Q. I have constant twitches in my upper arm. Could it be an early sign of ALS?

Answered by
Dr. Ashok Kumar Choudhary
and medically reviewed by iCliniq medical review team.

Hi doctor,

I am a 38 year old male, and I have been feeling twitches in my arm. I started feeling this constant twitch about six weeks ago. I did not experience any weakness in that arm or anywhere else in the body. The twitches lasted for about a week and then went away.

The twitches have now appeared four weeks later in the same area (upper arm). Again, there is no apparent weakness, which I have tested by lifting weights at the gym and both my upper and lower body strength seems to be fine.

What is worrying me to death is, could these twitches be an early sign of ALS? Is it possible that weakness will follow even though I do not have it now? Do ALS twitches go away for four weeks at a time and reappear?

If I started to experience constant twitches six weeks ago, if this was ALS should not I have experienced some weakness by now? Is the fact that the twitches are localized to the same place a bad thing?

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Dr. Ashok Kumar Choudhary

M.B.B.S., M.D. PSYCHIATRY
Andrology Geriatrics Psychiatry Psychologist/ Counsellor Psychotherapy Sexology

Hello,

Welcome to icliniq.com.

I have read your query and understand your concerns.

First of all, I will suggest you consider other possibilities before jumping to conclusions. There are a number of conditions which can present with twitches without any disease, and ALS (amyotrophic lateral sclerosis) is one of the remotest possibility for a 38 year old young male.

The commonest cause for twitches is simple worry or anxiety. I know at least 100 individuals with anxiety, who presented with simple twitches and no other symptoms. In my opinion, you need to see whether these twitches have any relationship with your anxiety level.

The another common conditions which present with twitches is endocrine abnormalities, such as thyroid and parathyroid disorders. In case the stress level is not able to explain the twitches, an evaluation for endocrine abnormality is indicated. The list may go on in a similar fashion.

Find the answers to your questions below:

  1. Yes, ALS can be a possibility, but it is very low considering your age and no weakness or stiffness of muscles.
  2. I do not think weakness will follow in your case.
  3. ALS is progressive and spontaneous, and remissions are rare.
  4. If it is ALS, two months is enough to develop weakness.
  5. Treatment of twitches depends on the etiology. If they are stress-related, then there is nothing bad, as they are indicating something correctable.

I hope this helps you. If you have more questions, feel free to write back.

For further queries consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist


Hi doctor,

Thank you for your answer. I do have one more question. My neck muscles are stiff and hurt when I turn my neck left, which is the same side where the arm twitches. Could this stiffness be related to ALS when looked at in combination with the twitches? To be clear, the neck stiffness feels like a muscle pull and hurts.

Dr. Ashok Kumar Choudhary

M.B.B.S., M.D. PSYCHIATRY
Andrology Geriatrics Psychiatry Psychologist/ Counsellor Psychotherapy Sexology

Hi,

Welcome back to icliniq.com.

Thanks for reverting with a valuable piece of information.

If we look at them together, the cause of twitches is much clear, as both things are related. If there is stiffness in the neck it could lead to compression over some unimportant nerve fibers, leading to twitching.

I need to reassure you again that at your age, with no family history of ALS and no weakness, the possibility of ALS is remotest, and I do not think this need to be considered among differential diagnosis while evaluating the problem.

I hope this helps you further. Thanks and regards.

For more information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist


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