Muscle Twitches and Weakness: A Neurological Perspective

Muscle twitching and weakness?

Hello, doctor.
For the past 5 or 6 days, I've been experiencing muscle twitching starting from my left calf, and now it has spread throughout my body, including my soles, face, and neck, with the primary area being my calves.
Sometimes the twitching is mild, while at other times it is quite pronounced.
My feet also tend to feel numb, and when I stretch them, it feels like I might cramp.
Upon waking, my calves are sometimes stiff, as if they are cramping.
Recently, when I got out of bed and tried to walk forward, my right leg felt weak, and I ended up falling to the ground.
There have been instances where I tried to stand up from bed but ended up sitting back down.
Additionally, I have difficulty swallowing; it feels like water gets stuck in my esophagus.
My hands feel somewhat weak when I make a fist.
In January, I read an article about amyotrophic lateral sclerosis (ALS), which frightened me and made me start paying attention to other symptoms.
Recently, I've noticed phlegm in my throat, and when I gargle or chew, my mouth easily feels sore.
Taking large bites makes it hard to chew, and when I lightly tap my upper front teeth with my lower front teeth, they tremble.
Climbing stairs makes my legs feel weak and fatigued, and I experience shortness of breath.
When walking, the front of my feet tends to drag, making me feel like I might fall.
While sitting, my feet feel like they are constantly shaking, and I find myself stretching and yawning frequently.
After inhaling, I feel like I suddenly release my breath, and my exhalations become shorter.
Speaking feels like it requires more effort from my throat.
My hands also feel fatigued during activity, and sometimes my fingers twitch.
When I exert myself, my hands shake, and I find it difficult to use chopsticks.
I tend to drop small objects easily.
My dominant right hand has a flatter thenar muscle compared to my left, but the muscle in the web space is more prominent, although it feels softer than it did three weeks ago.
Additionally, while reading, my eyelids tend to blink involuntarily, and I become easily startled by sounds.
Last November, I had shingles, and since then, I still experience a sensation on my back similar to goosebumps.
I also occasionally have headaches and scalp numbness.
I am currently 180 cm tall and weigh 77 kg.

Lin Xiansheng, 20~29 year old female. Ask Date: 2016/03/01

Dr. Lan Shengxing reply Neurology

Mr.
Lin suggests that you visit a neurologist for a thorough examination.
The incidence of amyotrophic lateral sclerosis (ALS) is extremely low, and sometimes these symptoms can also appear in individuals who are prone to anxiety.
A detailed examination to rule out any concerns is advisable.
- Lan Shengxing

Reply Date: 2016/03/01

More Info

Hello, thank you for sharing your concerns regarding the muscle twitches and weakness you have been experiencing. It sounds like you are going through a challenging time, and I want to provide you with some insights based on the symptoms you've described.

Muscle twitching, also known as fasciculation, can occur for a variety of reasons. It can be benign and related to stress, fatigue, or even caffeine intake. However, when accompanied by muscle weakness, it raises the concern for underlying neurological conditions. The symptoms you mentioned, such as the twitching in your calves, the feeling of weakness in your legs, and the difficulty swallowing, warrant a thorough evaluation by a healthcare professional, particularly a neurologist.

From a neurological perspective, muscle weakness can manifest in different ways. It can range from a mild decrease in strength, where you may feel that you are unable to exert your usual force, to a more severe form where you cannot lift or move a limb at all. The fact that you have experienced episodes of your legs giving way and the sensation of stiffness or cramping upon waking are significant and should not be overlooked.

The symptoms you describe, including the difficulty swallowing and the sensation of your throat feeling obstructed, could indicate involvement of the muscles that control swallowing, which are innervated by the lower motor neurons. This could potentially point toward a neuromuscular disorder, such as amyotrophic lateral sclerosis (ALS), which you mentioned. However, it is essential to note that ALS is a rare condition, and many other factors could explain your symptoms.

Given that you have already undergone several tests, including electromyography (EMG) and nerve conduction studies, and if these tests have not indicated any significant abnormalities, it may be worthwhile to consider other diagnostic avenues. For instance, further imaging studies, such as MRI of the brain and cervical spine, could help rule out structural causes of your symptoms. Additionally, a referral to a neuromuscular specialist may provide more targeted insights into your condition.

It's also important to consider the psychological aspect of your symptoms. Anxiety and stress can exacerbate physical symptoms, leading to a cycle of worry and increased muscle tension. If you find that your anxiety is significantly impacting your daily life, discussing this with a mental health professional could be beneficial. They can help you develop coping strategies and may suggest therapies that can alleviate some of the physical manifestations of anxiety.

In summary, while your symptoms are concerning and warrant further investigation, it is crucial to approach this situation holistically. Continue to work closely with your healthcare providers, and do not hesitate to seek a second opinion if you feel it is necessary. Keeping a detailed log of your symptoms, including when they occur and any potential triggers, can also be helpful for your doctors in diagnosing your condition. Remember, early intervention can make a significant difference in managing any potential underlying issues. Take care, and I wish you the best in your journey toward understanding and improving your health.

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