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muscle twitches and tingling in hands and feet
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muscle twitches and tingling in hands and feet

Starting about 5 weeks ago i had a sudden onset of muscle twitching in my left bicep (it went on for about one hour).  The next day i noticed that my left food had some tingling (pins and needle feeling) at the end of my toes.  Over the past 5 weeks the muscle twitching has spread to my entire body.  The twitches last only about 1 second, but when they happen they will occur in about 3-5 places around my body then stop (left tricep, right shoulder, legs, back).  This usually happens when my body is at rest (when watching tv, or when i am waking up in the am).  The tingling in my feet has spread to my fingers.  The tingling comes and goes, worse when i have shoes on for extended time.It also seems to be worse when my feet are in hot water (bathtub or hot tub).  In addition, my left hand has been falling asleep at night.  it sometimes wakes me. i can shake it around and it comes "back to life" quickly. this only happens when i am asleep.  I also have had some "prickly feeling" on my thigh and right arm. this was only present for a day or two and is not occurring now.
Other information.  I have a hx of gi issues and was on rifaxamin twice in Jan and Feb of this year.  I also started cymbalta (60 mg) in early Jan (for anxiety).  So i was on both meds when this started.
My concern:  i am not too worried about ALS as i have no loss of muscle strength ( i work out 3-5x/week).  I am somewhat worried about MS due to the twitching, tingling in hands and feet, and hand falling asleep.  
I saw my PCP last week.  He did some tests (thyroid, electrolytes, checking for muscle breakdown, vitamin b ect) that all came back normal.  My PCP states that he is not worried about MS.  He states that it is not that common in men and does not feel my symptoms are compatible with MS.  At this point he does not want to refer me to a neurologist. Your thoughts would be appreciated.
stephen
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Avatar_dr_m_tn
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 (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, which has a broad differential (including peripheral neuropathies).

You mentioned also having tingling sensations too. If symptoms migrate (move from one place to the other) as you describe and are intermittent, causes might include seizures, migraine disorder or metabolic problems such as low calcium or thyroid abnormalities.

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.

The other possibility is drug induced (?cymbalta). These medications can cause headache, fatigue, muscle spasms, tremor, paresthesias, rigors, etc.

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. Further workup such as EEG, EMG/NCS, or MRI would have to be decided upon by your neurologist depending on the clinical examination and historical findings. Also, you may want to discuss with your primary physician a possible adverse effect from the cymbalta.

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

11 Comments
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Avatar_m_tn
stephen i have similar symptoms as you and theyve been going on for 2 years and havent gotten better ive been to a neuro, rheum, psych, primary, chiro, cardiologists. i also have pvcs, pain in urethra, blurred vision, chest pain and pressure. docs seemed to have ruled everything out as well as MS although i fit every category of MS - im worse in heat. my feet burn...im currently on prozac and it hasnt done anything except make my legs burn, feet painful, i cant sleep. doctor tells me to continue it. ive been on klonopin which helps minorly for a short time. i feel like my immune system is on over drive. i get random feelings of allergic reaction. one ear will go red i have lower left back pain, twitching now since i started prozac. i feel unsteady and off balance. if you get any insight please let me know or check my leghtly post on my profile that i made almost a year ago. your symptoms like mine deffinitely point to MS and or like mine also lyme disease, candida, or Generalized anxiety disorder. if i were you i wouldnt take a chance go right to a neuro and rule it out. if you can catch MS early you can live alright with it. im scared to be honest i dont know whome to believe and want to find another neuro but who knows.
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Avatar_m_tn
also rule out thyroid, b12, vitamin d defficiency, pinched nerves.

