Muscles, ligaments & amp; Tendons

Muscle twitching - muscle twitching

Muscle twitching - muscle twitching


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Muscle twitching can be a completely harmless symptom, but it can also be related to various serious illnesses. The intensity of the muscle twitching is extremely variable according to the different causes. It ranges from barely perceptible twitching of individual muscle fibers and bundles to twitching of the entire muscle with movement effect. A medical examination of the complaints is strongly advised, especially in the case of repeated occurrence and muscle twitching with movement effects.

Definition

Muscle twitching in the broadest sense means all involuntary contractions of individual muscle fibers, muscle bundles, muscles as well as the simultaneous contraction of numerous muscle groups, such as in the context of an epileptic seizure. A distinction is made between the various forms in so-called fibrillations (twitching of individual muscle fibers, without movement effect), fasciculations (twitching of individual muscle bundles, noticeable but without any noteworthy movement effect), myoclonus (twitching of the muscle; with or without movement) and tremor (twitching of several muscle parts with regular tremors) as a movement effect). The so-called myokymia, in which a contraction wave passes through individual muscles without triggering movement, can also be assigned to the muscle twitches.

Symptoms

Depending on the extent of the muscle twitching, the symptoms can vary considerably. For example, while fibrillations can only be recognized with the help of special examination methods, tremors can often be easily recognized even by medical laypersons due to the clear tremor of individual parts of the body. The fasciculation is often seen in the twitching of individual muscle bundles in the facial area, such as twitching of the eyelid. The myoclonus usually appear as twitching of several muscles and is often accompanied by a significant movement effect. They can be observed, for example, in epilepsy, but also with a tick.

A tremor arises from the increased involuntary rhythmic contraction of different muscle groups and their opponents, but here too there are clear differences between the various forms of tremor. For example, a distinction is made between the resting tremor and the action tremor, depending on the circumstances in which the symptoms mainly occur. The extent of the muscle twitching and possibly accompanying symptoms often provide important information about the cause of the symptoms. Therefore, in connection with the description of the causes of muscle twitching, there is also a more detailed explanation of the respective symptoms.

Causes

First of all, a distinction must be made between the pathological forms of muscle twitching and the more harmless muscle twitches, such as the so-called benign fasciculation. While the former are an expression of a disease, the latter is often assumed to be related to psychological factors such as increased stress. Muscle twitches without an underlying disease are uncomfortable for those affected, but harmless from a health point of view.

Tick

One of the best-known forms of muscle twitching is the so-called tick, in which the contraction of individual muscles or muscle groups leads to involuntary movements such as blinking the eyes, raising the eyebrows or even more complex movements. The cause of a tick is suspected to be malfunctioning of the nervous system or, above all, disorders of the basal ganglia, which is why the complaints are assigned to the so-called extrapyramidal hyperkinesias (movement disorders that do not arise in the pyramidal system).

In rare cases, however, patients suffering from brain inflammation also develop a tick. In addition, a connection with the so-called striatofrontal dysfunction is discussed, which describes a disturbance of the control circuit in the frontal brain and striatum. As a rule, the tick is not associated with further health threats. However, more pronounced forms of a tick, which in addition to the involuntary movements can also be accompanied by involuntary vocalizations (for example in the context of Tourette syndrome), are usually a considerable burden for those affected in everyday life, which can lead to further psychological complaints.

Epilepsy

Uncontrolled, seizure-like muscle twitches are one of the main symptoms in the various forms of epilepsy. The muscles suddenly start to cramp due to causes not yet fully known. A real firework of neuron discharges takes place in the brain of those affected, which leads to false signals to the muscles. What triggers the disturbances in the brain remains largely unclear - despite significant research success in recent years. It is certain that special neurotransmitters play an important role here. However, the circumstances under which epilepsy develops from one-time seizures remains uncertain. However, genetic predisposition seems to be important for all epileptics.

Possible causes of so-called symptomatic epilepsy include, for example, congenital damage to the brain, malformations of the brain tissue or even brain tumors. For example, if a patient suffers a severe traumatic brain injury in an accident, this can also lead to the development of symptomatic epilepsy. Inflammation of the brain, such as that caused by viral (e.g. measles, TBE, hepatitis C) or bacterial (e.g. borreliosis, meningococcal) infectious diseases, may also be associated with epileptic seizures. In addition, pathological changes in the blood vessels in the brain, such as those that occur during calcification of the arteries, should be considered as a possible cause of symptomatic epilepsy.

Occasional seizures, which are accompanied by significant muscle twitching, but in the narrower sense are not to be classified as epilepsy, can be caused, for example, by high fever, a massive hypoglycaemia in diabetes or by the abuse of drugs, medication and alcohol. In the case of alcohol, both acute alcohol poisoning and withdrawal after many years of use are sometimes accompanied by epilepsy-like seizures.

