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In September I began havin food regurgitation, gastritis,

sore throats which soon began...
In September I began havin food regurgitation, gastritis, sore throats which soon began having paresthesias throughout my body . It was sometimes debilitating. After taking dexilant for a month I was soon put on lyrica for it. It has helped. Over the last couple of weeks I have began having twitches through my body in the same places as the paresthesias. I have had many test. My iron came back low as well as iron saturation. An emg showd bilateral brachioexus neuropathy possible pinched nerves in elbows. I had pain in these areas back in jusy after a truck slipped off a jack and hit my back as well as lots of working out. Pain in both elbows He did my electrical test on my legs and I guess he saw nothing obvious so didn't do the needles Though for 7 years I have had slight atrophy of left calf due to slipped disk in lower back. It has always spawned since then. I really have no weakness. I'm wondering could als be a possibility with the new twitches starting. I know it's a side effect of lyrica but just kinda freaked out. Nothing is showing up after many test. I have a small fiber biopsy scheduled as well as possible vascular thoracic outlet
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Answered in 56 minutes by:
1/15/2018
Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 6,416
Experience: American Board Certified Neurologist, Internal Medicine
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Hi, I am an American Board Certified Neurologist with vast experience in diagnosing & treating all neurological as well as all other health/medical conditions, and I am very glad to help you with your health concerns.

I see you have been having new onset muscle twitching and you are concerned whether this could be a sign of als. As a Neurologist I frequently diagnose & treat this type of health situation and I can certainly help you in this regard.

ALS definitely does not appear the cause for your symptoms such as muscle twitching etc

Please see there are myriad causes for muscle twitching and the presence of twitching does not automatically imply there is some serious underlying problem such as ALS (or MND/Motor Neuron Disease), and in fact muscle twitching is most often secondary to some non-serious (benign) causes, or secondary to some treatable/curable medical conditions (that are mentioned below) - rather than due to something of serious in nature like ALS etc.

Muscle twitching is most commonly secondary to following non-serious (benign) causes OR secondary to following treatable/curable medical conditions such as the following;

1) Stress

2) Anxiety/Nervousness

3) Muscle fatigue/heavy & prolonged exercises

4) Excessive caffeine intake

5) Sleep deprivation

6) Non-fatal medical conditions such as the following;

a) Thyroid gland dysfunction

b) Electrolyte abnormalities (calcium or magnesium)

c) Nutritional/vitamin deficiency etc

7) Medication side effects (such as Lyrica induced)

8) Benign fasciculation syndrome (BFS) is another common non-serious benign cause for muscle twitching etc

I am not telling all these are applicable in your case, but these are the common causes for muscle twitching that we come across in our clinical practice, and if the above possibilities have not already been ruled out then these need to be ruled out.

And also please see many times no obvious cause for muscle twitching is identified even after thorough evaluation and investigations – which is a good sign because such twitchings are unlikely due to any serious underlying health conditions

As mentioned earlier above you are unlikely developing als, and the following are the reasons;

First of all als is expected to present with progressive weakness of the muscles, as well as progressive atrophy of the muscles (progressive losing muscle bulk), but you are not having any such symptoms that are pointing towards the possibility of als.

In the absence of any obvious progressive weakness of the muscles or any progressive atrophy of the muscles this is unlikely from als

The pattern of twitching too is not pointing towards als, what you have is generalized twitching and this is not typical for als, by the time an als patient has generalized twitching they have so much clinical weakness & atrophy of the muscles they are wheel chair bound and need assistance for almost every daily activities, so this pattern of the twitching you are having is also indicating this is some benign issue rather than als.

You have or have had certain sensory symptoms such as pain, paresthesia etc. ALS is a type of MND (Motor neuron disease). It is called motor neuron disease because it is caused by the degeneration of the motor neurons. Being a pure Motor neuron disease als do the presence of sensory symptoms such as pain & paresthesia tells us conditions such as als are unlikely. Motor symptoms like progressive muscle weakness, progressive muscle atrophy etc are expected to be seen in a case of als but sensory symptoms like pain & paresthesia are not expected to be seen in a case of als, and if sensory symptoms are present we should start exploring other possibilities instead of als.

So looking from any angle you are unlikely a case of als, and als certainly does not appear the cause for your new onset muscle twitching

Once again I can very confidently & very strongly reassure you, there is certainly no evidence for als in you, and there is not even an iota of doubt in this regard, so please not to be scared.

