<s>[INST] Hi doctor, I am a 28-year-old male, approximately 93 kg, 1.89 cm. Over the past year, I have been getting muscle fasciculations on in my calves (mainly) and also in my quads. I have seen several doctors now and they have checked my reflexes and feeling in my legs and it is all fine. The fasiculations occur, or get worse when I do weights that strain the back of my neck, where it meets the base of my skull. For example shoulder press, or bench press. I have proven that this is the problem many times now. Caffine, alcohol, etc., are all stimulants that make it worse. However, the weights I mentioned above I am certain is the problem. The fasiculations are bad, I have had countless sleepless nights because the twitching is so bad. It is important that I find the problem as I do not want to stop weights permanently. I requested my doctor to prescribe me with blocker drugs and he has given me Gabapentin Milpharm 300 mg. These actually help and reduce the fasiculations. I also went to a chiropractor who was excellent in helping my mobility through my neck and back but could not stop the twitching. He said that I need to see a Neurologist. Does anyone know what is wrong with me? Or what I should do from here? [/INST] Hi. Involuntarily muscle twitching or fasciculations could result from various causes. Most common being anxiety, hyperthyroidism, nerve compression at lower back, restless leg syndrome, vitamin B12 deficiency, vitamin D deficiency. If we think of uncommon causes, they could be amyotrophic lateral sclerosis or multiple sclerosis. In my opinion, you need a comprehensive workup first. That includes thyroid profile, vitamin D and B12 levels, blood counts, MRI LS spine, EEG. So, you do not need to rush to a neurologist. First of all, go to your GP. Request him for these tests. Let the report come and then you can go for a neurology opinion. My recommendations in such cases for treatment would be taking Mecobalamineshots, Vitamin D and Calcium supplements. You can also ask your doctor to prescribe you Pregabalin in sustained release form for at least three months. </s>