Neurologist Gives Unexpected Test Results

Guys, last week I went to a Neuro who tested me and said everything seemed normal and I posted it here. He outsourced a nerve conduction test and emg which I have just returned from. I didn't know what to expect and quite honestly didn't think a Neurologist would give me the test. The results I was not supposed to know until Monday from my first neuro. This Dr. was wonderful. He has been a Neurologist for the past 20 years and studied at Northwestern and Cincinnati University. He knew I was apprehensive and I told him of My ALS fears. He did a reflex test on my knees and ankles and said everything was normal. I told him that I have continuos twitching in 1 arch of my foot and some in the other and have suffered some calf twitching that lasted about 3 months. He said that feet and calf twitching is EXTREMELY COMMON due to having to bear the weight of your body throughout the day. I asked him if he has it and he stated his eye has been twitching all week, and if he wasn't a Neurologist he would probably be where I'm at today. Med students he stated fear diseases like MND more than anyone. I asked him about als and he stated that weakness and atrophy are the presenting symptoms and every als patient he has diagnosed( most in there 60's, and 1-2 a year) didn't notice any twitching until it was pointed out. The muscle on the top side of the foot near the ankle and the muscle between the thumb and pointer finger are the most common sites of atrophy. He did say that tongue twitching can point to something possibly more ominous than twitching in the extremeties but said it is extremely hard to tell because the tongue has many nerves. ( I know people including myself who freak out over tongue twitches, but he said the tongue also shows signs of atrophy with rows up in down). This last statement may dispute some other Dr. findings, but in order for it to matter there has to be more there than twitching(weakness/Atrophy). He proceeded to due the Nerve test in my right arm and right leg, and than the emg. After every needle insertion was over I asked him if it was normal and he said yes. He noticed no fasciculations until my right foot. He asked if I could feel or hear that. He said your foot is fasciculating and the test would pop every couple of seconds. I asked if it was still normal and he said yes, he stated they look for waves and fibs for MND and said it sounds like rain drops on a roof when abnormal. He then went and poked my back 3 times which was not scheduled and he told me not to worry no als or mnd checking to see if possibly the nerve root may be partially compressed on that side causing the fascics. He could not find anything. He basically after a 2 hour examination said I'm not crazy I do have fascics in my foot and it is not MND. Abnormalities would definetely show up on the emg and said the fascics were benign and very very common. He said there is a high scale and a low scale to everything IQ, pain, twitching, etc...Some people tend to have more than others in certain areas, everyone's body is different. He has definetely heard of BFS, he thought mine may be minor to others. To me it has been awful morning noon and night. I asked if the twitching is different with als he said yes. It is not rapid fire twitching or buzzing but is sporadic usually about 1 per minute but from his experience with patients not usually felt. It is in specific dying muscles where abnormalities would without a doubt show up on emg or in Neuro exam. Last but not least I asked him if I should stop worrying about this for now or ever. His respone was yes, and proceeded to tell me I have a better chance being hit by a car in this parking lot today than ever having ALS...Hopefully this helped some, I know the tongue and other twitching has plenty of room for debate, but I asked if a clean emg rules out als and his answer was a definitive YES. ( he did state he sees 10 MS patients to every 1 als). Thankyou to everyone on this board that helped mentally save me over the past 6 months, hopefully this info can help you. Weakness and atrophy he told me were the hallmarks not twitching...1 last thing als type reflexes he said our usually very brisk a 4 out of 4 on the scale and have clonus which is shaking of the leg muscle at extension(almost full extension by the way).

Most NM specialists believe that there is no such thing as "benign" tongue fasciculations. According to him, a teacher at the country's top med. school, even neurologists can make a mistake in recognizing tongue fascis.

Having said that, what most people experience is either some minor local or some gross tongue movement which they think is fasciculation.

Also, atrophy can be anywhere depending on the origin site - distal (e.g. Hallucis longus or Oppones Pollicis etc. in foot or hand) or proximal... usually happens hand in hand with weakness.

A clean EMG in the event of ongoing fasics is DEFINITIVE (only considering US studies - this exam. is very operator dependent and hence misleading). Not only that, even denervation of intrinsic foot muscles is not considered during diagonsis since many (over 25%) people have it !!!

Cases with fascis. only have happened (documented) but are rare and not for any length of time.