Why Can’t ALS Patients Feel Their Tongue Twitching?
Though tongue twitching can result from bulbar-onset ALS, the patient never feels the fasciculations.
When a person has bulbar-onset ALS, one of the symptoms can be a twitching tongue.
These fasciculations look like worms squirming under the tongue, says Anthony P. Geraci, MD, associate professor of neurology at Donald & Barbara Zucker School of Medicine in New York.
Despite this appearance, the patient cannot feel the fasciculations. Why is this? Dr. Geraci explains:
“I think probably people who have tongue fascics don’t notice them because they are a relatively late symptom, even if the ALS is bulbar.
“By that time, the patient will have some tongue weakness which leads to difficulty eating and speaking — THIS is what they notice.
“We use our tongues so frequently that it would be difficult for someone to actually feel fascics apart from the background normal tongue movements.”
How often does the person with ALS experience their tongue twitching?
“The squirming is subtle and sporadic,” says Dr. Geraci.
He adds, “The sensory nerves are indeed feeding that info centrally.
“But we have mechanisms in our brain to filter out sensory inputs.
“And my guess — this has never been studied — is that the brain suppresses those inputs because it is focused on other ‘duties’ of the tongue like eating and speaking.”
Dr. Geraci is also the director of neuromuscular medicine at Northwell Health in New York.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
What Bulbar Tongue Twitching Really Looks Like
A neurologist describes what bulbar-onset ALS tongue twitching actually looks like.
If you’re scared that you might have bulbar-onset ALS because you see your tongue twitching when you look at it in the mirror, you may be shocked at what you’re about to find out.
For the topic of what tongue twitching in bulbar-onset ALS really looks like, the expert source is Anthony P. Geraci, MD, associate professor of neurology at Donald & Barbara Zucker School of Medicine in New York.
Dr. Geraci explains, “Twitching of the tongue is a tricky subject, and that is because the vast majority of people who think their tongue is twitching are actually experiencing something else with their tongue, which could include:
“Tingling, numbness, some rare nerve disorders (many of which are treatable; inflammatory neuropathies), and very rarely dystonia, which is a problem that stems from the brain and not the tongue muscle itself.”
Dystonia is involuntary muscle contractions.
Dr. Geraci says that the only real cause of tongue twitching is ALS, and that “benign fascics never affect the tongue.”
But hold on! Before you panic, recall that Dr. Geraci described the ALS twitching as “quivering.”
Just what does this quivering actually look like?
Dr. Geraci explains, “The quivering is very impressive in ALS; it looks like a bunch of worms squirming around just beneath the surface.
“It is much more pronounced than the normal movements we see when we stick out our tongues.”
WORMS?! Is this what you see when you inspect your tongue for hours every day?
Or do you see very brief “jerks” in specific areas, jerking that looks like twitches?
When something jerks briefly, the word in the English language to describe this is a twitch.
People see the jerk, call it a twitch, and then think they might have ALS.
“People with ALS are never aware of the tongue twitching, NEVER,” says Dr. Geraci.
So if benign fascics never affect the tongue, then just what is that twitching you see in the mirror?
Let’s look at a great analogy:
Suppose you’re nervous as sh— and are told to stand on one leg and hold the other out at some crazy angle.
What are the odds that your outstretched leg will NOT be perfectly still?
The entire unit will be tremoring. This will occur even if you’re not nervous; it’s a sustained muscle contraction; the leg is not in a relaxed state.
There will be subtle movements, no matter how hard you try to keep the leg still.
When you examine your tongue for twitching, it’s stuck out; it’s in a state of sustained muscle contraction – even if it’s poking out just a little. Add anxiety to this, and what do you get?
Dr. Geraci explains, “So, to address the anxiety, if they see twitching they are seeing the normal muscle movements of the tongue — like standing on one leg, we can’t ever really get the tongue to relax when we look at it.”
I sent Dr. Geraci a YouTube video of a twitching tongue.
Every so often in the video, there appears to be a very brief fascic in one area of it. I asked, “What’s going on with this man’s tongue?”
“The answer here gets a bit complicated,” says Dr. Geraci. “Because it is so difficult to really hold the tongue in a state of complete rest, one can’t say if the twitches on the video are fascics or an actual motor unit contraction (the motor unit being the nerve connected to the muscle fiber).
“If the motor unit sends an impulse, the twitch will occur, but that is a function of the fact that even though the tongue SEEMS to be at rest, that man had to stick it out and therefore by definition he is using the muscle and it is NOT at rest.
