instruction: hello doctor I am a 42 year old female in good health aside from anxiety currently taking my citalopram a month ago I suddenly experienced muscle twitching all over both legs and this went on for two weeks I took magnesium and it subsided and has not really returned except for an occasional twitch here or there I am extremely concerned because over the course of the month I have had three episodes where I forgot how to swallow for a second it was scary and now I am afraid I have the onset of als I do also have a long time habit of throat clearing although I have not experienced any muscle weakness are those symptoms indicative of als
output: hi twitching of muscles can be due to anxiety as well as citalopram what is important is that you mention having them before initiating citalopram so it is unlikely to be due to the drug if it is occasional then you should rather not bother yourself because twitching intermittently is there even in an otherwise healthy individuals what is important is your sensation of forgetting to swallow this is drug induced akathisia or abnormal movement citalopram is known to have abnormal sensation restricted to tongue also hence if you feel that this is bothersome and progressing then you may change the medicine but my experience is that my is a very small dose to be causing side effects these symptoms are due to your anxiety as twitching was there before too and improved with magnesium your habit of throat clearing along with anxiety may be the cause of your feeling of forgetting how to swallow I have personally seen people having this because of acidity with reflux people with a habit of gulping food etc in many simple life situations I would rather like you to assure and to get relaxed with behavioral techniques and meditation if possible if it still persists then change of medications may be considered as far as als amyotrophic lateral sclerosis is considered I can only say that it requires nav nerve conduction test egg electromyography and mri magnetic resonance imaging for definitive diagnosis about have a family history but one should get thyearoid function parathormone and vitamin be tested because these are common and mics als twitching if reduced should be a reassurance against als I hope this helps