I have been experiencing on and off muscle twitching for the past two years. Please help.

Q. How to treat slow progression amyotrophic lateral sclerosis?

Answered by
Dr. Hitesh Kumar
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Apr 29, 2023 and last reviewed on: May 04, 2023

Hello doctor,

I have been having on and off muscle twitching for the past two years, and having no other symptoms. Could this still be slow progression ALS?



Welcome to icliniq.com.

I understand your concern.

I would like to know some details about your symptoms:

1. In which body parts, do you have twitching?

2. Are these twitching visible to the eyes? Or only felt inside?

3. Have you noticed any weakness or thinning of some part of arm or leg muscles? If yes, please describe.

4. Have you noticed any situations in which these twitching get increased? If yes, please tell.

5. How is your common mood today? Is it usually towards happy, toward sad or toward worried?

6. How is your sleep usually? Do you get sleepy quickly after laying in bed? Do you have frequent awakenings in night?

7. Have you undergone some investigations for this symptoms? If yes, please send as attachment.

Investigations to be done:

The investigations include T3, T4, thyroid stimulating hormone (TSH), serum vitamin B12, ECG (electrocardiogram), nerve conduction study all four limbs, serum calcium, and serum magnesium.

Differential diagnosis:

The differential diagnosis include-

1. Benign fasciculation syndrome.

2. Anxiety disorder.

Treatment plan:

Only twitching's cannot fulfill the diagnostic criteria for diagnosis of amyotrophic lateral sclerosis. There are many other possible etiology for twitching's.

Though ALS is progressive disease, with time more symptoms may appear.

Though no new symptoms in two years, make the possibility of ALS is lesser. Still, there are no tests or clinical methods to rule out ALS. ALS is diagnosed by clinical judgement and criteria supported by investigations.

Regarding follow up:

Revert with above mentioned information for better understanding and further judgement.

Hi doctor,

Thank you for the reply.

  1. Twitching is felt all over the body but mainly legs and arms.
  2. No weakness or thinning only when lying down, sitting, driving or in certain positions.
  3. My mood is fine, but I do experience a bit of worry and anxiety.
  4. Sleep is fine, no awakenings.


Welcome back to icliniq.com

Possibly these are fasciculations. If no other symptoms or weakness or muscle thinning, and no further progression over two years, possibility of ALS is down. With worried mood, chances are :

  1. Anxiety disorder.
  2. Benign fasciculation syndrome.

Hyperthyroidism needs to be ruled out.

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