couple more questions

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couple more questions

Postby Greg99 on December 28th, 2002, 11:38 am

Hi again,

Sorry I posted twice, as I didn't ask these questions in my first post! To recap, I have a twitch in my thumb, you can see a little muscle move in the fleshy part of my plam and my thumb will twitch. If I rest and watch my hand, it may twitch, then ten minutes later I'll look at it again, and it won't twitch, so it comes and goes, but has been "coming and going" for a week now. So here are my questions:

Would it be unusual for an 18 yr old to get ALS with no symptoms or weakness other than a twitching thumb that comes and goes throughout the day?

Is the thumb a "normal" place to get a benign twitch?

Finally, I have a routine physical coming up, and will ask the doctor about this twitch, what do you think will likely happen, will I have to go to a neuro, or will he be able to say what it is and send me home? Basically, what can I expect a GP to do with this?

Awaiting a response.
Thanks,
GREG
Greg99
 

Postby Arron on December 28th, 2002, 1:48 pm

Greg, you asked; "Would it be unusual for an 18 yr old to get ALS with no symptoms or weakness other than a twitching thumb that comes and goes throughout the day?"
ALS is VERY uncommon, especially in young people, but as with anything in life, there are always exceptions to any rule. ALS usually hits people in their 50's and beyond and it ALWAYS has weakness. I mean, that's what ALS is, right? Dying muscle tissue and nerve connections??? So it is literally impossible to have ALS without some kind of weakness or loss of muscle control, and obviously, if your brain can't command muscles to do their job anymore, that would mean weakness.

Your other question; "Is the thumb a "normal" place to get a benign twitch?"
Absolutely...

And your last question: "what can I expect a GP to do with this?"
That depends on your doctor's experience with twitches and his knowledge on the subject of benign twitches vs. twitches caused by a more sinister problem. It is very common for "good" doctors to have never heard of "BFS", so don't be surprised if he says nothing about it, and with that, also don't be surprised if he sends you to a neurologist for further testing. It is an individual thing based on their knowledge and experience, so obviously there is no "one" answer I, or anyone else, can give you on this question.

In a nutshell, yes, ALS does usually start in a hand or an outer extremity, but against that in your favor is; it is common for BFS to start in a hand as well and it does come and go. ALS doesn't uaually come and go and it always has weakness or loss of muscle control associated with the twitching, simply because that's what it going on with ALS... dying muscles and nerve connections, and as they die... they twitch. There is ALWAYS weakness associated with ALS twitches, period.
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Postby Greg99 on December 28th, 2002, 2:41 pm

thanks for the info, so with als you would experience weakness in the area where you have fascilations, therfore, since my right hand is just as strong as it ever was, that is a pretty good indication I don't have als? Thats how i understand it at least
Greg99
 

Postby Arron on December 28th, 2002, 6:08 pm

That's exactly how it is... keep in mind, weakness sometimes takes time to show-up in "some" cases. I mean, if ALS strikes a person and starts affecting a large muscle group at first, then obviously it may take some time before the person notices any weakness in those muscles, BUT, when it starts in small muscle groups, such as your thumb, it wouldn't take long at all for weakness or complete loss of control of your thumb to occur.

Time is on your side with BFS and so is the ultimate deciding factor, an EMG. If you have twitches now, in your thumb, and you get an EMG done in your arm on that same side, it will most certainly show up on an EMG, without a doubt.

You might hear "stories" about some people not noticing weakness or having a clean EMG at first, BUT that is usually misinformation and/or misreading the EMG results by an inexperienced doctor. The bottom line is simple. Muscles twitching because of ALS, are twitching because they are DYING. There is no if's, and's or but's about it. That is complete black and white. SO, if you have no weakness or loss of thumb control in say, another month or so, then it is hardly ALS. Some people say that it "can" take up to 13 months before any weakness shows up with ALS, and that is SO not the case in 99.9% of ALS diagnosis'. Yeah, maybe in a rare case, where ALS started in a large muscle group, such as a thigh muscle or a back muscle, then if an EMG wasn't done early-on to detect the ALS, it "may" take that long before that huge muscle group to finally show weakness. It's no brain surgery and ALS is really pretty simple in the way it works and presents itself. If you said your thumb doesn't move anymore or that you have trouble closing your thumb over your fingers to make a fist, then I'd say you probably have a problem, but from what you have described so far... it sounds pretty benign to me. Just see your doctor and if there is any doubt, get an EMG because they don't lie.
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