Twitching question

Thanks for this service; it is excellent.

My question pertains to a twitch I have noticed in my calves. I first saw this about 18 months ago, sort of forgot about it, and recently noticed again. The twitches are fine contractions in the calf muscle, like little heartbeats or an indentation from an invisible finger. I understand some degree of this sort of thing is normal, and I certainly have no weakness or other alarming symptoms--I jog about five times a week and generally feel great.

However, I have read (whether accurately or not) that so-called "benign" twitches will cease totally when the muscle is moved. On my calves, this does not seem to be the case; I have definitely seen the twitch with the calf contracted or stretched. While putting active weight on the leg (like pushing up from the floor through my toes), the muscle seems totally solid, but just flexing the calf does not stop the twitch.

The twitch is not always present at rest, but can definitely be seen most of the time when my legs aren't doing anything.

Does this sound like anything to be worried about at all?

For your information, I am 23.

Thanks again...

[Esteban Cheng-Ching, MD]

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 your doctor.
Without the ability to examine you and obtain a detailed history, I can not tell you what the exact cause of your symptoms is or how to treat them. However I will try to provide you with some useful information.
“Twitches” are a common manifestation that can be seen in the general normal population, however they are concerning in some patients as they may be associated with other conditions. Fasciculations are small, local, involuntary muscle contraction (twitching) visible under the skin arising from the spontaneous discharge of a bundle of skeletal muscle fibers. Fasciculations have a variety of causes, the majority of which are benign, but can also be due to disease of the motor neurons.
The main concern patients have when they have fasciculations is the possibility of Motor Neuron disease, of which ALS is one of them (Amyotrophic lateral sclerosis). Actually very few of the patients who seek medical attention for fasciculations turn to have this condition. In order to make a diagnosis of ALS, the patient needs to have findings of upper motor neuron and lower motor neuron disease in various segments of the body. This is difficult to explain, but basically a physician will be able to determine findings of upper and lower motor neuron based on history and neurologic exam. For this diagnosis, patients usually have symptoms like weakness, fatigue, muscle pains and cramps, voice changes, problems with swallowing, and other motor problems. Fasciculations by themselves do not make a diagnosis of motor neuron disease.
Common more benign conditions associated with fasciculations include caffeine use, anxiety, electrolyte abnormalities like changes in the calcium and potassium, thyroid disorders, or other endocrinologic disorders. Most of the time, the history and physical exam helps to determine the presence of one of these conditions, or blood tests may be needed.
There is a condition called Benign Fasciculations, in which spontaneous fasciculations occur and some people may have a widespread or relatively focal presence of fasciculations accompanied by cramps. On long term studies of these patients, it is found that this is a truly benign condition and does not confer a risk for motor neuron disease.
Medications, like stimulants, bronchodilators, amphetamines among others, may also produce muscle twitches, and this is easy to determine based on the history of what the patient is taking.
The fact that you have had this for long time, and do not describe other symptoms is reassuring, however I cannot be certain about this. As I said, without being able to obtain a detailed history and neurologic examination, and without being able to see the muscle “twitches”, I cannot tell you if what you have is concerning or not, and I cannot give you a diagnosis.
I think you should discuss this with your physician, and if needed, consider seeing a neurologist, if there is concern for an underlying neurologic problem.
I hope this information is useful.

[towriter]

Apologies--I should clarify the above. I do not mean to say that the twitching is constant and uninterrupted by moving the muscle; rather, with the calf muscle engaged (eg by lifting or pushing down my foot, without weight on it) I can--sometimes--see the same dispersed twitches in the muscle as I do when it is totally at rest.

Sorry for the confusion, and thanks.

[22dode44]

I have the same problem but my knees are loosen abet and I have been suffering from bad pain but the MRI showed unremarkable results ; however I didn’t notes  the Twitching nor the loosen of my legs so  is it related ?
thanx :D