Muscle twitching

Dr. Andrea Bannert has been with since 2013. The doctor of biology and medicine editor initially carried out research in microbiology and is the team's expert on the tiny things: bacteria, viruses, molecules and genes. She also works as a freelancer for Bayerischer Rundfunk and various science magazines and writes fantasy novels and children's stories.

More about the experts All content is checked by medical journalists.

Muscle twitching is an involuntary, sudden contraction of the muscles. It can be more or less severe and affect almost all muscles in the body. Muscles in the extremities and face (e.g. eyelids) twitch particularly often. As annoying as muscle twitching can be, it is usually harmless. But it can also be due to a serious illness. Read more about the causes and treatment of muscle twitching here.

Brief overview

Causes of muscle twitching: e.g. stress, mineral deficiency, stimulants (such as caffeine), various diseases such as ALS, Parkinson's or diabetes mellitus
When is muscle twitching dangerous? When it is a symptom of a serious illness. An indication of this may be that it does not only occur sporadically.
What can be done about muscle twitching? In the case of harmless muscle twitching, you can try to eliminate the cause (e.g. reduce stress, eat well, do not consume too much caffeine and alcohol). If underlying illnesses are the cause, the doctor will initiate appropriate therapy (e.g. with medication).
When to the doctor If the muscle twitching occurs more frequently and / or accompanies painful muscle spasms (such as in epilepsy)
Diagnosis: Consultation with the patient, physical and neurological examinations (ENG, EEG, EMG), possibly further examinations such as imaging procedures (such as computed tomography, magnetic resonance imaging) or analysis of a tissue sample (biopsy)

Muscle twitching: causes and possible diseases

Muscular twitching can be an accompanying symptom of many neurological diseases. These include disorders in the nervous system, especially in the brain and spinal cord as well as in the nerve cells of the muscles. In some people, all of the muscles tense up, for example in epilepsy. The muscle twitches are clearly visible here (medical: myoclonus) and so expansive that there is a risk of injury.

But there is not always a disease behind the twitches. Fasciculations, i.e. muscle twitching that can only be perceived as a fine tremor under the skin, are often harmless. 70 percent of the population have so-called spasms of falling asleep, which are medically completely harmless. Sometimes a temporary nerve irritation is also hidden behind the symptom.

In some cases the muscle twitching can be strengthened or activated by voluntary movements, then one speaks of an action myoclonus. In other cases, external stimuli such as touch, light or noise trigger twitching of the muscles (reflex myoclonus).

Diseases that cause muscle twitching

Tics, Tourette syndrome
epilepsy
Febrile seizures
Multiple sclerosis (MS)
Amyotrophic lateral sclerosis (ALS)
Parkinson's
Creutzfeldt-Jakob disease
Wilson disease
Diabetes mellitus
Inflammation of the brain or bleeding in the brain
Circulatory disorders, viral diseases and bacterial infections
Orthopedic diseases with nerve irritation

Essential tremor (ET): Involuntary tremor that is not a symptom of an illness, but occurs as an independent clinical picture. In 60 percent of patients, ET is hereditary. The tremor is most likely to be found in the hands and occurs especially when you want to hold something with them (such as a cup) or make movements (such as unlocking a door).
Restless Legs Syndrome: A neurological disease in which, especially in resting situations, there are sensory disorders and involuntary movements of the legs and, more rarely, the arms.

Other factors that trigger muscle twitching

mental imbalance, for example lovesickness
stress
stimulating substances such as caffeine
alcohol and drugs
Cold and hypothermia
Magnesium deficiency
Hypoglycaemia
Pinching of nerves
Side effects of medication
direct nerve irritation after examinations (e.g. brain water examination)

The muscle twitching usually takes place without pain. However, it can be accompanied by painful muscle cramps. Pronounced muscle twitching severely restricts those affected in everyday life, because targeted movements such as eating, drinking or writing become more difficult. The twitching often intensifies in stressful situations, so that patients are stigmatized as "nervous" or "insecure".

Muscle twitching - dangerous or harmless?

Muscle twitching is usually harmless and just a symptom of a lack of minerals, stress, too much caffeine, too little sleep or it is so-called sleep twitching. Medical professionals speak of such muscle twitching as benign fasciculation syndrome.

