Why My Anxiety Is All Over The Place I Am Really Worried?

Posted on Fri, 9 Oct 2020

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Fri, 9 Oct 2020 Answered on

Wed, 4 Jun 2025 Last reviewed on

Question : My anxiety is all over the place. I am really worried that i may hav ALS although I am aware this may be irrational . I have had a couple of responses but nothing that really assures me or stops me worrying. I have cramps in left calf and thigh for 2 months and twitching in same leg for one month. I have NO muscle weakness but i have read that some people have cramp and twutch before any muscle weakness or atrophy.

Answered by Dr. Ishu Bishnoi (1 hour later)

Brief Answer:
ALS diagnosis criteria

Detailed Answer:
Hello,

ALS disease can present with mentioned symptoms. But there are definitive criteria to diagnose it. I will narrate you the criteria, you can confirm it with neurologist help -
El Escorial criteria (1994)

UMN (upper motor neuron signs - increased tone in limbs, spastic limbs, increased reflexes like hyper knee jerk) and LMN signs (Lower motor neuron signs - thin limbs, low tone or flaccid limbs, absent reflexes) in three regions (upper limbs, lower limbs) of the body - Clinically Definitive

UMN and LMN signs in at least two regions, with some UMN sign above to LMN signs - Clinically Probable ALS

UMN and LMN signs in only one region, or UMN signs alone in two or more regions, or LMN signs rostral to UMN signs - Clinically Possible ALS

LMN signs only - Doubtful or suspected ALS

New criteria -
Chinese Medical Association criteria (2012)

Clinical or electrophysiological evidence (nerve conduction study showing positive nerve damage) of UMN and LMN signs in at least at three regions - Definitive ALS

Clinical or electrophysiological evidence of UMN and LMN signs in at least two regions, with some UMN signs rostral to LMN signs - Probable ALS

Clinical or electrophysiological evidence of UMN and LMN signs in one region, or UMN signs alone in two or more regions - Possible ALS

Above mentioned criteria are world wide used to diagnose ALS. A neurologist will confirm it by examining your motor system. It will include checking power, reflexes, tone and bulk of limbs. Then he or she will advise NCV (nerve conduction velocity) and EMG (electromyography study) to confirm findings.

My suggestion is don't panic. It is an uncommon disease. You should consult before doubting about it.

Hope it will help. Let me know if you have any doubt.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Ishu Bishnoi (50 minutes later)

Would there usually be muscle weakness my GP check my muscle strength and reflexes. I am hypothydrodism also and my levels were low

Answered by Dr. Ishu Bishnoi (2 hours later)

Brief Answer:
Interpretation

Detailed Answer:
Hello Alfairnie, welcome back.

Hypothyroidism can cause muscle weakness, weak reflexes and low tone (hypotonia). It can be the cause behind your symptoms. Wait till thyroid hormone profile becomes normal. Then get your motor system re-examined to rule out actual neuromuscular disorder.

Hope it will help. Please let me know if you have any doubt.
Thanks

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Ishu Bishnoi (2 days later)

Is cramp and twitching an intial sign of ALS or is it after muscle weakness

Answered by Dr. Ishu Bishnoi (4 hours later)

Brief Answer:
ALS initial signs

Detailed Answer:
Hello Alfairnie, welcome back.

It is correct that twitching and cramps can be initial presentation of ALS. Muscle weakness usually occurs later.

However, cramps and twitching are quite common symptoms, which usually occurs after fatigue, restlessness, excessive caffeine intake or vigorous exercise.

Hope it will help. Thank you

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Ishu Bishnoi (17 hours later)

I am now very concerned as I was led to believe by several drs that the weakness appears first and is the first thing to notice . I have had the cramping for 3 months and the twitching for about a month. I was fine with the cramping but got really anxious when I looked up the twitching and it led to ALS. my thyroid dr says imbalance would not cause cramp in one leg only and I am constantly testing the strength of my muscle in my foot and leg, which appears normal but I am now getting very anxious and your answer saying that weakness comes later leaves me feeling very scared. I appreciate your time and advice .

Follow up: Dr. Ishu Bishnoi (0 minute later)

Answered by Dr. Ishu Bishnoi (7 hours later)

Brief Answer:
ALS symptoms

Detailed Answer:
Hi Alfairinie, welcome back.

Please don't worry. Only cramps and twitching can not diagnose ALS. At least muscle weakness is needed to suspect it. It is true that ALS can present with any of above symptoms, but without weakness, doctors usually don't suspect ALS.

If you still feel unsure, you can get nerve conduction and electromyography study done. If both are normal, ALS will be ruled out.

Hope it will help. If you have any doubts, do let me know.
Thanks.

Above answer was peer-reviewed by : Dr. Prasad

Answered by Dr. Ishu Bishnoi (0 minute later)

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Ishu Bishnoi (44 hours later)

is the twitching in ALS constant . Mine disappears when moving around. Also would the weakness follow quite soon after twitch and cramp

Follow up: Dr. Ishu Bishnoi (0 minute later)

is the twitching in ALS constant . Mine disappears when moving around. Also would the weakness follow quite soon after twitch and cramp

Answered by Dr. Ishu Bishnoi (2 hours later)

Brief Answer:
ALS twitching and weakness symptoms

Detailed Answer:
Hello Alfairnie, welcome back.

ALS twitching starts intermittently after nerve damage. It starts due to denervation of muscle after peripheral nerve damage. And it will progressively increase in number and duration.

Weakness may be appreciated before or after it. However theoretically, weakness should start before twitching.

Hope it will help. If you have any doubt, let me know.
Thanks.

Above answer was peer-reviewed by : Dr. Yogesh D

Answered by Dr. Ishu Bishnoi (0 minute later)

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Ishu Bishnoi (16 hours later)

You said earlier weakness usually occurs later

Follow up: Dr. Ishu Bishnoi (0 minute later)

You said earlier weakness usually occurs later

Answered by Dr. Ishu Bishnoi (7 hours later)

Brief Answer:
weakness in ALS

Detailed Answer:
Hi Alfairnie, welcome back.

Yes, I said that weakness usually occurs later. But in last reply, I mentioned "However theoretically, weakness should start before twitching. ". It means weakness is appreciated later. Mild weakness usually goes un-noticed.

Twitching or fasciculations are visible signs, which can be appreciated whenever it occurs. Thats why I specifically mentioned theoretically, not practically.

Hope you understood my point and thanks for noticing it.

If you still have any doubt, do let me know.

Thanks

Above answer was peer-reviewed by : Dr. Yogesh D

Answered by Dr. Ishu Bishnoi (0 minute later)

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Ishu Bishnoi (2 days later)

I have a Gp appt today can you please tell me if twitching is constant even when moving about

Follow up: Dr. Ishu Bishnoi (0 minute later)

I have a Gp appt today can you please tell me if twitching is constant even when moving about

Answered by Dr. Ishu Bishnoi (6 hours later)

Brief Answer:
Twitching movement

Detailed Answer:
Hi Alfairnie, welcome back.

Twitching usually appears in resting muscle. It is involuntary contraction of small set of fibers in whole muscle.

Moving muscle causes voluntary contractions of most fibers and it leads to disappearance of twitching.

Thanks. If you have any doubt, do let me know.

Above answer was peer-reviewed by : Dr. Yogesh D

Answered by Dr. Ishu Bishnoi (0 minute later)