[QUOTE=arrigoar;25009]I believe that I have some atrophy in my right thumb pad, near my wrist. I have full function of my thumb. I am experiencing body-wide muscle twitches, that started after I noticed weakness in both my right leg and arm. I have been to my GP twice and he cannot detect any clinical weakness. I had an MRI of c-spine and brain, both were clean.

2 Questions...

1. It is my understanding that the sequence of a pathological neuromuscular disease, such as ALS is profound weakness, atrophy, then twitching. So in my case, if it truly was atrophy I probably would not be able to move my thumb, or at least have limited movement.


Typically yes, but of course, there are always exceptions. What is most profound in your case is your age. On the old forum, there were thousands of posts and probably thousands of people who passed through the ALS forum. I spent a lot of time researching their symptoms and many of them had different onsets. However, I don't recall coming across anyone who was as young as you, that's what you need to consider. Yes, if it were true atrophy you would have a difficult time doing much of anything with your thumb as there would be significant muscle loss by that time.

2. If you have had a clinical exam by a GP, who says reflexes are normal and muscle strength is good, doesn't this point away from ALS. When I spoke to my GP yesterday about my MRI results, he said that I could go to a neurologist if I want. He did not say it is necessary...so I am guessing that he is doing it for piece of mind. Is that a good sign pointing away from the dreaded disease as well?

Can't most GP's pick up some signs of clinical weakness??



I would be satisfied but everyone is different. Any doctor should be able to test reflexes and ascertain muscle strength. A neurological exam by a actual Neurologist is more thorough but given your age (not to beat a dead horse) I would consider this move unnecessary. You may want to see a neurologist, as you mentioned, for piece of mind, it would certainly help resolve some of your anxiety issues after he examines you. Think about it. In the meantime, don't waste precious time worrying about something that is so unlikely. Nearly four years ago, I developed almost exactly the same symptoms as you, almost overnight. My doctor was a bit concerned as he skipped the Neuro and ordered an immediate EMG, it was clean. Subsuquent exams have also been clean over the past 4 years (by neuros) and I am 35! I was convinced I was doomed to dissolve in a bed and wasted so much time worrying about it, to the point of developing ulcers and more health problems, it can be a vicious circle. Try to stay busy and try to enjoy life, hobbies and your family and if you feel the need for extra assurance, go see the neuro.