Wishing you a quick & complete recovery from your health symptoms! And also Wishing you the best health!

All the very best!

Please let me know if you have any additional questions or if you want to discuss this further. And please take a moment and kindly click a positive rating (preferably 5 Star/Excellent) to credit for the time & effort put by me in answering your health question, and this is the only way I will be credited for my service to you. Rating me now does not close your question and if you have follow-up or additional questions you can ask them after the rating too!

Assuring you the best services!

Best Regards!

Dr Subbanna MD

Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 6,416
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Customer reply replied 7 months ago
Thank you for your response. A little better detail on what I have going on. I was 220 pounds dec 17. I went on a vegan diet. Including lots of Grains wheat (gluten)and oats. When this condition started I was 165 pounds. Some of the theories from allergist, and neurologist is that I possibly developed some form of leaky gut which may have triggered this response. I have lost muscle mass but was probably due to the weight loss. My weight loss is symetrical mean I inf head to toe I lost not particular atrophy in one area. The plan as of now is to continue to take vitamin b,d, and multi with iron. Does this seam like a logical cause for my problems ? Does my emg on upper body not pertain to als bc I have actual pain? I had scattered non specific hyperintensities in periventri year area deep occipital but neuro says don't follow pattern of ms. Thank you for your assistance. This is just tough dealing with especially with all my test coming back negative. In October I could barely walk the length of a room, my asthma was really bad and was having heart palpations. The extreme fatigue subsided and I feel pretty good now aside from paresthesias and random twitching

You are very welcome! My pleasure! I am very glad you found the above information helpful! And I am sorry; I am not in a position to do the phone-service due to certain technical constraints. If you have received a phone-service offer on your screen please see it is just an automated response from the system and you may please ignore it, and if you have more questions I am available through this text/chat format we have already been using.

After going through these additional details but analysis and diagnosis have not changed and you are still not considered as a case of als

You do not have progressive muscle weakness or progressive muscle atrophy

And whatever muscle related symptoms you have been having are generalized, but in als the symptoms start usually in one limb or one region of the body and then gradually spreads to other areas of the body but you are not having this pattern

Also there is even some improvement of certain muscle related symptoms and this also indicates this cannot be als

And MS too unlikely if the white matter lesions do not follow the pattern for ms, also the pattern of your symptoms too dos not raise any suspicion for ms

Once again, there is definitely no evidence for als in you, and ms too is not suspected in you, so please not to be scared.

Wishing you all the very best!

Thanks & Best Regards!

Dr Subbanna MD

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And also want to add that the emg you have had was sufficient to rule out als, your upper limb emg has already ruled out als, and there is no need for another emg now - either for upper limbs or for lower limbs etc, you are certainly not a case of als.

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Customer reply replied 7 months ago
this should be my last question and thank you so much for your detail. My left leg does stand out more than everywhere else but like I said it has had serious sciatica for years. But the otherr through my right leg hips shoulders forearms and hands a fairly quick. and since the neuro just did the electrical portion of my legs and said the needle portion was over kill was that a good sign. The twitches started a couple weeks after the conduction studies

You are very welcome! Please clarify if you have any doubts. Even though the left leg has more prominent symptoms compared to other limbs or other regions of the body, but this still is not suspicions for als because if this were due to als then you are expected to see progressive left leg symptoms, more and more muscle weakness & more and more muscle atrophy in the left leg - but it really does not appear you are having this type of pattern related to your muscle symptoms, and also you had serious sciatica before and the left leg symptoms could be related to it rather than due to anything else including als etc.

Yes I fully concur with your clinic neurologist, a needle emg test is certainly considered as an overkill in your case, there is certainly no need for the needle part of this test and just electrical stimulation was all that was required in your case, and this is especially so since als is not considered as a differential diagnoses for your symptoms and symptom patterns.

Once again, there is definitely no evidence for als in you either clinically or by investigation wise, and there is not even one iota of doubt in this regard.

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And even though the twitching started after the nerve conduction test, still there is absolutely no possibility of missing als in you since the pattern of the muscle related symptoms you have been having including the twitching etc are not at all raising any suspicion for als.

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Customer reply replied 7 months ago
the findings on the upper body test wouldn't fall into the als category as a cause of the Bi lateral brachioplexus compression/ ulner nerve
Customer reply replied 7 months ago
Are you still there?

