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Constant calf twitching and all over random twitching - Anxiety/BFS or ...
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Constant calf twitching and all over random twitching - Anxiety/BFS or something serious?

I am a 33 year old male with bodywide muscle twitching.

Approx 9 months ago I began to notice occasional random twitches in my arms, back, abdomen and chest (at the time I thought they were heart / circulation related). Some are small twitches, some are real “thumpers”.

I also have constant bilateral calf twitching. I suspect that these were present months earlier, but I have only come to notice them about 3 or 4 months ago now I know what they are! They drive me crazy when I rest, but subside immediately when the muscles are used. I often find myself shaking my legs / feet to make the sensation go away. I have always had restless legs.

In early January my right thumb started twitching but then went after a week or so. I have had an eye twitch for years when tired and that recently came back for about a week and went again.

I also have recently suffered occasionally from a very fine trembling sensation in my hands and legs, plus occasionally get bilateral tingling in my hands.

I suffered from a chronic virus last year for 3 months, plus I had gastritis, for which i took PPI’s and antibiotics.

I have also been suffering from stress and anxiety, as my wife and I are trying for a baby and last year started my own business. I am currently seeing a therapist about my anxiety. I have noticed that the symptoms do ease if i have a couple of alcoholic drinks. I had tension headaches last year that the doctor put down to stress.

I have no muscle weakness that I know of, nor is there any apparent wastage. I still exercise regularly and I think I am as fit as I ever have been.

I am reluctant to go to my doctor about this if it is driven by anxiety because i don’t want this to go against me for medical insurance, etc.

I would like advice as to whether this is likely to be either stress related / Benign Fasciculation Syndrome, or does it fit the bill for something a lot more serious, i.e. MS or even ALS?

Thanks in advance!
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Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history, I can not tell you what the exact cause of your symptoms is. However I will try to provide you with some useful information.

Since it sounds like your muscle twitching has been occurring for months and you have not developed any other symptoms except some tingling, the most likely diagnosis is benign fasciculation syndrome. Benign fasciculation syndrome, which I will abbreviate as BFS, is a condition in which there are involuntary twitches of various muscle groups, most commonly the legs but also the face, arms, eyes, and tongue. If the diagnosis is confirmed and other causes are excluded, it can be safely said that the likelihood of progression or occurrence of a serious neurologic condition is low.

However in general (and please understand I am not trying to imply I feel this is the case in you), when fasciculations occur in the setting of associated symptoms such as progressive loss of sensation, tingling or numbness, weakness, trouble swallowing and other symptoms, the cause may be due to a peripheral nervous system problem. In general the symptoms would not be episodic and triggered by certain things but would be more constant/frequent without consistent triggers. The location of the problem could be the anterior horn cells, the area where the nerves that supply motor innervation to our body comes from. These are the cells that give off the nerves that allow us to voluntarily contract our muscles. The diseases that might affect the anterior horn cells include ALS (also called Lou Gherig's disease), a condition called spinal muscular atrophy, polio-like viruses, west nile virus, and other infections.
Another nervous system problem, neuropathy, may also lead to fasciculations. There will again be associated weakness or sensory changes.

It must be emphasized that in the MAJORITY of cases they are BENIGN meaning that they are of no consequence and are not resulting from a serious cause. In such cases, the twitches may be related to anxiety/stress, caffeine, and often occur after recent strenuous activity or muscle over-use. It is important in such cases to reduce stress/anxiety levels and to reduce caffeine intake.

When BFS is present but not particularly bothersome or disabling, treatment is not necessary. If severe and it requires treatment, there are a few medication options though this condition is not very common, and the research that has been done on its treatment is limited. Minimizing caffeine and stress, and treating anxiety if it is present, will improve your symptoms.

While I understand your insurance concerns, I suggest follow up with your primary doctor and you may benefit from evaluation by a neurologist as your primary doctor feels fit, just to make sure there is nothing else going on. Avoidance of caffeine, minimizing stress (easier said than done I'm sure), continued visits with your counselor, and regular exercise are all important to help decrease BFS.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck
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