Dr. Hitesh Kumar
Neurology
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Patient's Query
Hello doctor,
I am a 61-year-old male. About 1.5 months ago, I took a THC/CBD 50/50 ratio tincture. I have done this many times before with no prior symptoms. However, this time I woke up in the middle of the night with what I felt like repeated brain zaps (every minute or so), causing my body to sort of clench every time it happened. This went on for about five minutes before falling back asleep. I stopped taking the substance, and I felt fine, and symptoms did not repeat. However, I decided to take it once more roughly two weeks later and experienced the same phenomenon.
Since then, I have been incredibly anxious. I am feeling lightheaded a lot of the time, difficulty focusing, brain fog. As well, every time before I fall asleep over the last couple of days, right as I am drifting to sleep, my entire body jerks once, and I become immediately awake and alert, causing me to lose sleep. I read online this sounds like a hypnic jerk. However, I wanted to know if this is something serious, possibly. I am not sure if these are symptoms of anxiety or not because they tend to subside when I am distracted by things around me. Attached below is some recent blood work I had done.
Hello,
Welcome to icliniq.com.
I would like to know some further details about your symptoms:
Are you still taking THC/CBD these days? Or your last intake was one month before only? Since how long time you been consuming THC/CBD? Are you taking some other abusive substance too? If yes, please tell.
How is your sleep? Do you get sleepy soon after lying in bed? Or it takes a long time? Once you get sleepy, do you have frequent awakenings during sleep? Do you feel fresh on awakening from sleep in the morning?
How is your usual mood (inner feeling) in day-to-day activities? Happy toward the sad side (thinking about past events), toward the worried side (thinking about future things, irritable, or something else)? How is your appetite? Since when are you taking Propecia, and in what dose? The jerks which you mentioned happen in which body parts? Please specify. Are they always occur in the same body part or varying locations? Do jerks also occur while you are awake and doing your day to day activities?
Once these jerks happen, for how long duration they keep on continuing? Have you noticed any recent changes in your body weight? Your blood work is mostly within the normal range except creatine kinase. Had you got some intramuscular injections, or done heavy exercise, weight lifting before blood work?
Regarding follow up
Patient's Query
Thank you doctor,
No, I no longer take this substance since after my incident. I have done it for about two years before this. I do not take other substances.
I usually feel good, and I go to sleep pretty fast. I feel good after sleeping. However, recently (the last week or so) with my jerks. I am normally pretty anxious. Very worried about things, especially my health, lately. My appetite is good, no concerns.
I am taking Propecia for five years 1 mg per day. These jerks occur throughout my entire body and only at night right before bed. It causes me to almost jump (entire body). However, I will also get occasional leg twitches, arm twitches, etc. The jerks only occur when I am drifting off to sleep. And it is one single jerk to wake me up. But it will happen any time I try to sleep. I have lost roughly 20 pounds in six months. However, this was an intentional weight loss. I like to lift weights and do intense exercise once a day.
Hello,
Welcome back to icliniq.com.
As per your description, there is a possibility that these jerks can be hypnagogic myoclonus. Such jerks can happen in normal individual and get exaggerated in the anxiety state.
As you mentioned, you commonly feel anxious and worried and not feel happy, there may be some underlying psychiatric issue, which needs to be evaluated further. People with the underlying psychiatric issue are more prone to indulge in substance abuse.
The occasional muscle twitchings at arms and legs can be fasciculations, which are also more in an anxiety state. There are some neurological disorders in which such fasciculations happen like benign fasciculation syndrome, cramp, and fasciculation syndrome, motor neuron disease, etc. But your symptoms seem to be related to anxiety.
Investigations to be done
Differential diagnosis
Treatment plan
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Neurology
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