I have had a bubbling sensation in my lower legs / calves for the past six months. It ebbs and flows, somedays is more pronounced than others. I feel it more while I'm sitting down or going to bed / getting out of bed. It feels like little bubbles are popping, or a little twitch here and there. It does not cause me any pain, however I'm concerned that it is a sign of a larger issue (ALS, or another disease). I'm 31 years old. I've had a brain MRI and EMG - both of which have come back fine. Any idea what this is or what I can do to treat it / get rid of it?
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.
I am not quite sure what you mean by bubbling sensation. Is there actual movement of the muscles or is purely sensory? Since you mentioned ALS, I’ll briefly provide information here.
The majority of 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 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 this syndrome 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, the area where the nerves that supply motor innervation to our body comes from. 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. Additionally, metabolic reasons, such as thyroid disorder or calcium disorder can cause these feelings/findings.
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.
It is good that the MRI and EMG have returned normal. I would have your physician continue to monitor you for progression/changes. If not already done so, you should also discuss with your physician other reasons to have these changes as mentioned above. You may need a neuropathy evaluation based on more clinical history and examination.
Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.
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