Random Muscle Twitches

I am a 21 year old male who in 2009 was diagnosed with trigeminal schwannoma, I had the tumor removed in two separate surgeries but I was left with permanent nerve damage. The left side of my face is completely numb, causing me to have double vision, cornea damage, and I cannot open my jaw as far as I used to be able to. This last December I started noticing random muscle twitches in no specific regions, they don't interfere with anything they are just annoying. I have had somewhere in the neighborhood of 10 MRI's over the past 3 years and nothing abnormal other than the tumor has come up. I went to a doctor (not my neurologist) and explained the symptoms and he ran blood and urine tests which came back fine. I feel completely normal with no other symptoms but I am still worried seeing as I have had the tumor. My family has no history of any neurological diseases. I do drink a lot of caffeine and I have been under a ton of stress due to school. Any Ideas?
Thanks

[Christopher R Newey, DO]

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 a doctor.

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

It must be emphasized that in the majority of cases muscle twitches 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. Tremors of the hands can be physiological that is exacerbated by stress/anxiety and caffeine.

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.

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.

However in general if 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. Another nervous system problem, neuropathy, may also lead to fasciculations. There will again be associated weakness or sensory changes. Other possibilities include migraine, seizure, and metabolic disorders (such as calcium or thyroid disorders).

Often these symptoms may reflect emotional/psychiatric problems related to stress (what is called somatization disorder). The latter is a true medical condition whereby instead of a patient experiencing depression or anxiety, they experience physical symptoms, and once the stress is addressed, the symptoms resolve.

These are several causes of diffuse muscle twitches. I suggest follow up with your primary doctor and you may benefit from evaluation by a neurologist as your primary doctor feels fit. It is important that you discuss your concerns with him/her. You may need basic lab work to ensure your blood chemistry, particularly your potassium, sodium, and calcium, is normal.

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