Tremor, Fasciculations, and Tingling

[Dasobel]

Two months ago, during a stressful period, I began having transient pain in my hands, arms, and jaw.After a few days, I noticed fasciculations in feet and calves, myoclonic jerks, and misc. twitches--all in the span of maybe 5 days. I went online, read about "twitches and ALS", and convinced myself I had ALS. I was terrified, and experienced an extreme traumatic reaction--strong anxiety, shaking all over, greatly exaggerated startle, etc.Twice,I felt burning paraethesia's for about 30 seconds (arm).I completely freaked myself out.I guess what they used to call a "nervous breakdown."

Visits to two neuros and two clean EMGs convinced me I didn't have ALS,I calmed down, and my symptoms began to subside over a period of a week or two--with a few exceptions.

1)Tremor--I have had a fine postural and action tremor (simple, not intentional) ever since, mainly in hands and arms, but also head buzzes upon waking, and when I lift weights I can feel head and leg tremors during certain motions.
2)Fasciculations-- never fully went away, though much less. In feet/calves mostly, two twitchy hot spots on lips.
3) Tingling-- Mostly in feet, but also hands, arm.
4) Mildly exagerated startle-- nothing like it was, but not normal.

Nothing else. No visuals, weakness, fatigue, gait, coordination, etc.

I have thought maybe I have PTSD due to my traumatic episode, or maybe the onset of essential tremor--my tremor does fit ET well, and I've read BFS and tingling can be comorbid with ET.

But what about MS? Onset was sudden. Does MS usually present w/ tremor/fasc., w/some tingles?

[CCF-Neuro-M.D.-PW]

I cannot give you a formal clinical opinoin over the internet as this site is purely educational.

In general, MS presents with discrete episodes of neurologicval dysfunction - most commonly loss of vision in one eye, weakness or clumsiness of a limb on one side of the body, double vision, or spasticity in the legs with inability to walk. This does not sound like your symptoms you describe in your post. In MS these symtppms last for a few weeks then subside but may recur later at or another location in the nervous system. There is almost always signs on the MRI scan.

Tremor is relatively common in MS, but in the advanced stages, and is more coarse rather than the fine tremor of essential or physiological tremor, and is called a 'rubral tremor'.

Discuss your anxieties over your symptoms with your doctor - he willbe able to either reassure you or investiage where appropriate

Good luck

[Tom41]

I am new to this forum, and I would like to tell my story. I am a 33 year old male, on May 8th I started to have twitching of my lower left eyelid that went on for two weeks. Note that the previous eight-nine months were by far the most stressful experience of my life, with worries about unemployment, though  Following that I started to have twitches everywhere, though curiously enough the eyelids have now stopped. The left handside of the body is slightly more affected, though there are twitches everywhere except the hands and feet. No problems swallowing/talking at all, though I have twitches on the temple and the jaw sometimes. A doctor here adn a doctor in my home country which I recently visited tend to dismiss everything as stress-related, which could make sense, except I have never reacted to stress in this way. I saw a neurosurgeon who tested my reflexes/coordination on June 10th and tested my strength etc., he said I am absolutely normal, and an EMG on June 14th (three weeks into the generalized twitching) signalled no problem. Also, lots of blood work done, everything in order. I am now seeing another neurologist here in the USA to get a second opinion, as the symptoms continue. They tell me twitches usually are one of the last symptoms, so they should have already shown on ALS unless you have bulbar start, but as I said I have no problems talking/swallowing. I am terrified I might have ALS, despite the fact that the neurosurgeon (who also has a neurology qualification) dismissed the idea.

[Dasobel]

Tom, don't let your twitches freak you out. Believe me, I've been there, and so have many other posters on this site. My question above is about MS; I'm trying to figure out what's happened to me. I may never know, a lot of time these twitches and tremors are ideopathic, meaning there's no identified cause, just symptoms that scare you less and less as time goes by.

