Hello doctor, I am a 48-year-old male in generally good health. For the past year, I have been experiencing muscle twitches all over my body, not all at once. My right thigh may twitch for several days then stop. Then my left shoulder, or ankle, or bottom of my foot. I searched plenty about it and concluded that it probably was not ALS because I did not have any muscle weakness. I used to work out quite regularly but had not in the past couple of years. About a month ago, I decided to get back into my workout routine, and I noticed considerable weakness on my left side while doing a bench press. I get the dumbbells out I curl the same max left, and right arm, shoulder press the same, but tricep- that is where the weakness is. Doing tricep extensions, my right side can do 30 lbs while my left only 15. I had also noticed more twitching in my left tri lately, so I panicked. Went to my general practitioner who referred me to a neurologist for an exam and EMG. The physical exam only revealed slightly brisk reflexes in both legs on the knee test, but he said they were not hyper. All other reflexes normal. No Babinski sign. He could feel that my left arm was a little weaker in the strength test. Next was the EMG which he said was normal, muscle and nerve. Since then, though, my tri continues to twitch as well as below my left shoulder blade on my back, and it keeps me in a state of constant worry that maybe the EMG was done too early and I have ALS. I am continually comparing muscles in the mirror and can see slight areas on my left tri and shoulder that do not match the right. I have started some light dumbbell work on the left tri. When I first noticed the weakness, I could do 30 lbs max on my right, but only 15 lbs max on my left. Within the past two weeks, I have gotten the left side up to 20 lbs max. I am hoping that is a good sign but the twitching, along with knowing it is weak, are about to drive me crazy. What do you think about all of that? Should ALS be on my radar?
Hello. I am gone through your history. You are having unexplained twisting movements of muscles and weakness on the left upper limb. Your history does not mention any sensory symptoms or urinary bladder symptoms. Hence, I am assuming it normal. You are suffering for a year, but your disease remains almost static. I mean at present it is non-progressive or slowly progressive. You already have consulted a neurologist, and there is no hyperreflexia, wasting of hands or shoulder, Babinski absent, with normal EMG or NCV. Your disease is, at present looks benign. My advice is to look for a metabolic parameter like serum, calcium, thyroid function test, serum sodium, serum potassium, serum vitamin D3 level, serum vitamin B12 level. If above all are normal, then you repeat EMG NCS after three to four-month of the initial test. And keep follow-up with a thorough neurological examination by a neurologist. Ask me if still, you are in doubt.