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{{Short description|Spontaneous, involuntary muscle twitch}} |
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{{See also|Twitch (disambiguation)|Tremor}} |
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{{Infobox symptom | |
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{{medical citations needed|date=July 2020}} |
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Name = Fasciculation | |
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{{Infobox medical condition (new) |
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| name = Fasciculation |
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| synonyms = Muscle twitch |
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|image = Bfs spasm.gif |
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|alt = Animated image showing involuntary twitching in the upper eyelid of a young adult male |
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|caption = Animated image showing involuntary twitching in the upper eyelid of a young adult male |
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| pronounce = {{IPAc-en|f|ə|ˌ|s|ɪ|k|j|ʊ|ˈ|l|eɪ|ʃ|ən}} |
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| field = [[Neurology]] |
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A '''fasciculation''', or '''muscle twitch''', is a spontaneous, involuntary [[muscle contraction]] and relaxation, involving fine muscle fibers.<ref name= Blackman2019>{{cite journal |vauthors=Blackman G, Cherfi Y, Morrin H, ''et al'' |title=The association between benign fasciculations and health anxiety: a report of two cases and a systematic review of the literature |journal=Psychosomatics |volume=60 |issue=5 |pages=499–507 |date=2019 |pmid=31174866 |doi=10.1016/j.psym.2019.04.001 |s2cid=146012381 |url= https://discovery.ucl.ac.uk/id/eprint/10076229/3/David_The%20Association%20Between%20Benign%20Fasciculations%20and%20Health%20Anxiety_AAM.pdf}}</ref> They are common, with as many as 70% of people experiencing them.<ref name= Blackman2019/> They can be benign, or associated with more serious conditions.<ref name= Blackman2019/> When no cause or pathology is identified, they are diagnosed as [[benign fasciculation syndrome]].<ref name= Blackman2019/> |
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==Diagnosis== |
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| ⚫ | Fasciculations have a variety of causes, the majority of which are [[benign]], but can also be due to disease of the motor neurons. They are encountered by |
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{{further|Benign fasciculation syndrome}} |
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| ⚫ | The most effective way to detect fasciculations may be surface electromyography (EMG). Surface EMG is more sensitive than needle electromyography and clinical observation in the detection of fasciculation in people with [[amyotrophic lateral sclerosis]].<ref name=pmid18428004>{{cite journal |vauthors=Mateen FJ, Sorenson EJ, Daube JR |title=Strength, physical activity, and fasciculations in patients with ALS |journal=Amyotrophic Lateral Sclerosis |volume=9 |issue=2 |pages=120–1 |year=2008 |pmid=18428004 |doi=10.1080/17482960701855864 |s2cid=43321868 }}</ref> |
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| ⚫ | Deeper areas of contraction can be detected by [[electromyography]] (EMG) testing, though they can happen in any [[skeletal muscle]] in the body. Fasciculations arise as a result of [[depolarization|spontaneous depolarization]] of a [[lower motor neuron]] leading to the synchronous contraction of all the skeletal muscle fibers within a single motor unit. An example of normal spontaneous depolarization is the constant contractions of [[cardiac muscle]], causing the [[heart]] to beat. Usually, intentional movement of the involved muscle causes fasciculations to cease immediately, but they may return once the muscle is at rest again. |
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{{original research|date=December 2011}} |
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Tics must also be distinguished from fasciculations. Small twitches of the upper or lower eyelid, for example, are not tics, because they do not involve a whole muscle, but rather are unsuppressible twitches of a few muscle fibre bundles.<ref> |
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===Pathological conditions=== |