Another cause of occasional seizures is a shift in the mineral content in the organism. For example, if the potassium level in the blood rises sharply (hyperkalaemia) or the calcium concentration in the blood increases as part of hyperparathyroidism (dysfunction of the parathyroid glands with increased hormone secretion), muscle twitching and seizures are a possible consequence. In people with pronounced photosensitivity, occasional epileptic seizures are also triggered by extremely bright light pulses or the rapidly changing light-dark contrast (for example, flashing light in the camera or stroboscope in discotheques).

The intensity and duration of the epileptic seizure can vary significantly depending on the various causes and can range from localized seizures without impairing consciousness to severe seizures of the whole body, with temporary loss of consciousness and unwanted loss of urine and stool. The acute attack is usually over after a few minutes, but in severe cases it can last significantly longer than 20 minutes. In the course of the seizure, the patients often suffer secondary injuries from the sudden, uncontrolled fall to the floor and / or the extreme tension in the muscles. Damage to the brain is also threatened by the massively increased concentration of the neurotransmitters.

Nervous system disorders

The most well-known neurological disorder, which is accompanied by muscle twitching and a conspicuous tremor (tremor), is Parkinson's disease. Damage to the extrapyramidal-motor nervous system shows symptoms such as a general slowdown in movements (bradykinesis), muscle stiffness (rigor), changes in posture and a noticeable tremor. In the course of the disease, the complaints become increasingly severe, and further ailments such as muscle and joint pain or so-called sensations (numbness, tingling in the limbs) can be added. Even in the early stages of the disease, many sufferers show an impaired sense of smell. Bladder dysfunction and indigestion are other common symptoms associated with Parkinson's disease.

There are also various physical complaints, depending on the individual course of the disease. In addition to physical impairments, Parkinson's patients often suffer from various psychological complaints, such as a general lack of drive, a slowing down of thinking processes and restrictions in cognitive abilities up to dementia.

Another neurological disorder that can lead to muscle twitching is amyotrophic lateral sclerosis (ALS), the cause of which remains largely unclear to this day. In the course of this fortunately extremely rare disease, the nerve cells that control muscle movement are increasingly irreversibly damaged. Impairments of the muscles can depend on the affected nerve cells, muscle weakness to the point of muscle loss or increased muscle tension up to spasticity.

Often, those affected show accompanying symptoms such as swallowing problems, speech disorders and an insecure gait. In the further course, paralysis of the muscles also impair the respiratory function. Those affected have no prospect of a cure and usually only have a few years to live after the diagnosis.

As a central nervous system disorder, Creutzfeldt-Jakob disease can cause muscle twitching and even epileptic seizures. So-called pathological prions lead to pathological changes in the tissue structures in the brain and a subsequent death of the nerve cells. The disease became known in the wake of the BSE scandal that struck Great Britain in the 1980s and 1990s, and subsequently Germany as well. In cattle, the prions had triggered the so-called mad cow disease and it quickly became suspected that a newer variant of the transmissible Creutzfeldt-Jakob disease could be related to the consumption of beef contaminated with BSE.

In general, three different variants of Creutzfeldt-Jakob disease are distinguished: sporadic prion disease, genetic prion disease and the transmissible Creutzfeldt-Jakob variant. Both the sporadic and the communicable variant of the disease usually lead to the death of the patient within a few months. In the genetically determined variant, the course of the disease can extend over a significantly longer period after the outbreak (usually several years).

In the early stages of Creutzfeldt-Jakob disease, those affected often initially suffer from psychological problems such as fear and panic attacks, mood swings or even depression. Delusions can also occur in the course of Creutzfeldt-Jakob disease. Over time, those affected become increasingly restricted in their cognitive and motor skills. Memory disorders are one of the typical mental impairments and muscle twitches are considered a characteristic motor disorder. The eyesight of those affected is also often affected.

In the later course of the transferable variant, many sufferers also suffer from painful sensations, dizziness, nausea and vomiting. The extent of the motor impairments usually increases continuously and the muscle twitches often increase in the further course up to regular epileptic seizures. Due to the incorrect control of the muscles, many sufferers also suffer from severe body aches. In the course of Creutzfeldt-Jakob disease, the brain is increasingly destroyed and appears to be perforated like a sponge in the end stage. At this stage, those affected are no longer able to communicate with their fellow human beings and are often completely unable to move.

