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Do your stomach muscles twitch? Twitching is the everyday term for fasciculations, which are the abnormal movements of muscles.When your "stomach" twitches, the fasciculations are occurring in your abdominal muscles, but fasciculations can occur in any muscle in the body.

Fasciculations can be an everyday occurrence with no serious consequences, although sometimes their causes can be signficant.

Dehydration, electrolyte imbalances, and fatigue can cause twitching muscles. They can occur when high-dose steroid therapy is terminated abruptly, without tapering down the dosage.

Less often, fasciculation is a symptom of peripheral neuropathy, which can result from diabetes, HIV, injury, or chemotherapy. In rare instances, the underlying problem is a motor neuron disease such as amyotrophic lateral sclerosis (ALS, or, as it is called in Commonwealth countries, MND). In motor neuron disease, the muscles are "twitchier," that is the contractions come much more quickly, and they don't go away. If you have ALS (MND), you will have a range of disabling symptoms that get progressively worse. Chances are that motor neuron disease is not the problem, particularly if the twitching is limited to one part of the body.

Other rare possibilities include:

  • Epilepsia partialis continua. This condition is essentially an epileptic seizure limited to one muscle in the body. Once it starts, it can continue as relatively benign kind of status epilepticus, for minutes, hours, days, or even weeks. This condition is usually caused by very specific and relatively small traumatic brain injury. It can be incapacitating, but unlike status epilepticus that affects the entire body, it does not cause permanent brain damage. This condition is very rare. In the UK and the Indian state of Kerala, where statistics have been kept, it affects fewer than one per million people.
  • Myokymia. This condition is the quivering of a muscle, or even a group of muscles, that is not enough to move a joint. It most commonly occurs after extremely heavy exercise, but it does not necessarily affect the muscles that were exercised. A common manifestation of the condition is a "rippling" of the muscles beneath the lower eyelid, maybe spreading to the muscles beneath the upper eyelid. Myokymia is treated with a warm compress to relieve muscle tension, or a small dose of antihistamine to induce relaxation, or bed rest with no use of handheld electronics or computer screens until the eye muscles recover. When myokymia occurs in other muscles, the recommendation is still for moist heat and rest.
  • Stiff person syndrome is a condition of alternating stiffness and spasms that most closely resembles tetanus. It can involve abdominal muscles, but usually it starts in the legs, then goes to the arms, and then involves muscles in the neck, chest, back, and abdomen. Stiff person syndrome is usually treated with a drug called baclofen (Lioresal), sometimes delivered by a pump. Baclofen pump use elevates the risk of sudden death and crib death when the pump is used to treat infants.

Occasional twitches in the abdomen are scary, but they usually do not imply the presence of any disease other than benign fasciculation syndrome. Fortunately, when the diagnosis is benign fasciculation syndrome, there is a treatment that usually works, gabapentin, marketed in much of the English-speaking world under the trade name Neurontin. This drug relieves localized or focal seizures. It also relieves the pain caused by neuropathy, and it is sometimes prescribed for restless leg syndrome. Off-label, it is used to treat the mood swings in bipolar disorder and also social anxiety disorder and insomnia. Like many other medications to control muscle movements, it can cause drowsiness, dizziness, swelling of the hands and feet, lethargy, and weight gain, and it has to be monitored carefully in patients who had kidney disease. A newer form of the medication called gabapentin enacarbil may give faster and more complete control of symptoms than the original Neurontin.

Whether control over abdominal twitches is worth the side effects of Neurontin is for individuals to decide with their doctors. At least the process of prescribing the drug will involve testing to eliminate the possibility of the presence of more serious conditions.

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