“So the answer I would say is that yes, a person can feel a twitch or movement of the tongue.
“But unless they are many in number — hence the quivering — it is likely that they are seeing normal contractions of the muscles from its nerve because they just can’t keep the muscle at rest.
“That is one reason we do needle EMG on the tongue; the needle can discriminate between little contractions and fasciculations.”
Dr. Geraci also says that “it is incredibly rare for tongue twitching to be the first symptom a patient would have” in bulbar-onset ALS.
“If you think you are having twitching, gently stick your tongue out in front of the mirror and look at it.
“Twitches (from ALS) will make the tongue look as though it is quivering.
“If you see this, the best advice is to have your doctor or a neurologist take a look.”
Remember, the “quivering” looks like worms squirming under there, and despite this creepy description, the ALS patient with bulbar-onset will “never” feel this quivering or twitching.
Here’s an article explaining why the ALS patient with bulbar-onset NEVER feels their twitching.
Dr. Geraci is also the director of neuromuscular medicine at Northwell Health in New York.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
Top image: Shutterstock/MCarper
Causes of Twitching in Neck and Shoulder Muscles
A neurologist explains what may be causing twitching in your neck and shoulder muscles.
Have your neck and shoulder areas been twitching lately?
“For almost everyone – particularly young healthy persons — a simple twitch of a muscle anywhere in the body is completely normal and nothing to worry about,” says Anthony P. Geraci, MD, associate professor of neurology at Donald & Barbara Zucker School of Medicine in New York.
This could very well be the case of “Nedo,” a strength training enthusiast who posted about his shoulder twitching in a bodybuilding forum.
One person suggested dehydration was a cause, but Nedo reported that the shoulder twitching continued after drinking a gallon of water a day.
A twitching shoulder can be caused by dehydration, caffeine, magnesium deficiency, stress and exercising, including after an absence from exercise.
Lactic acid builds up from exercise in the muscle cell, says Dr. Geraci.
As this occurs, “a chain of events takes place that injures the cell and destabilizes its cell membrane. Normally, the membrane is kept stable by the single nerve fiber attached to it.”
Exercise affects the “chemical soup” inside a muscle fiber that sets off an “electrical impulse, referred to as depolarization,” says Dr. Geraci.
Shutterstock/Syda Productions
“This is the basic process that leads to muscle fiber contraction.” This fiber contraction is the twitching.
What if both the neck and shoulder are twitching?
“I see some patients who tell me about twitches of neck or shoulder muscles,” says Dr. Geraci.
“Advice on this subject would be lacking if I didn’t discuss the possibility that the ‘twitch’ is something else.
“Neck muscles generally are not stressed or worked out” from exercise, “so something else could be going on.
“Muscles of the shoulder can have twitches just from bench pressing for example, but from a neurologist’s point of view, neck and shoulder muscles can, in some instances, be considered as one anatomical unit.
“Two conditions should be considered if neck and shoulder muscles are ‘twitching.’ One possibility is that the person is having tics.
“Tics are brief jerks of groups of muscles and generally will therefore move a limb or the neck, sometimes ever so slightly that you would call it a twitch.”
Tics in adults can be caused by sleep deprivation or stress, or have no known cause.
Dystonia (involuntary muscle contractions) is the other condition, says Dr. Geraci, that can ever so slightly move a muscle in the neck that it seems like a twitch.
He explains that “dystonia can be caused by a brain tumor, Parkinson’s disease and Huntington’s, but two points:
“Exceedingly rare in brain tumor, and the other two are manifest diagnoses before dystonia sets in.
“In young people with neck dystonia it is practically always cervical dystonia alone.”
Back to neck twitching, Dr. Geraci says, “Benign tremor is fairly common and usually is inherited, so you would start by thinking about your parents and grandparents. Did they have twitching or movements of the neck or arms?
“The most common example of dystonia is something most people have heard about: writer’s cramp.
“Dystonia can be difficult to diagnose, especially in its early stages, even for a neurologist.
“It can cause the muscle to contract, again usually in groups and therefore one might notice movement of the limb or neck.
“The movement in the neck can be so subtle as to look like a brief twitch or even a rhythmic tremor.”
Dr. Geraci recommends having a neurologist examine you if you’re having excessive movements or twitching in the shoulder or neck muscles.
Tics and cervical dystonia are treatable, so early diagnosis is important.
