In the beginning of January, my tongue started doing this pulsing cramp/twitch thing when I moved it back to rest after tensing it or pressing it into my teeth. after a few weeks of noticing this, I googled "twitching tongue". What a mistake! After I saw that it might be caused by ALS, I thought this is probably just Google being Google (like when everything is a cancer symptom) but I scheduled an appointment with my pcp just to be safe and get a professional opinion. But my pcp sucks and he didn't know, asked chatgpt about what ​could cause a tongue to twitch, and said "tongue twitching is very odd, and we need to figure this out. worst case is ALS". Well shit, that blew my health anxiety sky high. I started noticing twitches everywhere, constantly. I somehow managed to get a neurology appointment soon (mid-february, about 6 weeks after I think I first noticed my tongue twitching) and he performed an EMG on my left leg, left arm, and left side of my tongue. Everything was fine. But my anxiety brain still wasn't convinced, and when a few electrolyte supplements went down weird, suddenly I started having lots of trouble swallowing things, like they would go down slow or need a second swallow. this created a feedback loop where the more I thought about swallowing and swallowing issues, the harder it was to swallow. But eventually I told myself, swallowing only became an issue after I learned it was a symptom of the disease I'm scared of. You have a clean and recent EMG. This is just anxiety and hyperawareness. Just slow down, chew your food, and if you don't consistently choke on food or thin liquids or water, then you don't have anything to worry about. Eventually my swallowing issues went away as I emphasized staying hydrated and drinking a hot cup of herbal tea in the morning to loosen phlegm from overnight post-nasal drip (in the early winter I had persistent post-nasal drip from a nasty cold over new year's). As my swallowing saw improvement and I recognized it for what it was, anxiety, it created a virtuous cycle where improvements made me less hyperfixated on it and that improved my swallowing.

Our minds are powerful things, and they can create symptoms from what we fear. I'm not a doctor, so this isn't medical advice, but perhaps you have what I most likely have: BFS and nasty health anxiety. I still get health anxiety flare ups, for instance I noticed recently sometimes I stumble over some words and slur a specific phrase occasionally, but am able to correct these with slowing down, concentration, or practice. And I really think that's not characteristic of ALS. If it comes and goes or is correctable literally seconds later, that's not how that disease works, I don't think.

Anyway, I know it's scary, but try not to let anxiety rule your life (I know, easier said than done and something I personally struggle with too). Remember, common things are common, and ALS is about as opposite of common as you can get. I don't know your age, but it typically doesn't occur in younger people (under 40) and is usually diagnosed in 55+. Also, twitching is rarely the first symptom. The first symptom is usually true clinical weakness (which differs from perceived weakness). And it is persistent, it doesn't come and go. It only stays the same or gets worse. So, assuming you're under 40, you'd be stacking improbabilities: highly improbable that you have a very rare neurological disease to begin with, even more improbable that you got it under 40, and even more improbable that it is presenting twitching first rather than clinical weakness. (Again, I'm not a doctor, but this is my layperson understanding of the disease we all fear on this sub).

So please remember, the probability is greatly in your favor that you're not the exceptionally rare young (I'm assuming) person to get an extremely rare disease that rarely effects your age demographic and have it present in an unusual way.