{"id":18184,"date":"2024-02-07T13:55:55","date_gmt":"2024-02-07T13:55:55","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=18184"},"modified":"2024-12-27T10:57:15","modified_gmt":"2024-12-27T10:57:15","slug":"muscle-twitches-and-cramps","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/neurology\/muscle-twitches-and-cramps\/","title":{"rendered":"Muscle twitches and cramps"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Muscle-twitches-and-cramps-2024.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Muscle-twitches-and-cramps-2024.pdf<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>What are the common causes of muscle twitches and cramps?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Muscle twitching and cramps are common normal symptoms, occasionally they may indicate an underlying neurological condition but are nearly always benign. In one study over 50% of the population had muscle fasciculation and 37% of had muscle cramps in a single year.<\/p>\n\n\n\n<figure class=\"wp-block-table aligncenter is-style-stripes\"><table class=\"has-standard-black-color has-light-accent-blue-background-color has-text-color has-background has-link-color\"><tbody><tr><td>&nbsp;<strong>Muscle fasciculation. <\/strong>Usually seen or felt, most commonly in the calves and after exercise but may be more widespread. They can be associated with cramps and in the absence of weakness are usually \u201cbenign cramp\/fasciculation syndrome\u201d. Nearly always benign. Health-related anxiety (MND specifically) can amplify them.<\/td><\/tr><tr><td><strong>Myokymia<\/strong>: painless repetitive muscle fibre twitching, commonly seen around the eye or first dorsal interosseous muscle. Nearly always benign.<\/td><\/tr><tr><td><strong>Myotonia: <\/strong>described by patients as \u201cmuscle stiffness\u201d or discomfort rather than visible twitching with an inability to relax a muscle. It&#8217;s rare and suggests underlying neuromuscular disease (e.g. myotonic dystrophy or neuromyotonia).<\/td><\/tr><tr><td><strong>Muscle cramps: <\/strong>the sudden involuntary painful contraction of an isolated muscle cramp is usually benign and commonly worsened by exercise, dehydration, or pregnancy, and especially sleep in the elderly (sleeping with feet plantarflexed). Occasionally, when profound and\/or associated with other symptoms such as weakness, they may indicate underlying neuromuscular disease. Metabolic disorders may also cause cramp.<\/td><\/tr><tr><td><strong>Blepharospasm<\/strong>: This is bilateral repeated eye closure (blinking) due to overactivity of the orbicularis oculi muscle. Benign, if annoying and cosmetically embarrassing, and can cause effective blindness in more severe cases.<\/td><\/tr><tr><td><strong>Hemifacial spasm<\/strong>: what it says on the tin- unilateral eye blinking with upwards twitching of the corner of the mouth.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>M.A &amp; J.S. 07-02-24<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\"><strong>What treatments are available\/ When should I seek advice from Neurology?<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><table class=\"has-light-accent-blue-background-color has-background\"><thead><tr><th>Condition<\/th><th>Treatment<\/th><th>When to seek advice from Neurology<\/th><\/tr><\/thead><tbody><tr><td>Cramps<\/td><td>Calf muscle stretches before bed. Reduce diuretics\/caffeine. Vitamin B complex, Diltiazem, Quinine (recommended short course)<\/td><td>Unusually profound\/debilitating and\/or associated symptoms, notably weakness<\/td><\/tr><tr><td>Myokymia<\/td><td>Explanation and reassurance<\/td><td>Any neurological symptoms other than myokymia<\/td><\/tr><tr><td>Fasciculation<\/td><td>Explanation and reassurance. If severe then treatment of health anxiety.<\/td><td>Any wasting\/weakness, or very florid or widespread, or with severe cramp<\/td><\/tr><tr><td>Blepharospasm\/hemifacial spasm<\/td><td>Conservative or botulinum toxin<\/td><td>If causing problems<\/td><\/tr><\/tbody><\/table><\/figure>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\">&nbsp;<strong>What questions should I ask?<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Is there any weakness \u2013 if so, this would suggest referral appropriate?<\/li>\n\n\n\n<li>Is there a family history (common in benign cramp-fasciculation syndrome)?<\/li>\n\n\n\n<li>Are they on medications that might cause either electrolyte imbalance or the symptoms (e.g. diuretics, methylphenidate etc)?<\/li>\n\n\n\n<li>Is it nocturnal only \u2013 if so, any symptoms to suggest restless legs syndrome?<\/li>\n\n\n\n<li>What are they concerned about? Googling fasciculation\/muscle twitching immediately leads to articles about MND. Most people will be reassured with careful explanation that isolated fasciculation is common, but occasionally this can evolve into health-related anxiety which in turn can amplify fasciculation. Health anxiety, especially common in health professionals, requires explicit explanation and avoidance of repeated reassurance.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>What tests should I do in primary care?<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Biochemical screen including U&amp;Es, calcium and TFTs<\/li>\n\n\n\n<li>Creatine kinase (trivial increase about reference range rarely relevant)<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Muscle-twitches-and-cramps-2024.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Muscle-twitches-and-cramps-2024.pdf<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>References:<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Dijkstra JN, Boon E, Kruijt N, et al. Pract Neurol 2023;<strong>23<\/strong>:23\u201334.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Erogu M. The perils of being your own doctor. Guardian 4 Aug 2016 (article about benign fasciculation).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Jon Stone and Richard Davenport<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Consultant Neurologists, NHS Lothian 2023<\/strong><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Muscle-twitches-and-cramps-2024.pdf What are the common causes of muscle twitches and cramps? Muscle twitching and cramps are common normal symptoms, occasionally they may indicate an underlying neurological condition but are nearly always benign. In one study over 50% of the population had muscle fasciculation and 37% of had muscle cramps in a single year. &nbsp;Muscle fasciculation.<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":4173,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[1078],"class_list":["post-18184","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-muscle-twitches-and-cramps"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/neurology\/https-apps-nhslothian-scot-refhelp-muscle-twitches-and-cramps\/\" rel=\"tag\">Muscle-twitches-and-cramps\/<\/a>","rttpg_excerpt":"Muscle-twitches-and-cramps-2024.pdf What are the common causes of muscle twitches and cramps? Muscle twitching and cramps are common normal symptoms, occasionally they may indicate an underlying neurological condition but are nearly always benign. In one study over 50% of the population had muscle fasciculation and 37% of had muscle cramps in a single year. &nbsp;Muscle fasciculation.","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/18184","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=18184"}],"version-history":[{"count":4,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/18184\/revisions"}],"predecessor-version":[{"id":22180,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/18184\/revisions\/22180"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4173"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=18184"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=18184"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}