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Caring doc
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Experience:  Internal Medicine Specialist. MBBS,MD
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I have been experiencing random body parts jerking while I

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I have been experiencing random body parts jerking while I am falling asleep (right before I enter a deep sleep). This has been happening for a week now constantly. I am pregnant (4 weeks) and take vitamins. I have increased magnesium just in case I was deficient recently but it doesnt appear to be helping. Sometimes my whole body will jerk while other times it is just a finger or hand or leg that lifts up. It is very weird and is really effecting my sleep- sometimes taking me over an hour to actually get to sleep.
I have no other problems that are happening- and no jerking during the day.Please help!
Could you explain your situation a little more?
Since when have you been having these symptoms?

Do you have any other complaints?

Is this your first pregnancy?

Have you checked your CBC , Serum iron levels?

Do you take any drugs?

Do you have any other medical condition?
Customer: replied 7 years ago.
This is my 3rd pregnancy (they think possibly twins - I already have 1 set of twins but it appears there could be a set again- never did fertility).
Since I have been pregnant I have had burping problems or similar to hiccups- not sure- it is on and off- seems that in the last 2 weeks it has gotten better but is still happening- I just thought it might be pregnancy.
Had blood work done as a pregnancy work up last week-waiting on nurse to call back with results and I am not sure if she checked serum levels- I will have to ask.
I do have a heart condition- mitral valve prolapse and recently they discovered (on 5 year echo follow up b/c of the prolapse) that I have bulging in my atrial septum- I am seeing another cardiologist for a 2nd opinion on this in a couple of weeks as it was never discovered before.
I do get sensory issues on occasion- in fact I saw a doctor a year ago because I woke up in the middle of the night and my throat, arm and chest were nump- took a few min before feeling came back. He did some work up and an MRI on my head and neck- all came back normal. They also did a nerve conduction test which came back normal as well. Sensory problems have been much better in the last year that I barely notice any problems now- but on occasion I still have some minor problems- like my arm falling asleep or my big toe, etc.
I do get minor twitches sometimes too- but not much more than what happens to others I know. Seems like they act up at night before bed when I am relaxed- might have a twitch in my thigh and arms, etc a few times but never when I am fully awake and moving around. Like I said- the body jerks are occuring right as I am about to go into a deep sleep. It is very very annoying. My leg might pick up or my fingers squeeze, next my arm jerks up, if I turn over then my other arm will do it. I counted last night and it happened 30 times before I feel asleep.
Once I am asleep I am never woken up. Also I have noticed if I am extremely tired it will stop happening or happen less as I go to sleep quicker.
I have been really stressed this month- but not daily just in general- and especially stressed when I found out if could possibly be twins again. So I am not sure if this is related.
I do not do any drugs- never have- and I dont drink either. I dont take any prescription drugs.
From what you have mentioned you are most probably suffering from Restless legs Syndrome. It is sometimes precipitated or made worse by pregnancy. It has many etioligies however it is most commonly associated with nutrient deficiencies.

Since this is your third pregnancy it is vital that you check your cbc for anemia especially iron deficiency which is most commonly associated with this condition. Taking multivitamins would not help be of help as the quantity of iron in them is much less.

Secondly there are other underlying conditions which have to be ruled out. There might be folic acid deficiency or a thyroid problem. Some drugs like antiemetics might worsen this condition.

So I would advise you to screen for iron deficiency, folic acid deficiency , TSH ( to look at thyroid and stop drugs like motilium which might worsen it.

The best treatment of Restless legs syndrome is to treat the underlying condition.
Customer: replied 7 years ago.
I read earlier about restless leg syndrome and it said people have the urge to move their legs- while I dont have that urge. I have involuntary muscle jerking (basically in a nutshell) and it is all muscles- toes, foot, arms, shoulder, I think even my eyebrows which is strange. Sometimes I even have my body squeeze tightly- like my legs are squeezing up toward my stomach- but just for a second and then I am back awake.
I just wanted to run this by you because I could find on restless leg syndrome about muscle jerking- but I guess that doesnt mean it cant be!
It was scary for me initially because when I looked it up thinking it was nutritional - ALS and MS popped up. ALS especially was frightening- but I dont have any muscle weakness so hopefully that can be ruled out!
Thank you so much for your help and response. I am so desperate to be spared from whatever this is that I am being plagued with! :-)
Restless legs syndrome is a broad spetrum . It starts with urge to move but it can progress to jerks and involvement of other parts of body.

In any case you need to screen for deficiency states before you start fancy treatment especially keeping your pregnancy in mind
Caring doc, Doctor
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Customer: replied 7 years ago.

These are muscle fasciculations and patient first needs to have a metabolic panel checked. This is NOT Restless leg syndrome.

For the information of so called neurologist Fasciculation is the involuntary contraction of few muscle groups which mostly doesnot result in perceptible movement or jerking of a limb. It can be present normally in a well toned healthy individual. Also it doesnot result in cramping.

