Muscle Twitches in the Back: When to See a Neurologist

Muscle twitching in the back?

My mother has a peculiar issue.
She is about 55 years old and has a fixed point on her back that intermittently twitches.
This has been happening for several years, but the frequency has increased recently, occurring about ten times a day.
Each twitch lasts approximately 3 to 10 seconds and is not painful, except for one instance when she bent over and experienced a slight sharp pain.
Other than that, everything seems normal, and she does not experience any weakness or other symptoms.
However, sometimes when she wakes up, her hands feel a bit stiff and numb, even though she hasn't put pressure on them.
What could be the cause of this? Should she see a neurologist? Thank you.

A Cheng, 50~59 year old female. Ask Date: 2014/04/03

Dr. Gao Chunde reply Neurology

Involuntary muscle twitching at a fixed site is theoretically due to increased excitability of the nerves that control that muscle, which can occur due to factors such as emotional stress, muscle overuse, intake of stimulants in the diet, or nerve instability and damage.
Another possibility is muscle denervation, where the motor neurons that innervate the muscle are dying or have died, commonly associated with motor neuron diseases, often referred to as amyotrophic lateral sclerosis (ALS).
However, this condition typically presents with weakness and is mostly systemic.
It is important to monitor whether the muscle at the fixed point has atrophied or diminished compared to the corresponding muscle on the opposite side, whether there is an increase in the frequency of twitching, or if there are signs of weakness or reduced mobility in other areas.
In such cases, it is advisable to seek further evaluation from a neurologist.

Reply Date: 2014/04/03

More Info

Muscle twitches, also known as fasciculations, can be a common occurrence and are often benign, especially when they are localized and not accompanied by other concerning symptoms. In your mother's case, the twitching in her back that has been present for several years and has recently increased in frequency may not be indicative of a serious underlying condition, particularly since there is no associated pain, weakness, or significant functional impairment.

Fasciculations can occur for a variety of reasons, including:
1. Benign Fasciculation Syndrome: This condition is characterized by persistent muscle twitches without any underlying neurological disease. It is often benign and can be exacerbated by stress, fatigue, or caffeine intake.

2. Muscle Fatigue or Overuse: If your mother has been more active or has engaged in activities that strain her back muscles, this could lead to muscle twitching as a result of fatigue.

3. Electrolyte Imbalances: Low levels of certain electrolytes, such as potassium, calcium, or magnesium, can lead to muscle twitching. Ensuring a balanced diet can help mitigate this.

4. Nerve Irritation: Sometimes, a nerve can become irritated or compressed, leading to localized muscle twitching. This could be due to posture, muscle strain, or even sleeping positions.

5. Anxiety and Stress: Psychological factors can also contribute to muscle twitching. Stress and anxiety can lead to increased muscle tension and twitching.

Regarding the occasional stiffness or tingling in her hands upon waking, this could be related to several factors, including:
- Nerve Compression: This can occur due to sleeping positions that put pressure on nerves, leading to temporary numbness or tingling.

- Circulation Issues: Reduced blood flow during sleep can also cause temporary numbness or tingling sensations.

Given that your mother has experienced these symptoms for several years without significant changes in her overall health, it may not be urgent to see a neurologist. However, if the twitching becomes more frequent, is accompanied by other symptoms (such as weakness, pain, or changes in sensation), or if there are concerns about her overall neurological health, it would be prudent to consult a neurologist.

A neurologist can perform a thorough evaluation, which may include a physical examination, a review of her medical history, and potentially diagnostic tests such as electromyography (EMG) or nerve conduction studies if deemed necessary. These tests can help determine if there is any underlying nerve or muscle pathology.

In summary, while muscle twitches can be concerning, they are often benign, especially in the absence of other symptoms. Monitoring the situation and consulting a healthcare professional if symptoms change or worsen is a reasonable approach. Encouraging your mother to maintain a healthy lifestyle, manage stress, and ensure proper hydration and nutrition can also be beneficial in managing her symptoms.

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