Constant Calves twitching for 9 years - anyone else have this?

[Basilanna]

I never connected the restless legs and constant calves twitching with the zoloft I started 9 1/2 years ago. I had been on impramine and dispramine for 20 years before the switch. I did not have any leg problems on them. Anyone else have constant movement in their calves?

[Hidden]

Hi Basilanna.

Welcome to this forum, I hope you find it helpful and supportive.

I am presuming you're asking fir belp and suggestions. Not everybody wants that.

As you're new to the site, just a tip on how to use it more effectively. No criticism intended.

You may not find it helpful to write two posts at the same time, especially if they are more or less about the same thing.

You may get conradictory answers, repeated answers and so on. It could get quite confusing for you.

In order to help, it would be good if you can give some more information, by answering a few questions. If you could spend just a few minutes to answer it could be really helpful for both of us.

Could you clarify what you mean by "constant" twitches? Does this mean 24/7 literally ALL the time? Has anybody told you that they happen when you're asleep?

Can you describe the twitches? Would you call them big or small? Does your leg actually move either at knee or ankle? If small can you actually see any twitches in your calf muscle?

I have to know this to figure out if your twitches are either due to RLS or something else.

Also if you're taking any medications specifically for RLS, it would help me to know. If so please tell me their names, doses and how long you've taking them.

I note you have been taking antidepressants for many years, would you mind telling me why?

I can say antidepressants can make RLS worse, especially SSRIs like zoloft.

There are some "antidepressants" that are known to be less of a problem for RLS. However, despite being called that, they may not be particularly good ones!

You may be quoted nefazadone, trazadone or buproprion.

I do know that the first two aren't generally used fir depression, they are used as sedatives, to help sleep.

The third is quite popular amongst RLS sufferers. It's known as wellbutrin in the US.

I lpok forwar to your reply

[Basilanna in reply to Hidden]

My twitches are 24/7 and you can see the movement like something crawling under the skin. I also feel vibration or buzzing. I was diagnosed with restless legs. Tried requip didn't really help any. I also get the urge to move legs at night,but not every night. I have ocd so antidepressants are for that and anxiety and depression. First reported restless legs my vitamin d level was low,but taking vit d didn't make a difference in the rls.

[Twitcher56 in reply to Basilanna]

Hi Basilanna,I am new to this fantastic forum and was going to post the exact same question. I have had the same twitching symptons in my calves for many years which I first noticed when I developed RLS about 25 years ago. I get the buzzing sensation and it looks like there is something crawling under the skin almost constantly. I have never taken any medication. I do a lot of sport and keep fit and eat pretty well. I manage the symptons with lots of stretching and massage before bed but recently, I have noticed the RLS and twitching getting worse along with cramps in feet and calves and am on the point of going to seek medication as resultant insomnia is unbearable. I do get a lot of lower back pain and neck pain and I have noticed symptons can be worse when these flare up and have been wondering if it could be some kind of nerve damage. Last time I went to the doctor he told me it was stress and that I should get therapy and do breathing exercises. He advised against medication as it could turn me into a shopoholic, gambler or worse! This time, I will be armed with a lot more information gleaned from this site. Cheers.

[Hidden in reply to Twitcher56]

Hi twitcher.

Whether the symptom of something crawling under your skin is part of your RLS or not is down to how much this particular symptom varies in relation to your RLS symptoms. I.e. does this symptom appear and disappear at the same time as your other symptoms.

Compare all your symptoms to the RLS diagnostic criteria.

See this link

irlssg.org/diagnostic-criteria

This particular symptom may be due to fasciculations in additon to RLS.

In relation to RLS the first things to be considered before resorting to medications are 1) iron therapy and 2) avoiding exacerbating factors.

However, if RLS is severe, e.g. daily and creating insomnia, then these two may take time amd medication may be a more immediate solution. They should STILL be tried and medication use may only be temporary.

I've replied to Basilanna about iron, so please read this and see this link

sciencedirect.com/science/a...

