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What now?
Dear Doctor(S),
I appreciate the help you provide the public with this great web page.
This is my question: in November of last year I started to have muscle twitches all over my body. A month later my ankles and feet began to hurt. I also felt muscle cramps in my calves and a pain that radiated all along my ring and little fingers of both hand and up to the elbows. I felt a similar kind of pain on the sides of my little toes upmy ankle and calves. I felt my hands and feet were swollen, red, and weak.I also felt (still do tingling in both feet and hands). My endocrinologist ( I Hashimoto's disease) ordered some bloodwork to check muscular enzymes and to check for lupus, rheumatoid arthritis, etc. All tests were normal except for a high IGg count "suggesting a chronic inflammatory condition). I also saw a neurologist who ordered an emg/nerve conduction test last week. The emg was normal. I do not get as many twitches as before, but they seem to be more deep in the muscle, and moving the whole muscle. I was pain-free for about a month but now the pain is back. I also feel that my hands are slightly stiff when I write, and I feel my ankles and knees are also slightly stiff when I walk. I have noticed that when I take antihitaminics, I feel almost normal (although the twitching does not go away).
I would like to now if 1)The emg absolutely rules out a neuromuscular cause for my symptoms, and 2)what other possible conditions may be causing these symptoms? 3)What does it sound to you like?
I am 36, male, graduate student, in otherwise good health. I neither smoke nor drink.
I appreciate your clinical thoughts.
Sincerely,
Al
I appreciate the help you provide the public with this great web page.
This is my question: in November of last year I started to have muscle twitches all over my body. A month later my ankles and feet began to hurt. I also felt muscle cramps in my calves and a pain that radiated all along my ring and little fingers of both hand and up to the elbows. I felt a similar kind of pain on the sides of my little toes upmy ankle and calves. I felt my hands and feet were swollen, red, and weak.I also felt (still do tingling in both feet and hands). My endocrinologist ( I Hashimoto's disease) ordered some bloodwork to check muscular enzymes and to check for lupus, rheumatoid arthritis, etc. All tests were normal except for a high IGg count "suggesting a chronic inflammatory condition). I also saw a neurologist who ordered an emg/nerve conduction test last week. The emg was normal. I do not get as many twitches as before, but they seem to be more deep in the muscle, and moving the whole muscle. I was pain-free for about a month but now the pain is back. I also feel that my hands are slightly stiff when I write, and I feel my ankles and knees are also slightly stiff when I walk. I have noticed that when I take antihitaminics, I feel almost normal (although the twitching does not go away).
I would like to now if 1)The emg absolutely rules out a neuromuscular cause for my symptoms, and 2)what other possible conditions may be causing these symptoms? 3)What does it sound to you like?
I am 36, male, graduate student, in otherwise good health. I neither smoke nor drink.
I appreciate your clinical thoughts.
Sincerely,
Al
Dear Tom:
The fasciculations would not respond to the NSAID. Fasciculation are caused by irritation of the muscle, the tendon problem was helped by the indomethicin.
CCF Neuro MD
The fasciculations would not respond to the NSAID. Fasciculation are caused by irritation of the muscle, the tendon problem was helped by the indomethicin.
CCF Neuro MD
Dear CCF Neuro MD,
Your April 9 post states "most likely it was inflammation of the nerve." I am assuming this response is directed to my post of April 7. If so, thank you.
My question now is, should I just continue with the Indomethacin, or should I be looking for a cause of the nerve inflammation? Also, could the nerve inflammation be a cause of the muscle twitches?
The first course of indomethacin was ten days, and after it ran out I stopped for about two days and the symptoms came right back. My doctor's office called in another ten days, and upon resuming the indomethacin the symptoms are back under control. I don't really want to be on indomethacin long-term, as I understand it has some undesirable gastric side affects.
Anyway, I will leave this up to my primary doctor, but I would be interested in any comments you might have.
Thank you again!
