Muscle Tremors: Symptoms, Concerns, and Next Steps

Q: Muscle Tremors: Symptoms, Concerns, and Next Steps

Hello： You are concerned about Parkinson's disease, which typically does not occur in your age group unless there are familial genetic factors involved. <br>Instead, you should consider drug-induced extrapyramidal syndrome, which occurs when the body's motor system is disrupted b

About muscle twitching?

Hello Doctor, I have recently noticed a lack of sensation in a specific area at the back of my throat, which made me worried enough to see a doctor.
The doctor reviewed my previous reports, tested my reflexes with a hammer, conducted a consultation, and had me close my eyes and touch my nose with my fingertip.
He diagnosed me with autonomic nervous system dysfunction (I forgot the details).
(1) During the examination, he asked if I experienced any hand tremors and had me extend both arms.
After observing, he remarked that I indeed had some tremors.
This made me anxious, especially since my great-aunt (my grandfather's sister) has Parkinson's disease, prompting me to research more about it.
The more I read, the more concerned I became.
Recently, I have noticed that my hand tremors seem to have worsened; even using chopsticks to eat feels shaky.
Two years ago, I also experienced similar hand tremors for a while, but they eventually disappeared.
(2) Additionally, I have been experiencing muscle twitches.
Based on my observations, the twitches occur in various locations (such as the soles of my feet, lower back, palms, arms, and rib muscles) and are not confined to a specific area.
I read online that this condition can cause low-frequency twitching.
I should mention that sometimes the twitching is high-frequency (possibly 5-8 times per second), but at other times, it is just a single twitch (which occurs quite frequently).
There have been instances of twitching...
twitching or twitching...
twitching...
twitching (with each "..." lasting about 0.5 seconds).
Sometimes, I can even feel the muscles in my forearm about to twitch (that kind of sensation just before a twitch occurs).
There was a time about six months ago when I woke up in the middle of the night to find the muscles in my neck twitching rapidly, with a more pronounced amplitude (though I did not experience hand tremors at that time).
When I support weight with my hands, they tend to shake.
I wonder if it’s because I am overly concerned, as it seems more pronounced than before.
About a year ago, I experienced tremors in my left jaw while drinking water.
At that time, I had nerve conduction studies done due to pain in my hands and feet (Note 1).
On the day I received the report, I asked the doctor about it while drinking water, and he simply said, "Okay, I understand." Just yesterday, I discovered that moving my jaw to the left at the bottom can trigger the tremors.
(3) Regarding urination, I have noticed that it has become somewhat more difficult than before.
Sometimes, I feel like I need to wait a little longer for the urine to fully expel after I think I’m done.
(4) While walking, I have experienced pain in my thigh, which I am unsure if it is nerve-related or something else.
The pain occurs at a specific point while walking but goes away after a moment.
This has happened in both thighs, but my walking seems normal.
(5) I believe my muscles are not particularly stiff, at least not to my awareness.
(6) The tests I have undergone were primarily due to pain in my hands and feet => one year ago, I had nerve conduction studies and electromyography on my right side (Note 1) => after the tests showed no issues, the pain disappeared => six months ago, I experienced occasional pain + a weak electrical sensation in my arm (or a slight vibrating feeling) + occasional weakness in the first joint of my left hand (which resolves within half a day to a day) + occasional eye movement issues (without double vision) => awake brain waves / evoked potentials in the upper limbs / strength / hearing (I expressed my concerns about MS to the doctor).
Finally, I have been experiencing this strange sensation in my throat recently (I only listed what I believe is relevant).
I have seen a total of four neurologists and neurosurgeons (I visited one of them the most frequently, and the basic diagnosis has been autonomic dysfunction).
However, I am unsure if I might have Parkinson's disease.
Should I return to a major hospital for further testing? If so, what information should I provide to the doctors there? Thank you for reading this.
I am unsure if I am overthinking my symptoms, but the more I look into it, the more it seems like I might have something serious.
I am overwhelmed with fear but also reluctant to go to the hospital (not for any pride issues; it’s just that every time I plan to go, the waiting feels torturous, and I have this feeling that I might not be sick at all, which is why I am asking here).
Thank you, Doctor.

xuesheng, 20~29 year old female. Ask Date: 2021/04/07

Dr. Jiang Junyi reply Neurology

Hello: You are concerned about Parkinson's disease, which typically does not occur in your age group unless there are familial genetic factors involved.
Instead, you should consider drug-induced extrapyramidal syndrome, which occurs when the body's motor system is disrupted by certain medications, leading to abnormal muscle tone, parkinsonism-like symptoms, tardive dyskinesia, and akathisia.
For this matter, neurologists specializing in movement disorders are primarily concentrated in the Taiwan Movement Disorder Society (http://www.tmds.org.tw/).
I recommend that you consult a neurologist from the society for discussion regarding examination and treatment.
Wishing you good health, peace, and happiness.
Dr.
Jiang Junyi from the Department of Neurology at Taoyuan Hospital cares about you.

Reply Date: 2021/04/07

More Info

Understanding muscle tremors can be a complex issue, especially when accompanied by other symptoms such as muscle twitching, weakness, and sensory changes. Based on your description, it seems you are experiencing a range of symptoms that could be indicative of various underlying conditions, including anxiety, neurological disorders, or even benign muscle fasciculations.

Firstly, muscle tremors can be categorized into several types, including resting tremors, action tremors, and postural tremors. Resting tremors are often associated with conditions like Parkinson's disease, while action tremors can occur during voluntary movements. Given your family history of Parkinson's disease, it is understandable that you are concerned about this possibility. However, it is important to note that not all tremors indicate a serious condition. Many individuals experience benign tremors that do not progress to a neurological disorder.

Your symptoms of muscle twitching or fasciculations, which you describe as occurring in various locations (such as the feet, back, arms, and ribs), are often benign and can be related to stress, fatigue, or even dehydration. These involuntary muscle contractions can be exacerbated by anxiety, which may lead to a cycle of worry and increased muscle tension. It is crucial to differentiate between benign fasciculations and those associated with more serious conditions, such as motor neuron diseases.

The sensation of a "dead" area in your throat and the difficulty with urination you mentioned could also be linked to autonomic nervous system dysfunction, which can occur in various conditions, including anxiety disorders. The autonomic nervous system controls involuntary bodily functions, and when it is out of balance, it can lead to symptoms such as changes in sensation, urinary difficulties, and even gastrointestinal issues.

Given your concerns and the complexity of your symptoms, it would be prudent to seek further evaluation from a neurologist, particularly one who specializes in movement disorders. They may recommend additional tests, such as MRI scans or more specific neurophysiological tests, to rule out conditions like multiple sclerosis (MS) or other neurological disorders. It is essential to provide your neurologist with a comprehensive history of your symptoms, including the onset, frequency, and any triggers you have noticed, as well as your family history of neurological conditions.

In the meantime, managing anxiety through relaxation techniques, physical activity, and possibly cognitive behavioral therapy could be beneficial. Engaging in regular exercise can help reduce muscle tension and improve overall well-being. Additionally, maintaining a healthy diet and staying hydrated can support muscle function and reduce the likelihood of cramps or twitching.

In conclusion, while your symptoms warrant further investigation, it is essential to approach this situation with a balanced perspective. Many individuals experience muscle tremors and twitching without a serious underlying condition. By consulting with a specialist and addressing your anxiety, you can gain clarity on your symptoms and take appropriate steps toward management and treatment. Remember, early intervention and a proactive approach can significantly improve your quality of life.

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