Eaxcerbating factors. There are many of these, too numerous for detail here. They are things which make RLS worse.

Alcohol, sugar, smoking (tobacco/nicotine) and caffeine can make RLS worse.

MANY medicines, prescribed or not. Incl. Antidepressants, antiemetics and sedating antihistamines, PLUS.

Inflammation caused by bowel conditions, sensitivities, allergies or diet. It depends on the individual, but even eating "well" isn't the same as eating what's best for you. Or, avoiding what's bad for you, as an individual.

There are some other health conditions which contribute to RLS, incl. Diabetes, hypothyroid, kidney disease, anaemia, anything causing hypoxia or neuropathy.

It's usually peripheral neuropathy that exacerbates RLS, diabetic, hypoxic or due to nerve compression. However, spinal neuropathy, compressed nerves or back pain can be associated with RLS.

Lifestyle can affect RLS too. Again diet, but also activity levels.

Be aware that keeping "fit" is not the same as keeping "healthy". Note recent footballer who had a cardiac arrest. "Sudden death syndrome" is not uncommon in sports.

Similarly whereas gentle exercise, yoga stretches and massage are good for RLS, too much or too strenuous is NOT good for RLS.

Be aware that what's "strenuous" is a somewhat subjective judgment. What you think isn't strenuous, may be objectively too much for RLS.

It does appear that like most doctors, yours is quite ignorant about the management of RLS. Stress can be another exacerbating factor, but it's not the cause.

Iron deficiency is.

Was that mentioned?

I love the colourful language, shopoholic etc, but again, a good demonstration of ignorance.

This is not to criticise your Dr. They lack proper training.

If your RLS is as severe as it seems to be, then I'd say not offering a medication is unacceptable and could lead to ever increasing health problems, not to mention suffering.

More later.

[Hidden in reply to Twitcher56]

Later

Excuse the brevity, written more than once today

3 officially recommended drugs for RLS.

Whether you use one or not and which particular one depends on how succcessfully the drug controls the RLS symptoms without causing too many side effect or risks. None are perfect and benefits must outweigh costs.

First line (first to be used) Alpha 2 delta ligands (ligs) or dopamine agonists (DAs)

Second line (used when firsts fail) Low dose strong opioids

Ligs = pregabalin, gabapentin (or in USA gabapentin enacarbil)

DAs = pramipexole, ropinirole or rotigotine.

You should be offered a choice of the first line.

Ligs are effective for RLS and are good at helping sleep. They have some side effects, some of which often wear off after a while.

Cause dependency : hence withdrawal effects

Long term risks, small risk of tunnel vision and respiratory problems (the latter in people with other respiratory problems). Augmentation, see below.

Ligs can cause addiction if you abuse them to get a high.

DAs are effective for RLS and are known to be effective very quickly. They have some side effects, some of which often wear off after a while.

"Sudden daytine drowsiness" can be a problem and can make driving dangerous.

Cause dependency : potentially VERY severe withdrawal effects.

Short term/long term risks. Impulse Control Disorder (ICD) and dopaminergic augmentation. Both of these are life changing conditions.

ICD = compulsive gambling, shopping, eating or hypersexuality and is not that common.

Augmentation = a significant worsening of RLS symptoms and with DAs it is very common.

Note the augmentation caused by a lig is not quite the same and is far less common. Ligs do not cause ICD.

DAs aren't classed as addictive, probably because I can't imagine anybody wanting to abuse them!

I'm afraid your Drs reference to shopoholic etc is a further demonstration of their ignorance, i.e. no mention of the far more common augmentation and no mention of the ligs.

International guidelines for the first drug treatment of RLS

pubmed.ncbi.nlm.nih.gov/274...

I hope this helps

[Twitcher56 in reply to Hidden]

Hi Manerva,Thanks for taking the time to reply in such detail and your advice is very helpful. I agree with your comments on diet and have noticed symptoms worsen if I drink too much caffiene or alcohol. I do over do the exercise sometimes which can also make it worse. I did have an Iron test a year ago and ferratin level was around 100 and normal but am taking iron tablets anyway to see if they can help. Have tried magnesium and vitamin D which seemed to help for a short while but not for long. I hate the idea of taking drugs but things have got so bad lately that I think i will request a course of ligs to see if they make a difference. Thanks again.