Tom
Your April 9 post states "most likely it was inflammation of the nerve." I am assuming this response is directed to my post of April 7. If so, thank you.
My question now is, should I just continue with the Indomethacin, or should I be looking for a cause of the nerve inflammation? Also, could the nerve inflammation be a cause of the muscle twitches?
The first course of indomethacin was ten days, and after it ran out I stopped for about two days and the symptoms came right back. My doctor's office called in another ten days, and upon resuming the indomethacin the symptoms are back under control. I don't really want to be on indomethacin long-term, as I understand it has some undesirable gastric side affects.
Anyway, I will leave this up to my primary doctor, but I would be interested in any comments you might have.
Thank you again!
Tom
Dear Al:
Likely it was inflammation of the nerve.
CCF Neuro MD
Likely it was inflammation of the nerve.
CCF Neuro MD
Al,
I noticed your a few weeks ago, because I was having many of the same symptoms (although no tingling). It started about a year ago with periodic episodes of what I perceived as weakness in my legs, mostly left side. I then began having lots of muscle twitching all over my body. The muscles actually kind of "jump". A couple months after the periodic episodes of weakness, I began having pain in or near my left achilles tendon. It felt like cramping, but would come and go. Extremely painful at times. I've had an EMG and neuro exam, both normal. The neuro doc told me the fasciculations were normal, just ignore them.
Then a couple weeks ago I began developing severe pain in the bottom of my right foot, about the same frequency as the pain in left tendon. It was extremely painful and I was having difficulty walking because of it. I went to my primary care MD, she said it was plantar fascitis, and put me on indomethacin.
Well, the indocmethacin seemed to clear everything up. The fasciculations did not disappear completely, but became much less frequent.
My only question now is what the underlying condition might be that would be so dramatically helped by indomethacin. Maybe the neuro forum docs have some ideas.
Regardless, I am simply glad to be feeling so much better. You might mention this to your doc and try the indomethacin.
Good luck.
I noticed your a few weeks ago, because I was having many of the same symptoms (although no tingling). It started about a year ago with periodic episodes of what I perceived as weakness in my legs, mostly left side. I then began having lots of muscle twitching all over my body. The muscles actually kind of "jump". A couple months after the periodic episodes of weakness, I began having pain in or near my left achilles tendon. It felt like cramping, but would come and go. Extremely painful at times. I've had an EMG and neuro exam, both normal. The neuro doc told me the fasciculations were normal, just ignore them.
Then a couple weeks ago I began developing severe pain in the bottom of my right foot, about the same frequency as the pain in left tendon. It was extremely painful and I was having difficulty walking because of it. I went to my primary care MD, she said it was plantar fascitis, and put me on indomethacin.
Well, the indocmethacin seemed to clear everything up. The fasciculations did not disappear completely, but became much less frequent.
My only question now is what the underlying condition might be that would be so dramatically helped by indomethacin. Maybe the neuro forum docs have some ideas.
Regardless, I am simply glad to be feeling so much better. You might mention this to your doc and try the indomethacin.
Good luck.
Dear Sarah:
Yes, an unilateral babinski would be more worrisome than bilateral. Alot depends on the etiology. Usually, the finding of a babinski sign is abnormal. However, it can be seen in patients who are very nervous and/or tickelish, and unless the neurologist takes his/her time, it might be thought of as a Babinski. Assuming that you were not nervous or overly tickelish, and your neurologist is a good neurologist, then the finding of a babinski sign would indicate some lesion in the motor tracts, some place from the motor cortex through the spinal cord. Yes, it might be from a birth injury. Without other neurological signs, I would not be too worried. I would wait for the brain MRI, and that may be telling as far as the eitology.
Sincerely,
CCF Neuro MD
Yes, an unilateral babinski would be more worrisome than bilateral. Alot depends on the etiology. Usually, the finding of a babinski sign is abnormal. However, it can be seen in patients who are very nervous and/or tickelish, and unless the neurologist takes his/her time, it might be thought of as a Babinski. Assuming that you were not nervous or overly tickelish, and your neurologist is a good neurologist, then the finding of a babinski sign would indicate some lesion in the motor tracts, some place from the motor cortex through the spinal cord. Yes, it might be from a birth injury. Without other neurological signs, I would not be too worried. I would wait for the brain MRI, and that may be telling as far as the eitology.
