Worried about muscle twitching

This post is for one of the MDs. I am a 51 yr old woman very nervous about muscle twitching. It began about 6 weeks ago when  my left great toe began twitching (muscle on the foot that moves the toe out away from the other toes).  Within 2 days there were random or repetitive twitches all over my body (except my face and neck)-both limbs and trunk.  Most of those settled down although I still have twitches in my arms and legs--some days worse than others.  The most affected places now are the left foot--my toe twitches almost continously.  Sometimes the muscles under the arch of my foot twitch as well.  The right hand is somewhat involved as well. I went to a neurologist at a good center who specializes in neuromuscular diseases. He did a very complete exam and told me not to worry--my exam was normal--no reflex changes; no weakness; no atrophy; no need for an EMG--and he would see me back in 3 months.  But the twitches in the left foot have become somewhat stronger.  I am consumed with worry and look at my foot and hand all the time trying to see if there is any atrophy. I really don't think so and I can still do everything I've always done--walk on my toes; walk on my heels; etc.  How long would it take to develop atrophy after twitching starts???Of course the internet is a scary place but we all go there when we have problems. I am hoping one of the MDS can respond and tell me if they think I should continue to worry or if I can relax!  Thanks so much!

[Cleveland Clinic, MD]

I am happy to address the questions that you pose, although it is important that you recognize that my impression is based entirely on the information you have provided in your posting and is by no means a substitute for an office visit with a neurologist.  Diagnosis is contingent on detailed history and physical exam and as such, the following information should be considered solely for educational purposes. Let me start by giving you some information about fasciculations in general.

A fasciculation or what is usually called "muscle twitch" is a small, local, involuntary muscle contraction (twitching) that is visible under the skin. it is caused by spontaneous discharge of a bundle of muscle fibers. This can occur in any voluntary muscle group but is most common in the eyelids, arms, legs, and feet. Even the tongue may be affected. The twitching may be occasional or may go on nearly continuously.

They have a variety of different causes, the majority of these are benign, but can also be due to disease of the motor neurons. Common causes include the following:

. Dehydration and Fatigue  
. Werdnig-Hoffman disease
. Amyotrophic lateral sclerosis (ALS) which is a rare cause
. Organophosphate poisoning
. Magnesium deficiency (which can be caused by stress, inadequate dietry intake or magnesium loss due to severe diarrhea)
. Medications: this includes anticholinergic drugs over long periods, in particular ethanolamines such as Benadryl, used as an antihistamine and sleep aid, and Dramamine for nausea and motion sickness. Stimulants can cause fasciculations directly. These include caffeine, pseudoephedrine (Sudafed®), and the asthma bronchodilators albuterol/salbutamol (e.g. Proventil®, Combivent®, Ventolin®). Benzodiazepine withdrawal is another possible factor

and then actually most cases don't have a well-identified cause and has therefore been given the title benign fasciculation syndrome (BFS) which I believe is your diagnosis based on the information you gave and the conclusion of your neurologist.

In addition to twitching, patients with BFS often experience pain, paraesthesia, generalized fatigue, exercise intolerance, globus sensation and/or muscle cramping. Another common feature of the disorder, is an increase in the patient's level of anxiety, especially health-related anxiety.

The diagnosis is usually made by exclusion, when other muscle and nerve diseases, medication exposures are ruled out. This is typically achieved by reviewing the history carefully for any possisbilty of exposure to the above mentioned medications and the course of the fasciculations compared to the drug exposure. checking some lab tests including muscle enzymes, sometimes magnesium level (80% of population have inadequate magnesium intake in their diet). Then doing electrodiagnostic testing (NCS/EMG) which should show no evidence of significant nerve or muscle damage and this excludes primary nerve/muscle disease.

Treatment is usually the treatment of the underlying cause (if any is detected). and if it's a true benign fasciculations syndrome the treatment is reassurance that this is not a serious disorder, that the course is bengin. managing any underlying anxiety. and probabely repeating the EMG in 6-12 months to make sure it's not a brewing organic disease. Some people use medications like beta blockers or some anti-seizure medications to control the symptoms with variable results. In many cases, symptoms can be significantly reduced through a proactive approach to decrease the overall daily stress. Common ways to reduce stress include: exercising more, sleeping more, working less, meditation, and eliminating all forms of dietary caffeine (e.g. coffee, chocolate, cola, and certain over-the counter medications).

