HomeAnswersNeurologyalsI am suffering from health anxiety and scared of ALS. Please help.

I am suffering from health anxiety and scared of ALS. Please help.

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At August 22, 2018
Reviewed AtSeptember 13, 2023

Patient's Query

Hi doctor,

I am suffering from health anxiety, and I am scared of amyotrophic lateral sclerosis (ALS). I started getting muscle twitches all over my body about six months ago. It started after I stopped taking Valium 10 mg daily for seven months (in suppository form). However, they still occur. I have discontinued Benzodiazepines (Valium and Xanax) for about seven months. I am very focused on my every movement. I have done two neurology exams (one by a psychiatrist and one by a neurologist). Both were normal. I also did two electromyography (EMG) on the same day. The psychiatrist did an EMG, a paraspinal EMG and tested 28 muscles altogether. His impression was healthy except for isolated fasciculation potentials in the right medial gastrocnemius. However, the above muscle was silent at rest with standard motor unit configuration and usual recruitment pattern. He said the study was healthy and did not suggest any motor neuron disease. The neurologist tested again because I made him do it. He did the nerve study and EMG directly on my right hand and arm where I am complaining as well as left hand, left arm, and left leg. He did not find any fasciculations and said it is all normal. The doctor told I do not have ALS. Both the doctors said there is no need to repeat the test. My questions are: 1. Would the EMG directly pick up on the right hand if ALS were present? 2. Should I be concerned about these fasciculations which can turn into something? 3. If the fasciculation is due to ALS, will they show any other issues on the EMG? 4. Can anxiety make fasciculation worse? 5. Is it possible to focus on a body part so much?

Answered by Dr. Aida Abaz Quka

Hi,

Welcome to icliniq.com. Your symptoms could be related to benign fasciculation syndrome, which is associated with multiple muscle fasciculations in the absence of any neurological disorders. Of course, anxiety can trigger this clinical situation. As your EMG (electromyography) was normal, we can exclude any possible ALS (amyotrophic lateral sclerosis). ALS patients also have an abnormal physical exam (neurological signs). So, I do not think that you suffer from ALS. I would just recommend performing further tests: 1. An EEG to exclude possible myoclonic epilepsy. 2. Thyroid hormone levels for possible thyroid gland dysfunction. 3. Vitamin D and vitamin B12 plasma levels for the possible deficiency. If all these tests results are normal, I would recommend discussing with your doctor on the possibility of starting Clonazepam, which is a Benzodiazepine which can help reduce anxiety and fasciculations. It is better tolerated when compared to Diazepam when used for a long time (it does not lead to addiction and tolerance).

Patient's Query

Thank you doctor,

I need clarifications for the following questions. 1. Can electromyography (EMG) show the fasciculations and is it normal? If it were abnormal would it have shown other things along with the fasciculations on the EMG? 2. Is it possible for me to focus on my hand that I am creating a psychosomatic situation of feeling things that are not there? 3. The EMG was done directly on the hand. I focused on it, and it was normal. I have done two regular neurological exams and two normal EMG. It is part of my anxiety, and I have started treatment for that. What made this worse for me? I have a friend who was just diagnosed with amyotrophic lateral sclerosis (ALS), and he had twitching. He also had weakness in his arm.

Answered by Dr. Aida Abaz Quka

Hi,

Welcome back to icliniq.com. The fasciculations can be detected by electromyography (EMG) as involuntary muscle contractions. But further signs like denervation and reinnervation pattern are needed to suspect for amyotrophic lateral sclerosis (ALS). The EMG was performed in 28 muscles (attachment removed to protect patient identity). ALS diagnosis is based on the presence of pathological signs in almost all the muscles. So, if there is disorder present, it would be detected by the EMG. The EMG can detect changes even when there are no fasciculations because it can detect the nerve damage even in early stages. So, in my opinion, you have nothing to get worried.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Aida Abaz Quka
Dr. Aida Abaz Quka

Neurology

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