instruction: hello doctor I have been experiencing muscle twitches in several areas of my body for a period of three weeks it stared in a small area in my back then stopped returning in my right hip and since then the twitching has appeared at my right shoulder both thighs both hamstrings both calves forearms and both arms it lasts not more than five seconds and stops when I exercise or contract the muscle the twitching tends to increase when I am anxious which is often at present my left forearm and fingers experienced slight pins and needles I have no obvious signs of muscle wastage and no clinical weakness I have full use of all limbs workout daily with no obvious decrease in intensity should I be worried about als as it is causing me to have anxiety attacks and to question everything
output: hello welcome to icliniq com twitches are seen in als amyotrophic lateral sclerosis however they usually start in the hands and are accompanied by the thinking of muscles or atrophy of muscles a much more common cause of twitches is anxiety leading to hyperventilation leading to decreased calcium level in the blood in your case the most likely cause of twitches is anxiety however since I cannot conclusively rule out the possibility of als I suggest you do nerve conduction studies which can diagnose als please feel free to followup with the nerve conduction study report and we can discuss in detail