ALS Muscle Twitching vs. BFS Muscle Twitches: Key Differences?
The term “twitching” is ambiguous; there are different kinds.
Certainly, there are variations between ALS muscle twitching and that of BFS.
What are the differences between the twitching muscles of ALS and those of BFS?
“In benign fasciculation syndrome, the muscle twitching is often widespread throughout the body,” says Bonnie Gerecke, MD, director of the Neurology Center at Mercy in Baltimore.
“For example, one can experience twitching in an arm, eyelid, torso or foot,” continues Dr. Gerecke, referring to BFS.
“The twitches in benign fasciculation syndrome are brief and can be frequent.”
You may feel these as very short-lived creepy-crawly sensations, or squiggly worm sensations, right under your skin.
These are especially apparent while you’re sitting still at a computer, while reading or watching TV, and can occur seemingly relentlessly.
With BFS, the twitching will stop the second you begin moving the affected area.
So if the twitching keeps recurring in a hamstring or quad muscle while you’re at the computer, it will stop when you get up and walk, march in place, or even remain seated but bounce the leg up and down.
With benign fasciculation syndrome, you may notice a predictable trigger, namely, whenever your calve muscle twitches, it’s always after you’ve run on a treadmill or used a stationary bike.
Or the twitching that runs rampant in your upper legs and butt always occurs after a rigorous hike. However, benign fasciculations can also occur randomly.
“In ALS, the muscle twitching often starts in one region and spreads locally,” says Dr. Gerecke.
“For example, there can be twitching isolated to the right hand and then it may spread to the right arm and then the left hand and the left arm.
“Also, in BFS, the twitching is not associated with other signs or symptoms [other than maybe cramping of the muscles].
“In ALS, when a patient experiences muscle twitching, there is almost always associated muscle atrophy (shrinkage of muscles) and muscle weakness.”
Early ALS muscle weakness is often asymmetric, may be subtle but may also be more suddenly obvious, and it is also painless.
Be on the lookout for new-onset clumsiness, tripping or difficulty with routine tasks.
- A very concerning sign is when these issues are getting worse.
- BFS does not make tasks difficult or cause stumbling or clumsiness.
Dr. Gerecke has a special interest in ALS, myasthenia gravis, myopathy/muscular dystrophy, peripheral neuropathy and radiculopathy. She is board certified in general neurology and neuromuscular medicine.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
.
Top image: Shutterstock/Alexander Raths
Break Deadlift Plateau in Middle Age with One Exercise
It is just ridiculously aggravating when you’ve hit a plateau in the deadlift, especially if you’re middle aged and wondering if this is a sign you’ve reached your all-time limit. (more…)
Will the Rack Pull (Top Deadlift) Thicken a Woman’s Back ?
The rack pull is a great strength training move that very few women do out of fear it’ll bulk their back.
Absolutely false; rack pulls will burn fat and do several wonderful things for a woman – without bulking up her back. (more…)
Bulbar Onset Symptoms vs. Laryngeal Cancer: Symptom Comparison
Laryngeal cancer is one of the scariest diseases, but it would be appealing to someone who’s just been diagnosed with bulbar onset ALS.
Symptoms overlap in these two conditions.
“Both conditions can be associated with hoarseness,” says Bonnie Gerecke, MD, director of the Neurology Center at Mercy in Baltimore with a special interest in neuromuscular disorders, ALS and EMG.
So if you’ve had an unexplained, persistent hoarse voice lately … and no other symptoms with it … it’s understandable how you can be in a state of panic.
Bulbar Onset Symptoms
“There are many different bulbar onset symptoms,” says Dr. Gerecke.
“These include the following: dysarthria (slurred speech), dysphagia (trouble swallowing), trouble chewing, drooling, moving the tongue in the mouth and hoarseness.”
Difficulty speaking (dysphonia) is also a symptom, and this may occur without slurring. The tongue will also shrink due to eventual atrophy.
And of course, there’s the tongue fasciculations, but these are not the same “twitches,” tremoring or quivering that a healthy person sees when they stick out their tongue and inspect it.
It’s impossible to keep the tongue perfectly still when inspecting it, especially if you’re scared of what you’ll see.
The tongue is not designed for meticulous control of movement. It’s not like a finger that you can hold perfectly still.
The tongue twitches of bulbar onset ALS are undulating and wormlike.
Laryngeal Cancer Symptoms
Dr. Gerecke says, “In contrast to bulbar symptoms due to ALS, patients with laryngeal cancer often experience pain when swallowing. They may also experience sore throat, a lump in the neck and cough.”
Bulbar Onset Symptoms that Laryngeal Cancer Will Never Cause
• Speech characterized by “effortful, slow productions with short phrases, inappropriate pauses, imprecise consonants,” says a report in the BMC Ear, Nose, and Throat Disorders (Nov. 2001).
• Slurred speech
• Breathy speech
• Trouble chewing, a feeling of weakness when doing so
• Difficulty moving the tongue within the mouth
• There may be lip involvement very early on, affecting swallowing.
• Saliva control when eating. There is excess saliva regardless of eating as the ALS progresses.
