Herniated Disc Stress: Twitches?

[Phoenixfire]

Hi my name is Uriel. i had back surgery in March 2009 for a herniated disc. The weeks after that I was really stressed out regarding some medical issues.About 4 weeks after the surgery I started having this twitches most commonly on my calfs, but also widespread through out my body. Face, arms, torso, legs, back, you name it. But the ones on the rest of my body come and go, the ones on my legs and feet are pretty much constant. About a year before the surgery I remember having this small twitch on my left thumb but went away after a few days. About 10 weeks after my fasciculations started I went to see a neurologist who did a neurological clinical test and told me it was good, I told him I fear ALS and he told me he did not think I had that. However he order a EMG so that my mind would be at ease, so about 10 to 11 weeks after my fascis started I did an EMG, this is the final report: AbnormalBased on extensive study of the left leg, arm and thoracic paraspinal muscles, there is no EMG evidence of a diffiuse motor axon loss process, such a motor neuron disease. fasciculation potentials are identified in distal leg and foot muscles, without accompanying evidence of active or chronic motor axon loss. A prominent cramp discharge was identified in the posterior tibialis muscle".My fear now is was this EMG done too early? what is the prominet cramp discharge? is that why it is abnormal? My Neurologist at the Cleveland Clinic (one of the best I hear) told me there is no indication at all that i might have any neouromuscular disease including ALS. He told me he was 95% sure I had nothing to worry about. I wondered what the other 5% meant. My situation right now is, I still have the fasciculations, they seem to get worse after working out, but are there trough out the day. My left calf muscle feels a bit tired almost on the verge of cramping, but it doesn't. My legs sometimes feel a bit stiff, my shoulders specially the left one feels a bit tired too and they shake when I stress them. it seems my joints on my shoulders wrists neck crack very easy. The fasciculations on my calf muscles sometimes are strong and continue even when i flex my calfs and sometimes are very subtle more like a ripple or a wave under my skin, sometimes I feel buzzing in my feet and left hand. on top of all that I just can't take ALS off of my mind. Do you guys think I should do another EMG? My doctor told me he will not order another one because things don't progress that quickly, so maybe in a few months I should do another one?Thank you all for taking the time to read this post. This has really have me worry as my body is doing things that has never done before.Appreciate your input.BlessingsUriel

 

[bfhopeful2]

"there is no EMG evidence of a diffiuse motor axon loss process, such a motor neuron disease."Concentrate on the possitive. NO ALS. You may have an injury, other things like neuropathy might be part of that 5%. The anxiety over it is overwhelming. I know. I asked my doctor yesterday if you can have an emg too early. Mine did come back normal, but so did yours really with the exception of the cramping. And he said no, an emg would pick up on ALS. Because by the time you develop fasiculations you already have muscle dying.I would suspect it all has something to do with your back.

 

[bfhopeful2]

One more common theme you should recognize. Most of us, about 80% can tell you that we all started this at times of great stress. I can also tell you that for most of us and I am guessing you too, this isn't your first bout with health anxiety.

 

[Phoenixfire]

Hey thanks for your reply. I did ask my doctor if it could be related to my back surgery and he said probably not because my fasciculations are all over my body. And yes there have been other times where i have been anxious because of health issues I know I try not to think about ALS but it just keeps coming back. Some days are better than others though it's hard not to think about it when your body is twitching so much you know?. I thought fasciculations usually stop when you move a muscle. I asked my doctor the same question and he said not to pay too much attention to the fasciculations themselves as much as what accompany them.Anyway thank you so much for your response, I really appreciate it.blessingsUriel

 

[bfhopeful2]

I have been experiencing this since around April 15th. It started after a lot of stressful situations built up in my life. I got a bicep muscle that would not stop for three days. Then I started noticing them in my right calf and within weeks they were wide spread over my entire body. So about 3 months into it I have seen 2 Neuro's, 4 physical exams, EMG, NCV, MRI, EEG, multiple blood tests and everything has come back negative. I have been down this road before with breathing problems, vertigo, chest pain and a few other things. I have the symtpoms and medically there are no answers for them. For me personally I think I do it to myself with the excessive worrying. I have lost no strength and have good and bad days with the twitching. Let's face it, anxiety sucks. It will ruin your life. Get a hold of it while you still can. See a therapist a physchiatrist, get some meds. Let's face it, you need it. Even if you had something bad, you still need something to help cope. Here are some quotes from Neuro's that I have used to help get me by. "The EMG should find abnormalities, IF present, when muscle fasciculations are pathological. This is because, fasciculations only occur late in pathological diseases and therefore the process should and is always present by the time they appear. I have never seen a report where the EMG has been normal and the patient has ALS. This would not be the case in benign fasciculations because they do not occur due to observed abnormal pathology.""Fasciculations caused by ALS are due to dying muscle tissue (actually necrotic). So, fasciculations due to ALS are always accompanied by muscle weakness and EMG changes. Benign fasciculation are not due to dying muscle tissue, but irritated muscle membranes. They are not accompanied by muscle weakness, nor are there EMG changes. Fasciculations can be seen in a number of diseases, such as nemaline rod myopathy. So, if there is muscle weakness with EMG changes, then fasciculations are due to a specific disease. When they occur in isolation, they are usually of the benign variety. Any and every neurologist will tell you this."“I am sorry that your having these fasciculations. Without muscle weakness being demonstrated on neurological exam, a normal needle EMG exam, you do not have ALS. The muscle becomes dead in ALS and the EMG picks up fasciculations and fibrillations. A normal EMG tell you that the muscle is not dead. Once ALS is diagnosed, the average lifespan is disappointly short, 3-5 years. There would have to be ongoing disease of some time (5-10 months) before one sees obvious fascicualtions and therefore by now, you would have epxressed the neurological exam findings of profound muscle weakness. So, again, I do not think you have ALS, nor have we seen anyone with fasciculations and a normal EMG needle exam develop ALS. Benign fasciculations are really bothersome and cause a great deal of anxiety (which makes them worse, by the way).” “Without muscle weakness being demonstrated on neurological exam, a normal needle EMG exam, you do not have ALS.”

