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I am an American Board Certified Neurologist (studied & worked in USA) with a vast neurology clinical practice experience. I am familiar with the condition that you have described and can help you with your questions/concerns.
There are myriad causes for muscle twitching and based on the history you provided that it is of recent onset and no muscle weakness then ALS is unlikely!
Some common causes for muscle twitchings include;
1) Thyroid gland dysfunction:
2) Electrolyte abnormalities:
3) Medication side effects:
4) Excessive caffeine intake:
For thyroid dysfunction & electrolyte abnormalities a blood test for TSH & electrolytes will resolve the issue.
I assume you are not on any medications now. If ‘yes' and if they were started recently then it is worth holding them for few days & see what happens(not all meds can be stopped abruptly; some of them needs to be gradually tapered off).
If excessive caffeine intake is there then reduction can help.
You have not mentioned any stress/anxiety etc, so that is a less likely possibility but if you feel these conditions may exist then treating them will help you with the twitchings too. The treatment consists of counseling/therapy, medications (like Tab Buspar, Xanax) to reduce stress etc.
Benign fasciculations as the name implies are benign in nature. But it is a rule out diagnosis, means we need to rule out other possibilities before considering this as a possibility.
ALS is unlikely with your presentation. However if the twitching do not get better, and all above investigations look ok then you need to see a clinic-neurologist to undergo a clinical examination and also an EMG (needle test). This test is highly useful to study the muscles and will provide us more insight into your condition. This test will help in ruling out ALS as well, and again ALS is unlikely possibility in your case, but these are the investigations you need with your presentation.
Sometimes symptoms come & go without any consequences, hopefully that is all you have. All the Best!
These are my opinions & recommendations based on the details provided, and if you are seeking a more elaborative discussion or have additional concerns then please ask any number of questions until you clarify all your doubts.
Thanks for these additional details.
1) The twichings disappeared before reappearing is a good sign when we look at ALS possibility. With ALS the twitchings usually are continuous, even if not continuous but disappearing for about 2 weeks is very unusual.
2) Very difficult to correlate with physical exertion to twitching. It may occur if concomitant sever dehydration also exist, and that is due to electrolyte abnormalities irritating the muscle fibers. And we have already mentioned the electrolyte possibility. In my opinion physical exertion is not causing the twichings (unless you were dehydrated too).
3) If you have stress then it can trigger twichings, no doubt about it.
4) To be honest with you it is difficult to consider the twitchings are due to exertion and then a constant re-irritation. We see patients with twitches very commonly and I am not aware of that as a possibility in any of my patients. Even in books I am not aware of coming across that as a possibility
5) I agree while the reappearance of twitches will obviously concerning however recurrent twitches are seen in varieties of non-ALS conditions like stress, benign fasiculations, thyroid etc. In fact with ALS we see constant twitches rather than on and off. So that seems a sign in favor of you!
6) To be honest with you I cannot rule out ALS 100% based on 'no muscle weakness', but nearly 100% in your case based on no muscle weakness, also the recent onset, disappearing pattern etc.
So if you ask me to put all the pieces of information together and give you an estimation then in my opinion ALS is extremely less likely in your case. I also assume you have no family history of ALS (please correct me if I am wrong) and if that is true then it is very near to "zero" percent in your case.
Nevertheless I recommend you to see a clinic-neurologist as described earlier and undergo further evaluation. The blood tests may be ordered by your family Dr or the neurologist. The EMG test is done by the neurologist. And of course by the time you see them if twitches disappear permanently then no further interventions are required. All the Best!
Please ask any numbers of questions until you clarify all your doubts.
Thanks Very Much for the bonus as well. Please follow up any time if you require my services again. All the Best!
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