I have Alt-<x> AND Ctrl-<x> bindings to cast a spell gem. It works with left and right alt/ctrl.
I use all these combos quite often, depending on how my hands/fingers are positioned on the keyboard at the moment I need to cast.
Most commonly used (and most important) spells always in the first few gems - so if I'm using the mouse, I can still easily cast them with just the left hand.
Spell lineup is
1 lvl 4 mez
2 tash (can be a swap slot)
3 root
4 ae stun
5 ae mez
6 swap slot, mostly Calm or buffs
7 charm
8 theft of thought or swap slot if fighting mobs with no mana
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