Dr. Subbanna, If it wouldn’t be too much trouble I would…

I have tried to answer your health questions & health concerns, point by point below here;

If it wouldn’t be too much trouble I would like to ask you another question regarding my twitching condition. The random twitching as a whole has subsided quite a bit and although I do experience the occasional random twitch everyday, it does not worry me as It did previously

-------------Absolutely no trouble or any issues, I will be very glad to help you with your health concerns. First of all, I am very glad to hear the random twitching you used to experience has subsided quite a bit, although I see you still experience occasional random twitching every day – but your statement that it does not worry you as it did previously – is perfectly appropriate reaction to this situation, in fact the twitching in your case should not worry you at all, because your muscle twitching is not at all secondary to als, it is totally benign in nature such as due to bfs etc, and anxiety too appears contributing, one or otherway there is absolutely no suspicion for als in you, and also the twitching overall improving quite a bit also categorically rules out als, because in als, once the twitching starts is will remain constant and also keep worsening as the disease progresses, but any this kind of improvement in the twitching clearly indicates your muscle twitching is not at all related to als.

However, I have started to experience a new symptom which has caused me some anxiety and I would like to get your professional opinion on it. 3 days ago I noticed that my left thumb, in particular the large muscle between the base of the thumb and base of the index finger (I guess you would call the abductor and flexor pollicis) have felt very fatigued.

--------------While I am sorry to hear you are having new health concerns now, but please see there is indeed no suspicion for als in you, once again. The bulk of the muscles that are present in the base of the thumb are also called as thenar muscles and these muscles include as you have also correctly put - APB (Abductor pollicis brevis), FPB (Flexor pollicis brevis), and also another short muscle of the thumb called as Opponens pollicis etc; and the bulk of the muscle that forms the base of the index finger or the region between the thumb and the index region is also called as FDI (First dorsal interossei) muscle. I have checked the various pictures you have provided very carefully, which also gives appearances from different angles too, but I am really not able to see any obvious muscle atrophy in the regions that you have mentioned above, or in any other regions of your hands. Even if there is slight difference, such slight side to side differences are well known in normal individuals, so it is of no concern at all. But anyway I was not able to see any obvious side to side differences or any atrophy at all. Also when muscle atrophy is present muscle weakness is always present, but in your case it does not appear you are having any muscle weakness, so this also indicates there is no true muscle atrophy in your case, and this once again indicates you are not at all a case of als.

I also started to notice that at rest, those muscles seem to continue to move on there own almost like a rolling wave in the ocean type movement

------------This appears again, a totally benign phenomenon, and this is absolutely not indicative of any disease process.

This has caused me great concern because I have read that MND’s like ALS typically start in the distal muscles like the hand and in particular the thumb

--------------While I can fully understand this has caused you great concern, especially this is a new symptom for you, and also it is true that mnd such as als starts in the distal muscles, such as hand region, that too especially the thumb region muscles, but you are not having any als typical symptoms or signs at all. You are neither having progressive muscle weakness nor progressive muscle atrophy etc, so this cannot be als

At present, I don’t seem to have any clinical weakness in my thumb as I am able to move it at will and I can grip normally similar to my right hand

----------------As mentioned earlier too, to start suspecting als, one must have progressive muscle weakness, rest of the issues you have mentioned are not uncommon in many normal individuals, especially individuals with severe health anxiety etc, but in the absence of progressive muscle weakness - als cannot be suspected at all in your case

Another concerning symptom is that it appears that the left thumb muscles appear to be smaller and have more noticeable indentations than my right hand which is triggering fears of potential muscle atrophy. (I will attach pictures for your reference)

--------------As mentioned earlier too, the left thumb region muscles really do not appear different in these pictures, but even if you have noticed such difference, as mentioned previously too, but when muscle atrophy is present muscle weakness too should be present, so you cannot be having just muscle atrophy without any obvious weakness, this is another way of telling there is no true atrophy of muscles in your case, and also accordingly you cannot be a case of als

Is it possible that I could potentially be experiencing the early signs of muscle loss and/or a neurological disease? I am worried that although I don’t have any true clinical weakness now, that In a few weeks or months I may start to lose function of my thumb. Let me know if you think these new symptom are benign in nature and “all in my head” or if my new symptoms should be of concern.

----------------Please see, there is really no evidence for any early signs of muscle loss or any other neurological illnesses in you. If any neuro condition can cause muscle atrophy, as mentioned previously too – such condition whether it is als or any other condition – should cause very obvious muscle weakness too, but in your case no muscle weakness has been noticed, and this indicates you are really not having any neurological illnesses including als etc, otherwise also I was really not able to see any muscle atrophy in your hands including the left hand regions that you are concerned too, so this is certainly anxiety that is getting the better of you, and there is absolutely no evidence for any neurological signs in you, related to any diseases including als etc.

Once again I can very categorically reassure you, please see there is absolutely no evidence for any neurological illnesses in you including als etc, your symptoms are totally benign issues, and anxiety is certainly playing a very predominant role here, there is not even an iota of suspicion for any neurological illnesses in you including mnd such as als etc too, your health is perfect and you are definitely not having any neurological health issues, so please not to be scared.

Wishing you the best health!

All the very best!

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Best Regards!

Dr Subbanna MD

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