Sincerely,
CCF Neuro MD
Is a bilateral babinski a better finding then a unilateral one. I have a bilateral babinski's sign that was found during a routine neuro for headaches. The neuro said the headaches were tension and not related but that he needed to do MRI's. The cervical spine was normal and I am having a scan of the brain. There seems to be a lot of contraversy over this and whether a normal subject can have this sign. My doctor said he thought it could be an old injury from birth since I have no other neurological signs.
Maybe one of the doctors here could explain what type of injury could cause this and whether it can be benign? Since its not in the cervical area, where else in the brain would it have to be? I know that a mass & MS have not be ruled out, but I was told that it's not likely since other then a very high level of anxiety over this I feel fine!
P.S. This is a wonderful site and very helpful to many people! Thank you
Maybe one of the doctors here could explain what type of injury could cause this and whether it can be benign? Since its not in the cervical area, where else in the brain would it have to be? I know that a mass & MS have not be ruled out, but I was told that it's not likely since other then a very high level of anxiety over this I feel fine!
P.S. This is a wonderful site and very helpful to many people! Thank you
Dear Lavon:
Thanks for your comment. The one caveat to your problem was the focal abnormality on neurological exam. This is unlike the original poster. An abnormal neurological exam is always a worrisome sign, and even with a normal EMG would signal a problem.
Sincerely,
CCF Neuro MD
Thanks for your comment. The one caveat to your problem was the focal abnormality on neurological exam. This is unlike the original poster. An abnormal neurological exam is always a worrisome sign, and even with a normal EMG would signal a problem.
Sincerely,
CCF Neuro MD
I am hesitant to put in my 2 cents worth but would like to comment on the idea that a negative EMG relieves concern. I too started out with weakness, cramps, fasciculations and plantar fasciaitis. I did develop hyperactive reflexes and an upgoing left Babinski as well as perceived "stiffness" in my left hand and my legs. My EMG was normal as was my LP and various lab tests. Rather than a non worrisome diagnosis I find myself faced with a Primary Lateral Sclerosis verdict- everything but the neuro exam negative. I realize this is really rare but had I stopped looking I'd still be wondering what was wrong and what I could do. Lavon
Dear AL:
There is something called monoclonal gammopathy (in your case monoclonal IgG) that can cause a peripheral neuropathy. However, if it was causing problems you would have seen a change on EMG as it causes axonal degeneration. I would just do as what your neurologist is doing, watch it. Since you have no EMG changes, I do not think this is causing your problems.
Sincerely,
CCF Neuro MD
There is something called monoclonal gammopathy (in your case monoclonal IgG) that can cause a peripheral neuropathy. However, if it was causing problems you would have seen a change on EMG as it causes axonal degeneration. I would just do as what your neurologist is doing, watch it. Since you have no EMG changes, I do not think this is causing your problems.
Sincerely,
CCF Neuro MD
This is weird because I have been having the same thing for a month.
Initially they started out slowly, with only minor twitching and jerking all
over my body, then they got so bad that I was jerking all over, in fact in my
doctors office he commented that it looked somewhat like seizures. After several days
of that, they calmed down a little bit, and now I am back to having minor twitches all over,
with occasional violent spasms, which sometimes wake me up at night. I thought they were getting
better, so I did not go to my doctor again, but they are still bad, so I will probably go back
this week. I am 22 years old and a college senior with a number of other health problems
including gastroparesis and prolonged qt. When this all started, I had a fever and bad headache
and neuro responded below and also told me it could be related to a virus. I have a tendency to
get weird viruses because of a weakened immune system, so this would not be a suprise (I had the parvo
virus in September and had a weird response...bruising all over my body, muscle and bone pain
plus a rash and fever, and flulike symptoms...after several days of stress not knowing whether it was
leukemia, I was eventually told it was parvo). I have not wanted to go back to my doctor though
because if I have to go back for these spasms, he is going to start running tests which I don't have the time
for and they don't sound pleasant anyway. He talked about doing a test where they put needles in my
muscles to measure something? I don't remember much about what he said about it. My brief neurological
exam was normal. Does anybody know about this test they are talking about doing? I
want to know what it's like and what they would be looking for. Also, I have been having a lot
of severe headaches since the spasms started, and I rarely have headaches. The headaches have
been significantly better this past week. Is this related to spasms?