Jerks or feeling or being cramped are not attributed to fasciculations. And for the information of so called neurologist fasciculations is not a diagnosis per se it is a sign . She would know if she went to a medical school.

What I replied to dear customer holds absolutely valid .
I certainly hope that it is not standard in Pakistan to teach that Restless Leg Syndrome involves eye brow twitching.

Patient does not mention cramps.

For the pateint: it would be prudent to check your anti-GAD antibodies to rule of Stiff Person/Stiff Limb syndrome.
For the record Fasciculations is not a diagnosis anywhere in the world. I think they teach that to all American undergrads.

Her main problem pertained to limbs . She needs to be investigated not necessarily for anti GAD anitbodies.

Considering in mind that it is her 3rd pregnancy and she might be having twins puts her body at a great demand for nutrients especially Iron and iron deficiency is very common in this population subset. It is vital that she begin her workup on those lines. Getting a basal metabolic profile is a basic test which might be done during her workup.
I think I'm pretty sure I mentioned fasciculations in the context of metabolic disturbance.

Your diagnosis of Restless Leg Syndrome as muscle twitching in shoulder and eyebrow deserves a mention in a special journal.

For the record, muscle twitching in shoulders and forehead are not features of RLS.

Patients symptoms do not meet criteria for RLS, which are:
urge to move legs relieved with movement,
unpleasant sensation completely or partially relived with movement
above symptoms worse at rest/at night

Customer: replied 7 years ago.
I looked up muscle fasculations- I know what these are as I doctor told me a year ago what it is. This is what I found online on fasculations- A
fasciculation [f?.?s?k.ju.'le?.??n] (or "muscle twitch") is a small, local, involuntary muscle contraction (twitching) visible under the skin arising from the spontaneous discharge of a bundle of skeletal muscle fibers.
I get them sometimes- stress- fatigued, etc- I know healthy people who get them as I have seen it happen to others- like a twitch under the skin so to speak.
I am getting body jerks- or spasms. ONLY when I am about to go into a deep sleep- my hand or fingers move- or my leg. My shoulder will spasm sometimes too- it started happening about a week ago and is happening every time I am dozing off to sleep now- and is bothersome. As I said- this never occurs when I am active and awake- only right before a deep sleep- but it will keep arousing me and take me longer to fall asleep.
I looked up the stiff person syndrome but it doesnt seem to fit me- I dont have ANY back problems- EVER- or sit like a tin-man. I also dont have body cramps or stiffness. I have 3 kids and run around constantly with them and go places, etc without ever having any problems.
THANKS for freaking me out though!! I needed that!
If you experince these muscle jerks exclusively when you try to fall asleep, these are normal hypnagogic muscle jerks. These are not pathologic and often get worse with sleep deprivation.

If they continue to occur in sleep, or begin to wake you up at night, you may have Periodic Limb Movement of Sleep.

Also, be careful not to take too much of magnesium supplements; you can get a lot of Mg from eating things like avocados and pumpkin seeds.

By the way, congratulations on your pregnancy!
Customer: replied 7 years ago.
Can too much magnesium cause muscle jerks?
I am experiencing these jerks ONLY when trying to fall asleep- thats it. I mean I get fasculations at rest sometimes- but never when I am active moving around.
The jerks are happening a lot- about 30 times before I am actually able to fall asleep- but once in a deep sleep I am not waken by them- in fact - once asleep I get very good sleep- its just that these body spasms have affected me by making it harder or taking longer to fall asleep- can hypnagogic muscle jerks occur a bunch for weeks??
also- what could be the cause? How can I get better, I need to especially if I have twins on the way- again!
Hypnagogic muscle jerks are not related to magnesium. The more sleep deprived you are, the more often they may happen. Some poeple are more susceptible to them. The fancy name for it is hypnagogic myoclonus. Most people experience it, and since it only affects you briefly it is nothing to worry about.

Fasciculations at rest can be normal in physically active people, be a sign of electrolyte abnormalities or, as you already looked it up - a sign of ALS; the latter is highly unlikely here.
If you sleep well through the night and your husband/significant other does not tell you you kick him at night, then you likely do not have PLMS.

You should always ask your OB about taking additional supplements in pregnancy. Extra magnesium may interfere with labor later on.

Two twin pregnancies - that is amazing. All the best.
Customer: replied 7 years ago.
can hypnagogic muscle jerks occur constantly and over and over before falling asleep- like 20-30 times ??
If so- it would make sense- But I dont have any falling sensations w/it. I am just drifting off to sleep and all the sudden my arm pops up- or my finger moves, or my legs move- or foot, etc.
eventually- I get so tired- that I sleep- and then stay asleep when in a deep sleep.
Dear *****ient please dont freak out . Dont worry your mind with all these fancy names . Just get your iron, folic acid and calcium levels checked. Deficiency of Calcium may also cause this and this can happen given your body`s excessive requirement.

