The muscle twitches badly

Painful twitches and cramps in the legs

A then 48-year-old man presented himself to our consultation at the end of 2017 because, after a spinal surgery operation many years ago, he began to experience increasing twitching of his right leg, which soon also affected the left leg and who also suffered from severe leg cramps. This pain occurred mainly after prolonged walking and severely limited the patient. There were no comparable complaints in the arms.

In the years before, numerous external neurological investigations were carried out with laboratory examinations, MRI recordings (of the previously operated spine, isolated the legs, as well as the entire body), a muscle biopsy, functional tests of the muscles, nerve measurements (neurographs) and examinations of the muscles (electromyographies, EMG). These examinations did not provide any information about the cause of the symptoms and a diagnosis could not be made. There was therefore no specific therapy.

In our first neurological examination in 2017 - almost 8 years after the onset of the symptoms - there was a largely normal clinical finding with clearly visible twitching of the legs, especially of the calf muscles on both sides, but without muscle wasting or weaknesses.

In the additional electrophysiological examinations carried out by us (electroneurography, transcranial magnetic stimulation), no relevant abnormalities were found. The only noticeable finding was provided by EMG examinations of both legs: As expected, there were numerous fasciculations on the upper and lower legs on both sides, especially in the calf muscles.

The course of the complaints (i.e. fasciculations and cramps) with a slow increase over many years, the normal examination findings and the additional electrophysiological examinations led us to the assumption that a so-called benign crampi fasciculation syndrome is likely to be present.

We began treatment with carbamazepine, a drug originally developed to treat epilepsy, which is used in benign crampi fasciculation syndrome. There was a clear decrease in the symptoms very quickly, whereby the painful cramps in the legs, which were very stressful for the patient, could be treated very well and he thus gained mobility and quality of life. The patient accepted the side effects of the drug in the form of a slight morning drowsiness and a slight dizziness.

The case illustration illustrates a relatively rare disease as the cause of fasciculations and very painful leg cramps. It also illustrates that muscle twitching doesn't always have to be a sign of a serious medical condition. In this case, the cramps could be significantly alleviated by a drug and the patient's quality of life became much better. The problem of leg cramps at night, which is common in the population, unfortunately cannot always be treated as successfully as in this case.