Exploring Symptoms of Tingling

[jstanley0]

First off, I haven't been diagnosed with anything yet. That won't come for at least two weeks - I had my first EMG today (hands and arms); I have a second EMG next week (tongue and lower body), and a followup appointment with the neurologist after that, when he will go over the test results with me. Let me back up a bit - about 4 months ago, my first symptoms appeared - a tingling feeling in the feet (and occasionally hands and face). That only lasted a couple of days, and was followed by a vibrating sensation in my feet and left inner thigh, as if somebody had taped a pager to my skin. This feeling was constant for a couple hours a day. This went on for a week or two in my feet, and another couple weeks in my thigh, and then pretty much went away. Next up, I felt a repeating twitch in my right leg just above the knee, as if someone was tapping it with a hammer. I could see and feel it moving through the skin. This went on for a few minutes and went away, but totally freaked me out. I didn't feel this again for two weeks, but then it started happening once or twice every day, in various parts of my body (both arms, both legs, my back, even my head).I've been to the doctor several times, and they did blood tests--all normal--and a brain MRI--also normal. Yesterday I finally got in to see a neurologist, and he did a clinical exam. I was able to walk on my ankles and toes, and touch my nose with my eyes closed, and push back against his hands. No problems there. There were a few tests I don't know whether I passed - he asked me to close my eyes and hold out my arms, for instance, and I don't know what he was looking for. The first worry was the reflex test ... I had almost no response to anything. The knee-jerk thing was it. After the clinical exam, he said he wanted to have nerve conduction studies done to rule out motor neuron disease. That's my second worry - that he thought this test was necessary. I've read elsewhere on this site that EMG is needed to _confirm_ ALS when clinical tests show suspicion, not to rule it out - but I suppose neurologists have differing opinions on this. He scheduled me for two separate appointments - one for the upper body, one for the lower body.I had my upper-body EMG this morning. It was a bit unpleasant but not as bad as I worried it would be. My fingers were cold, so he made me run them under warm water for a few minutes before starting. I have no idea how the first part of the test went, where they taped electrodes in various places and ran current through them. I felt the shock and my arms twitched consistently each time the machine clicked. Some graphs appeared on a screen, but I have no idea what to look for there.On the second part of the test, he stuck needles in various muscles and listened to electrical activity. Here's my third worry ... in one muscle, he detected spontaneous twitches, stacatto pops on the machine, that I did not feel. These came a few seconds apart. He asked if I felt the twitch in my right hand, and I didn't - but I did feel a twitch in my left foot at about that time...During the test, he told me about a friend of his with similar symptoms that turned out to be benign. After seeing two doctors, two medical techs, and a neuro, I've heard plenty of mentions of "multiple sclerosis" and "motor neuron disease", but this was the first time I heard "benign fasciculations" - interestingly enough, he said they don't use that term (benign) anymore! So is it just "fasciculation syndrome"? My fourth worry came when he asked if I had any difficulty swallowing - which I said yes, a few days ago, but it's gotten better now that my allergies are clearing up - and tongue fasciculations - which I said no, I haven't felt any, but then he said you don't always feel them. If I stick out my tongue and look in the mirror, I can see my tongue twitch. He said he may test my tongue at next week's appointment (gosh, electrodes in the tongue, now that sounds pleasant!)Anyway, as the test was over, he told me not to stress about it too much. Hard not to stress over the spectre of the death sentence that is motor neuron disease - even if it's unlikely. Hopefully in two weeks I'll get a benign diagnosis and I can go on with my life...

 

[Krackersones]

I know what you are going through. I have twitches/vibrations etc on and under my tongue every day (just a few times each day not constant). The neuros have asked to see my tongue but only wanted to view it while it is resting in my mouth. The movements the tongue makes when you stick it out are normal. I have the same symptoms as you and they came on suddenly like yours. I've had three clean EMGs but slowed nerve conduction in sensory nerves on the nerve conduction test. The fact that you have slow or no reflexes is good. ALS comes with brisk reflexes. Unfortunately, my reflexes are brisk but that I'm told that could be normal too. Your symptoms could be a type of neuropathy that is treatable or will resolve on its own. I know it's hard not to worry but remember there are many others who have gone through what you are and there is support here on this board.Regarding blood tests, I had maybe 30 plus different ones. The neuros think my problems were caused by an immune reaction. The evidence for this is I had Raji immune complexes, very high ANA titres, and monoclonal gammopathy (although only trace amounts and subsequent tests were negative). I have yet to lose any strengths in almost a year with this but the symptoms have never subsided causing me to take Klonopin twice a day to keep functioning.I

 

[beensuggested]

