Hi all, I hope someone can help me. I am a 28 year old male and for the past three months I have had a constant twitch in my left bicep. The twitch is non stop 24/7. Sometimes the twitch is quite fine where you can barely see it, other times it moves my whole bicep.
Now, I'm not new to twitching, I've had them all over periodically since school. They come and go and are usually worse when I'm tired or am working on a PC for example. I've had them before that have lasted for a few days or even a week, but never for this length of time.
I've had other symptoms recently which have been worrying me. I've had a strange feeling around my lips and mouth, like it's about to twitch but doesn't. I've also had a weird problem with my left hand where it feels like I've lost some of the movement in it. Both of these symptoms appear to have eased over the last few days. I've had no weakness in the arm though it does feel tired all the time. I also had a weird thing happen in my right bicep the other week. I carried a computer down a few flights of stairs and when I put it down my right bicep was shaking really fast. I massaged it and it stopped immediately.
I've been to my GP twice about this. The first time he took some blood tests and these came back fine apart from one of the liver tests was slightly abnormal. I went back again a couple of weeks later and told him I was worried it may be ALS or MS and he did some reflex tests and other examinations and said he didn't think there was any neurological issue. A bit of further information. I've had stiff and cracking joints since I was 16 and have had tests for arthritis and rheumatism etc, these have always been normal. My Aunt was recently diagnosed with fibromyalgia and my brother has epilepsy if this is relevant.
Any advice would be much appreciated as I'm really worried about this.
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.
From the description of your symptoms, sounds like you are having some muscle fasciculations. 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. I believe this also explains the feeling you get sometimes around the lips and mouth. 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 is essentially a diagnosis of exclusion
The diagnosis is usually made by a neurologist after a carefull history and thorough neurological examination to make sure you don't have other findings that might reflect an active disease process of the nerves or muscles. workup includes typically 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) to detect any nerve or muscle damage.
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).
So I would start by seeing a neurologist, preferabely someone with expertise in neuromuscular disease and get the evaluation done.
Thanks for using the forum. Please let me know if you need any help or have any additional questions.
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