Hello @rwtiii and welcome to Mayo Clinic Connect. I wanted to bring you into a discussion with other members who have shared about their fasciculations, so you will notice I have moved your post here:
- Benign fasciculation syndrome (BFS): https://connect.mayoclinic.org/discussion/benign-muscular-fasciculation/

@harryfrenchuk is new to this discussion and other members who may be able to come in include @tjb1982 @bpaul @miep and @realshadowfax.

Has BFS been mentioned to you previously?

I would ask the doctor about electrolyte levels, too (PCP or neurologist). Sometimes fasciculations "just happen" and are "benign" -- which ultimately means they don't know what the cause is, but it sounds to me from the work up you've had so far that there's nothing life threatening, but you should obviously continue to work with your doctors to rule everything else out. Might need additional MRIs for the rest of your spine to try to rule out MS, maybe.

For context, I have had fasciculations for a few months that have come and gone (mostly gone lately), but a burning/numbness on my tongue that seems unrelated. EMG/NCS/complete CNS MRI revealed nothing remarkable, like yours. I'm continuing to monitor it, because if it gets significantly worse, then I'll head back in, at which point they'll likely send me to a research/teaching hospital (or, e.g., Mayo/Cleveland clinic). But it isn't debilitating at this point. Just feels like I burned my tongue on hot coffee for days on end.

My PCP and neurologist suggested anxiety and prescribed Lexapro 10mg daily, which may or may not have reduced the fasciculation symptoms, but hasn't affected the burning sensation, so I'm planning to stick with it for a few months (6 total) and then see what happens when I go off of it.

Unfortunately a lot of things can go wrong with the body and most things are not well understood or "idiopathic," "functional," etc. Someone made the comment that an anxiety diagnosis in a lot of cases is kind of like the old fashioned "hysteria" diagnosis, but ultimately if you end up there, you need to look for more opinions or ask yourself if it's really affecting your life enough to want to pursue it further. The big, well known things (particularly ALS) have been ruled out in your case, so I'm not sure how much farther your neurologist can/will go with you and may end up recommending a teaching hospital, etc.

good luck and keep us posted.

I had an outbreak of fasciculations last summer that started with one finger twitching and eventually grew to spasms throughout my body that disrupted my sleep and scared me a bit. I did research on my own and found that BFS is way more common than any of the serious illnesses. As I reported in an earlier post, I noticed that in my last blood test my calcium levels were in the low normal range so I started supplementing my diet with crushed egg shells (which is a good source of calcium). Starting in around October my spasms and twitching began to subside and are now at a very low level. I get an occasional spasm but it does not disrupt sleep. I can't say for sure it was the calcium that caused the problem but from my research it appears nutrition or lack thereof can often be a factor with BFS. I hope this helps in some way and that your condition improves over time.