First of all. If we are looking to rule out NMD or ALS, ONE EMG is all that is necessary. ALS is a disease that occurs within the spinal cord and specific motor neurons. So if you are having leg problems I can stick you in the arm or the tongue and I can see what the issue is. There is no reason to go back for other areas. I am not sure why your neuro has this protocol and will not further surmise. HOWEVER ALS or NMD would have been ruled out following the first EMG. If he is testing further it is NOT for those conditions but rather to rule out localized issues elsewhere wither in the ability of the nerve to reach the muscles in a localized area - think like carpal tunnel, or back at the spinal cord - think disc herniation or degeneration. Please DO NOT SAY THAT ALS COMES WITH BRISK REFLEXES. Deep tendon reflexes can be hypo - because there is an issue with degeneration or compression or because the patient has more control over the area so they appear less that someone elses. Deep tendon reflexes can be hyper because they just are or because there is degeneration or for a myriad of reasons that are TOTALLY BENIGN. The only time we get concerned and then even at that point 9 times out of 10 it is nothing insidious or fatal is when there is a CHANGE in the reflexes ie hypo to hyper or normal (if we really want to get clinical here - +2) or hyper to hypo. what we never like to see is a pathologic reflex and even then that can be due to a benign condition. So what I am saying is you are extrapolating your fears at what you think the neuro is thinking when you actually have no empirical knowledge of whether you results were pertinent or not. If the neuro mentioned BENIGN then you are already 90% there to not worrying. Shame on your neuro for not discussing more with you and running a second test at a later date without any discussion with you at that time. So far I am not impressed. Look, if you don't know what the doc is actually looking for with a test, then you can't assume. Each individual test is just a part of the whole clinical picture combined with the symptomology and history and believe me, you doc already has a basic differential diagnosis of what is going on. Honestly these diseases that everyone is worried about are alhtough not that common as far as ALS, more common with MS - but REALLY we have a pretty good idea of what is going on and the tests confirm what we think or it sends us to evaluate something else.I think you can relax and not worry.Kit

 

[bfhopeful2]

my emg came back stating no facisculations, but I twitch a lot. how is that possible? can you have muscle twitching that is not faciculations, or is it possible that they just didn't show. Cant see that considering they did arms and legs and nothing? my calf twitches all day and you can see it with your eyes.

 

[SlavinBreeze]

Same as mine recent situation. The Neurologist (she) didn't see fasciculations during standard exam but in that moment I did feel it in my legs. I don't understand. All EMG came out normal!

 

[MarioMasher]

The simple answer is that what we think are fasciculations and what a doctor thinks are fasciculations are not necessarily the same thing. To quote the movie The Princess Bride, "That word, I do not think it means what you think it means." Twitches are not always fascics. Too many people around here think they can play doctor and just throw around medical terms as if they really understand what they mean. Sometimes a twitch is just a twitch. In almost every single scenario imaginable, a twitch means nothing to a doctor.

 

[bdaddyjohnson]

Great now I am confused, I thought fasciculations was a fancy word for twitches. Can't we just KISS (keep it simple stupid)?

 

[bfhopeful2]

my grandmother was diagnosed with als 6 months after they thought she had a stroke. she just had trouble speaking and 6 months later can't open her eyes or lift a pen. she has a computer that she can barley type on that speaks words for her and I asked about twitching and kind of said twitching! Not really one of the symptoms I was worried about. Beleive me if you had ALS you would know it. I am past that. I just want to stop these annoying fing twitches.

 

[jstanley0]

I just had my second EMG, and I'm feeling better about life, despite having many more fasciculations detected in my legs today than were detected in my arms last week (he only found fascics in one muscle last week - four or five this week). For some reason, when he detected a fasciculation I didn't feel last week, I stressed about it, and I was worried about the legs, because I feel a lot more twitches in the legs than in the arms. Then I thought--wait a second--these twitches are why I'm getting these tests done in the first place - don't I want hard medical evidence that these are real and I'm not crazy? (I first showed a fascic to my wife a few days ago - and that felt good to have one timed when somebody else could see it.) The fact that he detects fascics that I don't feel isn't crazy either--he said you can only feel them when they're in the most superficial layers of muscle.Anyway, I asked the doctor if he sees fasciculations in normal people, and he said yes - that fasciculations in absence of any other electrical abnormalities are by definition _benign_. Then he said "And I can tell you right now that I don't see anything else wrong--no positive sharp waves, no fibrillations, no recruitment abnormalities, no evidence of denervation." ) I asked him about last week's EMG of my arms, and he said, "Same."Last week he wouldn't tell me _anything_ about my preliminary test results. Maybe he wanted to calm my anxiety, or maybe my asking him questions about his specialty helped (he's quite enthusiastic about what he does).I don't have a diagnosis yet--the EMG tech will report the results to my neuro, and my follow-up is next week--but the preliminary EMG results pretty much point straight at BFS, and it's clear the EMG tech doesn't believe I have **S (he says "I'll report the results, and your doctor will talk to you about things, and he may want to order another test if your symptoms worsen or you experience weakness"). So that's a huge relief.After he finished on my legs, he said "I think we have all we need." So he didn't find the tongue EMG necessary after all. I asked if he can detect motor neuron disease with an EMG anywhere in the body, and he said "In more advanced cases, usually, but sometimes early on before it becomes systemic, we might not see anything in unaffected limbs." So I guess opinions differ on this point.I'll post a follow-up after I visit the neurologist next week - but so far, so good.