Tweaked by a muscle twitch?

From an uncontrollable fluttering eyelid to a pulsing calf muscle, these small, rapid involuntary muscle contractions may happen at any time — and can be annoying. A common cause is overexertion, says Dr. Justin Kwan, an assistant professor of neurology at the University of Maryland School of Medicine in Baltimore. He experienced as much following a recent 22-mile run he completed as part of his training for an upcoming marathon — his calf and thigh muscles twitched briefly immediately afterward.

“Another common cause would be stress or anxiety — some people do notice fluttering of their eyelids very asymmetrically,” Kwan says. “Again, speaking from personal experience, right before I prepare for major examinations or even sometimes give a talk — when I get very nervous, or anxious or stressed — I do notice that.”

[See: 9 Tips to Tame Work Stress.]

Eye Twitch, You Twitch, We All Twitch

Clinicians say almost everyone experiences muscle twitching, also called fasciculation, at one time or another — and it usually goes away on its own. In cases where twitching persists, addressing everyday factors that frequently contribute, including too much caffeine, dehydration and a lack of sleep, can limit the annoyance.

But sometimes muscle twitching becomes a source of concern for patients who worry it’s an ominous sign of an underlying medical condition, says Dr. Charles Kim, assistant professor of rehabilitation medicine and anesthesiology and a pain management specialist at Rusk Rehabilitation at NYU Langone Medical Center in New York City. “For the vast, vast majority of people, it’s benign,” he says.

But experts say that doesn’t mean doctors should dismiss patients’ concerns, either. Rather, Kim notes, less commonly muscle twitching can, in fact, be a symptom of an underlying neurological issue like a pinched spinal nerve called radiculopathy. Kwan adds that patients should take notice if they’re experiencing other associated symptoms in addition to muscle twitching, such as muscle atrophy, or the muscle getting smaller; numbness; weakness; or loss of muscle function. Taken together with muscle twitching, these symptoms might indicate the need for further evaluation to determine if a person could have an underlying nervous system disorder, he says.

In rare instances, muscle twitching may be an early sign of the progressive neurodegenerative disease ALS, or amyotrophic lateral sclerosis, which affects the function of nerves and muscles. Also called Lou Gehrig’s disease, ALS takes the lives of most who develop the condition within in three to five years of initial symptoms, according to the National Institutes of Health. Concern about ALS is frequently the reason patients end up seeing a neurologist about muscle twitching, Kwan says.

[See: What Only Your Partner Knows About Your Health.]

What to Expect if You See a Doctor

“If someone’s worried their muscle twitching might be an early sign of ALS, it doesn’t hurt at all to see somebody,” says Dr. Anthony Windebank, a neurologist at Mayo Clinic and professor of neurology at Mayo Clinic College of Medicine in Rochester, Minnesota. Experts recommend starting with a primary care doctor, who can do an initial assessment and refer the patient to a neurologist as necessary. Tell your doctor if you have a family history of ALS or other neurological disorders.

A primary care doctor can also run basic blood tests to check for other causes of muscle twitches, such as a magnesium or calcium deficiency, which could be addressed by taking a supplement and making dietary changes. In addition, a neurologist or physiatrist — a physical medicine and rehab doctor — can perform electromyography or EMG. “It’s a very common test: The physician puts a little needle into muscles, and that actually records the electrical activity of the muscles,” Windebank says. He adds that the test is highly effective in determining if a muscle twitch is benign or may be an early sign of a serious disease.

Medical issues that cause metabolic disorders, including low potassium and kidney disease, can also cause muscle twitching, as can neuropathy — any type of nerve damage — and an autoimmune disorder called Isaacs’ syndrome, which is characterized by continuous muscle fiber activity. Kwan says certain anti-seizure medications, like gabapentin, may provide relief for patients with Isaacs’ syndrome who experience frequent twitching. Clinicians say for most who experience muscle twitches, medications aren’t recommended, except in rare instances where frequent twitches have a significant impact on quality of life or disturb sleep. “Any prescription medication should be used with caution given the potential side effects,” Kwan adds. Rarely, for instance, patients who take gabapentin may experience gait ataxia, or staggering — unsteady gait that causes their walking to appear uncoordinated. For those with underlying medical issues that result in muscle twitching, treatment is usually individualized to treat the specific condition.

In some instances, medications ranging from antidepressants and anti-anxiety medications to stimulants and steroids can cause muscle twitching via effects on muscles and nerves and electrolyte imbalances, Kim says. Taking water pills, such as to control blood pressure, for example, can lead a person to urinate a lot, which may cause an electrolyte imbalance that leads to muscle twitching. “If a person suspects that a medication may be the cause of muscle twitching, I would recommend a visit with their health care provider,” Kim says. Discuss with your doctor whether adjusting prescription drug dosage, taking alternative medications or stopping medications would be appropriate.

[See: Which Practitioner Do I See, and When?]

Making Lifestyle Tweaks

Experts reiterate that nonmedical changes are typically enough to combat frequent muscle twitching. “I think the most important thing is just looking at your lifestyle and [seeing] what sort of things may be contributing to it,” Kim says. He adds that includes finding ways to cope with work stress, like meditation, staying adequately hydrated and getting enough exercise, while not overdoing it. “It’s achieving a balance. Often times the muscle twitching is a sign there’s some sort of imbalance going on in your life.”

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When Is a Muscle Twitch Cause for Concern? originally appeared on usnews.com