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Dr. Bob
Dr. Bob, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5514
Experience:  Neurology & Int Medicine (US Trained): 20 yrs experience
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Hi, I would prefer only neurologists to address this query. I

Resolved Question:

Hi,
I would prefer only neurologists to address this query.
I have posted before but I need further clarification.
Brief history: twitching and buzzing started 2006. Partial emg in 2007. Only contract fasciculations noted. Everything settled. Dec 12/jan 13 twitching persistent in elbow. 2 clinicals and 1 full body emg in feb 13...all normal. April 14 twitching started very sporadically in left FDI. Mid june 14 to present day left FDI twitches 24/7. Saw neuro who says I have no clinical abnormalities on examination and stated I was v strong. He advised not to bother with another emg. My concern is the persistent nature of this twitch and I think I can also see atrophy in the left FDI when compared with the right. I pointed this out to the neuro who said. You are strong. Going out of my mind with worry.
How do I attach a video.
Submitted: 3 years ago.
Category: Neurology
Expert:  Dr. Bob replied 3 years ago.
Dr. Bob :

Twitching is merely a sign of neuromuscular irritability. It is very common and non - specific. While many patients with MND have twitching, very few people with twitching have MND.

Customer:

Hi Dr Bob,

Customer:

Being as anxious as I am, I am not sure how to interpret your response. As you rightly stated my fear is of MND. So, given the tests I have had to date should I ignore this fear as its unlikely? Is a twitch this persistent and in this location not quite ominous?

Dr. Bob :

This system

Dr. Bob :

Sorry. ..This symptom is not ominous at all, particularly in the absence of other evidence of MND.

Dr. Bob :

Keep in mind that when we see MND (ALS being the most common form) the weakness that inevitably comes tends to come early and progress rapidly.

Dr. Bob :

In addition, by the time atrophy is apparent, there is usually a loss of one third or more of the motor neurons.

Customer:

Even with its persistent nature? What bugs me is that both times I visited the neuro, the twitch temporarily ceased. It has been 24/7 since mid june. I guess the location, the fact that its focal and its persistence made me think along a sinister thought. I did keep showing the neuro the areas where I believed I had atrophy and he just stated that I was strong. I also believe his neuro exam was cursory at best. Should I have EMG?

Dr. Bob :

While the presentation can be variable and the diagnosis unclear in the earliest stages, it does not stay this way for too long.

Dr. Bob :

Was your last EMG in ' 13 or this year?

Customer:

Last EMG was feb 13. Full body.

Customer:

One before that was 2007 on forearm and thenar eminence only.

Dr. Bob :

6 months is enough time for things to change and the disease to declare itself more definitively, but your symptoms haven't changed dramatically, so it would be better to follow your neurologist 's advice and wait a bit longer.

Customer:

Ps neuro told me no point in repeat emg as nothing showing clinically. He believes this is a continuation of my past twitching. I asked uf this could be unrelated given new location, duration, frequency. He didnt think so.

Dr. Bob :

If you do it again now, and it is normal, you will likely not get another one at all unless the symptoms progress significantly.

Dr. Bob :

If things are a bit worse in another 6 months, that might be a good time to repeat the test. If everything is the same or better you will not need it at all and will have saved yourself the time and inconvenience.

Customer:

So as a take home message...the fact that this twitch is relentless and persistent for approx 9 weeks and the fact that it is focal to the left FDI is NOT ominous or worrisome? I am 41 female with a history of twitching and clean clinicals and EMGs to date. So what is the liklihood of this being very early MND???

Dr. Bob :

Very low. ..almost zero

Dr. Bob :

In fact, with clean neuros and clean EMG s, you are less likely to have it than I am. :-)

Customer:

Thank you Dr Bob. One last query....I have done copious reading online re this subject...not always a good idea. Anyway, a lot of info state that if fasciculations are present and are MND related EMG should pick it up. If twitching was related to MND, would I be experiencing more symptoms as opposed to persistent, focal twitching within 9 weeks?

Customer:

Ps I was hoping to post my video clip but I dont seem to be abke to upload it.

Dr. Bob :

Yes...This would be very unusual for focal twitching alone to be a sign of ongoing MND that started in 2006 or 2007. It just doesn't add up.

Customer:

And if this episode is totally unrelated to my twitching history.....would I have a few more symptoms in addition to the focal twitching in the space of 2 months approx.?

Dr. Bob :

Well, you can't just reset the clock on your twitching. :-)

Dr. Bob :

Whatever was causing it then is presumably still at play here.

Dr. Bob :

And that is most likely not MND.

Dr. Bob :

It just doesn't add up.

Dr. Bob :

You're going to be fine. You have doctors looking after you and following you . They will jump on any worrisome changes I am sure.

Customer:

Thanks so very much Dr Bob for your reassuring words. You have been exceptionally helpful. Thank you.

Dr. Bob :

In the meantime, benign fasciculations are not only strongly associated with health anxiety, they are also more prevalent in the setting of stress, fatigue, poor sleep and other"lifestyle" issues.

Dr. Bob :

So be sure to take excellent care of yourself!

Dr. Bob and other Neurology Specialists are ready to help you