No, absolutely not, if the emg/nerve conduction test showed findings such as brachial plexopathy then the test must have shown both motor & sensory findings. Sensory findings are not at all expected to be seen in the emg/nerve conduction study in pure motor conditions such as als (als is a motor neuron disease and is an example of pure motor condition without the involvement of any sensory systems).

So if your emg/nerve conduction test has identified brachial plexopathy then als diagnosis has been automatically ruled out in your case.

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Customer reply replied 7 months ago
Thank you. I would like to discuss with you some details about what test I have had and coming up. As well as your opinion on why could be going on with me since nothing has really come up so far other than possible mal absorption problem. Would we need to start a new thread or could we continue from herewith a new charge after the question?

You are very welcome! You may post the questions here too, it is fine. For the next few hours I am going off line and be away from computers, but after say about 7 to 8 hours from now I will be back online and at the site here again and available to answer your questions.

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Customer reply replied 7 months ago
One more question pertaining to the als. My patient notes say OSAS mild by questioning. Could this be a sign? I'm guessing this means obstructive sleep apnea syndrome. Please correct me if I'm wrong

Yes, the abbreviation appears obstructive sleep apnea syndrome although you may confirm with from your doctor’s clinic too because this is not a commonly used abbreviation for this condition. But I am not able to think of any other health condition with this type of abbreviation so this must be the sleep apnea condition itself, but please double check with your dr too about this.

Now coming to the als concerns – please see obstructive sleep apnea is not considered as a sign of als. If someone is having als and the als is causing the involvement of the muscles related breathing such as the chest wall muscles, throat, larynx and pharyngeal muscles etc then they experience breathing issues throughout the day but not just during sleep time as it happens with obstructive sleep apnea syndrome, accordingly obstructive sleep apnea is not considered as a sign of als.

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Customer reply replied 7 months ago
I have had a pretty good work up
Protein electro good
Sed rate good
B 12 good
Thyroid good
CBC good
Heavy metals mercury lead arsenic good
Iron 10 points low
Iron saturation 8 percent low
Copper borderlineIs there any other test or advise you could give. I have a small fiber biopsy coming up. The paresthesias are all over including my face. The lyrica does help 150 twice a day The twitching like I said is in left calf mostly but also feet ankles quads lats biceps I'm currently taking b complex,multi with iron, probiotic
Like I said the issue started as severe stomach pain which spread to throats and mouth Then burning tingling began in hands and feet and continued to spread. Cardiac work ups and gastro work ups were good. Is there anything else you could advise? Have you seen cases like this that ended up with any success? Thank you

You are very welcome! I see the investigations have not revealed anything major. The iron deficiency is being treated already, and if there is copper deficiency then consuming copper rich diet can help, and later if necessary copper supplements can help.

If lyme has not been tested and if there is risk for lyme then this test need to be considered

If the twitching are not coming under control then one of the following meds can help;

Muscle relaxant such as Baclofen or Tizanidine

Beta blocker such as Propranolol

Benzodiazepines such as Alprazolam etc

The small fiber neuropathy workup should help if the paresthesia/pain etc are due to small fiber neuropathy

If small fiber neuropathy is diagnosed and if a cause for this condition is found out then appropriately treating it can help.

The pattern of the symptoms you have been having is pointing towards the possibility of some benign issues so the prognosis is considered excellent in your case, the symptoms may bother for some time but eventually all these symptoms are expected to resolve and in fact my clinic experience shows almost all these types of cases will fully recover, it may take some time though, but they all recover so the successful outcome is the norm rather than the exception with these cases.

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Customer reply replied 7 months ago
Doc if we did the needle portion of the legs to check the sciatica can the test differentiate between disk problems and als damage?

Yes, the needle portion of the emg test can certainly differentiate between sciatica/disc related damage versus als related damage during this test

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Customer reply replied 7 months ago
Thanks doc. We had discussed finishing the test bc of the slipped disk issues I've had all these years that caused the leg pain. Thanks for easing my mind on the als worry with the above discussions

You are very welcome! Yes the needle emg test can certainly help in differentiating als from other causes of leg symptoms, and as mentioned earlier too als does not appear the cause for your leg symptoms, rather it is sciatica related.

