Aa
Odd symptoms onset
I'm having tingling/pins and needles sensations in my left foot. I'm having twitching in my calves and feet (more on the left leg and its also a pulsing sensation in my calf). I'm also having some twitching in my arms, hands, and eyes. But most of the twitching is in my calves and feet. The tingling/pins and needles started out of the blue on night and the twitching started a few days later. It didn't start in one area and spread. It started all over. Any ideas what this could be? ALS and MS were two things that really worried me, but I'm hoping those are unlikely since the onset of the twitching was so sudden and widespread. Its been going on about two weeks, with a few days in between where things appeared better. Thanks,
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 diagnosis is. However, I will try to provide you with some information.
“Twitches” are a common manifestation that can be seen in the general normal population, however they are concerning in some patients as they may be associated with other conditions. Fasciculations are small, local, involuntary muscle contraction (twitching) visible under the skin arising from the spontaneous discharge of a bundle of skeletal muscle fibers. Fasciculations have a variety of causes, the majority of which are benign. The main concern patients have when they have fasciculations is the possibility of Motor Neuron disease, of which ALS is one of them (Amyotrophic lateral sclerosis). Actually very few of the patients who seek medical attention for fasciculations turn to have this condition.
Regarding ALS, it is a disease of the motor neurons, associated with progressive weakness, significant loss of muscle strenght, sometimes affecting the “bulbar muscles”, which are the muscles of mastication and phonation. Usually the voice has like a nasal quality, and progressively worsens. The patients also have muscle fasciculations, which are like muscle “twitches”, and are visible in the bulk of the muscle. Commonly in the thighs or shoulders, but can be seen in other locations. The disability is progressive, and the muscle bulk is lost with time. The diagnosis is made by a good history and neurologic examination, and an EMG usually helpful. Sensory symptoms like tingling and pins-needles are not manifestation of ALS.
Fasciculations by themselves do not make a diagnosis of ALS, and findings of upper motor neuron signs and lower motor neuron signs in different segments of the body are required to be present for this diagnosis. The onset is progressive and gradual, and not rapid like in your case.
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. 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.
Regarding MS, this is a condition in which the patient has damage of the central nervous system, affecting 2 or more locations in at least 2 or more episodes. The symptoms are variable depending on the location affected. Patients can present with visual loss, double vision, balance problems, focal weakness, numbness, problems in the spinal cord leading to paralysis or sphincteric incontinence, and gait problems. These patients have findings on MRI showing the lesions in 2 or more locations, and this test is used for the diagnosis. The history and physical exam are also key for the diagnosis, and if needed other tests may be required, like spinal tap to assess for cerebrospinal fluid markers of inflammation. Evoked potentials is another type of study that may be needed if other tests are not conclusive. From the description of the symptoms and no evidence of more than one episode on different locations, it does not sound like MS.
From the information you provide, and without being able to obtain a detailed history and a good neurologic examination, I cannot tell you what the most likely diagnosis is. I think it is very important for you to talk to your physician and discuss your concerns, also if needed consider seeing aa neurologist to get a second opinion.
I hope this information is useful.
Without the ability to examine you and obtain a detailed history, I can not tell you what the diagnosis is. However, I will try to provide you with some information.
“Twitches” are a common manifestation that can be seen in the general normal population, however they are concerning in some patients as they may be associated with other conditions. Fasciculations are small, local, involuntary muscle contraction (twitching) visible under the skin arising from the spontaneous discharge of a bundle of skeletal muscle fibers. Fasciculations have a variety of causes, the majority of which are benign. The main concern patients have when they have fasciculations is the possibility of Motor Neuron disease, of which ALS is one of them (Amyotrophic lateral sclerosis). Actually very few of the patients who seek medical attention for fasciculations turn to have this condition.
Regarding ALS, it is a disease of the motor neurons, associated with progressive weakness, significant loss of muscle strenght, sometimes affecting the “bulbar muscles”, which are the muscles of mastication and phonation. Usually the voice has like a nasal quality, and progressively worsens. The patients also have muscle fasciculations, which are like muscle “twitches”, and are visible in the bulk of the muscle. Commonly in the thighs or shoulders, but can be seen in other locations. The disability is progressive, and the muscle bulk is lost with time. The diagnosis is made by a good history and neurologic examination, and an EMG usually helpful. Sensory symptoms like tingling and pins-needles are not manifestation of ALS.
Fasciculations by themselves do not make a diagnosis of ALS, and findings of upper motor neuron signs and lower motor neuron signs in different segments of the body are required to be present for this diagnosis. The onset is progressive and gradual, and not rapid like in your case.
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. 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.
Regarding MS, this is a condition in which the patient has damage of the central nervous system, affecting 2 or more locations in at least 2 or more episodes. The symptoms are variable depending on the location affected. Patients can present with visual loss, double vision, balance problems, focal weakness, numbness, problems in the spinal cord leading to paralysis or sphincteric incontinence, and gait problems. These patients have findings on MRI showing the lesions in 2 or more locations, and this test is used for the diagnosis. The history and physical exam are also key for the diagnosis, and if needed other tests may be required, like spinal tap to assess for cerebrospinal fluid markers of inflammation. Evoked potentials is another type of study that may be needed if other tests are not conclusive. From the description of the symptoms and no evidence of more than one episode on different locations, it does not sound like MS.
From the information you provide, and without being able to obtain a detailed history and a good neurologic examination, I cannot tell you what the most likely diagnosis is. I think it is very important for you to talk to your physician and discuss your concerns, also if needed consider seeing aa neurologist to get a second opinion.
I hope this information is useful.
Your information was very thorough and makes me feel a bit better about my symptoms and about my PCP's dismissal of my symptoms.
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