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{{cite journal|url= https://d1wqtxts1xzle7.cloudfront.net/62154985/22._TIC_10.1920200220-73731-xvf2fo.pdf?1582237254=&response-content-disposition=inline%3B+filename%3DTic_disorder_definition_clinical_context.pdf&Expires=1594852037&Signature=M5jspfaapRSdO3HtflIOLfUA1LTFzYnhBpyq5WKoNWvzokN-ZBxxGQupdgroalVSF7iBch5mBOygBYllUqPrCV1KRaVVUd-MWHovSHFFjnEGVdW-2sdHUQXejhXVx-0DfMZVufscBG7Dvl~4dR8u50E0KAECaP69SxN2aaA3Q3Vpf3ivoOCU9fj8WqxUsqJgelEnq6smwiXU5zujC90xyDvetTTfJYZweNEobMH-cqY0sTMjWXmH~-mCX8O6SKa0Lf1RdvDgXO-FLPml36Zf20sD6RR8IO1poxgtPsIrZ632qJL23ELOQTnDwUUNDkNBnz0YJU6hyxFLTGYBy0mz1w__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA |archive-url= https://web.archive.org/web/20200715213358/https://d1wqtxts1xzle7.cloudfront.net/62154985/22._TIC_10.1920200220-73731-xvf2fo.pdf?1582237254=&response-content-disposition=inline%3B+filename%3DTic_disorder_definition_clinical_context.pdf&Expires=1594852037&Signature=M5jspfaapRSdO3HtflIOLfUA1LTFzYnhBpyq5WKoNWvzokN-ZBxxGQupdgroalVSF7iBch5mBOygBYllUqPrCV1KRaVVUd-MWHovSHFFjnEGVdW-2sdHUQXejhXVx-0DfMZVufscBG7Dvl~4dR8u50E0KAECaP69SxN2aaA3Q3Vpf3ivoOCU9fj8WqxUsqJgelEnq6smwiXU5zujC90xyDvetTTfJYZweNEobMH-cqY0sTMjWXmH~-mCX8O6SKa0Lf1RdvDgXO-FLPml36Zf20sD6RR8IO1poxgtPsIrZ632qJL23ELOQTnDwUUNDkNBnz0YJU6hyxFLTGYBy0mz1w__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA |url-status= dead |archive-date= 2020-07-15 |title= Tic disorder: definition, clinical contexts, differential diagnosis, neural correlates and therapeutic approaches |publisher= MeDOA Publications |journal= Journal of Neuroscience and Rehabilitation |date= 2019 |volume= 2019 |issue= 1 |vauthors= Perrotta G |quote= Tics must also be distinguished from fasciculations. Small contractions of the upper or lower eyelid, for example, are not tics, because they do not involve an entire muscle. They are contractions of some bundles of muscle fibres, which can be felt but just seen. These contractions of the eyelids also differ from tics in that they are not suppressible, are strictly involuntary and tend to fade after a day or two.}}</ref> |
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* [[Neuromyotonia]], also known as Isaacs' syndrome |
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* Diseases of the lower motor neuron, such as: |
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** [[Poliomyelitis]] |
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** [[Amyotrophic lateral sclerosis]] (ALS) |
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** [[Spinal muscular atrophies]] – including [[spinal muscular atrophy]] (SMA), [[spinal and bulbar muscular atrophy]] (SBMA), and others |
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* [[Acetylcholinesterase inhibitors]]: |
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** Some medications to treat [[myasthenia gravis]] contain acetylcholinesterase inhibitors |
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** [[Organophosphate poisoning]] (e.g. [[insecticide]]s) |
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* [[Benzodiazepine withdrawal]] (a class of [[psychoactive drug]]s; the most well-known example is [[Valium]]) |
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* [[Magnesium deficiency (medicine)|Magnesium deficiency]] (a [[dietary mineral]]) |
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* [[Rabies]] |
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==Causes== |
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| ⚫ | The most effective way to detect fasciculations may be surface electromyography (EMG). Surface EMG is more sensitive than needle electromyography and clinical observation in the detection of fasciculation in people with [[amyotrophic lateral sclerosis]].<ref name=pmid18428004>{{cite journal |vauthors=Mateen FJ, Sorenson EJ, Daube JR |title=Strength, physical activity, and fasciculations in patients with ALS |journal=Amyotrophic Lateral Sclerosis |volume=9 |issue=2 |pages=120–1 |year=2008 |pmid=18428004 |doi=10.1080/17482960701855864 }}</ref> |
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| ⚫ | Fasciculations have a variety of causes, the majority of which are [[benign]], but can also be due to disease of the motor neurons. They are encountered by up to 70% of all healthy people,<ref name= Blackman2019/> though for most, it is quite infrequent. In some cases, the presence of fasciculations can be annoying and interfere with [[quality of life]]. If a [[neurological examination]] is otherwise normal and EMG testing does not indicate any additional [[pathology]], a diagnosis of [[benign fasciculation syndrome]] is usually made.<ref>{{Cite journal|last1=Filippakis|first1=Alexandra|last2=Jara|first2=Jordan|last3=Ventura|first3=Nick|last4=Ruthazer|first4=Robin|last5=Russell|first5=James|last6=Ho|first6=Doreen|date=2017-04-18|title=A Prospective Study of Benign Fasciculation Syndrome (S45.007)|url=https://n.neurology.org/content/88/16_Supplement/S45.007|journal=Neurology|language=en|volume=88|issue=16 Supplement|doi=10.1212/WNL.88.16_supplement.S45.007 |s2cid=80074693 |issn=0028-3878|url-access=subscription}}</ref> |