I am not a doctor--  but based on my own consultations with neuros, and on heavens knows how much I've read about it, you DO NOT have ALS. Believe your doctor. The muscle jerks you describe are called myoclonics, and they have NO place in ALS presentation. Other twitches, like more "regular" and fine ones you may see in your calves and feet especially (or your eye twitch), are fasciculations, and in the absence of other serious symptoms (like clinical weakness or muscle atrophy) are benign. There is an entire syndrome known as Benign Fasciculation Syndrome (BFS) presenting with exactly your symptoms, and strongly linked to stress, and FAR more common than ALS

ALS fasciculations occur in a withered, atrophied muscle group, and at the END STAGE; and don't occur all over your body or in unaffected muscle groups. An example would be someone where ALS began in one hand (it begins unilaterally, usually just in one limb on one side)--  after a long period of weakness and dwindling ability to use the hand for basic activities, the diminished, visibly diminished muscles would twitch (in one spot) continuously until they "died out."

On top of all that, your clean EMG should reassure you even more.

I know it's scary, but you've got to trust your doc and stop surfing ALS sites; you ain't got it. Hang in there, you'll be ok!

[Tom41]

Thank you so much for your reassuring word and for taking the time to respond. I will try to believe you and stop making my wife's life impossible.

[Aub]

How do you post a question on this forum?  There is always a message saying they have reached the limit of questions for the day. I see the forum MD has answered so it would appear I would be free to ask my own question.

[Aub]

I HAVE BEEN TRYING TO POST A QUESTION FOR A LONG TIME.  YOUR SYSTEM KEEPS SAYING IT HAS REACHED IT'S LIMIT.  THAT IS TRUE EVEN IF THE FORUM MD HAS ANSWERED THE LAST QUESTION.  PLEASE TELL ME HOW TO POST.

[who_is_this]

Try between 8a-11am EST.  That's when people seem to have the best luck. You might have to try multiple times though, and sometimes it takes days/weeks to get in.   I did notice that there haven't been any new questions for a couple of days.  

Also, if you wish to address something to the forum admin, use the CONTACT button at the top of the page.  They don't routinely look in the forums at the questions/comments themselves.

[Aub]

I tried using the contact button to relate the fact I can't get in.  Nobody has responded to my complaint.

[longisland]

i am a 45 y/o nurse who suffered for the past 5 months with upper gastrointestinal nausea, gas, burning in stomach, insomnia, burning in upper arms, back, neck, knees,lips. rashes on my back, and numbness that would come and go for brief seconds in feet, arms, hands, i lost 13 pounds in three weeks and
suffered through these symptoms and continuous doctor appts to all kinds of specialist that had me take various blood tests and
MRIS ultrasounds, endoscopy etc etc etc. need i go on. i became so discusted that i knew i had to be my own physician and through prayer and research on my own believed that i had candida in the lining of my gut and was causing all these weird symptoms. i realized this after taking a questionaire test i found on the candida free website. as there is not actual diagnostic test for candida, as we all have normal candida in our stomach, but an overgrowth can cause serious problems.
I was initially diagnosed by my GI doctor with irritable bowel syndrome which is ridiculous as irritable bowel is lower bowel symptoms not upper. I would encourage you to look into candida.
i went to a naturopath and she gave me natural supplements for my stomach and i started taking a product called 3 lac which i purchased through info on the candida free website. all my symptoms disapeared and my sleep was restored . i cant tell you how many prescriptions these doctors ordered and had me trying, ridiculous!!!! the neurologist i saw started me on cymbalta to block the burning sensation i had which was agonizing but the burning never went away completly until i took the 3 lac for several weeks. i hope this helps you, best wishes.

[Do0gle]

I began experiencing pins and needles in my left arm and hand around 1-1.5 years ago. The area affected is mostly the back of my hand but I sometimes have abnormal sensations extending up my left forearm. Repeated queries to my doctor have so far led to no diagnosis. I was sent to see a rheumatologist and given a full diagnostic work-up, possibly based on my symptoms being related to RSI or carpal-tunnel syndrome. A subsequent occupational health referral led to general work-position recommendations that so far have not provided any resolution.

I experienced a number of other symptoms that led me to question if this could be onset of MS. I have painful feet (mostly in the morning), frequent abdominal disconfort (bloating and diahrea), and visual disturbance in the form of many floaters. Just in the last month have felt a little clumsiness and a 'feeling of weakness or heavyness' in my left arm and hand. I test my dexterity occasionally though, and it does not seem to be diminished. I remain, however, very concerned about the pins and needles and seeming numbness.

