or in the muscles or anything like that.

Anybody in your family that you know of ever suffer from twitchings like this? BFS is felt to have a preponderance of anywhere from 15-40% depending upon the study you read. Also, check out this poster that I found that was presented at the XXXXXXX Neurological Association's Meeting....does this fit you perfectly or what?

http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=8&ved=0CFIQFjAH&url=http%3A%2F%2Fwww.lahey.org%2FDepartments_and_Locations%2FDepartments%2FNeurology%2FPoster_ANA_BFS_2012.aspx&ei=LPhUVKyLN4yxyATEw4LoCw&usg=AFQjCNGgG8SlGlpzPk14-AxVeKdLSHzRnw&bvm=bv.0000,d.aWw

This is in .pdf format....took forever to open on my computer but it explains A LOT regarding your anxiety having to do with these twitches.

So THINGS you can do to relax your NERVOUS SYSTEM...well, there are many (but first I would check the metabolic side of the equation as I mentioned up ahead of this paragraph). There's all sorts of stuff that you may or may not amenable to...that your kids might get a chuckle out of watching you try but, I've done them....and I'm an assistant wrestling coach at the university here....so what the hell....I don't wear pink tootoos or anything but I'll take Yoga classes every now and again to stretch out and feel totally belittled by all these women (some older) that are so flexible compared to me that it's ridiculous....but seriously, Yoga has a great effect in general on muscle hyperactivity in things such as BFS. There's also Tai-Chi, again another great activity that occupies the brain and therefore, leaves less for it to think about in terms of muscle twitching.

How about a more basic question of whether or not you're in good physical condition....and that means both from a weight and stamina perspective. Do you do any bit of regular jogging, swimming, aerobic exercises? Is your weight under good control and are you on a good healthy diet (at least most of the time?)....if not then, would you consider this a great opportunity to jumping on the healthy bandwagon? We're not talking starvation diet or necessarily having to part with eveything you love....but reasonable modifications that you can live with easily which could make a difference overall to your risks for having a heart attack, stroke, or getting cancer?

There are breathing and relaxation therapies and exercises that can be done....talking about needles galore....how about going for acupuncture?

Hypnotism (nah...I'm not a fan of hypnotism myself....I've not seen enough success to make a general recommendation on that...)


Then, there are the old stand by types of things that do quiet the twitches down but now we're going to get into the realm of drugs that are potentially habit forming and I'm not sure you want to do that...especially since this is a benign process...but there are your Ativans, Xanax's, and if you wanted something with a nice long duration so you could potentially cut back on doses per week....you can try Chlordiazepoxide or Librium...great little drug that stays in your system forever but you'd only have to take it a couple of times per week once you got it up to good therapeutic levels in order to control the twitchings.

There are other drugs that are probably effective for some but less robust than the previous group I mentioned. Those would be your antiepileptic class such as Tegretol (most commonly used), Topamax, Gabapentin (least effective but least harmful in side effects), phenobarbital, Depakote, Keppra, Lamotrigine. But in these drugs there are all sorts of other side effects which are less those of addiction or dependency but they could slow you down mentally and even to some extent physically and if you work and have kids to play with and want to run up staircases and carry luggage....well, these drugs could get in the way.

So, there are some other choices to think about.....let me know what you think and if you want more ideas....unfortunately, we don't have a cure for this since we don't understand how it comes about.

So now, before bidding you adios on this particular message....I must BEG YOUR PARDON for the long winded explanation but as you know....I hate leaving things to anyone's imagination and so I hope you've had the time and patience to see this really big note through...maybe you can just jot some points down and get rid of the rest.

Again, best of luck to you, your Pacers, and your Colts.....but I hope they lose when they meet our Cavs and Browns! HA!

I also once again extend an invitation to say Hello if you're ever headed East toward XXXXXXX and please keep the information flowing as it becomes available.

Thank you for all the kind comments you've posted...management clearly prefers those to jeers and sneers so if it's possible....keep 'em coming if you think my responses are deserving....if not I totally understand. These things are like WAR AND PEACE....but at any rate....it's the way I am I guess.....I've tried to change my ways but just don't feel comfortable leaving out information that I think people would like to know...if for only a moment regarding their health.

This query required 105 minutes of physician specific time to research, review, and document for final draft envoy.

Getting in touch with me directly can be done either by responding to this question or by using:

bit.ly/drdariushsaghafi

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Brief Answer:
Glad to hear back from you sir---

Detailed Answer:
Thanks for taking the time and effort (and money) to send a message on what you're feeling. I can appreciate both the fact that you are CEREBRALLY aware of all the plethora of evidence we have against your having ALS while AT THE SAME TIME you are PARADOXICALLY as aware of some of the other things which appear to be in contradistinction to those facts.

I guess there is not way to really "win this battle" as one of my most trusted mentors from my training days told me not more than several months ago. Did you have a chance to read the article I sent you the link on which was actually a poster presented at the XXXXXXX Neurological Association on people with BFS and their apparent heightened levels of anxiety which seem to be out of their control. Interestingly enough there is no such relationship in ALS having to do with states of overanxiousness.

Perhaps, I could point that out to you...in and of itself....to help you see the dividing line which clearly demarcates ALS from what you have which we believe to be BFS.

For some odd reason I had it in my mind that you were from Indiana...but not so, MASSACHUSETTS, huh? Love XXXXXXX of course...been there a few times and it's just one of the most beautiful cities in the country.....I'll call her the land of perpetual construction and motion.

Was it determined that you were actually magnesium deficient? Or did you just decide to start taking it?

Well, I have my own confidence tempered with the professional knowledge that ANYBODY can develop ANYTHING at any time which is to say that ALS is never out of the theoretical differential diagnosis for ANY HUMAN BEING. I don't think there is a person who can say that they have a guarantee that they will never become affected by Disease X or never Die from disease Y.

Let me know how I can help or support you through these times. Would you consider speaking with a psychologist or therapist on methods and ways to cope with the type anxiety and stress you have.

In the mean time if you are ever thinking of dropping in on the Rock 'n Roll Capital of the World then, please call Parma Neurology at 440.842.3816 and we'd be very happy to set up time to visit in the office. For the interim though, I suppose you'll just have to settle for some neurologist who moves within the the milieu and academic presence of Harvard, MIT....am I missing some impressive Hall of Higher Learning?

Cheers!

This query required 49 minutes specific physician directed time for review, research, and final draft documentation for envoy.

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