Can Muscle Twitching Be a Symptom of ALS?

Muscle twitching is a hallmark symptom of ALS (amyotrophic lateral sclerosis). It develops because the disease damages nerves involved in motor function.

This article will explore why muscle twitching develops in people with ALS and the treatment options for those who have the symptom.

Older patient talking to doctor

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What Is Muscle Twitching?

Muscle twitching, otherwise known as fasciculation, is an uncontrollable movement of the muscles. It can happen either because the muscle contracts or the messaging system between the muscle and brain is damaged.

In some cases, the twitch can be visible to the naked eye. However, if the muscles affected are deeper under the skin, a person may feel the movement but not be able to see it. When muscle twitches, you will see the muscle under the skin jerk or move quickly. It may also resemble the appearance of small worms moving underneath the skin.

When to Worry About Muscle Twitching

Muscle twitching can be a benign event not correlated with severe health conditions. However, it can indicate various types of diseases, such as autoimmune disorders, metabolic disorders, and nervous system conditions. It is worth visiting your healthcare provider if you notice other symptoms alongside the twitch, such as muscle loss or weakness. 

Is Muscle Twitching a Symptom of ALS?

Muscle twitching is common in people with ALS. In fact, it is one of the signs that medical providers use to help diagnose the disease.

ALS causes muscle twitching because of how the disease affects motor neurons. Motor neurons are cells that act as the brain's messaging system to the muscles; they help control speaking, moving, swallowing, and breathing.

So when the brain wants a movement or function to occur, the motor neurons pass that message on to the muscles it takes to perform the task.  In ALS, those neurons can become damaged, or worse, killed off. When that happens, communication between the muscles and the brain becomes compromised and stops working altogether.

Brain Cell Toxins

In people with ALS, specific brain cells known as astrocytes produce toxins. When the toxins are released, they can spread to nearby areas and kill neurons responsible for motor functions along the way.

The toxin causes the neurons to explode in on themselves. Because of that neuron death, the communication system between the brain and the muscles becomes faulty. That is what leads to the twitching.


Necroptosis is a term for an event that occurs because of necrosis and apoptosis. Apoptosis is cell death that occurs due to aging or development.

Necrosis, on the other hand, is the death of tissue, cells, or neurons because of an outside factor, such as trauma or illness. Research indicates that neuron death in ALS can be attributed to necroptosis.

How Does Natural Cell Death Contribute to ALS?

Though cells and neurons slowly die naturally, that doesn’t mean that everyone develops a neurodegenerative disorder. However, natural death in combination with other disease activities can encourage a faster progression, and thus, worse symptoms.

Immune System Dysfunction

The immune system may also play a role in cell death in people with ALS. Research has found that a specific type of protein known as NLRP3 inflammasome can help the progression of ALS.

The protein promotes the proper function of the innate immune system response, which is the first responder to health threats. When the protein doesn't do its job correctly, it sets off a chain of events that increases inflammation and the death of neuronal cells.

Treatments and Management of Muscle Twitching

Although muscle twitching in ALS doesn’t typically come with pain, it can occur so often and be so pronounced that it affects a person’s day-to-day life. Because of that, specific treatments have been made available so that people with ALS can be more comfortable.

Some possible treatments include:

What Is the Best Treatment for Muscle Twitching Caused by ALS?

People respond differently to different medications, so the best option is the one that works best for you. There are several available, so speaking to your healthcare provider about muscle twitches will help you find the best one for you.

When to See Your Healthcare Provider

Muscle twitching is a sign of ALS, but that doesn’t mean everyone who experiences muscle twitching will do so because of the progressive neurodegenerative disease. Muscle twitching can also occur for other reasons, such as stress, too much caffeine, fatigue, or anxiety.

Watching for specific signs of disease can help you determine when you need to see your healthcare provider. Symptoms that indicate you should get medically tested include: 

  • Muscle weakness that starts in one area but begins to get worse
  • Speech problems or voice changes
  • Muscle weakening that leads to difficulty with lifting, climbing stairs, or walking

 These signs will start subtly and continue to worsen.


There are several reasons why ALS comes with muscle twitching, all of which revolve around the disease's effect on neurons. Neurons that control the communication pathway between the brain and muscles become damaged and die off in people with ALS, leading to a faulty line. When the brain and muscles cannot communicate properly, symptoms such as muscle twitching occur.

To treat muscle twitching, there are a variety of different medication options. The two most common are anticonvulsants and muscle relaxers. If you experience muscle twitching but do not have ALS, don’t panic. It does not mean that you have the disease. However, see your healthcare provider if you notice other signs, such as muscle weakness that worsens or speech changes.

A Word From Verywell

Muscle twitching isn’t always cause for concern. Many people experience it due to stress, caffeine, or anxiety. That said, because muscle twitching can be a sign of a neurodegenerative disorder or other health issues, it’s always good to check with your healthcare provider if the muscle twitching persists for long periods or worsens.

Frequently Asked Questions

  • Does ALS muscle twitching hurt?

    People with ALS experience many symptoms. However, painful muscle twitching isn't usually one of them. The twitches that occur typically do so without the presence of any pain at all.

  • Is muscle twitching easy to treat in ALS?

    There are several treatment options available for people with muscle twitching as a symptom. The two most common are anti-convulsants and muscle relaxers. What you are prescribed will depend on your personal health history.

  • How do brain cells die in ALS?

    Several bodily functions falter and cause brain cell death in people with ALS. This happens because of brain toxins, necroptosis, and immune system dysfunction. The death of neurons in ALS is what causes symptoms.

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Angelica Bottaro
Angelica Bottaro is a professional freelance writer with over 5 years of experience. She has been educated in both psychology and journalism, and her dual education has given her the research and writing skills needed to deliver sound and engaging content in the health space.