i just want to add something in sorry for bumping on the thread... You said BFS? comes on widespread? But ALS starts in one limb and works its way around to others. My symptoms started in my left hamstring-buttox region. My hamstring however feels strong as before. It spread a little bit into other regions, and i get vibration feelings in my hands and feet sometimes. The Pins and needles i can def. relate too!! I get it all the time, ive notice to just ignore it and it goes away with a little time. I heard bfs can start in one local area, and spread as well. Lots of people told me on this site that, if theres no muscle weakness with twitching then there is no worry. Can like pain in the top of your hands be related to BFS? cause ive experienced some pain in the top of my hands as well, its like when i move my fingers i feel it in the top of my hand. But my grip is still really strong, being able to do the grib machine like 50 times and holding it together for a mintue, which hurts. And i heard with ALS, twitches just dont disapear for a while, there basically always there and visible to the eye. And they come only after the muscle really atrophied. I am sure you have heard my story already im a 22 year old male. My twitches have gone down thankgod, my left leg twitches but not nearly as much as it used too. I get the vibration feelings at the bottom of my feet, which have me a little worried. And i also have this feeling of when i move my fingers i feel it in the top of my hand and towards the left side of my hand. I also get the vibration feeling in it. I dont think its a cramp or spasms, because its like in my fingers not in my palm. And i know there is no true muscle in fingers, and the mear fact that i can still do the grib device baseball players use, show me my hands havent gotten and weaker. Scares me because i feel maybe its the beginning of me losing strenght, but i dont think real like achey pain is assoicated with ALS. I would just think that one day i wouldnt be able to lift the oj container like i did the day before, not like have this pain in the top of my hands.Thanks for all your helpfull answers, just trying to have a little piece of mind.