Muscle Tremors: Possible Causes and Next Steps

Q: Muscle Tremors: Possible Causes and Next Steps

Hello Ms. <br>Li： You mentioned that "the tremor sensation in the left chest almost never stops, and even when I wake up and open my eyes, I start shaking. <br>If I shake my body and legs vigorously, there is a temporary improvement, and it feels like the tremor disappears, but i

Muscle twitching for three weeks?

Hello, doctor.
At the end of 2021, I discovered that my prolactin levels were elevated (29.6), so my obstetrician prescribed cabergoline 0.5 mg, 1 tablet orally once a week, and Yasmin, 1 tablet orally daily.
I started taking the medication on December 29.
On January 4, I experienced severe dizziness, and from the next day, I began to feel dizzy and bloated every day, but I didn't think much of it (I also didn't check my temperature).
On January 15, I had a high fever (along with cold symptoms, and my menstrual period was approaching).
The fever subsided on the morning of January 16, but by evening, I started experiencing mild fever again.
On January 17, I began to have severe palpitations at night (the heartbeat was very loud, making it hard to sleep).
During the day on January 17, I went to the emergency room for an ECG, blood tests, chest X-ray, and KUB, all of which were normal.
On January 18, after taking Inderal 10 mg twice, the palpitations stopped, but that day or the next, I started to feel a severe tremor in my left chest that lasted for 24 hours.
My mild fever has persisted until now, February 4 (mostly around 37.8°C, never exceeding 38.1°C).
An echocardiogram on January 28 was normal, and blood tests (CBC, thyroid function, CRP, and electrolytes) on January 29 were also normal.
The cardiologist suspected it might be related to cabergoline, so I took my last dose on January 26.
As of February 4, I still have mild fever, and the tremor in my left chest hardly stops; I even wake up shaking as soon as I open my eyes.
If I shake my body and legs vigorously, there is a temporary improvement, and it feels like the tremor disappears, but it quickly returns.
However, I hardly feel this in my extremities (though occasionally I feel a tingling sensation in the soles of my feet).
Could this be related to something? Should I see a neurologist? Or do I really need to wait at least two weeks after stopping cabergoline? I'm really going crazy; could you please give me some advice?

Ms. Li, 20~29 year old female. Ask Date: 2022/02/04

Dr. Jiang Junyi reply Neurology

Hello Ms.
Li: You mentioned that "the tremor sensation in the left chest almost never stops, and even when I wake up and open my eyes, I start shaking.
If I shake my body and legs vigorously, there is a temporary improvement, and it feels like the tremor disappears, but it quickly starts again." This may warrant consideration of thyroid dysfunction.
I wonder if, when you discovered the elevated prolactin levels, the obstetrician-gynecologist assisted you in evaluating the structure and function of the pituitary gland.
Additionally, some medications may also trigger tremors in the limbs.
I recommend that you consult a neurologist for discussion and treatment.
Please ensure to practice self-protection, maintain cleanliness and disinfection, and adhere to new preventive health measures before and after your medical visits.
Thank you for your inquiry, and feel free to discuss any related issues further! Wishing you good health and peace.
Dr.
Jiang Junyi, Taoyuan Medical Center, cares about you.

Reply Date: 2022/02/04

More Info

It sounds like you are experiencing a complex set of symptoms that could be related to multiple factors, including the medications you are taking, underlying health conditions, and possibly stress or anxiety. Let's break down your situation and explore potential causes and next steps.

Possible Causes of Your Symptoms
1. Medication Side Effects: Cabergoline, which is used to treat high prolactin levels, can have side effects including dizziness, nausea, and even cardiovascular symptoms like palpitations. The fact that you experienced severe dizziness and heart palpitations after starting this medication suggests that it could be contributing to your symptoms. Discontinuing the medication, as you did, may help alleviate some of these effects, but it can take time for the body to adjust.

2. Hormonal Fluctuations: Since you mentioned that you have high prolactin levels, it's important to consider how hormonal changes can affect your body. Fluctuations in hormones can lead to various symptoms, including mood changes, fatigue, and physical sensations like tremors or shaking.

3. Anxiety and Stress: The combination of physical symptoms and the stress of dealing with health issues can lead to anxiety, which can manifest as physical symptoms such as tremors, palpitations, and dizziness. The mind-body connection is powerful, and anxiety can exacerbate physical symptoms.

4. Infection or Inflammatory Response: Your ongoing mild fever could indicate an underlying infection or inflammatory process. Even if initial tests came back normal, it might be worth investigating further if the fever persists.
5. Neurological Factors: The tremors and sensations in your chest and extremities could also suggest a neurological component. While it may not be the primary cause, it is worth considering if there are any underlying neurological issues that need to be addressed.

Next Steps
1. Consult a Neurologist: Given the persistence of your tremors and the unusual sensations you are experiencing, it would be prudent to consult a neurologist. They can perform a thorough evaluation, including a neurological examination and possibly additional tests such as an MRI or EEG, to rule out any neurological conditions.

2. Monitor Your 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 providers in diagnosing the issue.

3. Follow Up on Fever: Since you have had a persistent mild fever, it may be worth revisiting your primary care physician or an infectious disease specialist to explore potential causes. They may want to conduct further tests to rule out infections or other inflammatory conditions.

4. Consider Psychological Support: If anxiety is a contributing factor, consider speaking with a mental health professional. Cognitive-behavioral therapy (CBT) or other forms of therapy can help manage anxiety and stress, which may, in turn, alleviate some of your physical symptoms.

5. Lifestyle Modifications: Ensure you are maintaining a healthy lifestyle, including proper hydration, nutrition, and sleep hygiene. Gentle exercises, such as walking or yoga, may help reduce anxiety and improve your overall well-being.

6. Wait for Medication Clearance: It may take some time for the effects of cabergoline to fully clear from your system. While it’s important to address your symptoms, it may also be beneficial to give your body some time to adjust after stopping the medication.

Conclusion
Your symptoms are multifaceted and could be influenced by a combination of medication effects, hormonal changes, anxiety, and possibly an underlying infection. It is essential to work closely with your healthcare providers to explore these avenues and find a resolution. Don’t hesitate to seek help from specialists, and remember that it’s okay to ask for support during this challenging time. Your health and peace of mind are paramount.

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