Hi!I dont understand-i see so many different information about BFS and ALS cases.Here is one of them.I always heard that in ALS fasciculations comes after muscle weakness not before.Now on some page about EMG find totally different info.Here is link-post called "CTS testing" " 3) Is it likely that twitching can occur for six months without loss of strength and still get diagnosed with ALS???(..) yes it is possible, and that is why a follow up EMG is usually needed. Regarding time period after onset of twitching without weakness or an abnormal EMG, it is difficult to be absolutely precise in time. But several months are usually acceptable by the time fasciculation is seen, but provided no other clinical/EMG findings."I have fasciculations 3 months now start fell some weakness. But case is i dont understand what is good version: fasciculations can occur before weakness or not. Here in this link- they said like -yes its possible, why not.Hope You all one day will fell fine and calm, me too.Regards to all!
Twitching and ALS Diagnosis
- Thread starter TheShadow
- Start date
twitchplaysp
Well-known member
This confused me too. I think it's true that fasciculations in ALS always come after muscle weakness. But there have been some rare cases where a distinct, BFS-like twitching preceded the denervation-process, so that fasciculations were indeed the first symptom for these patients. Please keep in mind that this is the rare case of a rare disease whereas true benign fasciculations are much more common. It's not even clear if those reported cases are just simply a coincidence.
The_Shadow, lets' first forget about the link and talk about weakness.the issue is whether your weakness is clinical or not - because many of us feel so called perceived weakness.normally in ALS (normally means in statistical majority) people do not notice any neurological troubles before clinical weakness starts on them, which is usually (again in wast majority) means that people can not use their limbs properly - like cannot button the shirt, take small things (which is a loss of fine motoriccs) or even this stage goes not detectable and people start with complete hand or foot loss. usually it comes quite out of the blue.that is clinical weakness.it is accompanied usually by very prominent neurological signals like abnormal reflexes in the affected limb etc.people can have clinical weakness also as the result of ther degenerative process like spinal cord compression or neuritis. In fact any paralysis is a clinical weakness issue. But in ALS it is also accompanied by weird combie of reflexes change, very specific. etc.we in BFS often have so called perceived weakness wich is a feeling of heavy legs/hands, jaw muscles etc, sometimes even up to restricted mobilty. but at the same time clinical exam shows they are fully functional and reflexes are seldom affected or affected not significantly.by the way the quote is really confusing because I even can not understand what the doctor meant exactly - looks like he or she still tries to say that several month of fascics without changes on EMG and clinical changes are benign 
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