benign faasiculations and increased muscle cramping

[marcitm]

I was diagnosed with benign fasiculation syndrome about four years ago.  Although I do not notice any muscle weakness, I am noticing increased fasiculations and now have frequent cramping, charlie horses.  If I contract my quads they tighten and then release in what I can only describe as a big 'blump'  When I was initially diagnosed, I had an MRI which did show lesions, EMG which showed fasiculations, spinal tap was OK.  I do not take any medications because I am not physically bothered by any of the symptoms, although sometimes they tend to concern me emotiionally, i.e. 'is anything else going on?'  Should I have any further testing at this point and if so, what would you suggest?
Thank you,
Marci

[Cleveland Clinic, MD]

First of all, please keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.

A fasciculation or what is usually called "muscle twitch" is a small, local, involuntary muscle contraction (twitching) that is visible under the skin. it is caused by spontaneous discharge of a bundle of muscle fibers. This can occur in any voluntary muscle group but is most common in the eyelids, arms, legs, and feet. Even the tongue may be affected. The twitching may be occasional or may go on nearly continuously. Any intentional movement of the involved muscle causes the fasciculations to cease immediately, but they may return once the muscle is at rest again.

They have a variety of different causes, the majority of these are benign, but can also be due to disease of the motor neurons. Common causes include the following:

. Dehydration and Fatigue  
. Werdnig-Hoffman disease
. Amyotrophic lateral sclerosis (ALS) which is a rare cause
. Organophosphate poisoning
. Magnesium deficiency (which can be caused by stress, inadequate dietry intake or magnesium loss due to severe diarrhea)
. Medications: this includes anticholinergic drugs over long periods, in particular ethanolamines such as Benadryl, used as an antihistamine and sleep aid, and Dramamine for nausea and motion sickness. Stimulants can cause fasciculations directly. These include caffeine, pseudoephedrine (Sudafed®), and the asthma bronchodilators albuterol/salbutamol (e.g. Proventil®, Combivent®, Ventolin®). Benzodiazepine withdrawal is another possible factor

and then actually most cases don't have a well-identified cause and has therefore been given the title benign fasciculation syndrome

In addition to twitching, patients with BFS often experience pain, paraesthesia, generalized fatigue, exercise intolerance, globus sensation and/or muscle cramping. Another common feature of the disorder, is an increase in the patient's level of anxiety, especially health-related anxiety.

The diagnosis is usually made by exclusion, when other muscle and nerve diseases, medication exposures are ruled out. This is typically achieved by reviewing the history carefully for any possisbilty of exposure to the above mentioned medications and the course of the fasciculations compared to the drug exposure. checking some lab tests including muscle enzymes, sometimes magnesium level (80% of population have inadequate magnesium intake in their diet). Then doing electrodiagnostic testing (NCS/EMG) which should show no evidence of significant nerve or muscle damage and this excludes primary nerve/muscle disease.

Treatment is usually the treatment of the underlying cause (if any is detected). and if it's a true benign fasciculations syndrome the treatment is reassurance that this is not a serious disorder, that the course is bengin. managing any underlying anxiety. and probabely repeating the EMG in 6-12 months to make sure it's not a brewing organic disease. Some people use medications like beta blockers or some anti-seizure medications to control the symptoms with variable results. In many cases, symptoms can be significantly reduced through a proactive approach to decrease the overall daily stress. Common ways to reduce stress include: exercising more, sleeping more, working less, meditation, and eliminating all forms of dietary caffeine (e.g. coffee, chocolate, cola, and certain over-the counter medications).

Finally always seek medical attention if you develop new symptoms or if there is a change in your current symptoms because this might reflect another underlying disease process.

Thanks for using the forum. Please let me know if you need any help or have any additional questions.

[S.B.]

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