Q. Is it possible that my muscle twitching and cramps are early signs of ALS and EMG missed it?

Answered by
Dr. Aida Abaz Quka
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jan 20, 2022

Hello doctor,

I am extremely concerned that I have ALS due to twitching and cramps. I recently had an EMG performed, a nerve test, and other reflex tests. The neurologist said that I 100 % do not have ALS. I was willing to accept this, but I have some questions. Is it possible that I have bulbar ALS and an EMG missed it? Sometimes I slur my words. Also, is it possible that I have early symptoms and the EMG did not detect them? Please give me your valuable insight on this.

Thank you.



Welcome to

Thanks for writing in, and I understand your concern. It is not possible to have early signs like muscle twitching as they are present at a later stage of amyotrophic lateral sclerosis (ALS) when muscle wasting is present. Bulbar ALS can be detected on electromyography (EMG). Besides, in bulbar ALS, the gag reflex is diminished, there is persistent dysphagia. So, I do not think you have ALS. There are a lot of benign causes of underlying muscle twitching. I recommend getting vitamin D levels, vitamin B12 levels, thyroid hormone levels, and blood electrolytes. I would also suggest avoiding caffeine intake and taking plenty of fluids to stay well hydrated.

I hope this helps.


Hello doctor,

Thank you for your response.

Do you think that this is in my head that I might slur my words? Also, is my difficulty in swallowing persistent? Could you please clarify this for me?




Welcome back to

Yes, I think your anxiety is causing you difficulties in speaking. The difficulty in swallowing is usually persistent and progressive in ALS. So, I think that this is not your case. There is nothing to worry about. So, try to relax and do not worry about it further. I would recommend you to take magnesium supplements 300 mg to 400 mg daily to help improve your symptoms.


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