Vegetative dystonia

Disorders of the vegetative nervous system in the form of so-called vegetative dystonia are also associated with muscle twitches. The interaction between the sympathetic and parasympathetic as well as the information processing in the diencephalon is impaired in those affected, which in addition to muscle twitching can lead to numerous different complaints such as heart problems in the form of heart stumbling, rapid heartbeat, heart pain and tightness in the chest, or shortness of breath, headache and dizziness . Stomach problems - especially indigestion, stomach pressure and stomach pain or abdominal pain - are also considered possible symptoms of vegetative dystonia.

Furthermore, those affected often feel uneasy, they are easily irritable and often nervous. Sometimes there is a general lack of drive and the increased occurrence of panic attacks or existential fear. Vegetative dystonia is a relatively unclearly defined complaint to this day, which makes it difficult to make a clear diagnosis and has often given rise to criticism in specialist circles. There is no organic cause of the symptoms in vegetative dystonia, and serious health problems are generally not expected.

Other causes of muscle twitching

In addition to the causes of muscle twitching already mentioned, numerous other factors can be considered as triggers of the symptoms. For example, high fever can cause involuntary muscle contractions in the form of so-called febrile convulsions. Fasciculations can also be observed as late effects of polio in the context of the so-called post-polio syndrome. If the liver's detoxification function is impaired, this can lead to brain damage due to the increased concentration of chemical compounds such as ammonia or gamma-aminobutyric acid in the organism (hepatic encephalopathy). This in turn brings complaints such as muscle twitches in the form of myoclonus and tremor or progressive muscle breakdown.

The so-called serotonin syndrome, which is caused by a long-term increase in the concentration of the neurotransmitter serotonin and similar substances, can also be considered as a trigger for muscle twitching. This results in cognitive impairments as well as motor malfunctions, such as muscle twitching and tremors. The syndrome is often caused by the interaction between different drugs. Long-term therapies with special psychotropic drugs (neuroleptics) are considered to be a potential cause of motor disorders in the form of so-called late dyskinesias, which in turn can be associated with involuntary muscle contractions. An addiction to opiates can also cause massive muscle twitches if withdrawn accordingly.

If people suffer from a pronounced magnesium deficiency, this can lead to impaired muscle function such as muscle cramps (usually calf cramps) and muscle twitching. Most of the time, due to the magnesium deficiency, those affected are plagued by numerous other complaints, such as chronic fatigue, headaches, regular falling asleep in the hands and feet or back pain. Sodium deficiency or insufficient sodium in the blood (hyponatremia) can also be accompanied by muscle twitching in the form of myoclonus, tremor and, in extremely severe cases, even epileptic seizures.

However, not only the lack of required minerals should be considered as a possible cause of the muscle twitching, but also an excessive concentration of certain substances can cause the symptoms. For example, in Wilson's disease, the copper metabolism in the liver is disturbed, which results in an increase in the copper concentration in the organism. This in turn brings with it numerous complaints, which can also include muscle twitches in the form of tremors, rarely even epileptic seizures. If the carbon dioxide concentration in the blood increases (hypercapnia), muscle twitching and muscle spasms, in addition to changes in the skin's appearance (noticeable reddening) and cardiac arrhythmia, are among the possible consequences. A massive increase in carbon dioxide leads to impaired consciousness up to coma.

Furthermore, a pinched nerve can cause twitching of the muscles in the supply area of ​​the affected nerve due to the disturbed signal transmission. In the event of severe hypothermia, the body tries to stabilize its temperature through muscle twitching (trembling) and ultimately chills are just a special form of muscle twitching. A possible cause for the twitching of individual muscles, such as a nervous twitching of the eyelid, is also psychological stress, such as grief or stress.

Diagnosis

A detailed survey of the patients about the intensity of the muscle twitching, the affected muscles, already known previous illnesses, the taking of medicines and other potentially nerve-damaging substances often gives the first indications of the cause of the complaints. In the course of a subsequent physical examination, tests of reflexes, stimulus transmission or sensibility, balance, coordination and muscle strength can provide further important clues for the diagnosis.

A blood test in the laboratory is used to determine whether there are metabolic diseases, deficiency states or too high a concentration of certain substances in the organism and can also provide important information about possible infections or inflammatory processes. Special additional examination methods are used depending on the suspected cause of the muscle twitching. For example, the so-called L-Dopa test is used to determine Parkinson's. Electroneurography (ENG; measurement of nerve conduction speed) and electromyography (EMG; measurement of electrical muscle activity) are used to identify nerve damage. Electroencephalography (EEG) can be used to determine the electrical activity in the brain and thus, for example, the readiness of the brain for epileptic discharges.

Modern imaging methods such as functional magnetic resonance imaging (fMRI) enable a more detailed analysis of brain functions and other special examination methods, such as positron emission tomography (PET), are used for the targeted examination of neurological failures. Magnetic resonance imaging and computed tomography can generally make a significant contribution to the diagnosis. If in doubt, inflammation of the brain or meninges may require a lumbar puncture, in which a sample of the cerebrospinal fluid (cerebrospinal fluid) is taken.

