Muscle Twitches: When to Worry About Neurological Issues

Muscle twitching

Since June of last year, I have been experiencing twitching in my left eyelid.
After a month of this, I visited a neurologist who prescribed muscle relaxants and Riluzole, asking me to observe the symptoms for two weeks before returning for a follow-up.
During those two weeks, the eyelid twitching continued and I also noticed twitching in the corners of my mouth and chin, sometimes accompanied by a tingling sensation.
The doctor performed an electromyography (EMG) of my facial muscles and thyroid tests, all of which returned normal results.
I continued the medication and returned for a follow-up after another month.

Over that month, the facial muscle twitching persisted and evolved into generalized muscle twitching throughout my body.
At this point, I became very concerned about the possibility of a brain tumor or a motor neuron disease.
However, the doctor did not believe it was indicative of any brain growth and arranged for nerve conduction studies, which also returned normal results.
I was advised to monitor my symptoms and return for a follow-up in six months.

When I returned in December, the muscle twitching was still present.
The doctor arranged for a needle electromyography, which also yielded normal results.
I have since noticed that the muscle twitching tends to increase when I cough, exert myself, or cross my legs.
Changing my body position seems to alleviate or stop the twitching, but I am still quite worried about why my left eyelid, mouth corners, and chin continue to twitch frequently, and even my nose bridge seems to pulse like a heartbeat (though others cannot see it).

Is it really unnecessary to worry about this? A few days ago, I experienced dizziness and nausea, and at night, bright lights seemed harsh and uncomfortable.
During the day, my vision often becomes blurry (which resolves after blinking or using eye drops), leading me to overthink my situation.
I expressed my anxiety and concerns to the neurologist, who reassured me that the facial twitching is benign.
The doctor felt that my dizziness and sensitivity to light did not warrant a brain CT scan.

Should I really not worry about potential brain issues, or would it be prudent to pay for additional tests to ease my mind?

MM, 30~39 year old female. Ask Date: 2015/07/08

Dr. Gao Chunde reply Neurology

In fact, muscle twitching is primarily associated with peripheral nerve and muscle issues in the field of neurology, and it is not easily linked to the central nervous system unless there is a confirmed problem with the peripheral nerves, and the lesions point to an invasion of the peripheral nerves by lesions near the central nervous system.
A normal electromyogram (EMG) indicates to the neurologist that there are currently no issues with the peripheral nerves or muscles, which can provide reassurance.
However, other factors such as medications (gastrointestinal, asthma, psychiatric, etc.), metabolic issues (thyroid, caffeine, alcohol, etc.), or electrolyte imbalances (calcium, magnesium, etc.) should still be investigated thoroughly, especially electrolytes.
If these are replenished and the underlying cause is identified, the problem can be resolved.

Reply Date: 2015/07/08

More Info

Muscle twitches, medically known as fasciculations, can be concerning, especially when they persist or spread to different areas of the body. In your case, the twitching began in your left eyelid and has since progressed to your chin and other parts of your body. It is understandable that you are worried about potential neurological issues, such as a brain tumor or motor neuron disease. However, based on the information you provided, it appears that your healthcare provider has conducted a thorough evaluation, including electromyography (EMG), nerve conduction studies, and thyroid function tests, all of which returned normal results.

Muscle twitches can occur for a variety of reasons, and they are often benign. Common causes include stress, fatigue, caffeine intake, dehydration, and electrolyte imbalances. In some cases, muscle twitches can be associated with anxiety or heightened awareness of bodily sensations, leading to a cycle of worry and increased muscle tension. Given that your symptoms have persisted despite normal test results, it is possible that they are related to benign fasciculation syndrome, which is characterized by muscle twitching without any underlying disease.

Your description of the muscle twitching being more pronounced during activities such as coughing or changing positions suggests that it may be influenced by muscle fatigue or tension. Additionally, the fact that you have experienced some visual disturbances, such as light sensitivity and blurred vision, could be related to anxiety or eye strain rather than a serious neurological condition. It is important to note that while these symptoms can be distressing, they do not necessarily indicate a severe underlying problem, especially in the context of normal neurological examinations.

It is also worth mentioning that the presence of anxiety can exacerbate physical symptoms, leading to a heightened perception of bodily sensations. If you find that your anxiety is significantly impacting your quality of life, it may be beneficial to discuss this with your healthcare provider. They may recommend strategies for managing anxiety, such as cognitive-behavioral therapy, relaxation techniques, or lifestyle modifications.

In conclusion, while it is natural to worry about potential neurological issues when experiencing persistent muscle twitching, the normal results from your previous tests are reassuring. It is advisable to continue monitoring your symptoms and maintain open communication with your healthcare provider. If your symptoms worsen or new symptoms arise, do not hesitate to seek further evaluation. However, based on the information provided, there does not appear to be an immediate cause for concern regarding serious neurological conditions. Focus on managing stress and anxiety, and consider discussing any ongoing worries with your doctor to help alleviate your concerns.

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