<s>[INST] my brother has had a few episodes of extreme muscle twitching of all four extremities which cause him to have difficulty walking. after the episode is over he is extremely fatigue, wold sleep, when he wakes he is not having the shakes on the outside but says that he is having the shakes on the inside aand he still is having difficulty walking. Could this mean he might have MS [/INST] Hi, Thanks for your query. It seems that you have muscle twitches or articulations. These are small, local, involuntary muscle contraction and relaxation visible under the skin arising from the spontaneous discharge of a bundle of skeletal muscle fibers. You might consult your doctor who can order 1. A few blood tests including thyroid function tests, 2. Serum electrolytes including Serum calcium and potassium levels. 3. Serum B12 levels In case the above tests are normal further testing can be done including - nerve conduction studies, Electromyography, etc. These tests might help to diagnose any underlying neurological issues. I do hope that you have found something helpful, and I will be glad to answer any further query. Take care </s>