Muscle Twitches, Cramps, and Weakness: Neurological Issues - Neurology

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Involuntary muscle twitching, cramping, weakness in the left leg, and difficulties in walking?


Hello Dr.
Jiang! For the past three to four months, I have been experiencing involuntary muscle twitching, particularly noticeable on the left side of my body compared to the right.
My left leg tends to cramp when I intentionally tense it, and I also experience cramping in my palms when I exert force with my thumbs towards my palms.
The same situation occurs with my index fingers (both hands are affected).
When I sneeze, I feel cramping in the upper abdomen near the ribs.
My left leg feels weak, and I have difficulty lifting it to walk, which causes me to stumble and have unstable standing.
I find it hard to lift my left ankle.
I have already sought medical attention at a hospital, where I underwent two tests: 1.
A nerve conduction study (which showed no significant abnormalities) and 2.
Blood tests (which also showed no significant abnormalities).
The first prescription was for medication to repair spinal damage, taken once a day (but there was no improvement).
During my second follow-up, I informed the doctor of the lack of improvement, and he replied that he couldn't help further.
I would like to ask Dr.
Jiang for advice on what I should do next.
I sincerely appreciate any suggestions you can provide (I live in Taichung and my hospital is in the North District).

KUAKE, 40~49 year old female. Ask Date: 2021/10/02

Dr. Jiang Junyi reply Neurology


Hello Mr.
CooK: You mentioned that "when the palm is open and the thumb is pushed towards the palm, it can also cramp.
The same situation applies to the index finger (both hands can experience this), and sneezing can cause cramps in the upper abdomen near the ribs." This may warrant consideration of abnormalities in the neural structures from the cervical spine up to the brain, leading to upper motor neuron symptoms.
It would be more accurate if there are signs of upper motor neuron involvement such as enhanced tendon reflexes, the Hoffmann sign, or the Babinski reflex.
The most common cause is cervical degeneration causing spinal cord compression.
In addition to medication, rehabilitation therapy should also be included.
You mentioned "the hospital you visit in Taichung is in the northern district," which I assume means you are seeking medical care in Taichung? If the hospital you are visiting is a regional-level or higher facility, there is no need to worry too much.
I suggest that you consistently visit the same hospital, perhaps consulting different specialists who can examine and treat you from various perspectives.
If you wish to seek a second opinion, please prepare the complete records from your previous hospital for the expert's reference.
Thank you for your inquiry, and feel free to discuss any related questions! Wishing you good health, peace, and happiness.
Dr.
Jiang from Taoyuan cares about you.

Reply Date: 2021/10/02

More Info


Muscle twitches, cramps, and weakness can be concerning symptoms, especially when they appear suddenly or worsen over time. Based on your description, it seems you are experiencing involuntary muscle contractions, particularly on the left side of your body, along with weakness and difficulty in movement. These symptoms can be indicative of several underlying neurological issues, and it’s essential to approach them systematically.

Firstly, muscle twitches (also known as fasciculations) can occur for various reasons, including stress, fatigue, dehydration, electrolyte imbalances, or even benign conditions like benign fasciculation syndrome. However, when accompanied by muscle cramps and weakness, it raises the suspicion of more serious conditions, such as peripheral neuropathy, motor neuron disease, or other neuromuscular disorders.

Your recent tests, including nerve conduction studies and blood tests, have not shown significant abnormalities, which is a positive sign. However, the persistence of your symptoms suggests that further investigation may be warranted. Here are some potential next steps and considerations:
1. Further Neurological Evaluation: Since your symptoms are localized and have not improved with initial treatment, it may be beneficial to consult a neurologist who specializes in neuromuscular disorders. They may recommend additional tests, such as an electromyography (EMG) to assess the electrical activity of your muscles and help identify any abnormalities that might not have been evident in the nerve conduction studies.

2. Consider Structural Issues: Given that you mentioned a history of spinal issues, it might be worthwhile to investigate any potential structural problems in the spine that could be compressing nerves. An MRI of the cervical or lumbar spine could provide insights into any herniated discs or spinal stenosis that might be contributing to your symptoms.

3. Electrolyte and Nutritional Assessment: Sometimes, muscle cramps and weakness can be exacerbated by deficiencies in essential nutrients, such as potassium, magnesium, or calcium. A comprehensive metabolic panel can help assess your electrolyte levels. Additionally, ensuring adequate hydration and nutrition is crucial for muscle function.

4. Physical Therapy: Engaging in physical therapy can be beneficial. A physical therapist can design a tailored exercise program to strengthen your muscles, improve coordination, and enhance stability, which may help mitigate the risk of falls and improve your overall mobility.

5. Monitor Symptoms: Keep a detailed log of your symptoms, including when they occur, their intensity, and any potential triggers. This information can be invaluable for your healthcare provider in diagnosing the underlying issue.

6. Mental Health Considerations: Chronic physical symptoms can often lead to anxiety and depression, which can further exacerbate physical symptoms. If you are experiencing significant stress or anxiety related to your health, it may be helpful to speak with a mental health professional.

7. Second Opinion: If you feel that your current healthcare provider is unable to offer further assistance, seeking a second opinion from another neurologist or specialist might provide new insights or alternative treatment options.

In conclusion, while your initial tests have not revealed significant abnormalities, the persistence of your symptoms warrants further investigation. A comprehensive approach that includes neurological evaluation, potential imaging studies, nutritional assessment, and physical therapy may help identify the underlying cause and improve your symptoms. It’s essential to communicate openly with your healthcare providers about your concerns and work collaboratively to find a solution.

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