I am happy to address the questions that you pose, although it is important that you recognize that my impression is based entirely on the information you have provided in your posting and is by no means a substitute for an office visit with a neurologist. Diagnosis is contingent on detailed history and physical exam and as such, the following information should be considered solely for educational purposes.
From the description of your symptoms, sounds like you are having some muscle fasciculations. A fasciculation or what is usually called "muscle twitch" is a small, local, involuntary muscle contraction (twitching) that is visible under the skin. it is caused by spontaneous discharge of a bundle of muscle fibers. This can occur in any voluntary muscle group but is most common in the eyelids, arms, legs, and feet. Even the tongue may be affected. I believe this also explains the feeling you get sometimes around the lips and mouth. The twitching may be occasional or may go on nearly continuously.
They have a variety of different causes, the majority of these are benign, but can also be due to disease of the motor neurons. Common causes include the following:
. Dehydration and Fatigue
. Werdnig-Hoffman disease
. Amyotrophic lateral sclerosis (ALS) which is a rare cause
. Organophosphate poisoning
. Magnesium deficiency (which can be caused by stress, inadequate dietry intake or magnesium loss due to severe diarrhea)
. Medications: this includes anticholinergic drugs over long periods, in particular ethanolamines such as Benadryl, used as an antihistamine and sleep aid, and Dramamine for nausea and motion sickness. Stimulants can cause fasciculations directly. These include caffeine, pseudoephedrine (Sudafed®), and the asthma bronchodilators albuterol/salbutamol (e.g. Proventil®, Combivent®, Ventolin®). Benzodiazepine withdrawal is another possible factor
and then actually most cases don't have a well-identified cause and has therefore been given the title benign fasciculation syndrome (BFS), which is essentially a diagnosis of exclusion
The diagnosis is usually made by a neurologist after a carefull history and thorough neurological examination to make sure you don't have other findings that might reflect an active disease process of the nerves or muscles. workup includes typically checking some lab tests including muscle enzymes, sometimes magnesium level (80% of population have inadequate magnesium intake in their diet). Then doing electrodiagnostic testing (NCS/EMG) to detect any nerve or muscle damage.
Treatment is usually the treatment of the underlying cause (if any is detected). and if it's a true benign fasciculations syndrome the treatment is reassurance that this is not a serious disorder, that the course is bengin. managing any underlying anxiety. and probabely repeating the EMG in 6-12 months to make sure it's not a brewing organic disease. Some people use medications like beta blockers or some anti-seizure medications to control the symptoms with variable results. In many cases, symptoms can be significantly reduced through a proactive approach to decrease the overall daily stress. Common ways to reduce stress include: exercising more, sleeping more, working less, meditation, and eliminating all forms of dietary caffeine (e.g. coffee, chocolate, cola, and certain over-the counter medications).
So I would start by seeing a neurologist, preferabely someone with expertise in neuromuscular disease and get the evaluation done.
Thanks for using the forum. Please let me know if you need any help or have any additional questions.