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Stroke Doc
Stroke Doc, Board Certified Physician
Category: Neurology
Satisfied Customers: 51
Experience:  I am board-certified in Neurology and the subspecialty Vascular Neurology.
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I saw you answered an extensive ALS question earlier. I will

Customer Question

Hi Doc. I saw you answered an extensive ALS question earlier. I will keep this brief. I have had a lot of anxiety myself over the last eight months concerning ALS. I've had 3 normal EMGs which is a lot in an 8 month period. I get pain in my leg and arm, which i always thought was the onset of ALS -- i.e. my hand hurts, it must be in the process of atrophying. But from what i read, ALS isn't sensory. You can't feel it coming as it were. Is this accurate? Thanks.
Submitted: 5 years ago.
Category: Neurology
Expert:  Stroke Doc replied 5 years ago.

You are correct: ALS is not at all a sensory disorder. In fact, ALS is classified under a group of disorders known as "motor neuron disease." It specifically affects motor "neurons" (nerve cells) in the spinal cord. Sensation is completely spared with ALS. You would not feel the atrophy of ALS occurring. While EMG's can be normal early in ALS, by 8 months there should be significant evidence on EMG of ALS.

Pain in and of itself could be a number of things, depending on the type of pain (from arthritis to fibromyalgia to neuropathy [including small fiber neuropathy, which often does not show up on EMG/nerve conduction study], etc., etc.). But based on your comments above, if you have no obvious muscle atrophy, weakness, or fasciculations (twitching of muscle fibers), you can certainly rest assured that you do not have ALS.

I hope this helps.

Customer: replied 5 years ago.
I do have fasciculations and parathesia/muscle aches. After 8 months I'm back to working out again 6 times a week. I have actually been checked for small fiber neuropathy at the Cleveland clinic. I had an emg on both leg and arm 8 weeks ago. 15 spots all normal. My neuro trained at the Cleveland clinic during his fellowship. Actually I have had 3 emgs by three different neuros.
My pain is very variable. For instance I worked out on eliptical this morning for 25 minutes. Had a good day. Not much parathesia or twitching. Got home and left leg starts killing me. It is very variable. I've had all of the blood work up and MRI of lumbar, spine and brain. Normal. Had skin biopsy for sfn normal. After 8 months I have days where I believe I don't have ALS, but then I panic like this evening. I shouldn't associate this pain with that anyway. My fascics come and go. More when anxious. I've probably had 10 neuro exams in 8 months that are okay. Just don't understand variability of pain and symptoms.
Expert:  Stroke Doc replied 5 years ago.

Unfortunately, there is pain that cannot be explained to date by medicine. But I do hope you rest assured that ALS is not the cause. (As you may have read in my other post about ALS, there are multiple causes of fasciculations.)

This could be a case of fibromyalgia. Compression neuropathies can cause temporary symptoms of paresthesias as well. (The classic example is when your foot "goes to sleep.") These can happen with sitting in certain positions or resting a given body part on a surface such that a nerve is compressed. These typically are fleeting and would not be expected to show up on EMG/nerve conduction study. Without being able to examine you and actually see/do the tests, I'm not able to make a diagnosis.

Stroke Doc and other Neurology Specialists are ready to help you
Customer: replied 5 years ago.
Thanks Doc. i am getting to the point where i am feeling better about not having ALS. I bet neurologists see a lot of scared patients who think of the worst. Thank you.
Expert:  Stroke Doc replied 5 years ago.

We do see a lot of scared patients. We definitely prefer telling patients "It's not ALS" to "It's ALS." Best of luck to you.