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I have been having abdomen twitching now for over a month. I

Hello, I have been having...
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.
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Answered in 9 minutes by:
11/7/2013
Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5,814
Experience: American Board Certified Neurologist, Internal Medicine
Verified
Neuro Doctor :

Hi, I am Neuro Doctor, an American Board Certified Neurologist with vast clinical experience.

Neuro Doctor :

Have you noticed any muscle weakness or muscle wasting?

Neuro Doctor :

And do you have any family history of ALS?

Customer:

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

Neuro Doctor :

Okay I see

Neuro Doctor :

Have you lost muscle bulk?

Neuro Doctor :

or thinning of muscles?

Customer:

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

Neuro Doctor :

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

Neuro Doctor :

I meany it is by observation

Neuro Doctor :

sorry it was a typo

Customer:

No my muscles look the same

Neuro Doctor :

it is by observation (not it is my observation)

Neuro Doctor :

Okay I see

Neuro Doctor :

Any difficulty with walking?

Customer:

No

Neuro Doctor :

Okay I see

Neuro Doctor :

Any speech difficulties?

Customer:

No

Neuro Doctor :

Okay I see

Neuro Doctor :

Any difficulty with swallowing food or drinks?

Customer:

No

Neuro Doctor :

Okay I see

Neuro Doctor :

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

Customer:

No

Neuro Doctor :

Okay I see

Neuro Doctor :

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

Customer:

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.

Neuro Doctor :

Okay I see

Neuro Doctor :

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

Customer:

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

Neuro Doctor :

Okay I see

Neuro Doctor :

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

Neuro Doctor :

First of all ALS is unlikely

Neuro Doctor :

I do not see any evidence for ALS in you

Neuro Doctor :

The twitching appears to be related to stress and anxiety

Neuro Doctor :

Also stopping paroxetine might be contributing

Neuro Doctor :

Make sure you had thyroid checked too

Neuro Doctor :

because thyroid problems too can cause twitching

Neuro Doctor :

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

Neuro Doctor :

You may try to see a neurologist too

Neuro Doctor :

To undergo a neurological examination

Neuro Doctor :

followed by a nerve & muscle test called as EMG test

Customer:

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

Neuro Doctor :

But neurologicall illness like ALS is very unlikely in you

Neuro Doctor :

You do not have any evidence for ALS

Neuro Doctor :

The questions I had asked were about ALS

Neuro Doctor :

I will explain one by one

Neuro Doctor :

first of all family history

Neuro Doctor :

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

Neuro Doctor :

Also ALS is rapidly progressive

Neuro Doctor :

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

Neuro Doctor :

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

Neuro Doctor :

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

Neuro Doctor :

Twitching can occur anywhere

Neuro Doctor :

including abdominal area

Neuro Doctor :

different patients may have different patterns and locations of twitching

Neuro Doctor :

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

Neuro Doctor :

BFS is another possibility too

Neuro Doctor :

BFS is Benign fasciculation syndrome

Neuro Doctor :

It is as the name implies a totally benign condition

Neuro Doctor :

Why did you stop paroxetine?

Customer:

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

Neuro Doctor :

Okay I see

Neuro Doctor :

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

Customer:

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

Neuro Doctor :

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

Neuro Doctor :

Just one sake, let me finalize them

Neuro Doctor :


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



Neuro Doctor :

I have reposted the exact statements I had made earlier above

Neuro Doctor :

Are you now able too see them?

Neuro Doctor :

sorry typo, I meant to (but not too)

Customer:

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

Neuro Doctor :

You are welcome!

Neuro Doctor :

I strongly feel this is unlikely ALS

Neuro Doctor :

But you may see a neurologist in the clinic

Neuro Doctor :

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

Neuro Doctor :

This test is the best test to rule out ALS

Neuro Doctor :

It will check the nerve and muscles

Neuro Doctor :

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

Customer:

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

Neuro Doctor :

Yes, anxiety can certainly cause this

Neuro Doctor :

You need to treat the anxiety

Neuro Doctor :

What else you have tried other than paroxetine for anxiety?

Customer:

Nothing else..

Neuro Doctor :

Okay I see

Neuro Doctor :

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

Neuro Doctor :

I will post it here soon

Neuro Doctor :

I am typing and finalizing the list now

Neuro Doctor :

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

Neuro Doctor :

Almost done, just one sake

Neuro Doctor :

Okay I am ready, I will post it here now

Neuro Doctor :

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

Neuro Doctor :

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.

Neuro Doctor :

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.

Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5,814
Experience: American Board Certified Neurologist, Internal Medicine
Verified
Dr Subbanna MD and 87 other Neurology Specialists are ready to help you
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Customer reply replied 4 years ago

Can I ask another question?

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.
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Customer reply replied 4 years ago
Having more twitches now but all over body..
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.
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Customer reply replied 2 years 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 reply replied 2 years ago

Hello are u there

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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Dr Subbanna MD
Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5,814
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Experience: American Board Certified Neurologist, Internal Medicine

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