Muscle twitching

[Mary__0__0]

Posted by Ryan  on June 22, 1999 at 09:25:05
I am a 23 year old male with no history of muscle disease in my family.  I have had asthma all my life and have taken Theodur since I can remember (18 years at least).  About four months ago, I had a mild sore throat and started jerking as I fell asleep.  I was concerned when this continued so I went to my doctor and she told me that I was probably just anxious and prescribed a sample pack of Serzone to help me sleep.  She also suggested I get off my Theodur and she put me on Singulair.  Immediately, my blood pressure skyrocketed while taking both of these medications.  I talked to another doctor who recommended getting off Theodur first and then getting on singulair.  I tried that and have not had blood pressure problems since.  The sleeping problem has went away, however, I have noticed constant twitching in my muscles...mostly in my feet and calves.  Sometimes in my biceps.  This happens mostly when I am at rest.  It is sort of like a crawling underneath my skin.  Sometimes I can see it, other times I can just feel it.  The only medication I am on right now is Singulair.  My question is:  Can going off Theodur have this type of reaction since I was on it all my life?  I lift weights and have not noticed any muscle weakness or loss.  Should I be concerned about ALS at such a young age?  I take vitamins every day so I don't think it is a deficiency in Magnesium.  Thanks for any answers you might have.

Posted by CCF Neuro[P] MD, RPS on June 22, 1999 at 12:27:03
Dear Ryan:
Sorry to hear about your muscle twitching.  The most likely explanation is that you have benign fasciculations.  This means that there isn't a clear etiology of these events and that over time they will go away on their own.  There may be a possibility that they may be caused by theodur, although if you have been on this medication for awhile (likely you have) then it is cloudy if this is the reason.  There are many prophylaxic medications for asthma these days and so the choice is varied, from inhaled flovent, leukotriene inhibitors, etc.  
ALS is always associated with muscle weakness.  One can see fasciculations in the disease but without weakness, it is highly doubtful that one has ALS.  The fasiculations are bothersome, can be very bothersome, but usually self limiting. I have a muscle group in my arm that goes nuts sometimes, so I know what your going through (at least alittle).  In time, I will bet that these will go away for you.
Sincerely,
CCF Neuro[P] MD

Posted by Ryan on June 22, 1999 at 13:47:30
Thanks for the info.  One quick question:  are there any documented cases of ALS at such an early age such as mine?  I have read numerous reports and most say that the majority of the cases occur in middle age.  Once again, thanks for your quick response.

Posted by CCF Neuro[P] MD, RPS on June 23, 1999 at 11:04:35
Dear Ryan:
Unfortunately there are reports of younger patients having ALS.  We just diagnosed a 19 year old female with ALS yesterday.
Sincerely,
CCF Neuro MD

Posted by Doris on June 23, 1999 at 12:18:56
I have had a "bad back" all my life.  I was a tomboy when young and fell out of many trees, been in car accidents, and thought myself to be "Superwoman" at my job in my twentys as a CNA and "didn't need help" lifting patients twice my size. I now know how stupid that was. I underwent a CT in 1995 that showed 2 prorotruding disks and "ligamentum flavum facet hypertrophy"...what does this mean?  Also I had an MRI in 97 that still of course said the same only with "neural impingement" and more disk bulge. "Left sided laterally at L3-4 and left-sided neural foraminal encroachment on L4-5 disk bulge."  I suffer now with sciatica on my left side.  I have gotten so used to it I don't let it interfere but last week I found I couldn't get out of bed and couldn't walk well when I did the pain was so great.I can't sit either due to the sciatic nerve "screaming" in my left buttocks.  I am living on pain medication so that I can  work but feel that I am doing harm.  My GP suggested surgery and was going to set up and appointment to see someone who could do this but my problem is, I have seen and/or know many people who have had back surgery and they don't seem to be any better off and in fact some are worse.   What do your stats say?  What do you think and what is: Ligamentum flavum facet hypertrophy and Left sided neural foraminal encroachement. ?  It goes on to say that MRI with enhancement may be helpful and that Posterior spondylitic shanges esp. on the left side are noted. Also a moderate sized diverticulum of the 2nd portion of the duodenum and there is a rather prominent estrarenal pelvis of the right kidney without hydronephrosis.  What does all this mean? My GP tried to explain but he made no sense to me.   I also am bothered all the time with muscle twitch of both calves but esp of the left.  Everyone can see it and it's quite annoying. And at least twice a week I am awakened in the night with a horrible cramp of the back of my upper thigh that seems to generate from the small of my back.  I am in misery.  Than you for any help you can suggest.  

Posted by CCF Neuro[P] MD, RPS on June 25, 1999 at 17:53:03
Dear Doris:
Sorry to hear about your pain.  The ligmentum flavum runs from lamina to lamina on the posterior aspect of the vertebral canal.  Where the back part of the canal meets with the next vertebrae there is a facet or joint.  What is trying to be conveyed is that there is enlargement of this junction.  Sounds like that etiology in your case may be axial loading (too much weight on your spine without spinal support).  The neural foramen is the area that the nerves exiting from the spinal cord leave the spinal cord and travel to their muscles etc.  The discs are likely impinging these nerves in the L4/L5 area.  It sounds from what you describe to be the culprit for your pain.
The stats vary from surgeon to surgeon and from sugery type to surgery type.  Usually the surgery on the spine is the last recourse.  Because of this, the results may widely vary and at times unpredictable.  However, if the pain is bad enough surgery is often a good choice to try and relieve the pain.  There is little guarantee that a particular individual will be painless after surgery.  I would seek several opinions on your particular case from several surgeons.  Decide what your options are and then make the best decision you can.  
I am a neurologist and not a GI specialist so take what I say with a grain of salt.  A diverticulum is an outpouching of your bowel, located where the stomach and small bowel connect, the "s" curved duodenum.  These outpouching are prime areas for infection and when they do, they cause diverticulitis.  One would feel abdominal pain, but usually not back pain.  These can also bleed and cause bloody stools.  You also have a kidney abnormality of an extra piece of kidney in the pelvis of the kidney.
I hope this helps.
Sincerely,
CCF Neuro MD