Q. I have twitching of different muscles. Can I be sure it is not ALS?

Answered by
Dr. Hitesh Kumar
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on May 25, 2018 and last reviewed on: Aug 05, 2022

Hello doctor,

The last week and a half every few minutes, I got a muscle twitch in random parts of my body. My left eye twitches more constantly than that. I have general anxiety and major health anxiety which I am wondering can play a role. I have no muscular weakness at all, and no atrophy from what I can tell. My reflexes are normal except for brisk bilateral patella tendon reflex which I have had all my life. All strength tests are normal. Any idea what could be causing this?



Welcome to

Frequent muscle twitches without any muscle weakness or atrophy and normal reflexes can be due to anxiety. The other possibility can be benign fasciculation syndrome. But before labeling this, it is advisable to rule out other possible grave diseases.

Let me suggest a few tests:

1. T3, T4, and TSH.

2. Nerve conduction velocity test on all four limbs.

3. Electromyography on all four limbs.

4. MRI brain.

5. MRI cervical spine.

Review with the reports.

Thank you doctor,

I have been told in ALS, weakness, and atrophy happen before fasciculations. Also, that twitching starts in extremities and works its way centrally. Also, I never have fasciculations with movement. They stop when movement occurs. I know you need to do your job and make sure all bases are covered. But, can I be pretty sure it is not ALS?



Welcome back to

In ALS (amyotrophic lateral sclerosis), usually, atrophy and weakness are also associated. But it is not necessary that fasciculations start after weakness and atrophy. They can happen simultaneously too.

It is right that they usually happen in limb muscles (arm or leg), not usually involve facial muscles. But can involve the tongue.

Even by tests (NCV/ EMG/ MRI), it is not possible to rule out ALS 100 %. The diagnosis is a clinical diagnosis with the exclusion of other pathology. Maybe a followup and observation of symptoms with time will bring more clarity.

For more information consult a neurologist online -->

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