Question: Hello Doctor, I have been experiencing muscle twitches in few areas. One month back, it came on the left side of my face. When I visited the Physician in my area, he prescribed Methylcobalamin tablets and suggested that I should consult a Neurologist if the twitching doesn't stop next day. But, the twitching stopped after taking a few courses of the medicine and hence I considered not to proceed with any further treatment. Yesterday, while at home I experienced twitching on my left arm muscles for few minutes and I had methylcobalamin (Brand Name: Polycobal) tablet again and it stopped after some time. Today, I experienced minor twitching for few mins near the base of my right ear and it stopped on its own. Is it Vitamin deficiency or Calcium deficiency or initial symptoms of a neurological disorder. Is it necessary to undergo neurological tests to rule out problems? I do not have persistent twitchings. It appears and disappears on its own. I am 94 kg heavy, 5'11, 39 year old male with sedentary life style and not regularly taking nutritionally balanced food. Look forward to hear from you soon.

Dear doctor, did blood tests for electrolytes, Vitamins and Calcium, Magnesium etc. Everything seem to be in normal range except Vitamin D for which my value is 7.4 ng/ml (Normal range: 30 - 100 ng / ml) and Vitamin B12 for which my value is 155 (Normal range: 211.0 - 911.0 pg / ml). Even Magnesium is border line at 1.9 ( Normal range is 1.8 - 2.4 ). Besides, ESR is slightly high at 15 mm at 1 hr (Normal range is 0 - 14).

Based on these results, do you think if I take Vitamin D and Vitamin B12 supplements, the twitching will stop. Do you still suggest me to undergo neurological tests to rule out serious disorders like ALS. While I am typing this, I do not have twitching. I had experienced twitching on my left shoulder this morning but it stopped since afternoon. If I need to change some dietery pattern also kindly advise. I was planning to join a gym to tone my body before this twitching episode and I don't know whether I am fit to do it now.

Many thanks in advance for your kind advice.

Thank you very much doctor. Grateful, if you could kindly prescribe a commercially available Vitamin (D3?) tablet and dosage per day? Similarly, could u suggest a commercially available Vitamin B 12 and its dosage per day? Alternatively,Will CCM one tablet a day help? I also want your advice on whether I should undergo tests like EMG to rule out other neurological disorders? Please advise.

Many thanks doctor. You have cleared all my doubts with your excellent diagnosis and treatment options. One last question I have is whether I need to take Calcium Citrate supplement also? Since Vitamin D has been very low in body for a long time, the system for compensating the Ca loss might have started leaching Ca from bones. I feel fatigue and pain in calf muscles every evening and I always thought it was due to driving car in heavy traffic for commuting to office. Now I feel it could also be due to Ca loss from bones due to deficiency in Vitamin D. Hence, I need your advice as to whether taking Calcium tablets (what is appropriate dosage?). The other complication would be my tendency to develop kidney stones (the last time I had a stone was 4 years ago). Whether Calcium tablets may end up forming kidney stone in my body?

Since there seem to be no cure for BFS, I am wondering how long it will take cure this disorder or as many reports and online forums suggest, one has to live with this condition for a lifetime?

Many thanks for all your inputs and advice.