Magnesium augments the effect of calcium and causes mucle relaxation . It doesnot cause spasms.

You need to have simple test like CBC , BMP including Calcium levels which would point you in the right direction.

And please dont burden your mind I am here to help you

that's what exactly what it sounds like. Your brain senses the extreme muscle relaxation when you fall asleep and mistakes it for falling and this is where the position sense reflexes kick in. It's like it attempts to prevent you from falling.

Some people only have that falling sensation, some only the jerks, some both. If you sleep soundly afterwards there is nothing to be concerned about.
Customer: replied 7 years ago.
Caring Doc,
I didnt have my electrolytes checked- but my CBC run by my OB doctor is normal- they said iron was normal too...
I will get the other tests run though to check my calcium level though too.
I just hope it will stop because I am started to get really worried/scared now! :(
I pray for help on this!
It will be prudent to check your electrolyte levels including magnesium (calcium and magnesium "go" together) but that has not much bearing on hypnagogic myoclonus.

I think it is important for patients to know what they experience, both in medical terms and layman's terms and I like to explain to my patients what mechanisms lie behind what they experince. Many patients say it is empowering and they appreciate it, so I continue to do that.

Don't be scared. Even if there is an electrolyte abnormality it can be corrected. The growing demands of twin pregnancy may cause such changes but periodic checkups with your OB will keep everything under control.
Customer: replied 7 years ago.
What do I need to do if there is no electrolyte abnormality. Could it be just stress or something transient? Or would I need to further explore the problem?
Customer: replied 7 years ago.
I didnt know if you saw my reply...I had a normal CBC- Will get my electrolytes checked- but I am getting scared at this point if those are all normal...what would I do if they are normal? Does that mean the sleep jerks are something bad??
As you know, you do not have Restless Leg Syndrome as the previous doctor (Caring doc) suggested. You do not meet any criteria for it at all.

Again, hypnagogic muscle jerks are benign. Most likely it something transient and they will go away or at last diminish. It is often related to anxiety, stress and sleep deprivation but are also a normal occurence.
Customer: replied 7 years ago.
Just to get a clear answer on this- can hypnagogic muscle jerks occur multiple times(20+) a night right before actually falling asleep- or when trying to take a nap, etc. ??
I just wasnt sure if you realized it was happening that many times or if you thought it was just a couple of times before falling asleep.
I am happy to keep answering your new questions, but I hope you can consider accepting my answer.
Customer: replied 7 years ago.
I didnt realize I had to accept until my question was answered in full?!?
If yo can no longer answer- I understand
Thanks for your help.
Indeed, some people can have only 1-2 myoclonic spasms when they fall asleep, some may have dozens. It does not imply any pathology. In extreme cases, they can be too frequent to count. Since this is a transient phenomenon, it does not require pharmacologic treatment such as may be necessary for PLMS.
Just as they came on a week ago, they may suddenly go away. It is impossiblt to predict how things will go, but most likely this is not something you will have to deal with long term.
Just to correct the things for neurologist and the patient, Restless legs Syndrome is a sensory-motor disorder in which there is an irresistible urge to move the legs, or sometimes the upper extremities, that is often associated with a creepy-crawling or aching dysesthesias deep within the affected limbs. For most patients with RLS, the dysesthesias and restlessness are much worse in the evening or night compared to the daytime and frequently interfere with the ability to fall asleep. The symptoms appear with inactivity and are temporarily relieved by movement. In contrast, paresthesias secondary to peripheral neuropathy persist with activity. The severity of this chronic disorder may wax and wane over time and can be exacerbated by sleep deprivation, caffeine, alcohol, serotonergic antidepressants, and pregnancy.

When I mention this post I am quoting Harrison `s book of Internal medicine. So to be clear this disorder can affect upper extremities and is a plausible , irrefutable diagnosis in this case.
For the knowledge of our esteemed customer:

Periodic limb movements of sleep
(PLMS), previously known as nocturnal myoclonus, consists of stereotyped, 0.5- to 5.0-s extensions of the great toe and dorsiflexion of the foot, which recur every 20–40 s during NREM sleep, in episodes lasting from minutes to hours, as documented by bilateral surface EMG recordings of the anterior tibialis on polysomnography. PLMS is the principal objective polysomnographic finding in 17% of patients with insomnia and 11% of those with excessive daytime somnolence. It is often unclear whether it is an incidental finding or the cause of disturbed sleep.

PLMS occurs in a wide variety of sleep disorders (including narcolepsy, sleep apnea, REM sleep behavior disorder, and various forms of insomnia) and may be associated with frequent arousals and an increased number of sleep-stage transitions. The pathophysiology is not well understood, though individuals with high spinal transections can exhibit periodic leg movements during sleep, suggesting the existence of a spinal generator.

Treatment options include dopaminergic medications or benzodiazepines.

So I think that " hypnagogic myoclonus " would not sufficiently explain your diagnosis.