Is this ALS

[FreddyTeddy]

Symptoms began with neuropathic pain on back of hands (Left Hand in April, Right Hand four weeks ago) followed by parathesia, numbness, heaviness, weakness in hands and arms (forearm and upper arm). Arms very easily fatigued with pain. Fasiculation observed in right hand base of thumb muscles when contracted. Some spasms in muscles of little finger of left hand. Tingling quite frequent. No fasiculations seen elsewhere in hands or arms. Fine motor movement still ok but easily fatigued, writing ok but becomes painful. Occasional burning neuropathic pain, fingers, arms.
Two weeks ago both legs, parathesia mainly pins and needles, frequent and extensive. Some "crawling sensations" in legs but no observable fasiculation. Neuropathic pain toes right leg and elsewhere. Probability of compartment syndrome in both legs.

[FreddyTeddy]

HI
Something very strange has happened, my wife has started to get the same initial symptoms as mine above. Her doctor said it could be Carpal Tunnel, but it did not fit the classic symptoms of CT. The doctor ordered 4 blood tests.
I did not think that ALS was infectious .. are there other neurological  illnesses that are, that begin with neuropathic symptoms (e.g. pins and needles, electric shocks, burning sensation, heaviness)???

[Shazia Alam, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to obtain a history from you and examine you, I can not comment on a formal diagnosis or treatment plan for your symptoms. However, I will try to provide you with some information regarding this matter.

It must be emphasized that in the MAJORITY of cases, muscle twitching are BENIGN meaning that they are of no consequence and are not resulting from a serious cause. In such cases, the twitches may be related to anxiety/stress, caffeine, and often occur after recent strenuous activity or muscle over-use. It is important in such cases to reduce stress/anxiety levels and to reduce caffeine intake.

Benign fasciculation syndrome, which I will abbreviate as BFS, is a condition in which there are involuntary twitches of various muscle groups, most commonly the legs but also the face, arms, eyes, and tongue. If the diagnosis is confirmed and other causes are excluded, it can be safely said that the likelihood of progression or occurrence of a serious neurologic condition is low.

When BFS is present but not particularly bothersome or disabling, treatment is not necessary. If severe and it requires treatment, there are a few medication options though this condition is not very common, and the research that has been done on its treatment is limited. Minimizing caffeine and stress, and treating anxiety if it is present, will improve your symptoms.

When fasciculations occur in the setting of associated symptoms such as progressive loss of sensation, tingling or numbness, weakness, trouble swallowing or breathing and other symptoms, the cause may be due to a peripheral nervous system problem. In general the symptoms would not be episodic and triggered by certain things but would be more constant/frequent without consistent triggers. The location of the problem could be the anterior horn cells, the area where the nerves that supply motor innervation to our body comes from. These are the cells that give off the nerves that allow us to voluntarily contract our muscles. The diseases that might affect the anterior horn cells include ALS (also called Lou Gherig's disease), a condition called spinal muscular atrophy, polio-like viruses, west nile virus, and other infections.
Another nervous system problem, neuropathy, may also lead to fasciculations. There will again be associated weakness or sensory changes.  ALS is usually progressive and ends up leading to atrophy of muscle.  

To diagnose ALS, typically an EMG (electromyelography) is used—this is a needle exam which examines the function of the nerves and muscles.  Sometimes MRI of the brain can also be done.  

I suggest follow up with your primary doctor and you may benefit from evaluation by a neurologist as your primary doctor feels fit. It is important that you discuss your concerns with him/her.