Dr. Aida Abaz Quka
Neurology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I have had strong, persistent twitching in my left calf for over a week, sometimes with intermittent twitching in thigh, foot and buttock of the same leg. I am very concerned about this. I had a neurological exam (strength and reflex testing) at my general practitioner (GP), and he said all looked normal or good or no loss of strength or unusual reflexes. He ordered blood tests, and they have not come back yet, awaiting results. I have been exercising strenuously for the past few months and wonder if it could be exercise-related, but feel alarmed that it is on one side. Two weeks ago, I did not see a stair, stumbled and fell on my left hand, hurting my elbow, which has been in pain too. Physiotherapist hypothesizes this fall could have also brought on the twitch. I am seeking advice as I am quite scared that it could be a severe neurological condition since I twitch about once every three seconds, sometimes even more, and it has only let up for a few hours before coming back in the same calf and part of the muscle. I have not noticed any real weakness aside from slightly wobbly feeling legs (but can still do a full workout on the gym, walk on heels and toes without difficulty, etc.). Mainly the anxiety is keeping me awake and probably making it all worse. My muscles feel tight and compressed at the moment, from calf up to left hip or buttock.
Hello,
Welcome to icliniq.com. I passed carefully through your question and would explain that the twitching in this calf could be related to a twisted muscle or a pinched nerve (considering the straining physical activity that you have been doing lately and the falling). I would recommend performing nerve conduction studies and a lumbar spine X-ray study to exclude a possible pinched nerve or a bulging disc in the lumbar vertebral column. I would also recommend checking calcium, blood electrolytes, and vitamin D plasma levels for possible deficiency and inflammation tests like complete blood count, PCR (polymerase chain reaction), ESR (erythrocyte sedimentation rate). I hope you will find this answer helpful. I remain at your disposal for any further questions whenever you need.
Patient's Query
Thank you doctor,
I am very worried it could also be ms and have been having crippling anxiety over this. Does the fact that I am relatively young and do not have weakness or abnormal reflexes make that very unlikely? I am making myself sick with worry and have been sleeping very poorly. Also now I have twitching in the thigh and buttock associated with a bit of soreness. It does feel like it could involve the sciatic nerve, but I do not know. I suppose I am asking for some short term relief for my anxiety and the discomfort until I can see a neurologist. Can I let go of my worry and try to address the pain and anxiety in some way? I am worried since it is on one side only and not all over.
Hello,
Welcome back to icliniq.com. I understand your concern and would explain that your symptoms are not suggestive of ALS (amyotrophic lateral sclerosis) or MS (multiple sclerosis). The fact that your motor force is normal and healthy reflexes, can help exclude these two disorders. Anxiety is indeed playing an essential role in all this clinical situation, as it is well known to trigger fasciculations by increasing adrenaline levels. Anyway, we can not exclude a sciatic nerve involvement, because you have fallen. For that reason, I recommended performing a lumbar spine X-ray, and maybe later a lumbar spine magnetic resonance imaging (MRI) to exclude a bulging disc in the lumbar region, which could cause sciatica. From the other hand, nerve conduction studies would help exclude ALS or a pinched nerve. I hope you will find this information helpful. In case of any further questions, please do not hesitate to ask me again.
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Neurology
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