Fasciculation: Difference between revisions
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== Causes== |
== Causes== |
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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. |
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.{{medcn}} |
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===Risk factors=== |
===Risk factors=== |
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Revision as of 18:32, 15 July 2020
| Fasciculation | |
|---|---|
| Other names | Muscle twitch |
 | |
| Animated image of BFS in the upper eyelid of a 19-year-old 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 much 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
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.
Causes
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.[medical citation needed]
Risk factors
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.[3]
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 bronchodilators 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.
Treatment
Reducing stress and anxiety is therefore another useful treatment.[citation needed]
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
Fasciculations are observed more often in men, and clinicians are overrepresented in study samples.[1]
See also
References
- ^ 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.
- ^ 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.
- ^ 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.