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DrRussMD
DrRussMD, Board Certified MD
Category: Medical
Satisfied Customers: 64314
Experience:  Board certified Internal medicine and Integrative medicine. Many years of experience all areas.
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Hi,I am a 41 year old female from Northern Ireland with a

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Hi, I am a 41 year old female from Northern Ireland with a history of twitching. It began in 2006 with generalised twitching. I saw a top neurologist, here in Belfast, who completed a full neuro exam and didn't think much about it, said it would probably go away in time. Because the twitching continued into 2007, I saw another neurologist in 2007, who did neuro exam and partial emg on forearm and thenar eminence of left upper limb. Contract fasciculations were detected and they discontinued any further investigations as no weakness or atrophy was present. The twitching eventually subsided. Fast forward 6 years, December 2012/January 2013 and the twitching returned. It was particularly persistent in the left outer elbow joint area. I believed that I saw atrophy in the elbow area and in the thenar eminence and FDI on the left hand. The neuro completed 2 separate neuro tests on different days and said they were totally normal. I requested a full EMG/NCS. He felt it was unnecessary and a waste of my money but if it sought to reassure me he would organise it. I had the full body EMG/NCS (bar my tongue) on 17th Feb 2013, completed by a highly regarded neurophysiologist in NI. The results came back normal. I was reassured and the twitching eventually subsided. Fast forward 1.5 years to present....out of the blue in April 2014, I got the odd twinge and rapid twitch, lasting seconds, in the first dorsal interosseus muscle on the left hand. I got that sinking feeling again. It didn't really recur until around mid June (i think) when the FDI on the left hand went into constant twitch mode. At first, I think it was only visibly notable then it became physically notable and very annoying. I mean 24/7. Relentless. AND it is still twitching to this day!!! The twitching stopped for 1 week, last week and has since returned whereby the twitching is more intermittent but still there extremely frequently. I made another appointment on 23rd July 2014, with the very 1st neuro I saw in 2006, (he is one of the top guys in NI), unfortunately when I saw him it was during the week the twitching had stopped. He basically didn't even want to examine me and said that the twitching was not caused by my fear of MND and that he had 3 repeat clients who were similar to me. He also said he would have a tendency to over diagnose but has never under diagnosed. He didn't pay much attention (in my eyes) to the troublesome hand, where I feel there is definite difference in muscle bulk between the left and right FDI. I asked him to complete a neuro exam on me, he didn't think it was necessary?!?! I felt the exam was very quick and rushed because he had already made up his mind. He said I was extremely strong, however again I felt my left fingers weakened quickly in the abduction test....he rushed this bit. and I caught him doing my left arm reflexes a couple of times....he made no comment on this. I have a couple of related questions: I am concerned that most of my troubles are always on the left upper limb. should I be? If this is a benign thing why is there a shorter gap between the last 2 episodes? Is it not much more worrying that I have this persistent, localised twitching in the Left FDI starting in April 2014 and continuing to present? I do have twitching all over now but it is erratic and never in the same spot whereas this persistent hotspot in the webspace is continuing. I s this concerning? As I had a full EMG/NCS less than 1.5 years ago would it have any indications on present twitching? How likely is it that this present bout of twitching is entirely unrelated to my past history and is the initial onset of a horrible neurological disease? Finally should I request another EMG/NCS? Thank you for time and sorry the post is so long but I needed you to have an appreciation of the whole thing. Regards

Submitted: 2 years ago.
Category: Medical
Expert:  Dr. David replied 2 years ago.
This is Dr. David

it sounds like you have periodic episodes of benign fasciculations which is benign and common and normal.

I am glad you had a full body EMG/NCS and it was normal.

it doesn't sound like you should be concerned. you have seen many doctors already and had many tests.

it sounds like you are letting your anxiety get out of control on these benign fasiculations

benign fasiculation can be caused by excessive anixety, lack of sleep, low potassium or low magnesium levels.

fasciculations can be impossible to predict and can occur at any time and can have different periods of time between episodes.

your fasciculations are not concerning.

I bet you don't have a horrible neurological disease.

if you have another EMG/NCS it will be normal.

don't let your anxiety get too out of control on these fasciculations

let me know if you have questions.





















Dr. David, Board Certified MD
Category: Medical
Satisfied Customers: 45932
Experience: Board Certified Physician
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Expert:  DrRussMD replied 2 years ago.
Hello
I disagree
There is not enough to say this is BFS at this point.
Let me clarify a couple of things
A work up for the situation you have described is not completely unless you have had
Calcium levels
magnesium levels
thyroid studies
Maybe an MRI, but I need to ask you more questions.
The fact is that this is a relapsing remitting syndrome, and it affects one side more than the other, is that correct?
Customer: replied 2 years ago.

Yes that is correct. I also had a lot of blood tests done last jan 13 which all came back normal. Are you suggesting that I might have a motor neurone disease???

Expert:  DrRussMD replied 2 years ago.
No
I am suggesting that
magnesium needs to be at least 2.5. Normal goes down to 1.7 on most labs.
TSH needs to be below 2.5 and above .3. Most labs say .5 to 4.5 is normal.
Vitamin D needs to be 40 or above. Most labs go lower.
You need to make sure calcium is normal. This is not checked on routine labs, neither are the others.
You need a structural exam for structural stress [by a physical medicine and rehabilitation doctor].
If exam shows any hyper reflexes, you should have an MRI of the brain, which rules out MS>
That would be my appraisal from your story.
OK, so that is an initial answer….
Please use reply to expert if you have further questions. When you are ready, please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.
Customer: replied 2 years ago.

Dr Thomas. Thank you for your reply. I understand more tests are required to get to the bottom of these symptoms. One last clarification.....given the above info, can I stop worrying about motor neurone diseases? Or might that still be a differential diagnosis? Thank you for your time.

Expert:  DrRussMD replied 2 years ago.
I don't think this is consistent with motor neuron disease.
i would rule out the other possible problems.
Please use reply to expert if you have further questions. When you are ready, please click a positive rating [hopefully excellent]. If you forgot something, come back. I am here daily.
DrRussMD, Board Certified MD
Category: Medical
Satisfied Customers: 64314
Experience: Board certified Internal medicine and Integrative medicine. Many years of experience all areas.
DrRussMD and 4 other Medical Specialists are ready to help you