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Re: Bulbar onset

PostPosted: December 14th, 2014, 5:43 am
by joycecaroll
TwitchyDoc wrote:Without a video, it is way too subjective. They are fast, brief and multifocal.


I'm sorry, they come and go so fast. It's impossible for me to catch them on video.

Mine come in singles and sometimes in different spots with many hours between each twitch.

What so you mean by multifocal? Would they be multifocal and more frequent in the hyperexcitable phase? Even if there are no studies on frequency, what is your opinion as a neurologist?

Re: Bulbar onset

PostPosted: December 14th, 2014, 5:50 am
by TwitchyDoc
You still speak about the hyperexcitable phase with relation to mnd. But the pathology is the same as with idiopathic hyperexcitability syndromes. It is the same thing just the cause is different and as you know this phase has proved to be quite short in mnd, months or rather weeks.

Re: Bulbar onset

PostPosted: December 14th, 2014, 6:01 am
by joycecaroll
Okay. But do you have any thoughts regarding my questions?

What does multifocal mean?
Would you expect fasciculations to be more frequent than just 5 a day after two months if it was ALS? (I realize there might have been no studies dobe on this, I'm asking for yout opinion).

Re: Bulbar onset

PostPosted: December 14th, 2014, 6:02 am
by TwitchyDoc
Tongue as well as thenar muscles can be quite simply checked for hyperexcitability - stick it out slightly so it is relaxed and flick the edges with your fingers strongly. Any subsequent twitching?
Multifocal means its diffuse in multiple places.

Re: Bulbar onset

PostPosted: December 14th, 2014, 6:06 am
by joycecaroll
Okay I'll try that. But np thoughts on frequency? Soneone told me fasciculations eould be expected to bee very frequent in ALS - once they start they would not stop for several hours everyday.

Re: Bulbar onset

PostPosted: December 14th, 2014, 6:10 am
by TwitchyDoc
There is no rule. In denervation, they would not go away. But hyperexcitability is a different thing so the freqency can vary. I would not really worry about single twtches like you desvribe.

Re: Bulbar onset

PostPosted: December 14th, 2014, 6:19 am
by joycecaroll
F*ck. That worries me so much. Isn't there anything good you can tell me? Like shouldn't the fasciculations at least last longer? Like be there a few minutes anyway, before they go away?

Re: Bulbar onset

PostPosted: December 14th, 2014, 6:20 am
by joycecaroll
I'm really in panic.

Re: Bulbar onset

PostPosted: December 14th, 2014, 6:22 am
by TwitchyDoc
I already told you that I would not worry about the twitches you describe. We are NOT talking about mnd! In the hyperexcitability, the point is in randomfiring with no predictable pattern. With mnd, they would be more or less still present.

Re: Bulbar onset

PostPosted: December 14th, 2014, 6:28 am
by joycecaroll
TwitchyDoc wrote: With mnd, they would be more or less still present.

Evenin the hyperexcitable phase?

Re: Bulbar onset

PostPosted: December 14th, 2014, 9:10 am
by Ghayes420
Joyce carol. Please relax. I concur with tdoc. Just as I sent you in PM. What you have is normal for this group. Please try and relax.

Re: Bulbar onset

PostPosted: December 14th, 2014, 9:14 am
by joycecaroll
I just want to know that tvere eould be more fasciculations than just five a day in the hyperexcitable phase. Even if there is no rule, I woukd like to know that it's more likely for it to be more persistent.

Re: Bulbar onset

PostPosted: December 14th, 2014, 9:40 am
by TwitchyDoc
Joyce, we do not know that.... you act as if we know and do not want to tell you. I wish I could help but hey, it is only logical to think that the less you have them, the better.

Re: Bulbar onset

PostPosted: December 14th, 2014, 10:10 am
by joycecaroll
I thought you would have an idea of what to expect in the hyperexcitable phase. It would help to know that in most cases it's a continuous twitch.

Re: Bulbar onset

PostPosted: December 14th, 2014, 10:12 am
by joycecaroll
Also: if I can't produce twitches by hitting tongue with fingers, does that mean no hyperexcitability?