Q. Does muscle twitching in the arms, elbows, and nose bridge indicate ALS?

Hello doctor,

I am a 37-year-old man. A few years ago, I had terrible anxiety attack and had some strange symptoms like hand tingling and hand cramp, followed by muscle twitching in my arms around the back of my elbows and other twitching. I wondered whether this could be the start of ALS. I think I had the quake for about a month or two, but eventually, my symptoms disappeared, or I stopped thinking of them. Fast forward four years later, about a month ago, off and on, I had a tiny twitch on the bridge of my nose. I did not recall ever having that twitch before, so of course, I started to research whether this could be a starting point for ALS because that is where my mind always goes. I immediately began to notice twitching again on the back of my arms and elbows. I could feel them sometimes, sometimes not. It would almost feel like a bubble in my elbow. Then, within a few days, I began noticing muscular twitching in my legs, mainly in both calves. Again, some I could feel, some not. I remember thinking at one point, "Why are you focused on the elbows when the calves are going." Now, about two to three weeks later, my calves go pretty much non-stop while I am sitting or lying down. Same feelings, both legs. Almost like a ping pong of twitching and spasming, and I feel them. Mainly calves, but occasionally thighs, ankles, feet, etc. Different spots, but pretty constant. Elbows and back of arms are sometimes, but much less frequently, maybe a couple of times a day. I also notice my eyelid going and occasional random twitching in other spots.

I have no weakness. In fact, I now spend my days searching for strength tests and passing all of them. I do pushups, lift weights, run, stand on my toes on one foot, etc. Interestingly, I rarely notice or see twitching when I stand and do not seem ever to notice them if I am moving around. Also, if I rub my legs, they do not jerk. I suspect again that this is another flare-up of health anxiety. It is challenging because it is the first thing I think about when I wake up and the last thing I think about before I go to sleep. I feel like my work, and family lives are becoming less productive and less effective than some people with awful diseases. I did go to my primary care physician, who said my strength and reflexes were normal. Blood tests showed vitamin D deficiency, and I started taking supplements yesterday.

I guess my question is, again, does this sound like ALS? If I have good balance, good strength, and no weakness in any of the limbs but am having twitching with some sensory symptoms, would this point you away from this diagnosis, mainly because I have been twitching for a month now? Because of my anxiety, I may have a benign fascination syndrome because these cramps are in both legs (and occasionally in the arms) without weakness. Does this sound accurate? I want to relax and accept that the twitching, even though it is almost constant, is benign and not just a continuous drumbeat that I am dying.

Thank you.

Hello doctor,

Thank you for your response.

Is the popping feeling in my legs or thighs considered a sensory symptom? Also, I have some twitching all over, but 95 percent of them are in my calves and legs. However, because they are on both sides, I have read that points away from ALS, mainly because of no weakness. Also, one last thing, the normal reflexes would likely not be expected if ALS, correct?

Thank you.

Hello doctor,

One last question. After almost a month of constant twitching in both legs, I still have no weakness, am not tripping or falling, and seem to be stronger on the balance exercises. The heel walk, toe walk, calf exercises, etc., would not be the case if these fasiculations were ALS-related, right?

Thank you.