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Suggest treatment for twitching on the hands and thumb

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Posted on Mon, 4 May 2015
Question: Hi, i am a 22yr old male and i am concerned with a couple of symptoms that all started around the same time. First about 2 years ago i started having twitches in my left hand specifically my thumb, then it spread into my left arm then body-wide Fluctuations (small twitches) from an eye lid to my finger to a small part of my calf, basically everywhere sometimes even my face. Then shortly after i began having shocking sensations in my left index finger, it somedays its very bad some days its better. Then my feet started to become numb, extremely mild. but i do feel the pins and needles sensation.
I have had an EMG which noticed the fluctuations and diagnosed me with mild ulnar nerve entrapment and carpel tunnel on both hands. At that time i was also ordered an MRI which was compared to an MRI i had done 6 years earlier and there was no difference. I was still not satisfied i went to a different nuero who ordered an MRI with and without contrast of my Brain and Cervical spine. Again nothing out of the ordinary.
She diagnosed me with Benign Fluctuation Syndrome and told me to get some elbow splints and splint for my wrist to improve those syndromes. I also recently had a Spinal Tap done. I have been a hypochondriac since very young and since this has started it has caused me severe anxiety issues and depression. My question is do you think the nuero should have taken more steps to make sure it was not MS?
doctor
Answered by Dr. Dariush Saghafi (3 hours later)
Brief Answer:
Benign Fasciculation Syndrome

Detailed Answer:
Good morning. I am a neurologist from XXXXXXX Ohio.

I'd like to comment on your case just a little and hope it's helpful.

First, the diagnosis you were most likely given was BENIGN FASCICULATION SYNDROME (BFS). There is no such diagnosis that I'm aware of by the name of Benign FLUCTUATION syndrome.

Secondly, I believe the EMG you had detected FASCICULATIONS (muscle twitches) not FLUCTUATIONS (Marty McFly, Back to the Future and the FLUX Capacitor perhaps?).

Third, from your description of everything and as it has evolved I agree that the best diagnosis right now for your condition is BFS and I will provide you a little POETIC SUPPORT in just a moment which will explain.

Fourth- If you've been detected as having an ulnar neuropathy of some type then, in addition to wrist splints I think a little physical therapy is appropriate- there is a procedure they refer to as Gliding Tendon Therapy that may help that condition so ask about it if you first get a referral to PT. Your neurologist can order that if you ask for it.

Fifth- Yes, the neurologist did all that is recommended...in fact, did more than recommended by doing a spinal tap, in order to rule out MS. Current criteria REQUIRE the presence of at least 1 lesion of demyelination in either the brain or spinal cord and you've got clean studies (TWICE in fact..once with contrast and another time without). In fact, not only have you ruled MS on radiographic bases but you've also ruled out SARCOIDOSIS of the brain which is an MS mimicker.

To make one more point about the workup for MS- there is virtually no more to do in terms of workup to determine whether someone has or doesn't have MS other than a good neurological history, examination, MRI of the brain and spinal cord, and then, the EMG which concluded a fasciculation syndrome. So, I agree with your neurologist.....SORRY--- NO MS FOR YOU TODAY.....kind of like the Soup monger in Seinfeld..remember? NO ZOUP FOR YOU TODAY!

Sixth- Have you checked as far back in your family lineage as possible to see whether anybody else ever had twitches when they were young, bright eyed, and bushy tailed? BFS often times goes away after a few years on its own without any explanation. And people after a while have even come to me WORRIED that they no longer have it....HAHA! Can you believe that one! They start MISSING their twitching...because it's just so normal for them....go figure....

The condition of BFS is very common in young people and here is the POEM that says it all. I hope you enjoy it:


An Ode to Benign Fasciculation Syndrome (BFS)

If it twitches while in song,
If it twitches but it's strong,
If it twitches, twitches,
Twitches, TWITCHES ALL night long.

If it twitches here or there,
If it twitches everywhere,
Yet the fibers do not rustle,
When you go to make a muscle.

And you've been to Doctor 1,
And you've been to Doctor 2,
And you've been to Doctor 3,
But they all just look at you!

And you've done your labs,
Your sticks, your jabs,
And those painful EMG's
To be told you're fine,
You're good- Go home
An allergy to Cheese?

So finally, you arrive at home
And those muscles twitch no less.
Think back to what your Granny said,
"Dear Child- it's BFS!"


If you'd like the history on that poem it came to me after the gazillionth consult I received from people involved in the ALS Bucket Challenge which thankfully seems to have run its course and I hope never comes back! Now, of course, in your case you were thinking in terms of MS...which I agree is almost a much more PLAUSIBLE thing to think about as opposed to ALS for the symptoms you're having. Anyways, the 2nd last line of the poem says that it's the Granny telling the young person "Dear Child-it's BFS!" and that's because the lil 'ole Granny had it herself....It is hereditary in about 40% of cases which is why I asked you if there may be people in your family with twitching.

