Muscle Twitches: Insights on Neurological Concerns

Q: Muscle Twitches: Insights on Neurological Concerns

Hello： The differential diagnosis of multiple sclerosis is quite extensive, including factors such as genetics, infections, inflammation, metabolism, tumors, psychiatric conditions, toxins, and blood circulation issues. <br>When spontaneous remission of neurological symptoms occu

Muscle regeneration inquiry (Please let the doctor review this, thank you.)

If the doctor sees this, please just reply to this post.
Recently, I've been experiencing some symptoms that remind me of my concerns about multiple sclerosis from six months ago: sometimes, my muscles twitch before I fall asleep at night, and in the morning, I notice that the twitching is more pronounced, especially in the muscles that are active or under pressure.
There have been several instances where I woke up in the middle of the night and noticed (1) my muscles were twitching in a rhythmic manner (which feels different from usual) and (2) I experienced rapid visual disturbances, like flickering images, which disappear within 2-3 seconds (I suspect this might be related to my sleep).
Regarding the muscle twitching, my recent blood test for electrolytes came back normal.
After showing the doctor a video of my muscle twitching (specifically, a clip of my left foot twitching intermittently before stopping), the doctor performed some neurological reflex tests and took my history.
The doctor then ordered an electromyography (EMG) test.

As for my recent condition: a while ago, I found it somewhat difficult to write Chinese characters with my right hand (though I haven't written in Chinese for about a year).
Typing with it has been inconsistent, sometimes feeling awkward.
However, it has improved recently.
About two days ago, I experienced muscle pain in my legs and buttocks (it got better the next day, but then I had pain in the sole of the other foot, which also improved the following day).
I've noticed that my leg muscles are twitching more frequently.
I did change my shoes during those two days, switching from flip-flops to canvas shoes, which should have been more comfortable.

I am really scared and worried.
If I had a choice, I would not hesitate to choose multiple sclerosis over other diseases I used to worry about, as facing a terminal illness makes all previous concerns seem trivial.
The date for my tests feels so far away, and I dread facing it; perhaps it feels like my own judgment day.
I feel very conflicted inside, and my family doesn't understand me; they keep denying my condition, but a part of me is really resistant to the idea of having such a disease.

Dàxuéshēng, 20~29 year old female. Ask Date: 2021/05/02

Dr. Jiang Junyi reply Neurology

Hello: The differential diagnosis of multiple sclerosis is quite extensive, including factors such as genetics, infections, inflammation, metabolism, tumors, psychiatric conditions, toxins, and blood circulation issues.
When spontaneous remission of neurological symptoms occurs, the following symptoms should be considered for multiple sclerosis: unilateral painful optic neuritis; incomplete myelitis; solitary brainstem and cerebellar lesions; multiple central nervous system white matter syndromes; neurological symptoms that appear with heat and fatigue; and paroxysmal neurological symptoms.
When a physician has a high suspicion of such diseases, they will arrange for MRI of the brain and spinal cord, preferably with contrast to reveal new lesions.
There is still debate on whether patients with myelitis should also undergo brain MRI after completing spinal cord MRI.
Typically, T2-weighted imaging is recommended, and it is advisable to discuss and seek treatment with a neurologist.
Wishing you good health and peace.
Dr.
Jiang Junyi, Neurology, is concerned about you.
Basic examinations, along with contrast administration showing new T1-weighted lesions, indicate an acute attack.

Reply Date: 2021/05/02

More Info

Muscle twitches, also known as fasciculations, can be a source of significant anxiety for many individuals, especially when they are associated with neurological concerns. Your description of experiencing muscle twitches, particularly in the context of your previous worries about multiple sclerosis (MS), highlights the complex interplay between physical symptoms and psychological stress.
Muscle twitches can occur for a variety of reasons, and while they can be benign, they can also indicate underlying neurological issues. In your case, the fact that you have undergone tests such as an electromyography (EMG) and have had normal results is reassuring. An EMG can help identify nerve or muscle disorders, and normal results typically suggest that there is no significant nerve damage or muscle disease present. However, it is essential to consider the broader context of your symptoms and any accompanying experiences, such as visual disturbances and muscle fatigue.

The phenomenon of muscle twitching can be exacerbated by several factors, including stress, anxiety, fatigue, and even dietary deficiencies (such as low magnesium or potassium levels). Given that you mentioned experiencing anxiety and a history of worrying about serious conditions like MS, it is plausible that your psychological state may be contributing to the physical sensations you are experiencing. Anxiety can lead to heightened awareness of bodily sensations, making benign twitches feel more pronounced and concerning.

Your description of experiencing muscle twitches at night, particularly as you are falling asleep, is not uncommon. This can sometimes be related to a condition known as hypnic jerks, which are involuntary muscle contractions that occur as a person transitions into sleep. These jerks can be startling and may lead to further anxiety about muscle control and neurological health.
The visual disturbances you mentioned, such as rapid flickering, could also be related to fatigue or stress, particularly if they occur during periods of heightened anxiety. Stress can affect various systems in the body, including the nervous system, leading to symptoms that may mimic more serious conditions.
It is important to maintain open communication with your healthcare provider about your symptoms and concerns. If you feel that your symptoms are persisting or worsening, or if new symptoms arise, it may be beneficial to seek further evaluation. This could include additional neurological assessments or consultations with specialists who focus on neuromuscular disorders.

In the meantime, consider implementing stress-reduction techniques such as mindfulness, meditation, or gentle exercise, which can help alleviate anxiety and potentially reduce the frequency of muscle twitches. Ensuring adequate sleep, hydration, and nutrition can also play a crucial role in managing your symptoms.

Ultimately, while it is natural to worry about serious conditions, it is essential to focus on the information provided by your healthcare professionals and the results of your tests. Many individuals experience muscle twitches without any underlying neurological disease, and with appropriate management of stress and anxiety, these symptoms can often improve. If your concerns continue to weigh heavily on you, consider discussing them with a mental health professional who can provide support and coping strategies.

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