 

[Krackersones]

Could something have happened during or after the surgery to trigger an immune response? This is a prominent theory for many people including myself although the exact trigger is unknown. I can image there are a lot of things that happen with surgery that are new to the body and might trigger an unusual immune reaction (stress, new meds, etc). Just some thoughts.If you want to explore this angle, there are tests to see if your immune system is overactive.Krackersones

 

[Phoenixfire]

Hey first of all thanks for those quotes they are very reassuring and do help me feel a bit better. Regarding the surgery, yes I always wonder that, in fact I remember a doctor that did a blood test after my surgery asked me if I had a fever, I said no but he said something in my blood work was a high, but if I didn't have a fever it did not matter. So it made me wonder if it had anything to do with my immune system. Anyway Like I said I mentioned it to my doctor and he didn't seem concern at all.thanks you all for taking the time to answer my questions, in a way even though I'm sorry that you guys are going trough this also, it is also comforting knowing that I'm not the only person going through this. And that it is probably something not serious although annoying.blessingsuriel

 

[TimThomas24]

Uriel- I'm glad you made it over here from the medhelp board. I think you'll find it very reassuring to see so many people dealing with exactly the same stuff. I myself have had the exact same crampy/achey calf and the shoulder stiffness. The one thing about bfs is that it has all over effects and seems to morph and change regularly. Anyway, you sound like you have bfs and I'd take heart in the specific report on your emg which makes clear no motor neuron disease.

 

[Phoenixfire]

Hey , it is true this thing changes a lot. Yeah I guess this is a step forward as i used to visit an ALS forum. But after a few months of stubbornly fixing on having ALS and many kind and patient people that help me to see things in a different way, I now find myself visiting this forum having decided that yup, maybe BFS( as annoying as it is) is all I have.Thank you for your encouragement and reassuring words.BlessingsUriel

 

[CautiousExplorer]

ALS is both upper and lower motor neuron damage. Since lower motor neuron damage always shows up on the EMG, you are pretty cleared from having ALS. I'm just saying that if your fasciculations were the result of having ALS, where your muscles get disconnected from your brain and sort of act on their own untill they vanish, it would've showed up clearly on the EMG. Oh, and they always say that they're <insert random number> 95% sure that you dont have ALS. Its just to cover their asses.. since, well.. just because they cleared you now doesnt mean you can drop dead from lets say a heart attack 2 minutes later. Nothing is certain in life. Be glad you are healthy now

 

[RainCat]

You sound so much like me. No surgery yet but my lumber seems to be in a bad state ...check out my other postshave you heard of this?Diagnostic Criteria for adhesive arachnoiditis Primarily, diagnosis is generally by taking a history rather than clinical examination, as the syndrome does not have any specific typical picture and many of the features fit the criteria for generic chronic pain syndrome.The principal historical pointers are: 1. myelogram, particularly oil-based dye (pre-1987) 2. spinal surgery 3. repeated lumbar punctures 4. epidural/intrathecal injections of any type, particularly depo-Medrol, intrathecal chemotherapy e.g. methotrexate 5. infection: meningitis or epidural abscess 6. trauma 7. subarachnoid haemorrhage 8. chronic prolapsed discs or stenosisOther relevant historical details include: 1. autoimmune conditions 2. tendency to scar badlyMost patients have multifactorial arachnoiditis, i.e. commonly they will have started with a mechanical back problem, been investigated possibly with a myelogram, had spinal surgery, possibly repeatedly, then had epidural steroid injections for pain relief.Symptomatology:Most common symptoms 1. neuropathic pain, often non-dermatomal*; mostly lower limbs, low back but may also affect upper half of the body 2. secondary musculoskeletal pain +/- fibromyalgic symptoms; joint pains; headaches 3. bladder/bowel control dysfunction +/- sexual dysfunction 4. motor weakness, cramps (tonic) 5. profuse sweating/temperature control problems; CRPS type appearance.** will include allodynia, dysaesthesia, bizarre sensations (walking on glass, water running down the leg) transient lancinating pains/electric shock sensations; sensory inattention etc. as per other types of neuropathic pain. CRPS may appear as altered skin colour, swelling, change in sweating, exquisite sensitivity, after minor injury.The course of the condition is such that it tends to fluctuate, with intermittent flare-ups, but overall most patients will ?plateau out' and remain fairly stable unless there is an event such as a fall, accident or further surgery, which can cause a rapid deterioration.Diagnostic tests:The current investigation of choice is a T2 weighted, fat suppressed, high resolution MRI scan, including axial views.Typical appearance will vary according to the stage but may include: 1. nerve root clumping including a ?string of pearls' appearance 2. ?empty sac' appearance due to nerve roots adhering to each other and the dura 3. complete obliteration of the subarachnoid spaceIf oil-based dye has been used, it may persist as either a thin film spread over a wide are and resembling fat on MRI scan, or as discrete encapsulated deposits either in the spine and/or the basal cisterns (due to tilting of the X-ray table during the test).Obviously there may well also be other features related to the underlying spinal problem, e.g. stenosis, prolapsed disc, spondylolisthesis etc.