Dr. Geraci is also the director of neuromuscular medicine at Northwell Health in New York.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Source: forum.bodybuilding.com/showthread.php?t=947596&page=1
Why You Get Paralyzed During Sleep and Why It’s Harmless
Don’t be frightened of “sleep paralysis,” but instead, embrace it!
Have you awakened in the morning to find that your body is totally paralyzed?
I have! And I love it!
“Almost everyone has had the experience of being jerked awake just as they are falling into light sleep,” says Anthony P. Geraci, MD, associate professor of neurology at Donald & Barbara Zucker School of Medicine in New York.
“It feels as if someone has shaken you awake. These jerks are common and a normal part of the earliest stages of sleep and they are called hypnogogic myoclonic jerks.
“Not to worry – these occur as a part of the center of your brain, called the thalamus, starts to shut down your motor system.
“This occurs as a protective mechanism, and in fact we are essentially paralyzed during about 75 percent of normal sleep.”
Sleep Paralysis Is Normal
It’s believed by researchers and physicians to be a protective mechanism against physically acting out our dreams.
However, it’s only fair that I mention that those who are authorities on out-of-body experiences (astral projection) believe that sleep paralysis is either the astral body re-entering the physical body, or, it’s a launching pad for an astral projection.
Now you can be a skeptic, but here’s a phenomenon that I can’t explain with my OWN sleep paralysis:
Every single time I have sleep paralysis, it follows a lucid flight dream! I find it extremely odd that my SP has never, ever followed a regular dream.
These lucid flight dreams of mine are spectacular in terms of imagery and experience, and I always feel that these excursions actually happened.
I have been told by those who’ve had out-of-body experiences that these are astral projections. I’d sure like to think so.
I can pop in and out of SP once it runs its course (a few or several minutes). If I wait too long to pop back into it, the window of opportunity for this closes.
Bottom line: Sleep paralysis does NOT mean anything is wrong with your body.
Dr. Geraci adds that myoclonus jerks do not happen during deep sleep.
“They can happen to some people during light sleep stages such as REM (rapid eye movement), but if you experience these occasionally, just roll over and go back to sleep.
“You’re just fine and these movements have nothing to do with your muscles.”
Dr. Geraci is also the director of neuromuscular medicine at Northwell Health in New York.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/ Africa Studio
Cause of Muscle Twitching in Arms: Biceps & Triceps
A neurologist answers what could make the arms twitch and whether or not the twitching is a worrisome symptom.
Do your arms (namely biceps and triceps muscles) twitch?
“Many people experience annoying twitching of the arms that can be anxiety provoking if you don’t know why it is happening,” says Anthony P. Geraci, MD, associate professor of neurology at Donald & Barbara Zucker School of Medicine in New York.
I myself have had, more than once, a twitching episode in my triceps, and it was prominent.
The muscle twitching followed a training session involving triceps routines.
Freepik.com/jcomp
“Though it is true that muscle twitches can occur in anyone, those who work out at the gym and exercise their upper bodies with weight training are more prone to get them.
“Why? Because the biceps and triceps muscles do MOST of the work.”
Many routines consist of a lot of arm work.
Though I don’t endorse isolation exercises as the foundation for building strength and muscle, I have to say it’s a reality that many people at the gym focus on exercises that involve the arms only.
However, chest routines work the triceps, and back routines work the biceps.
Dr. Geraci continues, “As the muscle exercises, some muscle fibers become ‘injured’ and must repair themselves – hence the twitch.
“Remember, your body is a fantastic organism that will take care of itself, given the proper nutrition and rest.
“So, your body is on its own clock, and muscle twitches will occur randomly and intermittently. Nothing to worry about and totally normal.”
Dr. Geraci is also the director of neuromuscular medicine at Northwell Health in New York.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Freepik.com/halayalex
Normal EMG Means NO ALS even with Neuro Symptoms
Finally, here’s the article that answers the question, “Can a person with ALS have a normal EMG?”
Does a normal EMG always mean no ALS?
Can a person have ALS and have a normal EMG?
What if the EMG is normal but you have symptoms like muscle twitching?
“There are three essential components for diagnosing ALS,” says Anthony P. Geraci, MD, associate professor of neurology at Donald & Barbara Zucker School of Medicine in New York.
“First, one must have both subjective and objective weakness in muscles both below and above the waist.”
In other words, the neurologist must show, from HIS end, that your perceived weakness is actually clinical weakness.
No, he won’t have you try to lift a 45 pound water cooler bottle over your head. Instead he’ll have you, for instance, press your foot against his opposing hand.