If it is not possible to determine the physical causes of muscle twitching using the diagnostic methods available, a psychological examination may be appropriate to check whether the symptoms are related to psychological factors.

Treatment

If the muscle twitches are based on physical causes, the therapeutic options are often extremely limited and only a relief of the symptoms - but no cure - can be achieved. For example, therapy for Parkinson's is aimed at slowing the course of the disease as far as possible, but those affected are not cured of their illness. In epilepsy, treatment is designed to prevent the onset of seizures, but here too, patients have had no prospect of fully overcoming their disease.

If the symptoms are due to deficiency symptoms, such as a magnesium deficiency, the increased supply of the necessary minerals via the food can help the muscle twitching to subside. Appropriate preparations from the pharmacy are used for severe deficiency conditions. If the concentration of potassium or other substances that can cause muscle twitching is too high, the aim is usually to lower the corresponding blood values ​​with medication while at the same time reducing the supply of the substances via food. If a bacterial infection is the cause of febrile seizures or inflammation of the brain, antibiotics can usually lead to promising cures. In the case of viral infections, however, the treatment option is rather limited and those affected are significantly more dependent on their self-healing powers. If a connection between the muscle twitches and the intake of medicines is suspected, these should be discontinued urgently or possible alternative preparations should be used instead.

Behavioral therapies are a widely used approach to treat tick disorders and are sometimes used in vegetative dystonia. In general, psychotherapeutic procedures can often be used to achieve comprehensive treatment success for mentally induced muscle twitches. In the case of severe forms, accompanying drug therapy comes into play. In the event of a tick disorder, this can also be used to suppress involuntary muscle movements (with the help of neuroleptics). Ultimately, there is a wide range of treatment options available that can at least alleviate the symptom of muscle twitching, even if the cause can often not be remedied.

Naturopathy

Naturopathy offers a number of promising approaches, particularly for psychologically induced muscle twitches, but also for incurable diseases such as Parkinson's disease that can contribute to relief. In accordance with the holistic approach of naturopathy, a whole bundle of different measures is often used to deal with the complaints at different levels. In Parkinson's, for example, movement or physiotherapy is used to counteract the motor impairments.

In addition, manual procedures such as osteopathy or massages and acupuncture can be used for this purpose. Various homeopathic remedies (e.g. Antimonium tartaricum, Agaricus muscarius) and Schüssler salts (e.g. No. 2 Calcium phosphoricum, and No. 7 Magnesium phosphoricum) are used internally to treat Parkinson's symptoms, with the choice of suitable remedies being reserved for experienced therapists should and the preparations can vary greatly depending on the constitution of the patient. With accompanying speech therapy, the language and swallowing problems that can be expected in the later course of the disease can also be prevented.

In the case of stress-induced muscle twitches, naturopathy uses psychotherapeutic measures that include learning special stress avoidance or coping techniques (e.g. autogenic training), as well as herbal active ingredients that are intended to counteract the nervousness and inner restlessness of the patient. Valerian, passion flowers and hops are particularly worth mentioning here. Different homeopathic remedies, such as Aconitum, Cocculus, Coffea or Zincum metallicum, can also be used against nervous muscle twitches, although the selection of suitable remedies is ideally in the hands of experienced therapists.

According to the various causes that can be the reason for muscle twitching, numerous other naturopathic treatment approaches are possible, ranging from relatively simple to implement nutritional therapeutic measures and hydrotherapy procedures to more complex methods that, for example, generally strengthen the immune system.

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Geogr. Fabian Peters

Swell:

  • Claudio L. Bassetti, Marco Mumenthaler: Disorders of Muscle Tone (Muscle Tension), Neurological Differential Diagnostics, Thieme Verlag, 6th edition, 2012
  • CE Elger, R. Berkenfeld (shared first authorship) et al .: S1 guideline, first epileptic seizure and epilepsy in adulthood, 2017, In: German Society for Neurology, ed. Guidelines for Diagnostics and Therapy in Neurology, (accessed October 6, 2019 ), DGN
  • M. Deschauer et al .: S1 Guideline Diagnostics of Myopathies, 2016, In: German Society for Neurology, Ed. Guidelines for Diagnostics and Therapy in Neurology, (accessed October 6, 2019), DGN
  • David Tanen: Serotonin Syndrome, MSD Manual, (accessed October 6, 2019), MSD

ICD codes for this disease: R25.2ICD codes are internationally valid encryption codes for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.


Video: Chronic muscle spasms and tightness caused by loose ligaments - Danielle Matias, PA-C (November 2022).