With ALS, you always have noticeable weakness and muscle atrophy before twitching. In fact, ALS twitches are usually so fine that they are hard to see unless directly under a microscope. I went through the same issues that you are experiencing around a year ago whenever I started randomly twitching on the side of my calf. During the past year, I've twitched on my both feet, at the elbows, neck, side of scalp, and even on my buttocks. ALS does not have random twitching and usually just focuses on one specific spot such as the hands, feet, tongue (rare) and leaves behind a trail of wasted muscle cells. Random twitching is completely benign.