“Second, a neurologist must observe certain findings on examination,” continues Dr. Geraci.
“Third, one must meet certain criteria on a test commonly referred to as an EMG.
“The full name of the test is EMG/NCV which stands for electromyography and nerve conduction velocity.
“EMG is the gold standard for diagnosing ALS, and results from this test can make the diagnosis very early in its course.”
Does a normal EMG mean you can’t have ALS?
Dr. Geraci says, “I use EMG in my office at least 15 times weekly, and about two to three times a month I see a patient who is concerned they may have ALS.
“After I examine them and do the EMG I can almost always give them the answer, and it is usually, ‘You can relax, you don’t have ALS!’”
Why do you say “almost always” and “usually”?
“I used the terms almost and usually because the reality is that rarely I do diagnose someone with ALS who comes in with fascics, but they usually have weakness and neurological findings.
Shutterstock/joshya
“Dozens, perhaps hundreds, of studies have documented the utility of EMG in diagnosing ALS.
“If a person has a normal EMG it is essentially impossible that they have ALS, but, the caveat would be that the person also would have a normal neuro exam (which is not just strength testing but also reflexes, and the discussion gets complicated so suffice it to say abnormal exam).
“It is an absolute that if a person has a normal EMG and normal neuro exam, they DON’T have ALS, period.
“If the EMG is completely normal in a patient with symptoms, ALS is effectively excluded and one would look for other diagnoses.”
Dr. Geraci is also the director of neuromuscular medicine at Northwell Health in New York.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/Okrasyuk
Twitching Above Ears: Causes & Solutions by a Neurologist
Find out from a neurologist what causes twitching above the ears and what to do about this.
Are you experiencing twitching above your ears?
It may feel like a very tiny muscle moving involuntarily. Or, it may feel like a tiny blood vessel throbbing.
Either way, the sensation is not easy to ignore. So what’s going on?
“Some of the most annoying twitching can be those coming from the face and head,” says Anthony P. Geraci, MD, associate professor of neurology at Donald & Barbara Zucker School of Medicine in New York.
“Yes, we have muscles on our heads! Most commonly, one may experience twitching of the muscles of the eyelids or even above the ears – the temporalis muscles.”
What causes this twitching (fasciculation) above the ears?
Dr. Geraci explains, “Both of these muscles have smaller than normal fibers, and the nerves to these muscles have to traverse ‘wild terrain’ as they course from inside our heads to the muscles on the outer portion of our skulls.
“So, the nerves can get irritated, and then the muscle fiber’s membrane becomes unstable and twitches.”
The situation, then, involves muscle fibers, not blood vessels, even though it may feel that way at times.
What can be done to subdue twitching above the ears?
“Substances such as caffeine can cause twitches also, so if you drink a lot of java, consider cutting back,” says Dr. Geraci.
“Otherwise, don’t let it worry you – I’ve never seen a patient with muscle twitches above the ears who had any medical problem to explain it!”
You may also want to ask yourself if you’ve been extra stressed or anxious lately.
Stress and anxiety may cause twitching of the muscles in the head or around the ears.
The stress/anxiety response can fire up the nervous system, increasing muscle tension and involuntary contractions (the “twitchies”), which may occur around the head or ears.
Heightened stress hormones and overactive nerves can cause these small muscle movements.
With all that said, you do not have to worry that you might have multiple sclerosis, Parkinson’s disease or any motor neuron affliction.
Dr. Geraci is also the director of neuromuscular medicine at Northwell Health in New York.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: ©Lorra Garrick
Muscle Twitches During Sleep that Aren’t Myoclonus Jerks
Find out about regular muscle twitching during sleep or shortly before, not the “jerks” of myoclonus…
This article is about regular muscle twitching as one falls asleep or during sleep, not the jerking movements that are termed myoclonus.
“A different sensation can occur during any sleep stage, but is most pronounced in some people as they first hit the pillow and start to fall asleep,” says Anthony P. Geraci, MD, associate professor of neurology at Donald & Barbara Zucker School of Medicine in New York.
“I am referring to muscle twitches, or fasciculations. These can occur in any muscle but are most pronounced in the upper arms and calves. Generally they do not occur in the muscles of the back.
“Here’s the rub: We tend to notice twitches as we start to fall asleep because there is nothing in our environment to distract us.
“As we fall asleep, we are essentially going into a deep meditation and our thoughts are turned inward.
