Hi, I am Neuro Doctor, an American Board Certified Neurologist with vast clinical experience.
Have you noticed any muscle weakness or muscle wasting?
And do you have any family history of ALS?
No history of ALS. what do you mean by muscle wasting?
Okay I see
Have you lost muscle bulk?
or thinning of muscles?
No I have not lost any muscle from what I can tell. How would I determine this?
It is my observation, if you compare side to side same muscle area then you may notice loss of muscle bulk in one side.
I meany it is by observation
sorry it was a typo
No my muscles look the same
it is by observation (not it is my observation)
Any difficulty with walking?
Any speech difficulties?
Any difficulty with swallowing food or drinks?
Did your dr mention any abnormal neurological findings during clinical examination (abnormal reflexes etc)?
Are you under any excessive stress, or do you have anxiety disorder?
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.
And have you had any blood tests recently to check thyroid, electrolytes etc?
Yes, I had some blood work not sure if he tested the thyroid but he said everything looked ok
Okay I will explain now the possibilities, and the treatment plan.
First of all ALS is unlikely
I do not see any evidence for ALS in you
The twitching appears to be related to stress and anxiety
Also stopping paroxetine might be contributing
Make sure you had thyroid checked too
because thyroid problems too can cause twitching
if thyroid test too is normal then this is most likely from stress and/or anxiety disorder
You may try to see a neurologist too
To undergo a neurological examination
followed by a nerve & muscle test called as EMG test
Why would the twitching be local in the abdomen for the most part? Why do think its not ALS?
But neurologicall illness like ALS is very unlikely in you
You do not have any evidence for ALS
The questions I had asked were about ALS
I will explain one by one
first of all family history
ALS is extremely unlikely around 38 unless you have family history of ALS
Also ALS is rapidly progressive
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
also you have no other symptoms like difficulty with walking, speech or swallowing difficulties which are commonly associated with ALS
You have no family history, you have no symptoms, your neuro exam was normal too
Twitching can occur anywhere
including abdominal area
different patients may have different patterns and locations of twitching
the presence of twitching in the abdominal area for the most part does not provide any additional clues regarding what is causing these twitches
BFS is another possibility too
BFS is Benign fasciculation syndrome
It is as the name implies a totally benign condition
Why did you stop paroxetine?
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
I have explained the different reasons above why this is unlikely ALS, are you able to see them above?
Its not coming up since my computer shut down. All I can see is from the point I turned it back on
Okay I see, I will repost the exact statements from above
Just one sake, let me finalize them
I have reposted the exact statements I had made earlier above
Are you now able too see them?
sorry typo, I meant to (but not too)
Yes, Thank you. is there any probobility it could be ALS? or is this ruled out?
You are welcome!
I strongly feel this is unlikely ALS
But you may see a neurologist in the clinic
The neurologist will examine you and also do an EMG/Nerve conduction test
This test is the best test to rule out ALS
It will check the nerve and muscles
But based on the info provided by you this is unlikely ALS
Can excessive anxiety cause these symptoms, and how can I treat it?
Yes, anxiety can certainly cause this
You need to treat the anxiety
What else you have tried other than paroxetine for anxiety?
What I will do now is provide you with a list of varieties of treatments for anxiety & stress
I will post it here soon
I am typing and finalizing the list now
The moment I finish with the list I will post it here
Almost done, just one sake
Okay I am ready, I will post it here now
The following is a list of anxiety & stress-busters that are commonly used;
Counseling/therapy (with licensed counselors)
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
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.
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.
Can I ask another question?