Fasiculations/Cramping in hand

[Lara Hill]

For about two months, I have been having twitching in my right hand.  I have always had muscle twitches in my feet, eyes, back, etc. for as long as I can remember.  But these twitches in my hand are in the palm - in the meaty part at the base of my thumb and pinky finger and have continued off and on for the last two months or so.  These twitches at first didn't seem like much to me, but after reading about ALS, I'm consumed with the fact that I have symptoms of the disease.  I don't really feel weakness or pain, although the last two days I have had some cramping in my hand.  I'm wondering if perhaps I could be making some of this up in my head.  You know - reading about it and convincing myself that I might have ALS.  Perhaps the "cramping" I'm feeling is self induced?  Maybe the twitches are too?  I'm only 30 years old and it seems awfully young to have ALS.  Also, I read that symptoms worsen rapidly.  How fast is rapidly?  I have made an appointment with a neurologist, but can't get in until the end of April.  Waiting a month to have my fears calmed or at worst case, confirmed, seems like an eternity.  Any thoughts on this would be greatly appreciated.

[kjan1010]

A related discussion, difuse body cramps and fasciculations was started.

[tion]

A related discussion, neck problems was started.

[tion]

A related discussion, cramping hands was started.

[CCF Neuro[P] MD, RPS]

Dear Lynn:

Fasciculations without muscle weakness on exam is almost never ALS.  Yes, anxiety can induce fasciculations and make them worse.  Whether your pituitary adenoma is contributing to the problem I can't tell.  However, your neurologist should be able to tell you.

CCF Neuro MD

[Lynn]

I am 20 years old and I have noticed faciculations all over my body including stomach, arm, leg and back.  It causes no pain or cramping.  I was just recently diagnosed with panic disorder and have yet to be treated.  I have a small pituitary tumor(macroadenoma 1 cm) and I take cabergoline or "dostinex", 1/2 of 0.5 mg per week.  Can pituitary tumors cause fasciculations?  Can stress and anxiety cause this?  Is ALS not common or unheard of in 20 year old females?  I am a bit of hypochindriac but I need to know if I should see my neurosurgeon or not???? HELP?

[CCF Neuro[P] MD, RPS]

I hope you two got together.

CCF Neuro MD

[TO GINNY/From Maureen]

Ginny:

I am also a fasciculator of 4 years and an acupuncturist and Mom of 3.  Would you like to chat confidentially?  ***@****

Thanks, Maureen

[CCF Neuro[P] MD, RPS]

Dear TML:

If the nerve damage was done during surgery, the amount of time that has passed would make further surgery unsuccessful.  If there is another reason for your pain, then another procedure might help.

CCF Neuro MD

[tml]

I have complete numbness in my lower lip and across the right-hand side of my chin following disastrous chin implant surgery. My last operation was 17 months ago - the implant was removed at this time. The pain is still quite severe. Can anything be done to repair the nerves in this area?

[ginny]

Dear Fellow Fasciculators,
    I have been diagnosed with this for approximately 4 years. It first started in my feet and now is over 80% of my body.  It is a constant challenge to accept the "benigness" of this condition.  About 4 years ago I had some vertigo and burning of my feet.  My MRIs and spinal tap were negative.  I have been reassured that I do not have MS.  I was diagnosed with a sensory peripheral neuropathy of my sural nerve of my right foot.  I was put on neurotin for the burning pain which I eventually weaned off of.  I am very active and work as a nurse anesthetist.  I try to avoid using nitrous oxide because of what I have read about it being neurotoxic.  I constantly wonder what is causing my twitching and I do alot of praying that it will not become obvious in my face. I am so glad I got into this forum to know there are other people experiencing this. We are not alone!!
For awhile I went on amyltriptyline so that I could better deal with this problem , but I eventually decided to try and deal with this problem off medication.  The last time, though, I went to the neurologist he told me I could try an anticonvulsant such as Dilantin.  I tried it for awhile but decided it was not working. I try to keep my caffeine intake down but I do love my coffee.  I hope this helps someone else.

[Tim]

Dear Benign Fasci.

Thank you for your comments. I am not one to worry about what things could mean. I am fairly active, run about 15 to 25 miles a week, have a fairly good upper body work out 3 to 4 times a week, and enjoy a good life. I know that any day, any one of us could receive terrible news about any one of thousands of conditions... If I live my life with muscles twitching and the cramping that I have endured for the past 3 years, so be it. I will not live in fear that things could get worse... if they do, we deal with it when it happens. As for my diagnosis and symptoms, I am laying them out there so that others who may be experiencing similar symptoms might have some hope. I place my trust and hope in God, and am assured that in all things, good and bad, He will be with me. I had an Uncle die of ALS a few years ago. As you stated, the twitching is only one symptom. Without the weakness and clumsiness in the feet and hands, I was not too concerned. Once again, thank you for your comments. I don't know that I can give up the caffeine, and I do enjoy a glass of wine occasionally as well as a cold marguerita on warm days.

[Benign Fasci. - welcome!]

