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Neurology (Expert Forum)
Worried about muscle twitching
Answered by
Cleveland Clinic, MD - Neurology
Cleveland Clinic
Cleveland - OH
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Worried about muscle twitching
by shand, Aug 22, 2007 12:00AM
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!
Doctor's Answer
by Cleveland Clinic, MD, Oct 26, 2007 10:45AM
, Oct 26, 2007 10:45AM
To: shand
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.
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.
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 :)
Thanks