Fasciculations are muscles out of control


DEAR DR. ROACH: I have had leg cramps for about 32 years while I have engaged in an active lifestyle. I was a jogger for some years, and now I work out at the gym. I am in my late 60s and have found that the leg cramps have gotten worse. I noticed three or four years ago that my leg muscles, especially in the calf area, would contract or pulsate, and jerk or jump, looking like they were about to cramp but not actually doing it. I have tried everything doctors have recommended: stretching, hot baths, staying hydrated. I even took quinine when it was available.

Two events have occurred while my cramps have been getting worse: I was diagnosed with a herniated disc in my back and my statin was doubled from 20 mg to 40 mg. The cramps are so bad now that I have torn tendons in both of my feet. I was taken off the statins for one month, but the cramps did not go away, perhaps got a little less severe. I do not know what to do, nor does my doctor seem to know. Are there any doctors who specialize in these muscle problems? There is no muscle pain except when they cramp, which is mostly at night while I am in bed. — C.H.

ANSWER: I have written several times about simple muscle cramps, and also about muscle damage from statins. However, what you are describing doesn’t sound like either of those. The “jumping” you are describing sounds to me like fasciculations, the medical term for uncontrolled muscle twitching. Fasciculations can happen in several neuromuscular diseases. The last case I saw of this turned out to be polymyositis, an inflammatory muscle disease. However, there are many possibilities — some more benign, some serious — and the best way to sort them out is to see a neurologist with special expertise in neuromuscular disorders. The neurologist may order an EMG, which looks at the electrical impulses to the muscle, or you may need a muscle biopsy.

DEAR DR. ROACH: Six months ago, I contracted Bell’s palsy. While I have recovered from the facial paralysis, I still have problems with dry eye on the affected side. The most helpful strategy has been constant use of goggles over my glasses to retain moisture. I have not been able to get an answer as to whether the situation is likely permanent, or I how much longer I will have to go around with goggles over my glasses to avoid my eye aching. Drops tend to irritate my eyes, and a “plug” was not recommended by my ophthalmologist. — M.F.

ANSWER: Bell’s palsy is a weakness in half of the face, usually sudden in onset and believed to be most commonly caused by a virus. It must be distinguished from a stroke, which it resembles, and that’s done with a physical exam from a skilled examiner. Some people recover fully, others only partially. Most recovery happens within six months of the onset.

Dry eyes can be a big problem in people with Bell’s palsy, usually because the eyelid doesn’t close completely and the moisture from the eye is constantly lost. Goggles create a high-moisture area around the eyes, minimizing moisture loss.

Rather than drops, I would recommend a gel during the day and an ointment at night. These should be less irritating to your eye than drops.

READERS: Facial paralysis can be caused by stroke. The booklet on stroke explains this condition that is deservedly feared by all. Readers can obtain a copy by writing: Dr. Roach — No. 902, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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