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Neuro Doctor
Neuro Doctor, Neurologist (MD)
Category: Neurology
Satisfied Customers: 4013
Experience:  American Board Certified Neurologist, Internal Medicine
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Hello, I have been having abdomen twitching now for over a

Customer Question

Hello, I have been having abdomen twitching now for over a month. I can feel them a lot more when I am laying down or resting on my couch. Can this be ALS? Today I started feeling little twitches in my arms and neck area as well.
Submitted: 1 year ago.
Category: Neurology
Expert:  Neuro Doctor replied 1 year ago.
Customer:

Hi, I amCustomer an American Board Certified Neurologist with vast clinical experience.

Customer:

Have you noticed any muscle weakness or muscle wasting?

Customer:

And do you have any family history of ALS?

JACUSTOMER-lbl32mph- :

No history of ALS. what do you mean by muscle wasting?

Customer:

Okay I see

Customer:

Have you lost muscle bulk?

Customer:

or thinning of muscles?

JACUSTOMER-lbl32mph- :

No I have not lost any muscle from what I can tell. How would I determine this?

Customer:

It is my observation, if you compare side to side same muscle area then you may notice loss of muscle bulk in one side.

Customer:

I meany it is by observation

Customer:

sorry it was a typo

JACUSTOMER-lbl32mph- :

No my muscles look the same

Customer:

it is by observation (not it is my observation)

Customer:

Okay I see

Customer:

Any difficulty with walking?

JACUSTOMER-lbl32mph- :

No

Customer:

Okay I see

Customer:

Any speech difficulties?

JACUSTOMER-lbl32mph- :

No

Customer:

Okay I see

Customer:

Any difficulty with swallowing food or drinks?

JACUSTOMER-lbl32mph- :

No

Customer:

Okay I see

Customer:

Did your dr mention any abnormal neurological findings during clinical examination (abnormal reflexes etc)?

JACUSTOMER-lbl32mph- :

No

Customer:

Okay I see

Customer:

Are you under any excessive stress, or do you have anxiety disorder?

JACUSTOMER-lbl32mph- :

Yes I have anxiety disorder where I was taking paroxetine for over 7 years 20mg. I quit taking it over 2 months ago. I have also been under a lot of stress since I have just started a new job.

Customer:

Okay I see

Customer:

And have you had any blood tests recently to check thyroid, electrolytes etc?

JACUSTOMER-lbl32mph- :

Yes, I had some blood work not sure if he tested the thyroid but he said everything looked ok

Customer:

Okay I see

Customer:

Okay I will explain now the possibilities, and the treatment plan.

Customer:

First of all ALS is unlikely

Customer:

I do not see any evidence for ALS in you

Customer:

The twitching appears to be related to stress and anxiety

Customer:

Also stopping paroxetine might be contributing

Customer:

Make sure you had thyroid checked too

Customer:

because thyroid problems too can cause twitching

Customer:

if thyroid test too is normal then this is most likely from stress and/or anxiety disorder

Customer:

You may try to see a neurologist too

Customer:

To undergo a neurological examination

Customer:

followed by a nerve & muscle test called as EMG test

JACUSTOMER-lbl32mph- :

Why would the twitching be local in the abdomen for the most part? Why do think its not ALS?

Customer:

But neurologicall illness like ALS is very unlikely in you

Customer:

You do not have any evidence for ALS

Customer:

The questions I had asked were about ALS

Customer:

I will explain one by one

Customer:

first of all family history

Customer:

ALS is extremely unlikely around 38 unless you have family history of ALS

Customer:

Also ALS is rapidly progressive

Customer:

so if you have twitching for over a month it is highly likely that you have by now noticed some muscle weakness, and loss of muscle bulk too

Customer:

also you have no other symptoms like difficulty with walking, speech or swallowing difficulties which are commonly associated with ALS

Customer:

You have no family history, you have no symptoms, your neuro exam was normal too

Customer:

Twitching can occur anywhere

Customer:

including abdominal area

Customer:

different patients may have different patterns and locations of twitching

Customer:

the presence of twitching in the abdominal area for the most part does not provide any additional clues regarding what is causing these twitches

Customer:

BFS is another possibility too

Customer:

BFS is Benign fasciculation syndrome

Customer:

It is as the name implies a totally benign condition

Customer:

Why did you stop paroxetine?

JACUSTOMER-lbl32mph- :

Sorry my computer shut down. Why did you say you would rule out ALS? I stopped taking paroxetine just because I wanted to try and stop. Was not hurting me or making me feel sick in any way

Customer:

Okay I see

Customer:

I have explained the different reasons above why this is unlikely ALS, are you able to see them above?