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Customer reply replied 6 months ago
Doc during the start of all my test when they were looking for diagnosis, I had a nuclear stress test with dye, cervical and lumbar MRI with contrast , thorcic mri with contrast , brain MRI with contast. Each were bout a week apart. So 5 test with contest about 6 weeks apart. Looking back I'm kinda concerned bout the gadolium and effects it could have on me. Especially with the Brain MRI with the hyperintensities. My creatinine serum was always within good range. Should I be concerned that more damage could of been done to my brain or could cause some other damage. Or should my body of disposed of it properly. It's been 3 months. Just looking back now it's kind of concerning

The contrast agents including gadolinium etc are not considered as any issue provided your kidney is functioning normally. Since your serum creatinine level was normal so there should not be any issues or concerns related to the contrast agents or the gadolinium etc and these agents are unlikely to have caused or going to cause any kind of injury or damage to any organs or tissues or cells in your body.

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Customer reply replied 6 months ago
Dr. I got my nerve conduction done on the left side. Could you take a look at it? Is it ok to ask on this thread so you get paid or should I start a different thread

Okay I see, I can send you a premium service offer.

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Appreciate it, please upload the test report here.

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Customer reply replied 6 months ago
Lol sorry I think I may have sent a pic of something witk related please disregard

The pages are in a side to side orientation, or down to up wards orientation, is there any possibility of sending another batch so that the information can be read from top to bottom orientation?

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Customer reply replied 6 months ago
Should be 4 pages. Writing may be smaller

They still appear side to side rather top to bottom orientation at my side, how do these appear at your side?

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Customer reply replied 6 months ago
Let me try again

It s fine, instead of reading the images here at the site itself, I have downloaded them now and reoriented the pages with the help of the computer "rotate picture" tool, it is okay if you cannot resend it. I am studying the reports now, I will follow up with you asap.

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Please see this emg test of the left sided nerves and muscles of both upper and lower limbs (on left side) is normal.

With your concern primarily being about the als, this test has categorically ruled out this possibility.

Your nerves and muscles are very healthy and there is absolutely no evidence for als based on this study. There was a single muscle (left extensor digitorum brevis) showing a minor insignificant finding – this is seen in many normal people and has no clinical significance and this is certainly has nothing to do with als etc.

ALS will produce certain very characteristic findings during needle inseryion into the muscles (such as increased insertional activity, presence of fibrillation potential, positive sharp waves, fasciculation potential etc etc) but your test is showing none of such findings.

Not only this test rules out any als, this test also rules out any other nerve or muscle pathologies too.

This is certainly a normal left sided emg/nerve conduction study, and also als has been categorically ruled out with this normal study.

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Customer reply replied 6 months ago
Sounds good doc. What about the left tibial motor ankle ? I noticed it was low or am I reading it wrong and something about the calf. and the l5 s1 12 ms

Everything else looks fine, a minor finding with the left ulnar nerve noted too, other nerves are all looking healthy and your muscles are all looking perfectly healthy too.

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Customer reply replied 6 months ago
Ok. Thank you. The only info I got today was it was normal but saw those few things. Wasn't sure if the sciatic stuff played a roll. Kinda already knew about the upper stuff from the previous one. Thank you for helping ease my mind on the motor neuron stuff. Now just gotta find what is causing all this stuff!

You are very welcome! While sciatica can still be causing the leg symptoms because the emg/nerve conduction test many times does not show any findings even if a patient has sciatica or pinched spinal nerves etc, so this emg test has not showed any sciatica but clinically you may be still a case of sciatica. I was only mentioning this test has now shown anything other than the couple of minor findings mentioned earlier above. So this test has not shown sciatica but this does not rule out sciatica possibility (clinically), but mnd/als is always diagnosed with emg test, emg test has to show mnd/als findings to make this diagnosis, period, if emg test does not show mnd/als then it automatically & categorically rules this possibility out.

So mnd/als has been already & categorically ruled out in your case.

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Customer reply replied 6 months ago
Thanks. Last thing. Do you agree with him skipping the right leg and only doing the leg that started and had the more severe facilitations.
Customer reply replied 6 months ago
Both upper had already been done but he also re did the left upper due to the facilitations spreading

You are very welcome! Yes, this study is more than enough since you are having more symptoms on the left side, and the fasciculations now have spread to the left upper limb too so if this is mnd/als then the left lower and upper limb study should have detected abnormal findings, but your emg test has not detected even minor findings suspicious for mnd/als, so this categorically rules out mnd/als, and also doing right sided emg study now is certainly redundant in your case because the more symptomatic side has already ruled out the disease in question – which is the mnd/als - so no more emg/nerve conduction studies are required in your case including the right leg etc - because it is too certainly expected to come normal too.

