What is causing that twitching in your muscles?

Dr. Jerry Fleishman of Medstar Franklin Square Medical Center
Dr. Jerry Fleishman of Medstar Franklin Square Medical Center (John J Coyle Jr / handout)

Ever sit in a chair and feel twitching in your eye? Or maybe your calf muscle. You may suffer from benign fasciculation syndrome.

Dr. Jerry Fleishman of Medstar Franklin Square Medical Center talks about how to manage the condition.


What is benign fasciculation syndrome?

It is a neurological disorder characterized by fasciculations, or twitching of various voluntary muscles in the body.


What are the symptoms of the syndrome?

Since many times this is a chronic disorder, it may lead to a variety of other signs and symptoms that might include generalized fatigue, muscle pain, exercise intolerance, or paresthesias, which is the prickly, burning, pins and needles, tingling feeling. The disorder also can cause muscle spasms, cramping, muscle stiffness, myoclonic jerks (a sudden, involuntary muscle spasm), itching or shakiness in the muscles. Additionally, symptoms may include those of anxiety such as globus, which is the sensation of having something stuck in the back of the throat. Headaches or shortness of breath also have been associated with this condition.

The symptoms may last for months or even years. In some cases, symptoms may linger or may come and go with periods of remission, while other times the symptoms may be prominent. In some instances, remission periods may become longer over time with symptomatic episodes occurring less and less.

The symptoms and severity differ from person-to-person.

What causes the twitching, numbness or tingling that people with the condition have?

By definition, BFS is idiopathic, which means that there is no known cause. There are certain medications that may trigger fasciculations but do not cause BFS. These may include Dramamine, Benadryl, Sudafed, Nortriptyline, Ritalin, or beta agonists of which the latter are a class of medications that are commonly used to relax the muscles of the airways and result in easier breathing in those people whom may have a history of asthma, bronchitis or emphysema, for example.

Fasciculations also may be due to trauma or an injury or may be symptoms of anxiety or depression. Some studies have suggested that there is a link to other stress-related conditions such as irritable bowel syndrome, heartburn and headaches. There are also some people who lack certain minerals, including magnesium or calcium, who also may develop fasciculations or even muscle cramps. Fasciculations also have been linked to strenuous exercise, alcohol, cigarette smoking, fatigue, excessive caffeine intake or in the setting of an underlying sleep disorder.

What body part is the twitching more likely to occur?

Twitching most often occurs in the calves and thighs but can occur almost anywhere in the body. Fasciculations or twitching of muscles may appear randomly or may persist in one muscle for an extended period of time. Fasciculations will be most noticeable when the body is at rest. There may be associated pain in the affected muscle.

The disorder is often confused with ALS, or Lou Gehrig’s disease. What is the different between the two diseases and how do you determine which one it is?

It is a distinctly different disorder from ALS. A major symptom of ALS is muscle wasting when muscles atrophy or become smaller over time. The person with ALS will begin to feel weaker as the condition progresses. People with ALS are many times not aware of their fasciculations and see their physician because of increasing weakness and reduced mobility that limit normal daily activities.

Many people with BFS fear that their condition can turn into ALS, but several large studies have not supported a link between these two conditions.


What is the treatment?

There is currently not a cure. Supplements and other complementary approaches can help manage this syndrome. A reduction in the fasciculations may be achieved with different classes of medications including beta blockers, anti-seizure medications, muscle relaxers or anti-inflammatory medications.

Supplements also may be helpful. For example, if it is felt that these fasciculations are caused by magnesium or calcium deficiency, then supplementing with magnesium or calcium may be effective in reducing symptoms. Reducing daily stress also can help with symptoms.

Is it something that can get worse over time?

The syndrome causes no long-term physical damage. Spontaneous remission has been known to occur, and in cases where anxiety is thought to be a major contributor, symptoms are typically lessened after the underlying anxiety is treated.

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