“This may cause us to over-interpret normal twitches of the muscles. Remember, our muscles are constantly repairing themselves from being used while awake, and during that process the muscle membrane can become unstable and contract.
“That’s it; ignore the twitching and let yourself slumber. Your muscles will do their thing and prepare for the next day of activity.”
I’ve had fascics upon awakening in the morning. It’s possible that the muscle was twitching while I was asleep.
There is nothing unique about slumber that would make typical twitching any more meaningful than fascics you experience while fully awake.
It’s just that for many people, sleep is mysterious, so any twitching right before or coming out of sleep tends to really grab one’s attention and lead to worrying.
Dr. Geraci adds, “If you think you are getting too many twitches, twitching of the back muscles or jerking movements that wake you from sleep, see your doctor or a neurologist.
“I see young and healthy patients with these symptoms on a weekly basis and invariably everything checks out fine!”
Dr. Geraci is also the director of neuromuscular medicine at Northwell Health in New York.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
Cause of Twitching Muscles in Your Chest
A neurologist explains what’s going on when your chest muscle (pecs) keeps twitching.
Does your chest muscle keep twitching?
“For those of you who bench press and are bulking up, the major upper chest muscle that provides the strength for pushing up the weights is the pectoralis major,” says Anthony P. Geraci, MD, associate professor of neurology at Donald & Barbara Zucker School of Medicine in New York.
“It would be very normal to feel a twitch in the chest, and many people feel that the twitch is deep and perhaps even under the pectoralis major,” continues Dr. Geraci.
“Well, there are only two muscles under the pectoralis major: the pectoralis minor and the intercostal muscles, neither of which contribute much to the power needed to bench press.
“The pectoralis minor rotates our upper arm, and the intercostals allow us to expand our chest when we inspire (breathe in).
“If you feel a twitch in your chest but don’t actually see it, that is because muscle twitches can occur anywhere in the muscle, and if they are in the deep part of the pectoralis major you probably won’t see it depending on the bulk of your muscle.
“Not to worry though, it is still just a benign fasciculation (twitch), and you can keep on pushing up that bar!”
What is the biochemical explanation for a twitch in the chest during or following exercise?
When a muscle cell is stimulated by exercise such as a chest press, several key chemical changes occur.
Calcium ions are released from the cell, enabling muscle contraction by facilitating the interaction between protein filaments in the cell.
Muscle cells use adenosine triphosphate (ATP) for energy, which is rapidly replenished through a chemical process.
This process produces lactic acid, which can lower the muscle’s pH and cause temporary fatigue or that all-too familiar “burn.”
One of the outcomes of this chain of events is “injury” to the cell membrane. (But it’s a good kind of injury because it trains the muscle to be stronger for the next chest day.)
This alteration in the muscle fiber’s “chemical soup” leads to random firing of nerves that contract the fiber: the twitching.
Think of this as your body’s built-in massager.
Dr. Geraci is also the director of neuromuscular medicine at Northwell Health in New York.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
Visible Muscle Twitches: Why You Can See Them, What It Means
A neurologist explains why some muscle twitching is visible and if there’s a difference between ones you can see and hidden fasciculations.
Have you been wondering if being able to SEE a muscle twitching has a specific meaning, versus not being able to see the twitching that you can so easily feel?
“A trap you don’t want to fall into is excessive worry simply because you can see a muscle twitch,” says Anthony P. Geraci, MD, associate professor of neurology at Donald & Barbara Zucker School of Medicine in New York.
“That just means that the twitch is near the surface, and the skin just above the muscle moves when the muscle fiber contracts,” says Dr. Geraci.
Translation: You probably have low body fat! This makes things more visible (e.g., veins in the forearms, “definition”).
Dr. Geraci continues, “These occur throughout the entire muscle in a random fashion and actually, you are having several-fold the number of twitches you actually see – you just aren’t aware of them!
“Seeing a muscle twitch rather than feeling one has no meaning at all and is no cause for concern.”
What about a visible twitch that’s like half a foot long?
I myself once had an elongated visible muscle twitch. After I did a set of pull-ups, a thumping fasciculation developed in my chest.
Though the chest is not a primary mover in a pull-up, it isometrically contracts during the movement.
At the gym, I could easily see the twitching in a mirror. It was a horizontal fascic about five inches long!
It was “flashing” beneath my chest muscle, right under the clavicle bone.
This visible muscle twitching persisted all day long and evening, but was completely gone come next morning.
It really is true: What you can see won’t hurt you.
