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What Causes Severe Involuntary Muscle Spasms And Contractions?

Posted on Tue, 28 Oct 2014

Question: I am a 54 year old male that is experiencing severe muscle spasms, contractions, and involuntary muscle movements. This happen after a period of rest. The longer the rest, or sleep, the more severe the reaction. It started in the legs a few years ago, but has grown exponentially in the past year. I did have a heart attack 4 years ago and had a stent set in place. The leg twitching started at least a year before the attack. I have been taking small amounts of testosterone supplements for about 10 years. These were not of the prescription variety. I have been on and off of these, the 40mg of Crestor, and 4 mg of Coversyl and there is no difference in intensity. I was prescribed 50mg of Sertaline with no affect on these symptoms. It did however calm my temper slightly and increase my sex drive. The muscle contractions and the extreme fatigue that they contribute to tend to counteract the sex drive. About a year before the heart attack I was an extremely fit, athletic man. I started to feel a slight decline in ability before the attack (likely due to the blockage). I did feel I had recovered to about 3/ of what would be expected after an attack, but the increased fatigue of the past year is getting worse to the point I sleep immediately after a 1 hour medium intensity bike ride (without much choice in the matter) . 5 years ago I had no need to sleep after 3 hours of high intensity riding. I have been checked for rhumatoid arthritis and it was negative. The hormonal imbalance shown on a blood test a few months ago, and the likely reason given by my physician as the case, is no longer, yet my symptoms are still here. There was no change in any medication, diet, or testosterone supplementation during this period. Can you help?

Answered by Dr. Suresh Heijebu (1 hour later)

Brief Answer:
Testosterone related adverse effects

Detailed Answer:
Hi Sir,
I have carefully read your query and understand your concern.

The current symptoms of restlessness in your legs along with feelings of fatigue can be strongly attributed to the testosterone supplementation.

The onset of sudden heart attack in a previously healthy individual can also be linked to testosterone.

I advice you to stop using testosterone at once now because of its serious long term side effect profile.

Rheumatoid arthritis has no link to your current problem.

Get screened yourself for iron deficiency and complete renal profile to evaluate the impact of testosterone use.

Drugs like benzodiazepines are the main stay of treatment.
These also dramatically improve the sleep pattern.

Iron salts to correct any associated iron deficiency anemia.

Sertraline should not be used as it can exacerbate restless leg syndrome.

Note these drugs have to be taken only under strict medical supervision.

Avoid coffee and alcohol.
Have regular exercise
Have whirlpool bath and vibratory stimulation to both your feet before sleep.

These measures can rapidly improve the clinical outcome.

I hope this info is helpful to you,
Thank you

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Suresh Heijebu (5 hours later)

My family physician diagnosed testosterone use as the cause of hormonal imbalance which in turn was causing the muscle contractions. Recent blood work reveled that the hormone levels are now normal, yet the problem persists. I was also off of the supplement for about three months with no change. I have researched on line and with a number of other local users and there is no mention of this side affect from testosterone supplement. Can I ask what studies were done to come to this conclusion? I want to stress this is not just RLS. Every muscle in my body is prone to these contractions and it leaves me quite sore. The smallest of movement that are performed to quickly when in bed can trigger them. You reference to benzodiazepines is to treat iron deficiency? Renal problems? Neither of these has been an issue throughout. I do not see the side affect of RLS contribution on the full sheet supplied from the pharmacy. Would you please elaborate on this? The increase in intensity from RLS to full body does somewhat coincide with the decision to try the Sertraline. This was prescribed because my cardiologist and family physician both felt my muscle weakness and fatigue was caused primarily by depression. I'm afraid it's the other way around. Incidentally, I chose to try it less than a year ago even though my attack was 4 years ago. I have been in the gym for 22 years with documented workouts. My strength has dropped about 25% and my endurance by 40% since the attack

Answered by Dr. Suresh Heijebu (6 hours later)

Brief Answer:
Benzodiazepines are indicated to counteract spasms

Detailed Answer:
Hi Sir
welcome back.

Let me first clarify that RLS is a wide spectrum disease not alone restricted to legs as cited in the name.

RLS can be primary or secondary in nature.

You seem to have overlapping features of secondary RLS with testosterone induced disordered muscle biochemical features .

RLS is also frequently associated with depression and altered mood pattern.

Hence you may not always find it as a direct contribution from your
testosterone pharmacy full sheet.

Steroids can paradoxically with unclear mechanisms reduce the protein synthesis within the muscle fibers,reduce the carbohydrate content in the muscle,mitochondrial alterations,electrolyte disturbances and increased protein degradation and abnormal muscle excitability.

This can lead to abnormal muscular spasms and involuntary contractions.

Of course depression can contribute to weakness and fatigue and sertraline can be indicated,but having said that this drug can cause sustained muscle cramps as their predominant side effect due to its anticholinergic action.

Hence I recommended you to stop this drug.

Instead escitalopram can be substituted for sertraline for its better safety profile.

Benzodiazepines are mainly indicated in your case to combat the muscle spasms and to improve the sleep pattern but not for iron deficiency or renal issues.
They are first choice drugs in all such cases.

Correction of iron deficiency if any can help to hasten the recovery.

I hope this will be helpful to you,
Post your further queries if any.
Thank you

Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj