instruction: hello doctor I was smoking weed for almost six years daily last july I stopped and then I started to have panic attacks with heart palpitation I went to a cardiologist and everything was fine but since then I became so anxious and I was aware of everything going on in my body after that I started to notice muscle twitching in every muscle at first I thought it was a heart issue but after seeing three cardiologists the results were the same my heart is fine then of course I googled it and I see some scary diseases like als I went to a neurologist who after some questions and examination said that it was due to an anxiety issue to be sure he sent me to an institute specializing in the detection of neuromuscular disease a neurophysiologist did a clinical examination strength reflex and an egg and no abnormalities was showed it were before three months a month later as my twitching was still going on I went to another neurophysiologist he did another egg and again everything was normal my neurologist said that it is impossible its als because muscle twitching for nearly eight months without any weakness and I started to have so tingling and buzzing sensation again my neurologist said that it is very common with an anxiety disorder like mine I started to take pills and to see a therapist for one month I have to say that twitching is way better when my anxiety is low but sometimes it came back strong I am so worried about als my questions are is egg test reliable is it true that usually fasciculations come after or along with the weakness in als fasciculation for eight months without any weakness does rule out als does als cause pain
output: hi I understand the problem you are facing it is partly due to anxiety and partly due to nerve and muscle hyperactivity coming to your specific questions yes fasciculations and weakness in als amyotrophic lateral sclerosis come together actually weakness comes first and fasciculations are generally unnoticed by patients they are usually revealed upon asking or found by egg electromyography egg is reliable and diagnostic for als fasciculations without weakness ruled out als eight months are a long duration for als if it would have been als it would have progressed to much extent and als is painless it is motor neuron disease so the sensory system is perfectly normal I would suggest you to try one tablet called carnisure plus contains levocarnitin 500 my and methylcobalamin 1500 micrograms it is a vitamin for muscle and nerves you can take it in the night daily for a few weeks and see the effect avoid coffee and other stimulants