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===Other medications=== |
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| ⚫ | [[Stimulant]]s can cause fasciculations directly. These include [[caffeine]], [[pseudoephedrine]] (Sudafed), [[amphetamines]], and the [[asthma]] [[bronchodilator]] |
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[[Risk factor]]s for benign fasciculations are age, stress, fatigue, and strenuous exercise.<ref name= Blackman2019/> Fasciculations can be caused by [[anxiety disorder|anxiety]], caffeine or alcohol and thyroid disease.<ref name= Turner2013>{{cite journal |vauthors=Turner MR, Talbot K |title=Mimics and chameleons in motor neurone disease |journal=Pract Neurol |volume=13 |issue=3 |pages=153–64 |date=June 2013 |pmid=23616620 |pmc=3664389 |doi=10.1136/practneurol-2013-000557 |type= Review}}</ref> |
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| ⚫ | Other factors may include the use of [[anticholinergic]] drugs over long periods.{{citation needed|date=August 2016}} In particular, these include [[ethanolamine]]s such as [[diphenhydramine]] (brand names Benadryl, Dimedrol, Daedalon and Nytol), used as an [[antihistamine]] and [[sedative]], and [[dimenhydrinate]] (brand names Dramamine, Driminate, Gravol, Gravamin, Vomex, and Vertirosan) for [[nausea]] and [[motion sickness]]. Persons with [[benign fasciculation syndrome]] (BFS) may experience [[paraesthesia]] (especially [[numbness]]) shortly after taking such medication; fasciculation episodes begin as the medication wears off. |
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| ⚫ | The depolarizing neuromuscular blocker [[succinylcholine]] causes fasciculations. It is a normal side effect of the drug's administration, and can be prevented with a small dose of a nondepolarizing neuromuscular blocker prior to the administration of succinylcholine, often 10% of a nondepolarizing NMB's induction dose. |
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| ⚫ | [[Stimulant]]s can cause fasciculations directly. These include [[caffeine]], [[pseudoephedrine]] (Sudafed), [[amphetamines]], and the [[asthma]] [[bronchodilator]] [[salbutamol]] (brand names Proventil, Combivent, Ventolin). Medications used to treat [[ADHD|attention deficit disorder]] (ADHD) often contain stimulants as well, and are common causes of benign fasciculations. Since asthma and ADHD are much more serious than the fasciculations themselves, this [[side effect]] may have to be tolerated by the patient after consulting a physician or pharmacist. |
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| ⚫ | Even if a drug such as caffeine causes fasciculations, that does not necessarily mean it is the only cause. For example, a very slight [[Magnesium deficiency (medicine)|magnesium deficiency]] by itself (see below) might not be enough for fasciculations to occur, but when combined with caffeine, the two factors together could be enough. |
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| ⚫ | The depolarizing [[neuromuscular blocker]] [[succinylcholine]] causes fasciculations. It is a normal side effect of the drug's administration, and can be prevented with a small dose of a nondepolarizing neuromuscular blocker prior to the administration of succinylcholine, often 10% of a nondepolarizing NMB's induction dose. |
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{{medref|section|date=January 2015}} |
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Inadequate [[magnesium]] intake can cause fasciculations, especially after a magnesium loss due to severe [[diarrhea]]. Over-exertion and heavy alcohol consumption<ref>{{cite journal |vauthors=Rivlin RS |title=Magnesium deficiency and alcohol intake: mechanisms, clinical significance and possible relation to cancer development (a review) |journal=Journal of the American College of Nutrition |volume=13 |issue=5 |pages=416–23 |year=1994 |pmid=7836619 |doi=10.1080/07315724.1994.10718430}}</ref> are also risk factors for magnesium loss. As 70–80% of the adult population does not consume the recommended daily amount of magnesium,<ref>{{cite journal |vauthors=Galan P, Preziosi P, Durlach V, Valeix P, Ribas L, Bouzid D, Favier A, Hercberg S |title=Dietary magnesium intake in a French adult population |journal=Magnesium Research |volume=10 |issue=4 |pages=321–8 |year=1997 |pmid=9513928 }}</ref> inadequate intake may also be a common cause. Treatment consists of increased intake of magnesium from dietary sources such as [[Nut (fruit)|nuts]] (especially [[almonds]]), [[bananas]], and [[spinach]]. Magnesium supplements or [[Magnesium (pharmaceutical preparation)|pharmaceutical magnesium preparations]] may also be taken. However, too much magnesium may cause [[diarrhea]], resulting in dehydration and nutrient loss (including magnesium itself, leading to a net loss, rather than a gain). It is well known as a [[laxative]] ([[Magnesium hydroxide|Milk of Magnesia]]), though [[Chelation|chelated]] magnesium can largely reduce this effect. |