If these answers satisfactorily answer your question then, I'd appreciate the favor of a HIGH STAR RATING with some written feedback on your part.

Also, closing the query on your end will be most helpful and appreciated so that this question can be transacted and archived expeditiously for further reference by colleagues as necessary.

Please keep me informed as to the outcome of your situation by looking me up at:

bit.ly/drdariushsaghafi

The query has required a total of 29 minutes of physician specific time to read, research, and compile a return envoy to the patient.







Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dariush Saghafi

Neurologist

Practicing since :1988

Answered : 2474 Questions

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Suggest treatment for twitching on the hands and thumb

Brief Answer: Benign Fasciculation Syndrome Detailed Answer: Good morning. I am a neurologist from XXXXXXX Ohio. I'd like to comment on your case just a little and hope it's helpful. First, the diagnosis you were most likely given was BENIGN FASCICULATION SYNDROME (BFS). There is no such diagnosis that I'm aware of by the name of Benign FLUCTUATION syndrome. Secondly, I believe the EMG you had detected FASCICULATIONS (muscle twitches) not FLUCTUATIONS (Marty McFly, Back to the Future and the FLUX Capacitor perhaps?). Third, from your description of everything and as it has evolved I agree that the best diagnosis right now for your condition is BFS and I will provide you a little POETIC SUPPORT in just a moment which will explain. Fourth- If you've been detected as having an ulnar neuropathy of some type then, in addition to wrist splints I think a little physical therapy is appropriate- there is a procedure they refer to as Gliding Tendon Therapy that may help that condition so ask about it if you first get a referral to PT. Your neurologist can order that if you ask for it. Fifth- Yes, the neurologist did all that is recommended...in fact, did more than recommended by doing a spinal tap, in order to rule out MS. Current criteria REQUIRE the presence of at least 1 lesion of demyelination in either the brain or spinal cord and you've got clean studies (TWICE in fact..once with contrast and another time without). In fact, not only have you ruled MS on radiographic bases but you've also ruled out SARCOIDOSIS of the brain which is an MS mimicker. To make one more point about the workup for MS- there is virtually no more to do in terms of workup to determine whether someone has or doesn't have MS other than a good neurological history, examination, MRI of the brain and spinal cord, and then, the EMG which concluded a fasciculation syndrome. So, I agree with your neurologist.....SORRY--- NO MS FOR YOU TODAY.....kind of like the Soup monger in Seinfeld..remember? NO ZOUP FOR YOU TODAY! Sixth- Have you checked as far back in your family lineage as possible to see whether anybody else ever had twitches when they were young, bright eyed, and bushy tailed? BFS often times goes away after a few years on its own without any explanation. And people after a while have even come to me WORRIED that they no longer have it....HAHA! Can you believe that one! They start MISSING their twitching...because it's just so normal for them....go figure.... The condition of BFS is very common in young people and here is the POEM that says it all. I hope you enjoy it: An Ode to Benign Fasciculation Syndrome (BFS) If it twitches while in song, If it twitches but it's strong, If it twitches, twitches, Twitches, TWITCHES ALL night long. If it twitches here or there, If it twitches everywhere, Yet the fibers do not rustle, When you go to make a muscle. And you've been to Doctor 1, And you've been to Doctor 2, And you've been to Doctor 3, But they all just look at you! And you've done your labs, Your sticks, your jabs, And those painful EMG's To be told you're fine, You're good- Go home An allergy to Cheese? So finally, you arrive at home And those muscles twitch no less. Think back to what your Granny said, "Dear Child- it's BFS!" If you'd like the history on that poem it came to me after the gazillionth consult I received from people involved in the ALS Bucket Challenge which thankfully seems to have run its course and I hope never comes back! Now, of course, in your case you were thinking in terms of MS...which I agree is almost a much more PLAUSIBLE thing to think about as opposed to ALS for the symptoms you're having. Anyways, the 2nd last line of the poem says that it's the Granny telling the young person "Dear Child-it's BFS!" and that's because the lil 'ole Granny had it herself....It is hereditary in about 40% of cases which is why I asked you if there may be people in your family with twitching. If these answers satisfactorily answer your question then, I'd appreciate the favor of a HIGH STAR RATING with some written feedback on your part. Also, closing the query on your end will be most helpful and appreciated so that this question can be transacted and archived expeditiously for further reference by colleagues as necessary. Please keep me informed as to the outcome of your situation by looking me up at: bit.ly/drdariushsaghafi The query has required a total of 29 minutes of physician specific time to read, research, and compile a return envoy to the patient.