Q. What is the possibility of muscle twitch for a long period without any related symptoms to be ALS?

Answered by
Dr. Upendra Kumar Shah
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Apr 27, 2020

Hello doctor,

I was smoking weed for almost six years daily. Last July, I stopped, and then I started to have panic attacks with heart palpitation. I went to a cardiologist and everything was fine. But since then I became so anxious and I was aware of everything going on in my body. After that, I started to notice muscle twitching, in every muscle.

At first, I thought it was a heart issue but after seeing three cardiologists the results were the same, my heart is fine. Then of course, I Googled it and I see some scary diseases like ALS. I went to a neurologist who, after some questions and examination said that it was due to an anxiety issue. To be sure he sent me to an institute specializing in the detection of neuromuscular disease, a neurophysiologist did a clinical examination (strength, reflex) and an EMG, and no abnormalities was showed, it were before three months.

A month later, as my twitching was still going on, I went to another neurophysiologist, he did another EMG and again everything was normal. My neurologist said that it is impossible its ALS because muscle twitching for nearly eight months without any weakness. And I started to have so tingling and buzzing sensation. Again my neurologist said that it is very common with an anxiety disorder like mine. I started to take pills and to see a therapist for one month. I have to say that twitching is way better when my anxiety is low but sometimes it came back strong. I am so worried about ALS.

My questions are: is EMG test reliable? Is it true that usually fasciculations come after or along with the weakness in ALS? Fasciculation for eight months without any weakness does rule out ALS? Does ALS cause pain?



Welcome to

I understand the problem you are facing, it is partly due to anxiety and partly due to nerve and muscle hyperactivity.

Coming to your specific questions:

Yes, fasciculations and weakness in ALS (amyotrophic lateral sclerosis) come together, actually, weakness comes first and fasciculations are generally unnoticed by patients, they are usually revealed upon asking or found by EMG (electromyography).

EMG is reliable and diagnostic for ALS. Fasciculations without weakness ruled out ALS, eight months are a long duration for ALS, if it would have been ALS, it would have progressed to much extent. And ALS is painless, it is motor neuron disease, so the sensory system is perfectly normal.

I would suggest you to try one tablet called Carnisure plus (contains Levocarnitin 500 mg and Methylcobalamin 1500 microgram). It is a vitamin for muscle and nerves, you can take it in the night daily for a few weeks and see the effect. Avoid coffee and other stimulants.

Thank you doctor,

I read on the internet that some people have fasciculation as a first symptom of ALS but it is only 7% of ALS patients. Is that true?



Welcome back to

This is true, but the important point is the progression of the fasciculations to weakness. Fasciculations of ALS will not be persistent for eight months without weakness, it would have lead to weakness by this time as it is a progressive disease, usually, from the onset of fasciculations to weakness takes one to three months, but not longer than that.

I hope your nerve excitation will recover soon.

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