[Hidden in reply to Basilanna]

What you describe sounds more like "fasciculations".

Fasciculations are small contractions of small groups of muscles and can therefore be seen, as you say, like something crawling under the skin. They can also be felt.

RLS does not normally occur 24/7. It is a "sleep related" movement disorder and therefore only occurs, or is worse at night. It does not normally then happen just any time, ( see below)

Visible, small muscle contractions and in fact involuntary movements of any kind are not a part of the diagnostic criteria for RLS.

Some people experience involuntary movements with RLS, but these aren't small movemenss and usually involve the whole limb.

Sorry, I realise now that a couple of my questions were ambiguous.

24/7 could mean that your symptoms could happen at any time during the day or they could happen all the time. The difference is important, but both are significant.

See above RLS does not normally happen at any time. It also doesn't happen all the time, i.e. "constantly". It usually only occurs when you are relaxing, sitting or lying down and is relieved by moving.

The "urge to move" is itself an ambiguous term. It means different things to different people. There are many reasons why people feel they need to move. The urge to move, in itself does not mean you have RLS.

The fifth criteria for RLS is that the symptoms cannot be explained by anything else.

Your symptoms, as you describe, could be explained by fasciculations.

Here is a link to the validated RLS diagnostic criteria.

If requip didn't help, it could mean either, that you didn't take enough or for long enough OR you're one of the few for which it doesn't work OR you don't have RLS. So it may be irrelevant.

I'm NOT saying you don't have RLS, it could well be that you do as well as having fasciculations.

There are a couple of things that might help confirm the RLS diagnosis as well as the diagnostic criteria. These involve taking a drug and therefore they are up to your doctor.

One is a dopamine test. This involves giving one or two doses of either Levodopa or a Dopamine Agonist. These are reknowned for their effectiveness in relieving RLS symptoms almost immediately, i.e. the same day as the first dose. So, if the drug relieves the symptoms, you have RLS, if it doesn't then you probably don't. A negative result however is not totally conclusive.

The other test is the "histamine challenge" test. In this case you may be given one or two doses of a sedating antihistamine. If this makes your symptoms worse then you may have RLS, if it doesn't then you probably don't. A negative result however is not totally conclusive.

The other ambiguous question was about the antidepressant (AD) Sorry, I should have been clearer. I wasn't asking what condition you are taking the AD for, I was asking why have you been taking one for years?

[Basilanna in reply to Hidden]

I do meet all the points of restless legs when I sleep. Not every night. It feels like a pressure builds until I have to move my legs to release. If I then take 2 Advil it relaxes my legs and I can sleep. I thought the twitching was also part,but I see they are not part of rsl.

[Hidden in reply to Basilanna]

OK, if you meet all the points then you have RLS.

Did the requip not relieve the urge to move?

Advil is not recommended for RLS. Unless inflammation is a factor in your RLS, then it will be of little value. Advil is not a muscle relaxant. I appreciate you experience it works, but there's no reason it should.

It's also not recommended because taking it too frequently or long term can cause some other serious health problems.

A benzodiazepine such as clonazepam is both a muscle relaxant and a sleep aid, but it's not advised long term either.

I strongly suggest you look at other treatments for the RLS. The main one is iron therapy, as iron deficiency is the main cause of RLS.

For this you need a blood test for serum iron, transferrin and ferritin. As a rule if your ferritin is below 75ng/mL, then iron therapy can help.

See this link.

sciencedirect.com/science/a...

Alcohol, sugar, smoking (tobacco) and caffeine can make RLS worse.

Food supplements such as magnesium, vitamin B12 and D3 can help. A strong anti-oxidant may help, e.g. celery juice.

It does sound as if you may have fasciculations as well.