all possible things to look into
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Avatar_m_tn
hey there. this stuff ***** and is scary.  I hate that my mind goes to the worst possibility, but it does.  i get mad at myself sometimes for how upset i get.  it is hard to distract myself with other things (esp. when you have physical symptoms that remind you that something is not right).  
i saw my pcp a few days ago.  he does not think it is ms, but he can not say for sure.  he feels that b/c my twitching is bodywide and the tingling in feet /hands is bilateral, that it does not match up with classic ms.  have a neuro appt in 4 weeks (hard to wait that long).  i see my pcp again on 3-27.  at that time if i want he will request that my insurance authorize an mri.  he worries that an mri will show some odd things that are not ms and then take us down a whole other path.  I just want some answers and to rule out serious stuff. if the mri is good and the neuro says it is not ms then i will likely be better able to move on.  i have two kids and am only 42.  i worry that ms will affect my ability to enjoy life and provide for my family.  one thing that i remind myself is that ms is not that common (i do not even know someone that has it...or at least know someone that has disclosed that they have it).   i wish you and everyone else dealing with this stuff the best.

stephen
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Avatar_m_tn
my pcp ran some basic tests (thyroid, b-12, sed rate).  all normal  (part of me wishes they were the issue)
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Avatar_m_tn
good work on getting the neuro work up - try and relax and think like i do - if somethings there someone will find it...but regardless of what advice your doctor might give you - you know your body better than they do. dont be afraid to push for your answers

keep us posted

Adam
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Avatar_m_tn
thanks for responding.  i am trying to manage my anxiety as best i can.  i have an appt with a neuro dr in 4 weeks.  my pcp dr is going to order an mri next week  (most likely to calm my mind).  I am wondering:  i have read that a neg mri does not completely rule out ms.  Is this true? also i have read that getting ms when you are older (my case being 42) is worse as you usually get "primary progressive"
i wouldn't be so scared of MS if it did not potentially involve being physically disabled (wheel chair bound).

stephen
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Avatar_m_tn
Stephen, I'm going through some of the same syptoms (symptoms).  1 year ago I herniated my L4/L5, after that a microdiscectomy to repair the disk.  After, I noticed cramping in my calves periodically but just got used to it. Since then, I also have a periodic buzzing, tingling or vibrating in my back and legs, but no pain.  I've learned to live with pain in my lower back and right foot due to the disc herniation.

1 month ago I noticed visible muscle twitching in my upper right tricep, along with very small twitches (mostly not visible) throughout my entire ebody, i.e. both calves and thighs.  There is no loss of strength in my right arm.

I went to Neurologist and he did a dexterity test and I passed.  He then did an EMG/Nerve study saw nothing related to a "central" issue, i.e. MS or ALS.  Said the right arm twitching could be a simple misfiring of the nerve.

I've always taken a multivitamin, to include magnesium and potassium, etc. so I don't think it is a deficiency.  I'm thinking it could be stress or something else, but I too worry about the more serious illnesses.

The twitching continues throughout my body and has me stressed out.  He said the twitching is not related to my previous back injury.  I go back for a follow up with the Neurologist next week for I assume more testing.

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Avatar_m_tn
just wondering...
i currently have had tingling in my feet and hands (i am assuming this is catagorized as peripheral neuropathy) for the past 6-7 weeks.   I had shingles on my upper back about 10 weeks ago. Could the peripheral neuropathy be related to the shingles?  the spot on my back where the shingles started still hurts.

stephen
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Avatar_m_tn
met with neuro yesterday. did a physical exam and test to assess my nerve functioning.  he said that there was nothing remarkable.  he suggested my pcp do some labs. i can see the neuro in 3 months if i do not improve, or sooner if new symptoms.  he did not think it was ms and saw no reason for an mri.  he was not the most engaging dr. he had an intern with him.  the two of them talked between each other.  i would have appreciated more communication, but oh' well.  still have tingling in my feet with some burning pain, esp left foot.  my hand feel better.  hopefully this will resolve on its own.  :)
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1689801_tn?1333986916
Hi Stephen,

I think the doctors here usually just answer your orginal question, this is to much work for him to cover all those questions. He is doing this after his full time work, once a week or so.

I have simular symptoms, but much more by now. I´ve had this since June 2010. I still don´t have a diagnoses, but it definetly is something simular to ms, exept they say it is more comon to not have the tingling on both sides. Just left or right. But that happens though. If you like you could read my journal, to see how my symptoms developed. Hope you get better, but these neurostuff can be SO strange. Sorry about my English.

My best,
Dagun
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