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    What causes fasciculations in feet, hands and chin?

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Posted on Wed, 1 Jun 2016 in Brain and Spine
Question: I have been experiencing fasciculations mainly in the calfs, but also in the feet, hands a little and yesterday very briefly in the chin. the GP yesterday did some tests on me, which she said were normal. they included babinski test, seeing how quickly I could move legs up and down agaisnt each other, using brushes, pens and other implements against my feet to see how good my responses were. i dont have weakness in my muscles, but they are stiff, and the fasciculations are getting worse and spreading. i also have red ear syndrome most days in one ear for about an hour, and headaches to the right of the occiput and around the ear. i am on propanolol for anxiety, amlodopine and candersatan for high bp. are these symptoms connected, is she right to say i dont have motor neurone disease. i am 55, male, and ct, mri scans and ent specialist, cardiologist and endocrinoligist have conducted tests in the last few months which were all negative. most seem to think my fasciculatations are due to stress/anxiety/depression.
doctor
Answered by Dr. Olsi Taka 1 hour later
Brief Answer:
Motor neuron disease unlikely

Detailed Answer:
I read your question carefully and I understand your concern.

I understand you are frustrated for having been found a tangible cause for your symptoms, but you should also feel relieved that the tests have not evidenced anything serious.

Regarding your worry about having motor neuron disease I do not think it is likely. As the name suggests motor neuron disease affects nerve cells conveying signals to muscles. As there is no impulse from the nerves supplying them, the muscles start to atrophy and develop weakness. So what I am trying to say is that weakness is the main feature of motor neuron disease, something which you say not to have. The lack of atrophy, Babinski sign or other abnormalities on neurologic exam further supports that.

Fasciculations are a symptom of motor neuron disease but they develop on top of the weakness and atrophy. So especially since they are so widespread as you describe some weakness or atrophy would be present. Actually them being so widespread is more against that diagnosis as motor neuron disease usually is much more insidious, starting in one region initially and only later gradually involving other regions progressively.

As for other possibilities I suppose since you have been to a endocrinologist you have already excluded metabolic causes (thyroid dysfunction, magnesium, calcium, potassium alterations etc).

In this setting I would tend to agree with your doctors that the most probable cause is benign fasciculation syndrome whose most common trigger is indeed anxiety. Probably something in addition to propranolol may be tried, like a benzodiazepine for a few weeks, magnesium supplements often result helpful as well.

One might consider the possibility of adding an ENMG (electromyography and nerve conduction studies) to the other tests you've had, not so much for motor neuron disease but for other neuromuscular conditions such neuromyotonia (very rare), but most probably won't reveal anything worrying.

I remain at your disposal for other questions.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka 22 hours later
Thank you for your reply. i think I should mention that my leg muscles have been quite stiff and I feel unsteady on them,which did not use to be the case, although I can walk around and exercise quite easily. also i have been getting feeling of tingling and pins and needles in my feet, especially over my left big toe last joint. on extension it feels as if the nerve is being pulled.this is getting worse. also i have an uneasy feeling either side of my spine at the back just where the last ribs exit.you are correct the endocrinologist did many tests including one for paeochromocytoma, which were all normal. i have been getting depressed and lacrimose too, especially in the mornings. i understand that this can be a symptom of motor neurone disease, but i also know that i have become more than overly worried that I have a serious illness since I lost my mother to a brain tumour last may and my father to a heart attack one week later. thank you for all your help and advice.
doctor
Answered by Dr. Olsi Taka 6 hours later
Brief Answer:
Read below.

Detailed Answer:
Thank you for the additional update.

My opinion remains the same though, if anything it reinforced my conviction that you do not have motor neuron disease (MND). Apart from the lack of weakness and atrophy, confirmed by your being able to exercise normally, these pins and needles, tingling sensations are not characteristic of MND. These are sensitive symptoms while MND as the name suggests affects motor neurons sparing the sensitive ones. The uneasy feeling in the spine hasn't much to do with MND either.

As for the depression and emotional lability being part of MND, yes they may be, but when they do it is usually at advanced stages when other signs are evident. Anyway certainly they are not something to lead to that diagnosis, it is a very rare cause of depression, certainly not the first thing to think about in front of a depressive patient.

Let me know if I can further assist you.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Olsi Taka 2 days later
thanks once again for your response. I have also in the last few nights experienced a slowly tightening jaw, which has stopped me sleeping. the dentist says i have been grinding my teeth too. i have taken nytol to help me sleep, but this doesnt always work. i find it very difficult to sleep, often waking at 3 to 4am and unable to get back to sleep. the insomnia has been going on for months, but the the jaw tightening only a few days. i dont know how long the grinding has been going on. do you think that taking a benzodiazepan, amitryptiline, or sertraline would be a good idea, as this is what various people have suggested (some different doctors). do you think these symptons are all down to stress/anxiety/depression? also I have been getting red ear syndrome most days, ie the right ear goes red except for the lobe, for no apparent reason once a day roughly for an hour or two. it is not because of temperature change, touching, or change of posture. is this connected in any way to the jaw grinding and tightening? many thanks once again for your continuing input.
doctor
Answered by Dr. Olsi Taka 8 hours later
Brief Answer:
Read below.

Detailed Answer:
Hello again.

Regarding the issues with the jaw tightening, teeth grinding, sleeping difficulties etc I would still say that anxiety is a likely cause. As I said before since you have had so many other tests it could be considered to have an EMG as well for other neuromuscular disorders like neuromyotonia, but I am positive nothing important will come out of it (in particular no ALS).

I do think you should take additional medication apart from propranolol as I suggested in my first answer. As to the choice of medication usually it is started with both an antidepressive (amitriptyline, sertraline, citalopram etc) as well as a benzodiazepine, because the antianxiety effect of antidepressives needs some weeks to develop. Afterwards benzodiazepines are withdrawn (as they develop tolerance and dependence) and continued with antidepressant only. There are many antidepressants, when there are sleeping difficulties I would prefer something which promotes sleep like amitriptyline or mirtazapine.

As for the red ear thing, that is not commonly associated with anxiety and I must confess I am not sure what is its origin. There is a condition known as red ear syndrome, but it is very rare though and its cause is not well understood. Several drugs have been tried for it, including amitriptyline which was mentioned before, so it might be beneficial on that regard as well.

I hope to have been of help.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Olsi Taka

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