ALS: Weakness Before Twitching?

[JohnMontan27]

Hi everyone - I am a bit confused...
From what I've read on this forum, weakness / atrophy seems to precede twitching in ALS.

However, I have also read in other sources that cramps / twitching and general pains can occur months before atrophy or objective weakness.

Can anyone who has seen a neuro and asked about this give me their input please?

Thanks

 

[LisaQ.]

We get this question all of the time, and while there is mention of the odd case where someone presents early on with twitching and cramping first, most neuros seem to debunk this from their personal clinical experience. Because **S is generally such a rapidly progressive disease, the emg findings would be diagnostically definitive, regardless.

In other words, it seems it can happen (rarely) on a strictly theoretical level, but none of our neuros have seen it personally. Many of them are quite comfortable not even doing emg's if there is no clinical weakness. Considering that they can be taken to the cleaners if they make a bad call, I would say they are pretty confident in their clinical judgement and assessment skills.

Someone else can chime in here if they have something more anecdotal to back this up, I'm just going by memory at 5 in the morning.

Blessings,
Sue

 

[Buckety123456]

When I saw the neuro last week I asked that very question, his reply was that weakness / atrophy are usually the initial symptom but not always and that is why he has requested an EMG. He did say that from the clinical exam he didn't think it was MND but the EMG will rule it out (hopefully).

 

[JohnMontan27]

Why is nothing ever cut and dried????

Thanks LisaLM - why are you up so early??

Pete - when is your EMG? Thought it was this week?