Thanks.
Initially they started out slowly, with only minor twitching and jerking all
over my body, then they got so bad that I was jerking all over, in fact in my
doctors office he commented that it looked somewhat like seizures. After several days
of that, they calmed down a little bit, and now I am back to having minor twitches all over,
with occasional violent spasms, which sometimes wake me up at night. I thought they were getting
better, so I did not go to my doctor again, but they are still bad, so I will probably go back
this week. I am 22 years old and a college senior with a number of other health problems
including gastroparesis and prolonged qt. When this all started, I had a fever and bad headache
and neuro responded below and also told me it could be related to a virus. I have a tendency to
get weird viruses because of a weakened immune system, so this would not be a suprise (I had the parvo
virus in September and had a weird response...bruising all over my body, muscle and bone pain
plus a rash and fever, and flulike symptoms...after several days of stress not knowing whether it was
leukemia, I was eventually told it was parvo). I have not wanted to go back to my doctor though
because if I have to go back for these spasms, he is going to start running tests which I don't have the time
for and they don't sound pleasant anyway. He talked about doing a test where they put needles in my
muscles to measure something? I don't remember much about what he said about it. My brief neurological
exam was normal. Does anybody know about this test they are talking about doing? I
want to know what it's like and what they would be looking for. Also, I have been having a lot
of severe headaches since the spasms started, and I rarely have headaches. The headaches have
been significantly better this past week. Is this related to spasms?
Thanks.
Yes. The elevated IGg was Monoclonal in nature. What does that mean or suggest? How would that differ from polyclonal?
THanks.
AL
THanks.
AL
I can sympathize with your symptoms because I to have been through the same thing. I have been twitching for about 6 months now with a negative neurological evaluation that included a negative EMG. I was wondering if anyone can comment as to the nature of a fasciculation that last longer than most. I have had one in my shoulder that has gone on for 12 days now pretty much non-stop. There doesn't appear to be any weakness just this annoying twitch. I actually had an EMG done in this shoulder 2 months ago. Are longer lasting fascics something to be concerned about? Ant responce from anyone would be appreciated.
Thank You...
Thank You...
Dear AL:
The negative EMG test is very reassuring that your disease is not worrisome, like ALS, or late onset muscle disease. Was the increased IgG called monoclonial in nature? I am assuming that the neurological examination was normal. There is an entity called benign fasciculations which give you muscle twitches or fascicultations without muscle weakness. We do not know what causes it. It is benign because it does your body little harm, but your psychological well being is another story. The fasciculations get better than worse, are made worse by anxiety and fatigue. They can last for weeks, months, or many months. They will usually go away on their own. I would bet that this is what you have.
Sincerely,
CCF Neuro MD
The negative EMG test is very reassuring that your disease is not worrisome, like ALS, or late onset muscle disease. Was the increased IgG called monoclonial in nature? I am assuming that the neurological examination was normal. There is an entity called benign fasciculations which give you muscle twitches or fascicultations without muscle weakness. We do not know what causes it. It is benign because it does your body little harm, but your psychological well being is another story. The fasciculations get better than worse, are made worse by anxiety and fatigue. They can last for weeks, months, or many months. They will usually go away on their own. I would bet that this is what you have.
Sincerely,
CCF Neuro MD
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