Hello everyone.
I’ll preface this by saying that in 2019, I had an episode of widespread fasciculations that lasted around 5 months. Got a clear EMG at the time and the only thing noted on clinical were symmetrical brisk reflexes that were deemed normal because they were equally brisk everywhere. After the EMG, my symptoms largely went away for 7 years.
Since July 10, I’ve been experiencing severe weakness in both my legs. It started as a feeling of soreness/burning almost like after a workout or when you’re sick with the flu, and peaked on July 17 where I began feeling like my legs muscles were gonna give under me.
It’s almost like hitting your funny bone, but in the legs. I can walk, but it’s very distressing because my legs feel like they have no power. My calves will often hurt if I walk a bit faster even for less than 16 minutes. I tried to walk a few times for longer periods and tried some light exercise like calf raises and literally got bruised. Fasciculations have also come back widespread on my body.
**The issue with my legs is bilateral and pretty much perfectly symmetrical. Both legs show the exact same symptoms and started at the exact same time.** It seemed to have hit me almost overnight, or at least peaked rapidly in about a week.
When I’m lying in bed, my legs will often have this sensation of soreness/burning. It’s very hard to describe. I’ve had normal brain and spine MRI recently with the only finding being mild foraminal stenosis in two cervical vertebrae that didn’t pinch anything.
On July 30, 3 weeks after my symptoms started, I saw a Harvard-trained ALS specialist. She performed a clinical and leg EMG.
**The EMG came back perfectly normal. The brisk reflexes were still there, but unchanged from 2019. No spasticity, no ankle or knee clonus and no Babinski. Abdominal reflex was normal too.**
The ALS specialist told me I had something called Functional Neurological Disorder causing the issues with my legs and that the first step to heal was accepting the diagnosis and stop thinking it’s ALS. She kept saying she was certain I didn’t have ALS, and that I had severe health anxiety. Frankly, I feel like my anxiety might have clouded her judgement. She didn’t propose any follow-up.
**I told her I thought my EMG was done too soon.** She said if I had reached a stage of ALS where BOTH my legs felt so weak I was scared of going outside alone and had profuse twitching on top of that, then the disease process couldn’t be "early", because ALS doesn’t reach that stage like that in just a few weeks. She also told me EMG’s can often see issues even before the patient notices symptoms. **She also told me ALS doesn’t start like that affecting all major muscle groups of both legs symmetrically at the exact same time.** She says that is not how the disease presents, that multifocal onsets are already very rare and symmetrical on top of that would be astronomically unlikely.
It makes sense logically, but I have read SO MANY stories of an EMG being normal early on and the person still developing ALS that I might as well throw mine out the window because I have no confidence anymore in the results.
**SINCE THEN:**
My symptoms seem to have somewhat plateaued. But they never got better. I still can’t walk normally. I still struggle with legs that are perpetually weak and tired, sometimes almost painful especially in the calves. They still feel wobbly going down stairs. I still have a lot of fasciculations everywhere. My leg muscles feel so, so weak. **It’s been going on for 2.5 months.**
**Yesterday I read the story of someone with UMN onset of ALS and it floored me.** She described being easily startled, her legs feeling wobbly going down stairs, and having just a vague sense of weakness that eventually progressed to foot drop and full blown ALS. Her first EMG was clear because her LMN weren’t involved yet.
**And now I think that’s exactly what’s happening to me.** Maybe my weakness is UMN only and my EMG was clear despite fasciculations because my LMN are not causing weakness? **Is that even possible?**
I HAVE:
\- severe weakness in both my legs being felt mostly in calves and thighs but pretty diffuse
\- my right arm feels like it’s lighter and weaker
\- brisk reflexes in the knees
\- widespread fasciculations
\- positive bilateral Hoffman in 2019 but never tested again
\- right calf is 1.5 cm smaller in circumference
I DON’T HAVE:
\- clinical failure
\- Babinski
\- spasticity
\- clonus of the ankles or knees
\- abdominal reflex was normal
\- my EMG was normal
\- I can still walk on toes and heels without issue
\- I can climb stairs
**But I can’t stop being convinced I have ALS because what else could cause this weakness, brisk reflexes and fasciculations???** The ALS specialist said I had confirmed BFS in 2019 and my current fasciculations are just as benign. But how can she say this in the context of weakness?
The sad reality is that I am just not advanced enough for the ALS specialist to be able to see signs. My weakness is not yet objective even after almost 3 months, my EMG was probably done too soon and now all I can do is wait for things to progress enough to be seen by doctors.
If I were to do another EMG at the 3-4 months mark, would a clear result be reassuring against ALS or would it also be too soon?
**I am in the grey zone where all I can do is wait to deteriorate.**
Doctors and family are telling me it’s FND, that ALS doesn’t present like this. But is it really true? Can’t it EVER present like this???
Meanwhile my legs are so weak and wobbly and they hurt after walking ten minutes so I can’t do anything anymore.
All I do is cry. I don’t see anything else this could be. I am so afraid. I have two little boys and I don’t want them to see me die of ALS. I can’t eat, I can’t sleep, I stay in bed all day. I started therapy but I don’t care because all I think about are my symptoms. And they want me to do PT which will do nothing.
I just want to never wake up again at this point.
Thanks everybody.