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| ⚫ | Even if a drug such as caffeine causes fasciculations, that does not necessarily mean it is the only cause. For example, a very slight [[Magnesium deficiency (medicine)|magnesium deficiency]] by itself (see below) might not be enough for fasciculations to occur, but when combined with caffeine, the two factors together could be enough.{{Citation needed|date=December 2024}} |
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Fasciculation also often occurs during a rest period after sustained stress, such as that brought on by unconsciously tense muscles. Reducing stress and anxiety is therefore another useful treatment.{{Citation needed|date= December 2011}} |
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There is no proven treatment for fasciculations in people with ALS. Among patients with ALS, fasciculation frequency is not associated with the duration of ALS and is independent of the degree of limb weakness and limb atrophy. No prediction of ALS disease duration can be made based on fasciculation frequency alone.<ref name=pmid18428004/> |
There is no proven treatment for fasciculations in people with ALS. Among patients with ALS, fasciculation frequency is not associated with the duration of ALS and is independent of the degree of limb weakness and limb atrophy. No prediction of ALS disease duration can be made based on fasciculation frequency alone.<ref name=pmid18428004/> |
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== Epidemiology == |
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Fasciculations are observed more often in males, and clinicians are overrepresented in study samples.<ref name= Blackman2019/> |
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==See also== |
==See also== |
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* [[Carnitine palmitoyltransferase II deficiency]] |
* [[Carnitine palmitoyltransferase II deficiency]] |
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* [[Myokymia]] |
* [[Myokymia]] |
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* [[Fibrillation]] |
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* [[Myoclonus]] |
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* [[Seizure]] and [[convulsion]] |
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==References== |
==References== |
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{{Reflist}} |
{{Reflist}} |
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== External links == |
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{{Medical resources |
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| DiseasesDB = 18832 |
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{{Nervous and musculoskeletal system symptoms and signs}} |
{{Nervous and musculoskeletal system symptoms and signs}} |
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Latest revision as of 04:18, 12 December 2024
 | This article needs more reliable medical references for verification or relies too heavily on primary sources. (July 2020) |  |
| Fasciculation | |
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| Other names | Muscle twitch |
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| Animated image showing involuntary twitching in the upper eyelid of a young adult male | |
| Pronunciation | |
| Specialty | Neurology |
A fasciculation, or muscle twitch, is a spontaneous, involuntary muscle contraction and relaxation, involving fine muscle fibers.[1] They are common, with as many as 70% of people experiencing them.[1] They can be benign, or associated with more serious conditions.[1] When no cause or pathology is identified, they are diagnosed as benign fasciculation syndrome.[1]
Diagnosis
[edit]The most effective way to detect fasciculations may be surface electromyography (EMG). Surface EMG is more sensitive than needle electromyography and clinical observation in the detection of fasciculation in people with amyotrophic lateral sclerosis.[2]
Deeper areas of contraction can be detected by electromyography (EMG) testing, though they can happen in any skeletal muscle in the body. Fasciculations arise as a result of spontaneous depolarization of a lower motor neuron leading to the synchronous contraction of all the skeletal muscle fibers within a single motor unit. An example of normal spontaneous depolarization is the constant contractions of cardiac muscle, causing the heart to beat. Usually, intentional movement of the involved muscle causes fasciculations to cease immediately, but they may return once the muscle is at rest again.
