Why do I have weakness in my arms and legs?

Question

Hello doctor,

I fear having ALS (amyotrophic lateral sclerosis) due to my current symptoms. For the past three weeks, I have had on-and-off weakness in my arms and legs. It first started in the hands, then went to the arms, then the legs. I am exhausted and have been anxious regarding this, and I consulted three doctors.

The doctors say it is anxiety. I had two physical examinations, and they said I am perfect, just shaky, and had blood tests for vitamins, kidney, liver, thyroid, etc, and all is perfect. I am petrified and need help, as my anxiety is going wild. I am very anxious about my health. I currently take Sertraline 150 mg.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query, and I can understand your concern.

I completely understand your concern. Anything suggestive of ALS (amyotrophic lateral sclerosis) is potentially frightening. However, the good news is that your symptoms, as you described, are not suggestive of ALS. The ALS weakness is not on and off.

If it causes weakness, it would be constant and worsening. The course of symptoms is not in favor of ALS. Even though weakness can extend from limb to limb in ALS, it is a gradual and slow phenomenon. Therefore, any weakness extending in just three weeks to multiple limbs is not ALS.

You wrote that your physical examination was normal. It is in favor that your problem is not ALS. Because when ALS causes weakness, the physical examination is always abnormal, provided that it has been done by an expert physician. You mentioned that your limbs are shaky. I need to know more about it.

Which limbs are involved?
When did it start?
Does it occur during action, for example, when you grab a cup, or occur at rest when your limbs are not in action?
Have you had any recent weight loss?
Since when did you take Sertraline with this dose?

It would be very beneficial if you could upload a short film of your shaky limb.

I hope this will help you.

Thank you.

Answer 2

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

According to your description, you appear to have an action tremor. This refers to shakiness that occurs when the hands are being used or when force is applied during an activity.

This type of tremor is relatively common. In many cases, it can run in families, with a history of similar symptoms in parents or grandparents.

In your case, the tremor may also be related to Sertraline, as tremor is a recognized side effect and can occur in some people taking the medication. Since you have been taking Sertraline for anxiety and stress management, any changes to your medication should be discussed with your doctor.

If the tremor is bothersome or interferes with your work, your doctor may consider a low dose of Propranolol, which can help reduce tremor symptoms in appropriate patients.

Given that you have had two normal physical examinations, there is reassuring evidence that your symptoms are not suggestive of amyotrophic lateral sclerosis (ALS).

However, if the episodes of weakness continue or worsen, it would be reasonable to arrange an appointment with a Neurologist for a more detailed evaluation. This may include investigations such as an MRI or electrodiagnostic studies if clinically indicated.

At present, the likelihood of a serious neurological condition appears to be low. Regular light aerobic exercise may be beneficial, and it may help to avoid focusing excessively on serious diagnoses while the evaluation is ongoing.

Please feel free to ask if you have any further questions, and keep your doctor updated about any changes in your symptoms.

Thank you.