JACUSTOMER-lbl32mph- :

Its not coming up since my computer shut down. All I can see is from the point I turned it back on

Customer:

Okay I see, I will repost the exact statements from above

Customer:

Just one sake, let me finalize them

Customer:


But neurologicall illness like ALS is very unlikely in you






8:39 AM



You do not have any evidence for ALS






8:40 AM



The questions I had asked were about ALS






8:40 AM



I will explain one by one






8:40 AM



first of all family history






8:40 AM



ALS is extremely unlikely around 38 unless you have family history of ALS






8:40 AM



Also ALS is rapidly progressive






8:41 AM



so if you have twitching for over a month it is highly likely that you have by now noticed some muscle weakness, and loss of muscle bulk too






8:42 AM



also you have no other symptoms like difficulty with walking, speech or swallowing difficulties which are commonly associated with ALS






8:42 AM



You have no family history, you have no symptoms, your neuro exam was normal too






8:42 AM



Twitching can occur anywhere






8:42 AM



including abdominal area






8:43 AM



different patients may have different patterns and locations of twitching






8:44 AM



the presence of twitching in the abdominal area for the most part does not provide any additional clues regarding what is causing these twitches






8:44 AM



BFS is another possibility too






8:44 AM



BFS is Benign fasciculation syndrome






8:45 AM



It is as the name implies a totally benign condition



Customer:

I have reposted the exact statements I had made earlier above

Customer:

Are you now able too see them?

Customer:

sorry typo, I meant to (but not too)

JACUSTOMER-lbl32mph- :

Yes, Thank you. is there any probobility it could be ALS? or is this ruled out?

Customer:

You are welcome!

Customer:

I strongly feel this is unlikely ALS

Customer:

But you may see a neurologist in the clinic

Customer:

The neurologist will examine you and also do an EMG/Nerve conduction test

Customer:

This test is the best test to rule out ALS

Customer:

It will check the nerve and muscles

Customer:

But based on the info provided by you this is unlikely ALS

JACUSTOMER-lbl32mph- :

Can excessive anxiety cause these symptoms, and how can I treat it?

Customer:

Yes, anxiety can certainly cause this

Customer:

You need to treat the anxiety

Customer:

What else you have tried other than paroxetine for anxiety?

JACUSTOMER-lbl32mph- :

Nothing else..

Customer:

Okay I see

Customer:

What I will do now is provide you with a list of varieties of treatments for anxiety & stress

Customer:

I will post it here soon

Customer:

I am typing and finalizing the list now

Customer:

The moment I finish with the list I will post it here

Customer:

Almost done, just one sake

Customer:

Okay I am ready, I will post it here now

Customer:

The following is a list of anxiety & stress-busters that are commonly used;

Counseling/therapy (with licensed counselors)

Biofeedback/Neurofeedback

Hypnotherapy

Acupuncture

Yoga & meditation

Deep breathing/Deep relaxation techniques

Herbal preparations like Rhodiola rosea, Valerian root extract, Kava

Benzodiazepines like Alprazolam or Clonazepam

SSRI agents like Paroxetine (which you already tried, and it seems it caused you side effects, and appears it was not helping much either)

Azapirone agents like Buspirone etc

Customer:

The list contains names of allopathic medications, non-medications, as well as complementary/alternative medicine options so that the treatment plan may be chosen depending upon the individual preferences. I am not telling all these above treatments are required in your case, but providing you with a list of treatment options that are available for the treatment of anxiety & stress.

Customer:

Once again I strongly reassure you there is no evidence for ALS in you. If you cannot get rid of this possibility then you may see a neurologist and undergo EMG test as mentioned above, but in my strong opinion ALS is unlikely in you.

Neuro Doctor, Neurologist (MD)
Category: Neurology
Satisfied Customers: 4013
Experience: American Board Certified Neurologist, Internal Medicine
Neuro Doctor and other Neurology Specialists are ready to help you
Customer: replied 1 year ago.

Can I ask another question?

Expert:  Neuro Doctor replied 1 year ago.
Hi, sorry I couldn't reply earlier as I was away from the computer and just returned.
Yes, if you have any further questions please let me know.
Customer: replied 1 year ago.
Having more twitches now but all over body..
Expert:  Neuro Doctor replied 1 year ago.
About the twitching I have already discussed in length with you and my analysis of your twitching does not point towards als or any serious neuro illnesses. And since I have not examined you this is the maximum I can comment through online, if you still cannot get rid of the idea of als from your mind then you need to see a neurologist in a clinic who can conduct a thorough neurological examination and then do the nerve test called as EMG/Nerve conduction test and I am sure the neuro exam and the emg test will come normal and als will be definitely ruled out but this approach seems to be the only way you will be convinced that you do not have als so see a neurologist and undergo the EMG test asap. Having more twitching or having it all over the body does not imply any serious diseases like als and I have already discussed with you why you do not have als; amount, severity, or location of twitching does not point towards als. And you can try the anxiety and stress diluters I had discussed earlier in my previous post. And if the twitching still bothers then you may try a muscle relaxant like Baclofen or a beta blocker like Propranolol etc which can control the twitching.
Customer: replied 4 months ago.

Hello Dr,

Have had a few more emgs and tests. My last emg found some issues with my back injury just wondering why this was not discovered in my other emgs. Plus lower mri showed mild stenosis in lower back. Can all this be related to als?

Customer: replied 4 months ago.

Hello are u there

Expert:  Neuro Doctor replied 4 months ago.
Hi, sorry I couldn't reply earlier as I was away from the computer and just returned.
Coming to the discussion; since the emg is normal als is definitely ruled out now. Now regarding the back injury issue; it is possible the emg changes from the back injury are mild and in these circumstances not all EMGs may pick the changes. And the mri findings in the lower back has nothing to do with als.
You have no als for sure. EMG test should not miss als even in early stages or mild stages so emg showing no findings of als implies you have no als for sure.
Please go through the above information and let me know if you have any further questions. And if you feel you have received the answer to your question please rate me to compensate me for the time and effort put by me in answering your question.

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