Dr. Aida Abaz Quka
Neurology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I am a 29-year-old male and in need of some reassurance over my serious health anxiety re motor neurone disease (MND) Amyotrophic lateral sclerosis (ALS). I am not normally anxious or depressed, married with a young daughter and a wife who is pregnant. It started with an entire all day leg ache (left leg). Two days later my arm started to feel weird, tingles and biceps hurt. Since then (three weeks ago now) I have had the following symptoms. Numb or tingle fingers, feeling of weakness (but not actually weak), pain in hands, feeling of stiffness in fingers, lots of muscle twitches across body but mainly legs, feet, hands and arms, cramp type feeling in both big toes and calf muscles (not full on cramp), nausea and dull headache, dry throat, lump in front feeling, and a scratchy throat feeling. I keep looking for atrophy, though nobody thinks I have that. A sore skin feeling across my lower ribs and upper back like sunburn but without the burn, fatigue. I have seen three general practitioners (GP)'s. All three have said they think I am fine, they do not have worries and one said I do not have MND. I have had a complete blood test which had come back as normal. At my third GP appointment, I was tested for strength and reflexes. She could find nothing clinically wrong, no weakness but did mention some quite brisk reflexes but they were symmetrical. Is this normal? a referral was made, she said she doesn't think it is MND or anything bad basically. I was diagnosed with health anxiety two weeks ago and I am currently taking each day 50 mg Sertraline. Can you please confirm that the symptoms I mentioned are not MND or ALS related? That the twitches are nothing to worry about using your expertise? Confirm that the brisk reflexes on both sides (symmetrical) are nothing to worry about. That the type of cramp I am experiencing is not related to ALS or MND using your experience.
Hello,
Welcome to icliniq.com. Your symptoms are not typical of ALS (amyotrophic lateral sclerosis). You should know that at your age ALS is a very exceptional diagnosis. But there are also a lot of other conditions that may mimic this clinical situation. For this reason, I would recommend performing some tests. Complete blood count for anemia, blood electrolytes for possible imbalances, thyroid hormone levels for thyroid dysfunction, vitamin D levels and vitamin B12 levels for a possible deficiency, nerve conduction studies would help exclude ALS and calm your anxiety.
Patient's Query
Hi doctor,
Many thanks for the response. I have had all of those blood tests, all came back clear or in the normal range (including thyroid dysfunction and vitamin levels). Appreciate the clear way you have answered my questions (aware my age is a factor) but I was wondering if I could dig a bit further, can you clarify why the symptoms listed are not typical? What is typical? To help me with my anxiety if you could directly answer the below question that would be wonderful. Can you confirm that in your opinion the symptoms I mentioned are not motor neurone disease (MND) or amyotrophic lateral sclerosis (ALS) related? That the twitches are nothing to worry about using your expertise. Can you please confirm that the brisk reflexes on both sides (symmetrical) are nothing to worry about? That the type of cramp I am experiencing is not related to ALS or MND using your experience? It is not a full blown cramp which I have experienced before.
Hi,
Welcome back to icliniq.com. Regarding the brisk reflexes, they do always show pathology. They could be related to physiological characteristics too. A central nervous system disorder (like multiple sclerosis) could also cause brisk reflexes. But a neurological exam performed by a neurologist is very necessary to determine if your reflexes are normal and exclude the presence of other neurological signs which are associated with brisk reflexes (like pyramidal signs). The pain or any other sensory problems are not typical of amyotrophic lateral sclerosis (ALS) and even exclude it. Anyway, I recommend performing nerve conduction tests to totally exclude ALS. The fasciculations and muscle cramps could be related to benign fasciculation syndrome, which is usually encountered in sensitive persons and not related to any medical disorder. Anyway, I recommend consulting with a neurologist for a careful physical exam, before coming to this conclusion.
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