Aa
Please help
HI,
I am a 40 year old woman who has been diagnosed with gastroparesis. I was on Reglan for over 6 months and switched to Domperidone in January. I am also on Protonix and Zantak for acid reflux. Right before that switch to Domperidone, I noticed twitches all over my body but mainly in my legs. At the same time, my bowels pretty much stopped working. I do not have the urge to defecate and when I do, it is only alittle bit at a time. I noticed my speech was slurred in October and recently feel as though the base of my tongue is stiff and swollen. My right ankle is weak and seems to want to turn inwards. My right hand seems weak and my pinkie and ring fingers seem to curl up (not when I sleep). I also have eye twitches only when my eyes are closed. Other symptoms include I have ridges on both of my arm's muscles almost like a ladder. I am being treated with asthma and my pft's have deteriorated this year. My pulmonogist feels it is because I am 30 pounds overweight and I am 4'11". He has taken me off all asthma medicines and nothing has changed for the better or worse. I had a neurological exam and all came back normal. I am scheduled for an EMG and an MRI in 3 weeks but the suspense is killing me.
My questions are:
1. I am currently on Xanax for anxiety due to these sysmptoms. Would my twitches "slow down" if it were ALS? I still have them but they are not as noticable.
2. Would the ridges on my arms be the beginning of atrophy? Does atrophy run horizonitally on a muscle? I have it on both arms.
3. My pft results are FVC 72, FEV1 77, FEV1/FVC 107, ERV 50, RV 96, TLC 81. All other numbers seem normal.
4. Would ALS start with spasticity or dystonia? What is the difference?
5. Do you think this is ALS and if not, what other things could cause this problem?
I am a 40 year old woman who has been diagnosed with gastroparesis. I was on Reglan for over 6 months and switched to Domperidone in January. I am also on Protonix and Zantak for acid reflux. Right before that switch to Domperidone, I noticed twitches all over my body but mainly in my legs. At the same time, my bowels pretty much stopped working. I do not have the urge to defecate and when I do, it is only alittle bit at a time. I noticed my speech was slurred in October and recently feel as though the base of my tongue is stiff and swollen. My right ankle is weak and seems to want to turn inwards. My right hand seems weak and my pinkie and ring fingers seem to curl up (not when I sleep). I also have eye twitches only when my eyes are closed. Other symptoms include I have ridges on both of my arm's muscles almost like a ladder. I am being treated with asthma and my pft's have deteriorated this year. My pulmonogist feels it is because I am 30 pounds overweight and I am 4'11". He has taken me off all asthma medicines and nothing has changed for the better or worse. I had a neurological exam and all came back normal. I am scheduled for an EMG and an MRI in 3 weeks but the suspense is killing me.
My questions are:
1. I am currently on Xanax for anxiety due to these sysmptoms. Would my twitches "slow down" if it were ALS? I still have them but they are not as noticable.
2. Would the ridges on my arms be the beginning of atrophy? Does atrophy run horizonitally on a muscle? I have it on both arms.
3. My pft results are FVC 72, FEV1 77, FEV1/FVC 107, ERV 50, RV 96, TLC 81. All other numbers seem normal.
4. Would ALS start with spasticity or dystonia? What is the difference?
5. Do you think this is ALS and if not, what other things could cause this problem?
Thank you so much for your reply. I had an EMG and it came back normal. The doctor did not test my tongue and I am very mad at myself for not asking for it. My tongue feels stiff and tight. It also has ridges along side of it. If I had bulbar ALS would the test that was done on my spine show up as Bulbar symptoms? Thanks so much for your time.
MEDICAL PROFESSIONAL
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 examine you and obtain a detailed history, I can not tell you what the exact cause of your symptoms is or how to treat them. However I will try to provide you with some useful information.
ALS is a disorder of the motor neurons in which patients present with progressive weakness, muscle wasting, atrophy, fasciculations, problems swallowing and speaking, and signs of upper motor neuron like spasticity, hyperreflexia and abnormal reflexes. The diagnosis is sometimes very difficult to make, and requires findings of what we call upper motor neuron and lower motor neuron, combined in several segments of the body. Many times patients are concern about this diagnosis, but they do not have it. The history, clinical presentation, neurologic examination, along with EMG studies are usually required for the diagnosis. Fasciculations or twitches are a common manifestation that can be see in the general normal population, and they are small, local, involuntary muscle contraction visible under the skin, arising from the spontaneous discharge of a bundle of skeletal muscle fibers. Fasciculations have a variety of causes, the majority benign, but also can be seen in ALS, and therefore normal people when they start experiencing fasciculations, they get concerned. Actually very few of the patients who seek medical attention for fasciculations turn to have this condition, and other features are required to make the diagnosis of ALS as I mentioned.