Tics must also be distinguished from fasciculations. Small twitches of the upper or lower eyelid, for example, are not tics, because they do not involve a whole muscle, but rather are unsuppressible twitches of a few muscle fibre bundles.[3]
Causes
[edit]Fasciculations have a variety of causes, the majority of which are benign, but can also be due to disease of the motor neurons. They are encountered by up to 70% of all healthy people,[1] though for most, it is quite infrequent. In some cases, the presence of fasciculations can be annoying and interfere with quality of life. If a neurological examination is otherwise normal and EMG testing does not indicate any additional pathology, a diagnosis of benign fasciculation syndrome is usually made.[4]
Risk factors
[edit]Risk factors for benign fasciculations are age, stress, fatigue, and strenuous exercise.[1] Fasciculations can be caused by anxiety, caffeine or alcohol and thyroid disease.[5]
Other factors may include the use of anticholinergic drugs over long periods.[citation needed] In particular, these include ethanolamines such as diphenhydramine (brand names Benadryl, Dimedrol, Daedalon and Nytol), used as an antihistamine and sedative, and dimenhydrinate (brand names Dramamine, Driminate, Gravol, Gravamin, Vomex, and Vertirosan) for nausea and motion sickness. Persons with benign fasciculation syndrome (BFS) may experience paraesthesia (especially numbness) shortly after taking such medication; fasciculation episodes begin as the medication wears off.
Stimulants can cause fasciculations directly. These include caffeine, pseudoephedrine (Sudafed), amphetamines, and the asthma bronchodilator salbutamol (brand names Proventil, Combivent, Ventolin). Medications used to treat attention deficit disorder (ADHD) often contain stimulants as well, and are common causes of benign fasciculations. Since asthma and ADHD are much more serious than the fasciculations themselves, this side effect may have to be tolerated by the patient after consulting a physician or pharmacist.
The depolarizing neuromuscular blocker succinylcholine causes fasciculations. It is a normal side effect of the drug's administration, and can be prevented with a small dose of a nondepolarizing neuromuscular blocker prior to the administration of succinylcholine, often 10% of a nondepolarizing NMB's induction dose.
Even if a drug such as caffeine causes fasciculations, that does not necessarily mean it is the only cause. For example, a very slight magnesium deficiency by itself (see below) might not be enough for fasciculations to occur, but when combined with caffeine, the two factors together could be enough.[citation needed]
Treatment
[edit]There is no proven treatment for fasciculations in people with ALS. Among patients with ALS, fasciculation frequency is not associated with the duration of ALS and is independent of the degree of limb weakness and limb atrophy. No prediction of ALS disease duration can be made based on fasciculation frequency alone.[2]
Epidemiology
[edit]Fasciculations are observed more often in males, and clinicians are overrepresented in study samples.[1]
See also
[edit]- Blepharospasm
- Carnitine palmitoyltransferase II deficiency
- Myokymia
- Fibrillation
- Myoclonus
- Seizure and convulsion
References
[edit]- ^ a b c d e f g Blackman G, Cherfi Y, Morrin H, et al. (2019). "The association between benign fasciculations and health anxiety: a report of two cases and a systematic review of the literature" (PDF). Psychosomatics. 60 (5): 499–507. doi:10.1016/j.psym.2019.04.001. PMID 31174866. S2CID 146012381.
- ^ a b Mateen FJ, Sorenson EJ, Daube JR (2008). "Strength, physical activity, and fasciculations in patients with ALS". Amyotrophic Lateral Sclerosis. 9 (2): 120–1. doi:10.1080/17482960701855864. PMID 18428004. S2CID 43321868.
- ^
Perrotta G (2019). "Tic disorder: definition, clinical contexts, differential diagnosis, neural correlates and therapeutic approaches" (PDF). Journal of Neuroscience and Rehabilitation. 2019 (1). MeDOA Publications. Archived from the original (PDF) on 2020-07-15.
Tics must also be distinguished from fasciculations. Small contractions of the upper or lower eyelid, for example, are not tics, because they do not involve an entire muscle. They are contractions of some bundles of muscle fibres, which can be felt but just seen. These contractions of the eyelids also differ from tics in that they are not suppressible, are strictly involuntary and tend to fade after a day or two.
- ^ Filippakis, Alexandra; Jara, Jordan; Ventura, Nick; Ruthazer, Robin; Russell, James; Ho, Doreen (2017-04-18). "A Prospective Study of Benign Fasciculation Syndrome (S45.007)". Neurology. 88 (16 Supplement). doi:10.1212/WNL.88.16_supplement.S45.007. ISSN 0028-3878. S2CID 80074693.
- ^ Turner MR, Talbot K (June 2013). "Mimics and chameleons in motor neurone disease". Pract Neurol (Review). 13 (3): 153–64. doi:10.1136/practneurol-2013-000557. PMC 3664389. PMID 23616620.