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Customer reply replied 6 months ago
Doc I guess I will continue to use this thread if it's ok with you so you know my history. I went in for a second opinion with a pre screening to see a neurologist. I saw the nurse practitioner. She mentions I had brady cardia and tachycardia on my previous reports and wants me to see another cardiologist and have more test done. She mentioned I could possibly have dysautonomia given the issues I've had. She also did blood work to have paraneoplastic sent off. She told me not to panic bc most people immediately thought cancer when that blood work was ordered but she said it could be other things. I have still managed to cause myself anxiety by looking these things up as I wait on my appointments. I know we have discussed that my symptoms could be benign and go away on there own. She even mentioned that even if it was autonomic dysfunction. I guess my question is do you think these things are likely causes for me and how worried should I be about the paraneoplastic test?

The presence of bradycardia and tachycardia etc do not automatically point towards the possibility of heart diseases or autonomic dysfunction etc but seeing a cardiologist, and also undergoing autonomic workup etc are fine. And also there is nothing in your history that is suspicious for any tumors or cancers etc, so the paraneoplastic workup is not going to diagnose any such issues, they are just trying to order as many tests as possible and also referring to as many specialists as possible and this is done commonly in clinical practice whenever symptoms persist, but your history is not suspicious for any tumors/cancers etc, and also as mentioned previously too als/mnd etc also has already been ruled out in your case.

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Customer reply replied 6 months ago
Thank you doc. I go in for the punch biopsy in the morning. Do you prefer I start a new thread on future questions or continue this one

You are very welcome! I hope punch biopsy as well as all the other investigations that they are going to arrange will shed more light in to the cause of your symptoms, but as mentioned previously too serious conditions including the ones mentioned earlier do not appear the cause for your symptoms. For future questions you may please start a new thread, I appreciate it.

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2,865 satisfied customers
What type of medication should I seek to help alleviate my
What type of medication should I seek to help alleviate my pain symptoms prior to visiting my neurologists?… read more
Jack Scariano Jr
Jack Scariano Jr
Neurologist (MD)
Medical doctor
1,056 satisfied customers
Have nerve neuropathy, burning sensation etc in head cranial
Have nerve neuropathy , burning sensation etc in head cranial neuropathy and have now started to have burning feet. At present on 150mg Lyrica daily for the cranial neuropathy. What could be the cause… read more
Dr. Bob
Dr. Bob
Neurologist (MD)
Doctoral Degree
3,773 satisfied customers
I have had ishemic stroke back in 2010, also have slightly
i have had ishemic stroke back in 2010, also have slightly raised sugar which is controled to 5.9a1c. i have devoloped in my whole left side numbness, pain, tingling, . it reacts very badly to weather… read more
Jack Scariano Jr
Jack Scariano Jr
Neurologist (MD)
Medical doctor
1,056 satisfied customers
I have been seeing a neurologist for over 7 yrs. I suffer
I have been seeing a neurologist for over 7 yrs. I suffer from chronic migraines 10+ per month. I hurt all over, skin, joints, muscles, ect. My neck and upper back muscles are always tight and "knots"… read more
Jack Scariano Jr
Jack Scariano Jr
Neurologist (MD)
Medical doctor
1,056 satisfied customers
Began with shoulder pain that led to thenar atrophy. Lost
Began with shoulder pain that led to thenar atrophy. Lost muscle mass and strength in right hand. MRI shows severe disc degeneration in C-5 C6 and C7-T1. First neurologist did emg one limb and hinted … read more
Dr. Mark
Dr. Mark
Neurologist (MD)
Doctoral Degree
2,191 satisfied customers
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Disclaimer: Information in questions, answers, and other posts on this site ("Posts") comes from individual users, not JustAnswer; JustAnswer is not responsible for Posts. Posts are for general information, are not intended to substitute for informed professional advice (medical, legal, veterinary, financial, etc.), or to establish a professional-client relationship. The site and services are provided "as is" with no warranty or representations by JustAnswer regarding the qualifications of Experts. To see what credentials have been verified by a third-party service, please click on the "Verified" symbol in some Experts' profiles. JustAnswer is not intended or designed for EMERGENCY questions which should be directed immediately by telephone or in-person to qualified professionals.

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