Ofcourse always seek medical help if your symptoms get worse, if you develop new symptoms like weakness or loss of muscle bulk.

Thanks for using the forum. Please let me know if you need any help or have any additional questions.

[autumndays]

It might be time for a second opinion!  You need to feel comfortable with the physician and his opinion.  Good luck!

[Beana9]

Hey Shand, i wouldn't worry...you probably just have BFS like me, its really annoying but its not life threatening and it doesnt turn into anything worse.  Here is some advise that helps calm the twitching:

Vitaspice, loaded with antioxidants which can help calm the twitching
Magnesium Supplements
Banannas
Blueberries
Vitamin D

It should help, dont forget to that the twitching is now associated with your stress of having other diseases.  This is just going to make your BFS worse.  Perhaps you can treat your anxiety, which helps, trust me!  Also, looking up symptoms on the internet is a form of hypochondria all its own, dont worry, also crunching your foot inbetween a heating pad and your other leg will help you relax in bed just before you go to sleep. O and FYI, my left toe does the same thing :)

[katjazz]

I am a 30 year old mother who teaches Jazzercise at least 5 times a week and sometimes more.  I'm a very active person and do toning exercises in addition to my classes.  I used to take Lexapro for depression and started having muscle twitches all over my body.  More so in my back, arms and legs.  I have since discontinued the use of it, but my muscle twitches continue.  They usually occur while I'm relaxing or before I go to bed.  The twitching isn't severe just annoying.  Along with the twitching I do sometimes feel tingling in my fingers or my feet.  I don't take any supplements and my diet can be inconsistent.  I often drink caffeine throughout the day.  Is this something to worry about or is it fatigued muscles that need more nutrition?  
Thanks

[RNRita]

Is it me or has this forum shut down?  I see no questions since August and no place to post a question.  Am I missing something?

[debbie cantrell]

can someone help me i have muscle weakness dizziness muscle twitching i dont know why i have been to the doctor about ten times with no help.

[debbie cantrell]

are you having problems tol

[mydogmira]

I am having all these  weird feelings since I gave birth 12 wks ago...I had a tingling feeling on the left side of my chin and I thought it was a reaction to Percocet...so I stopped taking it..well for the past 7 week I have all this pressure in my head..as if I were standing on my head and all the blood is rushing to it...I feel off balance at time with a bit of dizziness. The feeling you get when you try someone's glasses on and they are too strong..I have been feeling the tingling in my chin again and a tightening/tingling on the right side of my neck. I went to an ENT who put me on Allergy meds and said we will start there...it's not working. I am even using CBC etc..I  have a feeling they will all come back normal...I say this because before my pregnancy I was having  unexplained tremors and the tests came back normal..

if you have any suggestions..please please let me know..

[mydogmira]

IGNORE LAST POST>> MESSAGE WAS CUT

I am having all these  weird feelings since I gave birth 12 wks ago...I had a tingling feeling on the left side of my chin and I thought it was a reaction to Percocet...so I stopped taking it..well for the past 7 week I have all this pressure in my head..as if I were standing on my head and all the blood is rushing to it...I feel off balance at time with a bit of dizziness. The feeling you get when you try someone's glasses on and they are too strong..I have been feeling the tingling in my chin again and a tightening/tingling on the right side of my neck. I went to an ENT who put me on Allergy meds and said we will start there...it's not working. I am even using saline flushes for my sinuses...I saw a neurologist who ordered a ANA ANCA LYME TITER THYROID LEVEL CBC  MRI with Contrast..etc..The Neuro asked me if I had the off balance feeling at the same time I get the tingling sensation and I replied sometimes..and of course it happend tonight..I had all this pressure in  my head and felt off balance and had the tingling in my chin and right side of my neck..it last about an hour..My blood pressure is always normal..athough it was high at the end of my pregnancy..I checked my sugar and it's been fine...I  have a feeling all  my tests will  come back normal...I say this because before my pregnancy I was having  unexplained tremors and the tests came back normal.. oh and I now have a toothache on a tooth that I know I need a root canal for...
are these things all related?????????  PLEASE HELP

if you have any suggestions..please please let me know..

