I have twitches in arms, hands, feet and upper body. Should I concern about ALS or MND?

Question

Hello doctor,

I am a 38-year-old male. I am concerned about the possibility of ALS/MND. My symptoms to my knowledge started around August 2018 whilst doing a nursing degree at university. I developed a trapped nerve in my left ulnar nerve after sitting an exam and this seemed to trigger the events. Following this, I developed twitching which seemed to have no pattern and became widespread including arms, hands, feet, legs, and upper body area, neck, and mouth. I have checked my weight and measurements of legs, calves, upper arms and saw no gain or loss in that time and my weight has remained stable. I have been examined by two GP's fully in basic neurological strength tests and reflexes and they have both said that nothing is chronically neurologically wrong. I believe that I can see muscle loss around my shoulders and tongue but I can still lift both arms up as normal, speak, talk, and swallow.

I still go out for walks and do around 8-10 miles every other day in a brisk 2-hour walk without too many issues and can walk on heals and tip toes. I guess what I am trying to understand is if there was atrophy of the tongue would I be able to still talk and eat and move it and same with shoulders and in your honest view does it sound like I need psychological treatment for health anxiety. I have seen in a total of six GP's for this issue and have had two full examinations from two of them, one which was a private GP through my works place. I am currently on Zispin 15 mg.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern and would explain that your symptoms are not suggestive of ALS (amyotrophic lateral sclerosis) or MND (motor neuron disease).

You should know that there are a lot of benign causes underlying twitching (fasciculation), including anxiety, vitamin D or vitamin B12 deficiency, low magnesium or calcium levels, thyroid gland dysfunction and anxiety. Have you checked these blood lab tests?

As long as you do not have any atrophy or weakness and your nerve conduction studies are normal, there is no reason to panic about ALS or MND.

I recommend focusing on your anxiety in order to help manage it. It is also important performing the above mentioned tests (blood electrolytes, vitamin B12, and vitamin D plasma levels, thyroid hormone levels). As long as you are very active and no weakness, there is no reason to panic.

I hope this helps.

Answer 2

Hello,

Welcome back to icliniq.com.

I am glad to confirm that there is no atrophy in your tongue, based on these photos (attachment removed to protect patient identity). Nobody is completely symmetrical, but there is no sign of atrophy. As all the above tests have resulted in normal we can completely exclude ALS or MND. You should consider anxiety and benign fasciculation syndrome as the main cause of your complaints. So I would recommend trying to focus on your anxiety and try to manage it better.

A balanced diet and regular physical activity are necessary too. I would also recommend avoiding alcohol and caffeine intake, as they may trigger this situation.

I hope this helps.

I have twitches in arms, hands, feet and upper body. Should I concern about ALS or MND?

Ask your health query to a doctor online

Company

Customer Care

Get iCliniq