Twitches, occasional cramps, CPK 1500 in 24 yo male...ALS fear.

I am a 24 year old male with fasiculations, starting over the past month or two, and increasing in frequency. They are occur predominately in my LLE, but increasingly in my right arm, and occasionally in arms, face, and neck. They are also common in the upper eyelids. They do not follow a particular pattern, nor does anything seem to make them better or worse. They can occur in different muscles simultaneously. Occasionally, I have cramps in my feet when I curl my toes, or my neck when I yawn. I have had persistent jaw pain at the joint for more than two weeks now, after having a cramp in that muscle.

My PCP ordered an MRI of my lumbar spine which showed no herniation. I had a normal MRI of my brain. My liver, kidney, thyroid functions, chem 7, cbc, electrolytes, lead, copper are all normal. My B-12 level of 254, noted as low and my CPK of 1500, noted as very high. Referred to a neurologist who did an exam, and said that I appear to have normal muscle bulk and no visible weakness or atrophy. She ordered an EMG scheduled for two months from now. But because of the increasing twitches and the high CPK, I am very worried. Could this be ALS or something else very bad?

My questions:

(1) Would I have noticeable atrophy or weakness already if it were ALS? Or can you have twitches like this, but not yet have noticeable changes in strength or appearance?

(2) I started lifting weights two weeks prior to my CPK being checked. Could this really give me a CK of 1500?

(3) My stress level is a little high. I am finishing up my med school pre-reqs, and I work full time as an EMT. Does stress cause wide spread twitching? If so, do these often occur in various muscle groups simultaneously?

(4) I have had some increasing muscle fatigue in a particular area of my shoulder days after lifting weights. Is it likely to have atrophy in particular muscles, but not notice because they are “deeper” muscles, or because nearby muscles are compensating for their weakness?

Thanks much

[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 (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 (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. 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. Other possibilities include hypocalcemia and thyroid dysfunction.

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. Fibromyalagia is another medical condition that leads to whole body pains, and is best treated with medications such as lyrica and neurontin, exercise, and physical therapy.

You can have muscle twitching prior to atrophy or atrophy prior to muscle twitching. Your CK levels are high but may be a reflection of lifting weights. Have you lifted weights in the past? You could have a repeat CK level checked after a prolonged perior of not lifting weights. Additionally, some people have elevated CK levels at baseline. As already mentioned stress can cause muscle twitching.

I suggest follow up with your primary doctor and your neurologist. It is important that you discuss your concerns with him/her. An EMG/NCS will be very helpful to determine further what may be causing your symptoms and also to evaluate the “deeper muscles” that you asked about.

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

[pose]

I forgot an important piece of information:

Three years ago I had a microlaminectomy at L5-S1 to repair a herniation. I had twitching and atrophy to my RIGHT lower leg, which prompted an MRI and EMG, both positive. After the repair, the fasiculations of my RIGHT lower leg have never stopped, but now they are beginning to occur other places.

[mzak69]

Google "benign fasciculation syndrome". May be helpful.

Stress and worrying makes me twitch, so I'm sure it's not helping you.

Good luck.

[jessegoodgirl]

Your CPK levels at 1500 could very well be related to the weight lifting.  If you were not lifitng I'd be more concerned that your CPK is that high.  If you test again I feel they will be lower provided you have not worked out much before you take it.

I have been feeling very similar to you and Im also looking for answers.  I have slightly elevated CPK at 230.  But I also have twitching all over my body, legs, back, eyes, arms sore, calves etc.  I can cramp up in my toes or calves if I make certain movements.   I wish I knew what was causing it.  Im waiting for some more test results so we will see.