I should perhaps mention that I have also experienced palpitations or missed beats where I become very concious of my heart beat. This usually happens after eating.

I realise these could all be associated with stress, but the fact that the left-arm sensations are continuous (just varying in degree but always there) worries me a great deal. The heavyness and apparent weakness scared me to the extent that I felt some minor panic attacks.

Do these symtpoms sound at all like anything anybody has heard of? I would be very grateful for any advice.

Perhaps I should mention that

[face2face]

Hello Folks,

I am 23 years old and I have been dealing with fasciculations for at least 6 years. I have been on ADHD medication for that long. It is a known fact that certain medicines, particularly for ADD, ADHD cause fasciculations. Reason why is because alot of these medications contain hydrochloride, or some type of salt. Salt is what causes fasciculations. Because of the medication, the fasciculations have been very painful at times. Not because of fears of possible ALS, but because the salt in the bloodstream. Anyway I can't get into the anatomy of the whole process but here are some links that you can look at that might help you to better understand fasciculations and the bodily process. Be sure to read through everything throughly because you will not understand what you are reading if you don't.

http://www.innerbody.com/image/musc02.html

http://en.wikipedia.org/wiki/Muscle_contraction

http://en.wikipedia.org/wiki/Power_stroke

http://en.wikipedia.org/wiki/Sarcomere

[face2face]

Hello Folks,

I am 23 years old and I have been dealing with fasciculations for at least 6 years. I have been on ADHD medication for that long. It is a known fact that certain medicines, particularly for ADD, ADHD cause fasciculations. Reason why is because alot of these medications contain hydrochloride, or some type of salt. Salt is what causes fasciculations. Because of the medication, the fasciculations have been very painful at times. Not because of fears of possible ALS, but because the salt in the bloodstream. Anyway I can't get into the anatomy of the whole process but here are some links that you can look at that might help you to better understand fasciculations and the bodily process. Be sure to read through everything throughly because you will not understand what you are reading if you don't.

http://www.innerbody.com/image/musc02.html

http://en.wikipedia.org/wiki/Muscle_contraction

http://en.wikipedia.org/wiki/Power_stroke

http://en.wikipedia.org/wiki/Sarcomere

P.s. what sort of things help calm the fasciculations? Someone suggested magnesium, but is there anything else?

[BunnyFoofoo]

Hi , Im 44 years old and have been suffering with severe headaches and migraine headaches for literally years.  I also suffer from  tingling in my hands and are and tremors in my legs.  I have had several mri's on both my neck and brain.  My neck seems to have arthritus and somebone spurs pinching some nerves which may explain the headaches.  I have suffered depressionand mood changes for years, they now say i am bipolar, but sometimes i wonder if it may be signs of MS.  I suffer from cronic fatigue and  very rarely have the energy to leave my house even to go to the grocery store. I also have a pineal cyst which seems to remain stable. I have the results of an mri and i wondered if someone could explain some of the terms to me.  For the past 2 days I am experiencing stiffness in the left side of my face, and front of my throat.  Thank you for your help;
1.flow voids are identified in the vessels of the skull communicating patency.

2.There are a few tiny foci of increased signal  activity in the brain stem and flair images, suf=ggesting minimal chronic small vessal ischemic change or Virchow-Robin spaces. An abnormal enhancing mass lesion is not identified.
3.Scattered nonspacifichyperintense signal intensity prodominately in the frontopparietal white matter bilaterally.

I know this is a lot to read and hope someone that understands these MRI finding can explain them to me in a way I can understand,  Thank  you

[Neuron]

Hi,

I am a man in his 40s who until recently has not experienced any real serious health concerns.

After reading comments on this forum I think maybe I am experiencing anxiety or possible Lyme disease or very unlikely the beginnings of MS. Like alot of people the first twitching episodes really elevated my anxiety because of ALS.

In any case I thought I would add my recent experiences to this thread.



Previous to April 2006, for approximately one year, I was having on occasion sudden panicky awakenings from a sound sleep (usually just after falling asleep) and at times carpal tunnel syndrome symptoms accompanied the awakenings. In addition, I was on occasion being woken up by leg spasms, tremors or twitching; this has come about in the last few months. I thought at the time that maybe all these symptoms were related possibly to stress/anxiety.

