Q. I have difficulty in swallowing with muscle twitching. Do I have ALS?

Answered by
Dr. Gursimran
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Dec 01, 2020

Hi doctor,

About two months ago, I started experiencing difficulty swallowing solid foods. I visited my PCP, who ordered a swallow study. Results from the swallow study came back normal, nothing neuro-muscular. Additionally, I had an endoscopy and a laparoscopy. Both concluded evidence of LPR/GERD. I have been on Dexilant and Pepcid for about two months now, which has helped with my swallowing. Through this process, I developed pretty severe anxiety about swallowing and choking. I started avoiding foods and losing about 15 lbs in a month. During this process, I noticed all over the body twitching, which has yet to subside. I am eight months postpartum and recovering from thyroiditis.

My PCP sent me to see an endocrinologist due to my low TSH and free T4 levels (she sent me saying she thought I had a pituitary or hypothalamus tumor). Blood work and a thyroid ultrasound from Endocrinologist revealed the thyroiditis. I say all of this because I have been nervous and worried and likely developed a form of health anxiety. I am terrified something is wrong neurologically. I am still experiencing constant muscle twitches all over the body, mostly small, annoying twitching.

Additionally, along this timeline, I have also experienced an extremely stiff neck for which I see a chiropractor. I do not want to stress over it because I know that can make it worse, but it is difficult not to stress. I fear all of these issues are related (difficulty swallowing, muscle twitching, hormone regulation) and perhaps indicators of a neurological disorder. Obviously, any research on muscle twitching leads to MS or ALS. I have read about BFS, which seems more likely but would you like someone who knows way more than I do to provide suggestions? All indicators lead to anxiety being a prominent indicator for all of these things, but I would like someone else to weigh in.

Some additional symptoms I have experienced and did not necessarily put together with the muscle twitching are random muscle and joint pain that happens really quickly and then subsides, sometimes coming back in the same pattern. Last week, I had a burning sensation in my mid to right back for a couple of days. This morning the side of my right hand seems to have the same slight feeling of burning, sensitive to touch. Additionally, I will get feelings of goosebumps and tingles at random down my legs and my scalp. I know these can all be from anxiety, so hoping you can provide more insight.



Welcome to

First of all, I am so sorry about your symptoms. The first symptom is difficulty swallowing solids. Now mainly neurological and neuromuscular weakness leading to difficulty in swallowing is always for liquids and not for solids. So the symptom is that patients cannot swallow water but can easily swallow yogurt or bread, and they also complain of choking on water.

Muscle twitching all over the body is never because of ALS (amyotrophic lateral sclerosis). As in ALS, twitching remains on one or more fixed segments. This muscle twitching of the whole body could be because of vitamin B12 deficiency, vitamin D3 deficiencies, anxiety, BFS (benign fasciculation syndrome). As ALS presents with cramps, twitchings, difficulty swallowing liquids first, and atrophy of certain muscles.

Other symptoms that come and go away in seconds are secondary to anxiety, especially generalized anxiety disorder. You will need to be prescribed anxiolytics. Tablet Clonazepam 0.25 mg needs to be given whenever anxiety sets in. So, ALS does not look in the picture. Please continue to take supplement medicines like calcium and vitamin D in your regular schedule.

Thank you doctor,

Do you have any reasons to believe it could be MS or necessary to have a neuro evaluation to rule out anything else? It sounds like you confirm, much like I have suspected anxiety, stress, and taking care of a baby during a global pandemic have caused most of my symptoms.



Welcome back to

Yes, there is no reason to worry about MS (multiple sclerosis). Either as MS presents with vision problems and stiffness in legs and symptoms are very specific. I am quite sure about the anxiety part, and we have seen increasing health anxiety and fear among all the groups of people during this pandemic.

You will have to start with deep breathing abdominal exercises, which are natural anxiolytics, and so is yoga or engaging in sports activities.

For muscle twitchings, please take Vitamin D and Vitamin E supplements as they are helpful. You are doing a good job taking care of your baby, and please continue doing it with care.

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