• Tongue atrophy
• Tongue fasciculations
Laryngeal Cancer Symptoms that Bulbar Onset ALS will Never Cause
• Sore throat or a burning sensation
• Constant coughing or coughing up blood
• Pain when swallowing, though there is no mechanical difficulty.
• Ear pain or fullness despite no infection
• Lump in the neck that you can feel with your fingers
• Teeth becoming looser, or dentures suddenly not fitting right
• Bad breath despite home remedies
• Weight loss without trying
Symptoms Shared by Bulbar Onset ALS and Laryngeal Cancer
• Hoarse voice, though not all laryngeal cancers cause this.
• Trouble swallowing
• Trouble breathing (ALS causes this via a vocal cord spasm)
Benign conditions such as LPR can cause some of the symptoms listed here.
Laryngeal cancer is a very uncommon disease, and bulbar onset ALS affects about one in 300,000 people.
Dr. Gerecke has a special interest in ALS, myasthenia gravis, myopathy/muscular dystrophy, peripheral neuropathy and radiculopathy. She is board certified in general neurology and neuromuscular medicine.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
.
Top image: Shutterstock/ShotPrime Studio
Sources:
ncbi.nlm.nih.gov/pmc/articles/PMC60006/
cancer.org/cancer/laryngealandhypopharyngealcancer/detailedguide/laryngeal-and-hypopharyngeal-cancer-signs-symptoms
als.ca/sites/default/files/files/Bulbar%2520ALS.pdf
Can a Groove in the Thigh Muscle Ever Be an ALS Symptom ?
The groove or indentation appears in one thigh only, so this may mean the muscle is starting to waste away or atrophy from ALS, and unfortunately, this is the erroneous thought process that many people have when inspecting their body out of ALS fear. (more…)
Can You Be Anorexic but Not Thin or Underweight?
First of all, not all women who appear “too thin” have an eating disorder.
Anorexia nervosa is a term that many laypeople associate with a particular body appearance: emaciated or one that appears “way too thin” — such as the body of film star Angelina Jolie. (more…)
Why Don’t Stomachs of 600 Pound Life People Ever Rupture?
There are cases of people who’ve fatally ruptured their stomach from eating enormous amounts of food in a short period of time.
The “600 Pound Life” subjects apparently have not suffered this fate. (more…)
Can Chronic Subdural Hematoma Increase Risk of Alzheimer’s?
You may already know that a chronic subdural hematoma can cause permanent physical disability.
But what about an increased risk of Alzheimer’s disease?
Can the bleeding that contacts the brain set in motion a chain of biochemical events that ultimately lead to the development of Alzheimer’s disease or some other form of dementia?
A chronic subdural hematoma is a gradual or slow bleeding in the brain that occurs over weeks, following some type of trauma such as hitting one’s head on a car door frame, a slip-and-fall or a whiplash injury that jars the brain.
A cSDH is far more likely to occur in elderly people because, due to age-related brain shrinkage, there’s more room between the brain and dura, making it easier for veins to be torn.
However, it can also happen from head trauma to people in their 50s and 60s.
Blood thinning drugs, too, can cause a cSDH in elderly people.
Symptoms of Chronic Subdural Hematoma
The symptoms resemble those of a stroke and include cognitive impairment.
The patient won’t have all the possible symptoms since symptoms depend on the location of the bleeding.
However, a gradual onset of what seems like early Alzheimer’s can definitely be a symptom in an elderly person who, several weeks prior, banged their head from a fall or even just “nicked” it on an open cupboard door.
In fact, sometimes the diagnosis is highly suspicious for dementia —until a CT scan reveals the bleeding.
So on one hand, it’s accurate to say that a chronic subdural hematoma can cause symptoms mimicking dementia or Alzheimer’s disease.
But once the collection of blood and fluid is drained via a burr hole procedure, the patient usually has a full recovery. The “dementia” was temporary.
But is it possible for this insult to the brain tissue to raise the risk of future development of Alzheimer’s disease?
”Chronic subdural hematoma is very common in people within the older age group,” says Dr. Urvish K. Patel, MD, MPH, a research associate in the Department of Neurology at Creighton University School of Medicine/CHI Health.
“Due to an ageing population, chronic subdural hematoma is projected to become the most common adult neurosurgical diagnosis.
“Due to oxidation-reduction reactions in chronic subdural hematoma and exerting its effects using cytokines and inflammatory mediators, cSDH leads to neurotoxicity and inflammation-related brain atrophy.
“In such circumstances, it increases the risk of Alzheimer’s disease and dementia.”
Causes of Alzheimer’s Disease
In under five percent of cases, a genetic variant that’s present since birth will lead to the disease, though the mechanism is not known.
In the remaining 95 percent of cases, nobody knows just what exactly causes Alzheimer’s. What’s known, however, is what it’s associated with.
• Plaques. It’s believed that the presence of beta-amyloid plaques kills brain cells, but again, the mechanism of cell death is not known.
• Tangles. A protein called “tau” is key to the system of support and transport of nutrients to brain cells.
In the brains of Alzheimer’s patients, tau protein is tangled up inside brain cells, crippling the system.
Commonly Known Risk Factors for Alzheimer’s
• Age 65+
• Immediate family member has the disease.