In the evening of April 1st I was having continuous spasms,tremors in the legs and because the episode lasted 10 minutes or more I decided to go to Emergency. While there, I had a CT scan and during the time there I had no symptoms and was released with recommendations to see a neurologist. The first such similar spasm attack was the previous night in bed when I had to get up and just waited until the episode subsided in about 10-15 minutes. After these spasm attacks I now have the pulsing, twitching, vibration/tremor, burning sensations,upper back bug “crawly” feeling symptoms. The only other time I have had the continuous spasm symptom was during the EEG test.

Note: The carpal tunnel syndrome has improved with the use of wrist braces at night and the exercises recommended by the physiotherapist for the condition.

Note: My lower back has had a tender spot since 2001 and at times especially in the mornings and if I stay bent slightly over for a period of time, I get a stiffness feeling in the lower back.

Symptoms over the past 6 months: April thru September 2006
Intermittent twitching mostly in legs, arms, sometimes back and chest and “vibration”/tremor feelings in legs and “crawly” feeling in the upper back at times, fatigue and some muscle weakness, a bit of weight loss, occasionally balance trouble, right ear tinnitus, insomnia improving but still occurring as I will wake up a few times during the night; intermittently I have been taking clonazepam/oxyzepam for the insomnia. I have also had gastrointestinal problems though this has improved; my father has been diagnosed with hiatus hernia and I may have a genetic predisposition for this condition. One more symptom in the past couple of months is infrequent heart palpitations. In July I started getting the odd aching pain in my wrists and thumbs and at times it feels like some of my muscles are cramping, particularly the legs. In September occasionally I had the right side of my face get tingly and the right eye upon awakening was blurry/hazy but no pain behind the eye.

In general,I am experiencing these symptoms: insomnia, fatigue, sadness and at times lack of motivation, occasionally irregular heart beat, continuous tinnitus in the right ear, occasional burning sensations mainly in the legs and twitching/pulsing/vibration-tremor/cramping/tingling of various muscles throughout the body. The more active I am the more the symptoms are apparent in the muscles.

Medications: I was on Minocycline for several years, (discontinued usage March 2006), and tetracycline before that for quite a few years for acne. Again, to treat acne, I was on accutane for 5 months about 12 years ago. I am still using a quarter tablet of proscar for hair loss. For the anxiety and insomnia, I have been on occasion using clonazepam and oxyzepam. I am trying 1 SAMe supplement a day to improve my mood.

Medical Testing: MRI/CT/EEG - noteworthy event below
Note: During the EEG test when I was instructed to hyperventilate I did have spasm/tremor like actions in my legs and a little in my arms for a couple of minutes but only right after finishing the hyperventilation part of the EEG test.

Surgery: On Monday, June 26th 2006 the right nostril biopsy and right ear tube insertion. Right ear tube for pressure problem due to blocked eustachian tube and biopsy near old site of removed adenoids (adenoids); biopsy came back normal. MRI detected possibly sinusitis and mastoiditis on the right side. I was told by the doctor that the MRI results could be fluid in these locations and there is no plan for treatment, unless infection symptoms are apparent.

Genetics: Parents are in their early 80s and they both have been diagnosed with Polymyalgia Rheumatica. My mother was diagnosed in her 70s and my father at 83. Arthritis conditions run in the family as well as hiatus hernia,ENT and strokes issues. As far as I know there is no family history of ALS, MS, MD, Parkinsons.

I had two appointments with the neurologist. My second appointment to this neurologist was on Thursday, June 22nd 2006. The doctor said the CT/MRI/EEG results showed no signs of MS, Tumor or other concerns and that the nose and ear problems would not cause the twitching of the muscles. During the EEG incident the doctor said I had normal brain readings. The neurologist suggests I am experiencing anxiety and that she would recommend in the report to my G.P., an anxiety medication.

I did see my G.P. and he wanted to give me effexorXR for GAD. I did try it for a couple of days but it made me to spaced out so I am now dealing with this without drugs.

I do not work-out like I used to but I do walk daily and ride a stationary bike and do deep breathing exercises and trying yoga too.

A glimmer of hope in medical resarch?
http://www.rxpgnews.com/research/article_5011.shtml