[RNRita]

I sure am, but can't ask a question here because there is no place to do it and I see no one answering.  

[jmclain]

I am 46 y/o female with 1 1/2 year history of symptoms that come and go lasting from days to months. With almost total remission.   It began after taking a statin drug, but from the blood work it was unrelated........ It began with a pinch in my right bicep, after a month my legs began to feel weak and at times I would have "waves" of weak trembling feelings in both shoulders. I also had tremors in my right arm.  MRI of brain was within normal limits as was the initial Cervical MRI.   I was told to stay away from statins by the Neuro surgeon. He stated nothing on MRI could explain abnormal NCS or absent arm reflexes.  Symptoms went away but then returned 3 to 4 months later with the pinch feeling on the left bicep.  MRI showed pinched nerve on right but pain was on left so I did not have surgery.  Symptoms went away and then returned with a lot of twitching in left bicep and pinch type pain, I also tend to have twitches a lot more frequently everywhere compared to normal.  I have constant cramp like pain in both calves and burning in the back of my thighs.  4 weeks ago food didn't have as much taste and I have lost 12 lbs, I now weigh 117, so I wasn't over weight.  I was referred to a neurologist who stated he thought it was metabolic, but from exam definitely not MS. Thyroid normal, PTH normal but calcium slightly elevated 10.7,  he ordered a ionized ca. and a lyme disease test and scheduled me to return in 6 weeks.   This is so frustrating because I know on exam I don't appear weak, but I feel weak and clumsy, I don't think he gets how much this is altering my life.   Does it sound metabolic.... isn't that what they check before diagnosing ALS or with ALS would I show actual weakness on exam, ??  Also, is pain such as cramping and pinching  part of ALS symptoms?  Any Suggestions. Thanks for any help........

[patsy10]

ALS usually shows weakness on exam as well as obvious muscle wasting.  As far as I know it is diagnosed by EMG, exam and ruling other things out.  Yes, from my reading it can cause muscle cramping but no numbness or tingling.  Metabolic and mitochondrial disorders are diagnosed with a muscle biopsy.  My friend had one to rule these things out and it did show that she had myositis.  You should not have to wait 6 week for the results of 2 blood tests.  Ridiculous.  Honestly, I would make and appt. at a large teaching facility with a neuromuscular specialist.  You are right, they just don't get it how these things alter people's lives.  I'm not a doctor.  I've just done a lot of research trying to figure out what I have.  A doctor won't answer this.  You have to post it under "post a question" for them to answer.  It's tough to get a question posted though.  It took me weeks.  Best wishes to you.

[jmclain]

Thank you so much for your reply....I'm glad someone out there understands..........................

[Tee988]

I am a 66 year old female and lately I have been having jerking in the legs and jerking all the way to the breast. I is really severe and the next day I am extremely sore muscles.
Has anyone ever experience this?  It is really hard jerks, I can feel them coming on, my toes get cramps and than it starts.  Its extremely hard to sleep with the jerking so hard.
I would really like to know has anyone experience this and what is causing it. I do have fibro. But this is new!
Mazzie

[S.B.]

I have dx Benign Fasciculations Syndrom (syndrome) since 2005. Twitching started in right eyelid in March 2004. I have done 7 EMG (seven!), alot blood works, lab exams for Lyme Desease, CT & MRI several times etc. before I was calmed down. All day long, may I say 24/7, my calves and feets are twitching in last 3 years. I have noticed atrophy in right biceps but Neuros reassured me this is due to my spine's malfunction (?). I can run, lifting weights, squats, push-ups more than average man in my age (I am 51 now). Seems to me it looks like slow onset of NMD (ALS). I hope I am wrong.
Sincerely. Slavin (Croatia)
Sorry for grammar errors.