Serious illnesses are far less likely to cause muscle twitching. A sign of this may be when the twitching occurs more frequently. For example, in Parkinson's patients, muscle tremors are typically observed at rest (resting tremor). Metabolic diseases such as diabetes mellitus can also manifest themselves through muscle twitching - as can amyotrophic lateral sclerosis (ALS). In such cases, the muscle twitching or the underlying diseases are to be classified as dangerous or at least as serious.

Muscle twitching: what can you do about it?

In the case of harmless muscle twitching, there is a lot you can do yourself to put a stop to the annoying symptom. If a disease is the cause of the twitching, medical examinations and usually treatment by the doctor are necessary.

Muscle twitching: you can do that yourself

Relaxation: A common cause of fasciculations is stress. Then try to avoid or reduce stressors. You should also try relaxation exercises (such as autogenic training, yoga). These can also be helpful if essential tremors or other medical conditions are causing the muscle twitching.
No stimulants: Muscle twitching can often be avoided by keeping your hands off caffeine, alcohol and stimulating drugs.
Balanced diet: Sometimes a balanced diet can also help reduce muscle twitching. Pay particular attention to an adequate magnesium intake if painful cramps occur in addition to muscle twitching. Larger amounts of the mineral can be found in green vegetables such as spinach, broccoli, beans or peas, but also in cereals such as oat flakes, wheat bran or rice. For those who like fruit: Bananas contain a relatively high amount of magnesium.

Before taking magnesium tablets for muscle twitching you should discuss this with your doctor.

Muscle twitching: that's what the doctor does

Depending on the disease underlying the muscle twitching, the doctor can recommend various therapeutic measures - often in addition to the self-help measures mentioned above.

Medication

Often, underlying diseases can be treated with medication, for example:

Tics and Tourette: So-called neuroleptics help - active ingredients that dampen the functions of the central nervous system.

Epilepsy: For example, it is treated with carbamazepine, valproic acid, or clonazepam.
Essential tremor: It can often be relieved with beta blockers or anticonvulsants.

Sometimes muscle twitches are the side effect of certain drugs. In this case, you should discuss with your doctor whether you need to continue taking the drug in question or whether it can be discontinued or replaced with a better-tolerated drug.

Occupational and physiotherapy

If the muscle twitching is due to amyotrophic lateral sclerosis (ALS), regular physiotherapy and occupational therapy are very useful. This can have a positive influence on the progression of the disease. However, ALS cannot be treated or cured causally - neither through physical and occupational therapy nor through other therapies.

surgery

In some cases of disease-related muscle twitching, the doctor recommends surgery. Brain surgery can be useful for epileptics.In most cases, a region of the brain that repeatedly triggers epileptic seizures is surgically removed.

Surgery is also sometimes used for essential tremors: In this disease, a certain area of the brain sends a constant interfering signal. This area can be deactivated by means of an operation.

Muscle twitching: when do you need to see a doctor?

If the muscle twitching occurs frequently, you should have a doctor examine you medically to rule out a disease that requires treatment. A visit to the doctor is also essential in the case of violent myoclonia, i.e. violent muscle twitching, which may be accompanied by painful cramps.

Since nervous disorders are very often behind muscle twitches, a neurologist is the right person to talk to.

Muscle twitching: examinations and diagnosis

The first step is a detailed discussion between you and the doctor to collect the medical history (anamnesis). For example, the doctor asks you when, how often, where and under what circumstances the muscle twitching occurs and whether you have any other symptoms (e.g. painful muscle cramps, fever, etc.).

It is also important to know about possible triggers for the twitching, such as an injury or a recent nerve examination. Also tell your doctor whether and which medication you are taking and whether you have any previous illnesses (e.g. epilepsy or diabetes).

This is followed by a physical and neurological examination. In the latter case, the doctor checks the nerve and muscle function as well as the reflexes. The following methods can be used:

Electronurography (ENG): The nerve conduction speed is measured using electrodes.
Electromyography (EMG): In this examination, the doctor uses electrodes to check the electrical activity in the muscle.
Electroencephalography (EEG): The electrical activity of the brain is examined, also using electrodes.

Depending on the findings or the suspected cause of the muscle twitching, further examinations may be useful:

Blood and urine tests
orthopedic examinations
Imaging procedures such as X-rays, computed tomography (CT), magnetic resonance tomography (magnetic resonance tomography, MRT)
Removal of muscle tissue (biopsy) for a more detailed examination in the laboratory
Removal of nerve fluid (liquor puncture) for a more detailed examination in the laboratory