• MCI: mild cognitive impairment in older age that’s more than what would be expected for that age.
• History of severe head trauma (e.g., car accident, ladder fall).
• Lack of exercise
• Obesity
• High cholesterol
• High blood pressure
• Smoking
• Poorly managed type 2 diabetes
• Lack of vegetables and fruits
• Sub-high school education level
Age-related changes in the brain are also suspect as causative factors in Alzheimer’s. These include:
• Brain shrinkage
• Inflammation
• Free radicals
• Breakdown of a cell’s energy production
Delayed Treatment of a Chronic Subdural Hematoma
This heightens the chance of permanent deficits, as was the case with a 60-something man at my gym who was initially misdiagnosed a month after he fell and hit his head, then finally properly diagnosed a month after that.
By then the continuing buildup of blood and fluid in his brain had caused irreversible damage to the right side of his body — but left him cognitively intact.
A cSDH can be missed on a CT scan.
For optimal brain health, one should avoid the modifiable associated risk factors with Alzheimer’s.
Dr. Patel’s areas of interest are outcomes and survival studies and clinical trials in neurology, neuroepidemiology and translational medicine research.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
Can Anabolic Steroids Cause Bleeding in the Brain?
Long-term use of anabolic steroids can cause damage to the brain.
There are many causes of bleeding in the brain.
Some of these bleeds occur slowly and some are instantaneous and thus immediately life-threatening. (more…)
Early ALS Muscle Atrophy vs. Benign Atrophy Appearance
“It can be difficult to distinguish between early ALS atrophy and normal atrophy,” says Bonnie Gerecke, MD, MD, director of the Neurology Center at Mercy in Baltimore.
The typical course goes as follows:
• You notice a muscle has been twitching, such as in the calve, hamstring, chest or eyelid.
• After getting annoyed enough, you google “cause” of twitching muscles.
• ALS sites appear in the search results and grab your attention.
• You begin reading one ALS site after another, and all say that “muscle twitching” is a symptom, but they also say that “muscle atrophy” is a symptom.
• You then begin checking your muscles for signs of atrophy.
• You begin discovering signs of atrophy, such as one calve is bigger than the other, or there’s a “dent” in the front of your thigh.
Benign thigh dents take on a variety of forms.
Atrophy means shrinkage of muscle due to disuse. This happens in healthy people all the time, and can be quite noticeable depending on the circumstances.
We’ve all seen the atrophy of a limb after a cast for a broken bone, that’s been in place for weeks, is finally removed.
Telling the Difference Between ALS Atrophy and Benign
“Early ALS atrophy may be more focal,” says Dr. Gerecke.
“This means that it may start in a specific muscle group, such as the small muscles of the hand,” continues Dr. Gerecke.
“It then spreads to affect other muscles of the same limb, for example.”
So for instance, ALS may begin in the foot, then locally spread, being confined to the lower leg.
Eventually the other side of the body will become affected, most likely beginning with the opposite foot and lower leg.
ALS atrophy does not strike the entire body at the same time. It begins very locally.
Shutterstock/joshya
Dr. Gerecke explains, “Normal atrophy such as that associated with aging tends to be more symmetrical and diffuse.”
But what if you notice local atrophy?
Well, here’s the thing about this. You must ask yourself what proof you have that what you’re seeing is actually shrinkage of muscle.
If you frantically inspect your body in the mirror, you just might find what you’re looking for: signs of atrophy – or rather, what you THINK are signs, such as:
• One calve is smaller than the other.
• There’s a depression of skin below the right collarbone but not the left.
• One foot is slightly larger than the other.
• One forearm is smoother than the other.
• The veins in the top of one foot are more visible than in the other.
• One thigh has a dent.
Shutterstock/Motortion Films
You even confirm some of the size differences with a measuring tape. You’re convinced you have localized atrophy.
Dr. Gerecke says, “Normal atrophy is also not as pronounced as pathological atrophy associated with ALS.”
You may be thinking that ALS, like any degenerative disease, starts out very small; that it has a very early stage – and that during this stage, the atrophy would actually not be pronounced.
But if it’s ALS, it won’t be long before the wasting becomes increasingly obvious – and accompanied by weakness.
In fact, the weakness will very likely come before visible signs of muscle shrinkage.
So you have to keep reminding yourself of a few things:
• If you’re healthy, time passage will become very reassuring, since in a healthy body, there is no progression of visible or functional pathology.
• Parts of your non-dominant limbs are bound to be noticeably smaller than the dominant ones, but smaller doesn’t necessarily mean atrophied due to less use.
• You may find that your non-dominant left lower leg is smaller than your right, but that it’s also the leg you jump off of when doing single-leg jumps across a water puddle, and that your right leg was never the better one at leaping.
• The body is naturally asymmetrical. There are dips, dents and depressions on one side that are not on the other.
You’re not a Greek statue. You’re imperfect. There’s going to be asymmetry!
So though the visible distinction between early ALS and benign atrophy may be difficult to tell, just hold tight and realize that you are, from a statistical standpoint, panicking for no reason whatsoever.
Let time passage work its wonders on you.