Tim,

welcome to the club! Benign Fasic. and Cramping syndrome is fairly common, and essentially consists of a non-life threatening condition of prominent muscle twitching without weakness or other signs. Some people also have cramps, others do not. Check out the ALS forum on this site where the doctors very nicely describe the syndrome for the many people out there frightened their twitches automatically mean ALS (since twicthing is ONE of the symptoms and signs of ALS). The good news is , in a study of some 120 people with this syndrome, none of them have gone on to develop the life threatening ALS that so many worry of. Make sure you are well-hydrated, getting plenty of nutrients such as vitamin B, you can give up caffeine and alcohol as they appear to make the twitches worse...

I have twitched for 10 months now, nothing else, e.g. weakness....just twitches all over. Some days are better than others, some days I think they are gone and then they come back. I have had 3 normal neuro exams during this time so my neuro sees this as benign. My best advice to you is to get your remaining tests done as scheduled, and if they are normal, try as best you can to let this go. There are many who hang onto it with worry visiting Neuro after Neuro to get to the bottom of it, and I am convinced that makes things worse. The reality is our bodies are complex and we do not always know whey they do what they do.

[Tim]

Dear Lara and others,

An update to my diagnosis... I had my MRI and EMG last Friday. My neurologist stated that the EMG is not consistent with the diagnosis of Isaac's, but rather Benign Fasiculation and Cramping Syndrome. There was a black spot in my Spinal Cord that the neurologist referred to as a "Hemangioma" or an "Angioma". I hav not been able to find any information on the Benign Fasiculation and Cramping Syndrome, does anyone out there have any information for me. The follow up suggested by my neurologist is to have an MRI of my brain and a Cat Scan of my abdomen to check for any other blood clots. This is all to take place over the next two weeks. I still have not had any weekness except in the mornings, sometimes it is difficult to use my arms when having to lift them above my head. Would appreciate any information anyone might have. Thanks.
Tim

[CCF Neuro[P] MD, RPS]

thanks for the comment.

CCF Neuro MD

[Tim/From Maureen]

Hi Tim

I explored the Isaac's possibility for myself and have some information if you want.  I can be contacted at ***@****

Good luck.

[Tim]

Dear Lara,
I am 37 years old and I started experiencing twitching in my right bicep about 8 months ago. I attributed the twitching to the increased physical activity in my running and upper body workouts. As time passed, around December 99 and into January, the twitching became more of a constant twitch in both upper arms and my calves. I have, for most of my adult life had severe cramps in my feet and my calves. I saw a neurologist last week, and his preliminary diagnosis is Isaac's syndrome, also referred to as neuromyotonia. I can induce cramping in my abdomin simply by twisting my mid section, and can induce cramping in my forearms simply by flexing and relaxing. I might add that the twitching, or fasciculations in my muscles cover approximately 80% of my body now. I am certainly not trying to diagnose what you are experiencing, just sharing my experience. I am scheduled for an MRI, EMG and blood work ups next week.

[CCF Neuro[P] MD, RPS]

Dear Mark:

Carpel tunnel is due to repetitive wrist/hand movements.  There is predisposition in people who have small wrists, but there is no real genetic component with carpel tunnel disease.

Sincerely,

CCF Neuro MD

[Mark]

Is carpal tunnel syndrome an heredatary condition or is it merely caused?

[CCF Neuro[P] MD, RPS]

Dear Lara:

your are welcome.

CCF Neuro MD

[Lara]

Thank you for the information.  My mind is a little more at rest.  I will still keep my appointment with the neurologist just to be certain, but feel much better now.

Thank you very much for your time.  I truly appreciate it.

Regards,
Lara

[CCF Neuro[P] MD, RPS]

Dear Lara:

Upper motor neuron signs are lesions in the brain, and in ALS it is in the pyramidal tracts or motor strip.  They would be manifested in spasticity, increased reflexes etc.  While lower motor neuron signs would be fasciculations with WEAKNESS.  One needs both types of lesions for the diagnosis to be made of ALS.  Yes, the muscle weakness should be very evident.  Fasciculations in the hands can be from a number of reasons. It would be difficult to sort out based on the information on hand.

Sincerely,

CCF Neuro MD

[Lara]

Thank you for your thoughts on this.  

May I please ask what upper and motor neurons signs means?  Also, I'm assuming by your note that muscle weakness occurs along with the fasiculations, rather than a symptom that appears later and that if I had muscle weakness, it would be as noticable as the twitches?  

Fasiculations have never concerned me - it's the fact that they have been concentrated in my hand for several months that scared me.  Especially when reading that ALS symptoms often occur in the hand.  

Would you recommend that I keep my appointment with the neurologist?

Thank you again for your time and for sharing your thoughts.

Regards,
Lara

[RR]

Sorry about my typo...it should read"Dont expect the medical advise you will get here..."

[RR]

Check out the Neurology Web Forums at Massachusetts General Hospital.  Go to the "Neuromuscular" page.  There are alot of us twitchers there.  You will find that what you have is not uncommon.   Don't the expert the medical advise that you will get here, but sometimes it helps to know that others are in your condition.  Hang in there and may God give you peace!
P.S. you are very lucky to get a post here,  the advise is second to none!