Dr. Gursimran Singh
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
Hi doctor,
I have cramps in my calf and thigh for three months. Now I have twitching in my legs. I am anxious regarding ALS. Does this twitching occur constantly in ALS? Will it disappear while moving? Currently, I am taking Levothyroxine.
Hi,
Welcome to icliniq.com.
Kindly mention your age. Please mention whether these cramps occur on one side or both sides of the thigh and calf. Twitching in ALS (amyotrophic lateral sclerosis) occurs inconsistently and it usually appears while we tap the muscles. You can have many more symptoms. The frequency of cramps also gets increased and twitching also occurs in the shoulder.
Patient's Query
Thank you doctor,
I am 53 years old. My cramps got started three months back. I get them in my calf while sitting and watching TV. Sometimes, I will get them in my legs while sitting or exercising. My twitching got started before five weeks. Before a couple of weeks, I went to the doctor and he looked at my leg and tested its strength. He told me that I do not have any weakness. I searched my symptoms online. I got the diagnosis of ALS. I also read that twitching can occur consistently and it does not disappear even after moving. But it disappears when I walk.
Hi,
Welcome back to icliniq.com.
I understand your concern. Please answer my questions. Please mention whether the cramps and twitching occur on both the legs and thighs or in the shoulder. Please mention whether you have any problem in swallowing liquids. On ALS, legs, thighs, and arms tend to be weak but the power remains normal. Vitamin D deficiency is one of the prevalent causes of twitching and cramps. You can take over-the-counter vitamin D. To confirm it, you need to do EMG (electromyography) and NCV (nerve conduction velocity). Your history does not suggest ALS but ALS progresses slowly. Twitching occurs in various parts of the body such as calves, back of the shoulder, and tongue.
Patient's Query
Thank you doctor,
The cramps occurred spontaneously in the right calf and thigh. After that, twitching occurred in my calf and thigh at rest. I do not have any problem in swallowing. Is this due to vitamin D deficiency? Can it occur in one leg? I have an underactive thyroid. After getting cramps, I went to the doctor and he told me that it is not due to thyroid and it will not occur in one leg alone.
Hi,
Welcome back to icliniq.com.
Everything seems to be fine. Vitamin D deficiency or benign fasciculations or twitching occurs in one place alone. It gets subsided within a month or two after taking vitamin D supplements or decreased anxiety or after decreasing caffeine. Benign twitching can occur in some other place with a gap of a few months. Thyroid can cause generalized twitchings. It is good to take vitamin D supplements, reduce your caffeine intake and do yoga to reduce your anxiety. Wait for two weeks to get good results.
Patient's Query
Thank you doctor,
Does benign fasciculation cause any localized muscle cramps and twitching?
Hi,
Welcome back to icliniq.com.
Twitching is the other name of fasciculations. Cramps are not a part of benign fasciculation syndrome. It can occur due to vitamin D deficiency. You can ask your doctor to assess your tap-induced fasciculations around the shoulder and calf. You can check your plantar response and tone of your legs. It can get increased and plantar response can get extended if there is a problem. You can also check for tongue fasciculations.
Patient's Query
Thank you doctor,
I went to the doctor yesterday. She checked my body condition. She tested my muscle strength and reflexes. I think that she did a Babinski test on the soles of my feet. She used a blunt instrument with some pressure. She asked about my swallowing and speech. She told me that everything seems to be normal. I started to have cramps and fasciculations before a month. Please suggest.
Hi,
Welcome back to icliniq.com.
New symptoms with cramps and fasciculations can occur in patients with ALS. There is no induced twitching and so it seems to be good. Kindly take vitamin D supplements.
Patient's Query
Thank you doctor,
Do these reflexes look abnormal? Can I have weakness after three months of getting cramps? Would my plantar response and tone of the leg seem to be abnormal at this stage? I am still running every day by doing physical exercise and yoga? Can I have twitching due to anxiety? I have a twitching present only in my one leg. Does electrolyte imbalance cause symptoms in one leg?
Hi,
Welcome back to icliniq.com.
Regarding ALS, these reflexes seem to be abnormal. Weakness does not occur within three months and it comes later. You can have changes in plantar reflexes and tones. But it depends on the patient. If you are going well, then ALS is ruled out. Electrolyte imbalance and anxiety can cause twitching. If you have anxiety issues, then it has to be treated accordingly. Try to do deep breathing exercises. Please take vitamin D supplements or stand in sunlight for few minutes every day in the morning. Have a follow-up after a month.
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