Hi Arron
I hoped that you would respond "twiching all over" thread by poppo_w.
I am really wonder what is your opinion about perypheral nerves hyperexcitability (PNH) as a early symptom of ALS. I know you have read a lot about all this stuff so your opinion is very important for me (and not only for me, I think).
I have been thinking a lot about that and I would like to share my opinion.
What most of us call "fasciculations" are not this kind of fasciculations characteristic for ALS. ALS fascics are very fine, propably constant in every place they apear (not come and go) and they are hardly visible - that is way neuros use special lamp while looking for fascics.
This kind of fascics is ALWAYS a secondary symptom of ALS and is ALWAYS accompanied by weakness and it is impossible to have normal EMG of muscle with these fascics.
So you are totally right in all you say if you are talking about this kind of fascics.
But there is also the second truth. Many people (I think most of this site users) suffer from other kind of twiches. I have no idea if calling it fasciculations is not a mistake. Doesn't matter. These twiches are totally diffrent from ALS twiching:
1. stronger
2. come and go
3. random
4. visible (sometimes through clothes)
5. accompanied by fatigue (not weakness).
I think we should call it PNH. My question is: may PNH be a first symptom of early ALS. In my opinion (after reading poppo_w thread) the answer is YES. That is why some people with ALS tell us that they had fasciculations as first symptom - without weakness, without atrophy. They are talking about PNH not about ALS fascics. If they felt it strongly and wildspread it had to be PNH not ALS fascics.
What do you think?
Best regards
Marcin