Q. I get random twitches in biceps, back of legs, and calf muscles. Do these indicate ALS?

Answered by
Dr. Sudheer Ambekar
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Aug 29, 2020 and last reviewed on: Nov 13, 2020

Hello doctor,

I am a 39-year-old male. I am inquiring about some symptoms that I have been having for about two weeks. I have had random muscle twitches throughout the day. It seems to have started in my right biceps. Sometimes, I will feel it in my left biceps, back of my leg, and calf. I was recently admitted because my sodium was 120 and with admission I got back to normal. My potassium was only slightly low. A recent vitamin B12 check showed my level at 117. I have read so many bad things on the internet about what twitches could mean, like Parkinson's, or ALS . Now I am really worried. Is it possible that it could be the low vitamin B12 causing my symptoms? I started taking 2500 mcg Vitamin B12 when I got my result two weeks ago. If it is vitamin B12, how long could it take to get back to normal?

I am using Famotidine 20 mg, Lotrel 5/10, and vitamin B12 2500 mcg, and vitamin D.



Welcome to

There are many causes of muscle twitches, the common ones being anxiety, low potassium and also low sodium. In fact, muscle twitches can occur despite all the parameters being normal as well. Since, you said you were admitted for low sodium level, may I ask if the doctors found a cause as to why the levels were low?

ALS (amyotropic lateral sclerosis) is a rare condition and one should rule out commoner causes of muscle twitches before thinking of ALS.

Thank you doctor,

They could not pinpoint a reason for why the levels were so low. My primary care physician seems to think it was a lab error because my level was at 134 shortly after being admitted from the emergency department. In fact, the hospital doctor ordered another sodium test once I was admitted and even made the comment that it could possibly be an error because I had no symptoms of low sodium. I initially went to the ER because I was having heart palpitations. He did say that it was possible that I was very dehydrated. The twitching is not constant, however, it does happen randomly throughout the day. Sometimes, I do not feel it at all. Sometimes I will feel my finger twitch and it moves just slightly and sometimes my lip or eye will twitch. It just scared me really bad.



Welcome back to

Please do not read the stuff on google and imagine things. As long as your primary care physician does not think of ALS, you do not have it. In ALS, physical exam is of utmost importance. If you want to be sure, you could do nerve conduction studies. However, in your case, I would be concerned if there is an increase in the frequency and pattern of twitching associated with thinning of legs or hands. Otherwise, I would not think in terms of ALS.

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