Persistent Muscle Twitches: Causes and Concerns

Muscle twitching for several consecutive days, lasting for a few hours each day?

Dear Doctor,
My wife suddenly informed me last Saturday night that she was experiencing muscle twitching in her upper arm.
After observing the condition for several hours without any relief, we went to the emergency room early that morning.
Blood tests revealed iron deficiency anemia and low calcium levels.

Before the muscle twitching began, she had experienced insomnia for one to two weeks, which resolved after about a week.
Additionally, she had engaged in a week of intensive plank exercises, which is unusual for her as she typically does not participate in such vigorous activities.
My wife is generally prone to anxiety, has narcolepsy with cataplexy, experiences vivid dreams, and often feels fatigued even after long periods of sleep.

Previously, she had experienced facial paralysis on one side (suspected Bell's palsy).
As of today, she continues to have muscle twitching, which lasts for several hours each time.
There has been no muscle atrophy or weakness, and she has also experienced brief eyelid twitching.

I have researched many articles online and reviewed questions from others.
I would like to ask the doctor if the absence of muscle weakness or atrophy suggests that this is not amyotrophic lateral sclerosis (ALS) but rather benign muscle fasciculation.
Thank you.

Kang Kang, 20~29 year old female. Ask Date: 2018/04/23

Dr. Hong Weibin reply Neurology

There are many causes for muscle twitching, among which electrolyte imbalances, anemia, dehydration, and radiculopathy are common.
The diagnosis of benign fasciculation syndrome is typically made after excluding electrolyte imbalances, anemia, and neuromuscular issues.
As for amyotrophic lateral sclerosis (ALS), it commonly occurs in middle-aged and older adults, so in terms of age, it is less likely (assuming your wife is around your age, 28).
In ALS, muscle twitching is not limited to a specific area and can often be observed in muscles throughout the body.
In addition to muscle twitching, it is often accompanied by muscle weakness, difficulty swallowing, and speech difficulties, which gradually lead to muscle atrophy and problems with walking.
If muscle twitching persists after correcting low calcium levels and addressing anemia, it is advisable to seek evaluation from a neurologist.
Neurologists can perform blood tests, conduct a comprehensive neurological examination, and utilize electromyography (EMG) to assist in diagnosis.
Additionally, it is recommended to rest more, relax both body and mind, try meditation, and reduce the intake of stimulating foods (such as caffeine), which may help alleviate symptoms.
Wishing you a speedy recovery.

Reply Date: 2018/04/23

More Info

Dear patient,
Thank you for sharing your wife's symptoms and concerns regarding the persistent muscle twitches. Based on the information you've provided, it seems that your wife is experiencing benign muscle twitching, often referred to as fasciculations. These involuntary muscle contractions can be quite alarming, especially when they occur suddenly and persist for an extended period. However, the absence of muscle weakness or atrophy is a reassuring sign that suggests a less serious underlying condition.

Understanding Muscle Twitches
Muscle twitches can occur for a variety of reasons, and they are often benign. Common causes include:
1. Electrolyte Imbalances: Your wife's blood tests revealed iron deficiency anemia and low calcium levels. Both of these conditions can lead to muscle twitching. Calcium is crucial for muscle contraction and relaxation, and its deficiency can cause spasms or twitching.

2. Stress and Anxiety: Given that your wife has a history of anxiety and sleep disturbances, it is possible that psychological factors are contributing to her muscle twitches. Stress can lead to increased muscle tension and spasms, particularly in individuals who are predisposed to anxiety.

3. Physical Activity: You mentioned that she engaged in a week of intense physical activity, which her body may not be accustomed to. Sudden increases in physical exertion can lead to muscle fatigue and twitching as the muscles recover.

4. Sleep Issues: Sleep disturbances can exacerbate muscle twitching. Lack of restorative sleep can lead to increased muscle tension and spasms. It’s important to address sleep hygiene to improve overall well-being.

5. Caffeine and Stimulants: If your wife consumes caffeine or other stimulants, these can also contribute to muscle twitching. Reducing or eliminating these substances may help alleviate the symptoms.

Addressing Your Concerns
1. Benign vs. Serious Conditions: The fact that your wife does not exhibit muscle weakness or atrophy is a strong indicator that her symptoms are benign. Conditions like Amyotrophic Lateral Sclerosis (ALS), commonly referred to as Lou Gehrig's disease, typically present with muscle weakness and atrophy, which your wife does not have. Therefore, it is reasonable to conclude that her muscle twitching is likely benign.

2. Monitoring Symptoms: It is important to continue monitoring her symptoms. If the twitching persists or worsens, or if new symptoms arise (such as weakness, significant fatigue, or changes in sensation), it would be prudent to follow up with a healthcare provider for further evaluation.

3. Lifestyle Modifications: Encourage your wife to focus on a balanced diet rich in vitamins and minerals, particularly iron and calcium, to address her deficiencies. Regular, moderate exercise can also help improve muscle tone and reduce twitching. Additionally, practicing relaxation techniques such as yoga, meditation, or deep-breathing exercises can help manage stress and anxiety.

4. Sleep Hygiene: Improving sleep quality is crucial. Encourage her to establish a regular sleep schedule, create a restful environment, and avoid screens before bedtime. If sleep issues persist, consulting a sleep specialist may be beneficial.

5. Follow-Up with Healthcare Providers: Given her history of sleep issues and anxiety, it may be helpful for her to discuss her symptoms with a healthcare provider who can provide a comprehensive evaluation and recommend appropriate interventions.

In conclusion, while muscle twitching can be concerning, the absence of muscle weakness and atrophy, combined with the context of her recent physical activity and stress, suggests that her symptoms are likely benign. However, it is essential to remain vigilant and seek medical advice if her condition changes. Thank you for your inquiry, and I wish your wife a swift resolution to her symptoms.

Best regards.

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