Fasciculations by themselves do not make a diagnosis of motor neuron disease. Common more benign conditions associated with fasciculations include caffeine use, anxiety, electrolyte abnormalities like changes in the calcium and potassium, thyroid disorders, or other endocrinologic disorders. Most of the time, the history and physical exam helps to determine the presence of one of these conditions, or blood tests may be needed. There is a condition called Benign Fasciculations, in which spontaneous fasciculations occur and some people may have a widespread or relatively focal presence of fasciculations accompanied by cramps. On long term studies of these patients, it is found that this is a truly benign condition and does not confer a risk for motor neuron disease.
Medications, like stimulants, bronchodilators, amphetamines among others, may also produce muscle twitches, and this is easy to determine based on the history of what the patient is taking.
Patients with ALS will have problems swallowing, but I have not seen gastroparesis specifically in patients with ALS.
I do not know what you mean by “ridges” or “ladders” in your arms, and I cannot comment on this. And this is a neurology forum, and I cannot comment on your PFT results neither.
Regarding spasticity and dystonia, both are different issues. Spasticity is an increase in the tone that usually increases further as the muscle is stretched, and it is caused by central nervous system causes. In dystonia there are sustained muscle contractions causing “twisting”, repetitive movements or abnormal posture of a limb. Dystonia is not typically seen in ALS, and is more related to movement disorders.
With the description you give, and without being able to obtain a detailed history, and a good physical and neurological exam, I cannot tell you what the cause of your problems is, and I am not able to determine if this is ALS or not. I think that there are other conditions you mentioned that can be causing the twitches, like asthma medications or anxiety. I think that the best you can do is discuss your concerns with your neurologist, and try to find a cause for your symptoms. The MRI and EMG will be very helpful to determine what the cause of your problems is.
I hope this information is useful.
Without the ability to examine you and obtain a detailed history, I can not tell you what the exact cause of your symptoms is or how to treat them. However I will try to provide you with some useful information.
ALS is a disorder of the motor neurons in which patients present with progressive weakness, muscle wasting, atrophy, fasciculations, problems swallowing and speaking, and signs of upper motor neuron like spasticity, hyperreflexia and abnormal reflexes. The diagnosis is sometimes very difficult to make, and requires findings of what we call upper motor neuron and lower motor neuron, combined in several segments of the body. Many times patients are concern about this diagnosis, but they do not have it. The history, clinical presentation, neurologic examination, along with EMG studies are usually required for the diagnosis. Fasciculations or twitches are a common manifestation that can be see in the general normal population, and they are small, local, involuntary muscle contraction visible under the skin, arising from the spontaneous discharge of a bundle of skeletal muscle fibers. Fasciculations have a variety of causes, the majority benign, but also can be seen in ALS, and therefore normal people when they start experiencing fasciculations, they get concerned. Actually very few of the patients who seek medical attention for fasciculations turn to have this condition, and other features are required to make the diagnosis of ALS as I mentioned.
Fasciculations by themselves do not make a diagnosis of motor neuron disease. Common more benign conditions associated with fasciculations include caffeine use, anxiety, electrolyte abnormalities like changes in the calcium and potassium, thyroid disorders, or other endocrinologic disorders. Most of the time, the history and physical exam helps to determine the presence of one of these conditions, or blood tests may be needed. There is a condition called Benign Fasciculations, in which spontaneous fasciculations occur and some people may have a widespread or relatively focal presence of fasciculations accompanied by cramps. On long term studies of these patients, it is found that this is a truly benign condition and does not confer a risk for motor neuron disease.
Medications, like stimulants, bronchodilators, amphetamines among others, may also produce muscle twitches, and this is easy to determine based on the history of what the patient is taking.
Patients with ALS will have problems swallowing, but I have not seen gastroparesis specifically in patients with ALS.
I do not know what you mean by “ridges” or “ladders” in your arms, and I cannot comment on this. And this is a neurology forum, and I cannot comment on your PFT results neither.
Regarding spasticity and dystonia, both are different issues. Spasticity is an increase in the tone that usually increases further as the muscle is stretched, and it is caused by central nervous system causes. In dystonia there are sustained muscle contractions causing “twisting”, repetitive movements or abnormal posture of a limb. Dystonia is not typically seen in ALS, and is more related to movement disorders.
With the description you give, and without being able to obtain a detailed history, and a good physical and neurological exam, I cannot tell you what the cause of your problems is, and I am not able to determine if this is ALS or not. I think that there are other conditions you mentioned that can be causing the twitches, like asthma medications or anxiety. I think that the best you can do is discuss your concerns with your neurologist, and try to find a cause for your symptoms. The MRI and EMG will be very helpful to determine what the cause of your problems is.
I hope this information is useful.
Also, I failed to mention that my gastroparesis has been controlled with medication. Would this be possible if it were ALS?
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