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Your Good Health: Twitching muscles can be a sign of serious illness

Dear Dr. Roach: I am a 68-year-old woman in good health. For the past several days, I have had muscle twitches all over my body — subtle ones, but nevertheless almost constant. This odd event has me worried. It would seem neurological in nature.

Dear Dr. Roach: I am a 68-year-old woman in good health. For the past several days, I have had muscle twitches all over my body — subtle ones, but nevertheless almost constant. This odd event has me worried. It would seem neurological in nature. What could be going on?
 
B.P.

Frequent muscle twitches are called fasciculations, and they are quite common. As a primary-care doctor, I have patients who note these frequently, and fortunately, most often they go away as mysteriously as they came, only to return again, perhaps centred on a different area of the body. This condition is called “benign fasciculations,” and up to 70 per cent of people will experience this.

However, there are some neurological diseases that can first show up as fasciculations. Fasciculations are typical of what are called “lower motor neuron” conditions.

When they are accompanied by muscle atrophy and weakness, it raises the likelihood of a serious illness rather than benign fasciculations. Perhaps the most feared disease with prominent lower motor neuron symptoms is ALS (amyotrophic lateral sclerosis), but there are several other related diseases. If your muscle twitching is associated with other neurological symptoms, you should be seen promptly by your regular provider or a neurologist.

Dear Dr. Roach: In a previous column, you stated that DNA can be damaged by chemotherapy and/or radiation. I’m curious as to whether that damage can affect the outcome of DNA results for genealogy information.

J.P.

No; people who have had cancer treatment with chemotherapy or radiation still will get accurate results from DNA testing for genealogy or risk factor analysis. The damage done to the DNA is mostly in the cancer cells, and healthy cells have some means to repair any damage that may happen. Unfortunately, there still is some likelihood of damage to the healthy cells, and that’s one of the reasons why people who have undergone cancer treatment are more likely to get another cancer, and why they need regular follow-up, even years after their cancer has been cured.

Dear Dr. Roach: I have been diagnosed with ataxia. I had never heard of it before. My doctor said there is no cure and that I will continually get worse. So far, he is right. I have heard different reasons for this condition. One was that there is not enough oxygen getting to my brain. Another is that there was a change in my medications. Also, that it can come from damage from injuries to my head. Is it true that there is no hope?

D.F.

Ataxia is not a diagnosis, it’s a symptom. Ataxia simply refers to loss of muscle control of the body, and there are many causes. Some of them are reversible with treatment: alcohol use, vitamin E and other vitamin/mineral deficiencies, and Wilson’s disease (a disease of copper metabolism) often can be completely reversed with treatment.

Your doctor is right that some medications cause ataxia, especially anti-epilepsy drugs, sedatives and lithium. Head injury and stroke also may cause ataxia.

There are a large number of progressive ataxias, and these usually are diagnosed by an expert after extensive evaluation, possibly including MRI evaluation and genetic testing.

It seems like you have not been given a complete understanding of your condition. I would try to get a better understanding of the condition causing your ataxia from your doctor.

Much more information is available at the National Ataxia Foundation, at www.ataxia.org.

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 ToYourGoodHealth@med.cornell.edu.