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 twitching in my calf muscle for the past five days. I do not have pain, and the twitching is more significant in relaxing positions. Both the calves are twitching at the same time. Is this something I should be concerned about? I am worried about ALS.
Kindly help.
Hello,
Welcome to icliniq.com.
I understand your concern and explain that your symptoms are not suggestive of ALS (amyotrophic lateral sclerosis). It is a benign fasciculation.
I recommend checking vitamin D and vitamin B12 for possible deficiency and blood electrolytes for possible imbalance. In the meantime, I would recommend taking Magnesium supplements 300 to 400mg daily.
I hope you will find this information helpful.
Kind regards.
Patient's Query
Hello doctor,
Thanks for the reply.
I suffer from anxiety and OCD. Would you mind telling me why it is not an ALS?
Thank you for your reassuring message.
Hello,
Welcome back to icliniq.com.
Yes, I am sure that this is not ALS, as the symptoms have started very quickly, and they are localized in the lower limbs, and there is no muscle wasting or weakness. Anxiety is playing an essential role in this clinical situation. For this reason, I recommend taking plenty of water to stay well hydrated and taking Magnesium supplements.
So, try to relax and do not worry about it.
I hope you will find this information helpful.
Thanks.
Patient's Query
Hi doctor,
Thanks for the reply.
I wanted to update you on what happened overnight and would be keen to get your thoughts.
Today the twitching was still there in both calf muscles, but for the first time, there was pain. The pain from the calf muscles radiated to my foot. My two middle toes went numb for a short time.
Thanks.
Hello,
Welcome back to icliniq.com.
Thank you for the additional information.
Your symptoms suggest a pinched nerve (sciatica), especially if the pain and numbness are more prominent when walking or standing. Otherwise, if the numbness and pain are more noticeable while sitting, it would suggest peripheral neuropathy. I would recommend performing nerve conduction studies and consulting with a neurologist for a physical examination in such a case.
Anyway, numbness and pain are not symptoms of ALS. So, we can completely exclude this diagnosis.
I hope you will find this information helpful.
Regards.
Patient's Query
Hello doctor,
Thanks for the reply.
You have done such a fantastic help to calm my anxiety about this. The only thing that starts when I sit or lie down is the constant muscle twitching. The pain is felt only when walking, and it is on and off. Does that lead you to think of pinched nerves?
Thank you.
Hello,
Welcome back to icliniq.com.
Thank you for the additional information.
Yes, based on your description, I guess this is sciatica (a pinched nerve in the lumbar vertebral column). I recommend you wearing a lumbar brace during the day, avoiding weight lifting and prolonged standing.
If this situation persists, I would recommend performing a lumbar spine MRI (magnetic resonance imaging).
I hope you will find this information helpful.
Regards.
Patient's Query
Thank you doctor,
I wanted to have a follow-up after a few days as I have been making close notes of the symptoms. My GP is unsure of the diagnosis so he has referred me to a neurologist here. There is no pain for the last 4 days but there is a pattern that remains constant. I do not have pain when walking or sitting. I have calf twitches in both calves constantly when lying down or sitting. The twitching stops when walking or calms down dramatically, or at least seems to get reduced when having a hot bath. Now, while walking, my middle toes on both feet go numb at alternate times for a period of about 5 minutes and then come back to life where I get pins and needles as if they are waking up. This lasts for about 20 to 30 minutes and then one or the other foot toes goes numb again. This only happens when walking. My toes do not go numb when sitting or lying down. So when I am at rest my calves twitch and when walking my toes go numb. What to do? Thanks so much.
Hi,
Welcome back to icliniq.com.
Your symptoms are suggestive of restless leg syndrome or benign fasciculations syndrome. Regarding the numbness in the toe, it could be tarsal tunnel syndrome (a pinched nerve). In this regard, nerve conduction studies would help differentiate the above possible causes. You should discuss with your doctor. I remain at your disposal in case of further questions whenever you need me. Wishing you all the best.
Patient's Query
Thank you doctor,
But nothing dramatic in your opinion? I have OCD, so am finding it tough to switch off to this twitching and numbness. Thank you.
Hi,
Welcome back to icliniq.com.
As a neurologist, I would like to reassure you that your symptoms are not suggestive of anything serious. So, try to be relaxed and do not worry about it. Anxiety does not help. Instead, it may worsen muscle twitching, especially during the rest. Hope you will find this information helpful. Please let me know in case of further uncertainties. Wishing you all the best.
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