<s>[INST] Hello doctor, I have a question regarding ALS vs BFS. I have severe anxiety, a kind fo shakes when arms are crossed, swollen lymph node on the left side of neck, sore wrists, muscle spasms in calves, and on outstretch the left arm gets fatigued. I have done MRI, EKG, and MRI cervical spine. [/INST] Hello. I understand your concern and would explain that ALS (amyotrophic lateral sclerosis) does not usually cause just fasciculation. It is usually associated to progressive paralysis and muscle wasting in the hands and legs. Other symptoms like troubles with swallowing, breathing occur later after some months. During physical exam pyramidal signs and diminished neurological reflexes can be seen (by the doctor). So, I do not think that your symptoms are related to ALS. On the other hand the inflamed lymph node in the neck is not related to ALS. Nevertheless, the nerve conduction studies would help to definitely exclude ALS. You should discuss it with your doctor on the above test. I would also advise checking vitamin D and vitamin B12 levels for possible deficiency, thyroid hormone levels for possible imbalances. I hope this helps. </s>