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By : Ali Younes Ali Dr : Mehdi Delrobaei K.N.Toosi University of Technology By : Ali younes ali Dr : Mehdi Delrobaei Contents 1-Introduction and general description 2-Signs and symptoms 3-Risk factors 4-Causes 5-Ways of detection 6-Treatment 7-References 1-Introduction and General description Fasciculations (muscle twitch): is a small, local, involuntary muscle contraction and relaxation which may be visible under the skin Deeper areas can be detected by electromyography (EMG) testing, though they can happen in any skeletal muscle in the body Fasciculations can often by visualized and take the form of a muscle twitch or dimpling under the skin, but usually do not generate sufficient force to move a limb 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 Usually, intentional movement of the involved muscle causes fasciculations to cease immediately, but they may return once the muscle is at rest again. 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 virtually all healthy people, 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 2-Signs and symptoms The main symptom of fasciculation is focal or widespread involuntary muscle activity (twitching), which can occur at random or specific times (or places). Presenting symptoms of fasciculation may include: Blepharospasms (eye spasms) Generalized fatigue Muscle pain Anxiety (which can also be a cause) Exercise intolerance Muscle cramping or spasms 3-Risk factors 3-1Pathological conditions 3-1-1Neuromyotonia, also known as Isaacs syndrome : is a form of peripheral nerve hyperexcitability that causes spontaneous muscular activity resulting from repetitive motor unit action potentials of peripheral origin. Prevalence is unknown but 100– 200 cases have been reported so far. 3-1-2 Diseases of the lower motor neuron such as : Poliomyelitis: is an infectious disease caused by the poliovirus. In about 0.5 percent of cases there is muscle weakness resulting in an inability to move Amyotrophic lateral sclerosis (ALS) : also known as motor neuron disease (MND) and Lou Gehrig's disease, is a specific disease which causes the death of neurons controlling voluntary muscles Spinal muscular atrophies – including spinal muscular atrophy (SMA), spinal and bulbar muscular atrophy (SBMA), and others. 3-3-3 Acetylcholinesterase inhibitors: Some medications to treat myasthenia gravis contain acetylcholinesterase inhibitors Organophosphate poisoning (e.g. insecticides) 3-3-4 Benzodiazepine withdrawal (a class of psychoactive drugs; the most well- known example is Valium) 3-3-5 Magnesium deficiency (a dietary mineral) 3-3-6 Rabies 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 3-2 Other medications 3-2-1 Risk factors for benign fasciculations may include the use of anticholinergic drugs over long periods 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 3-2-2 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. 3-2-3 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 might not be enough for fasciculations to occur, but when combined with caffeine, the two factors together could be enough 4-Causes Tension and exhaustion May be the result of side effects of some medication drugs Intensive exercises Lack of healthy nutrition The presence of certain immune diseases Diseases of the nervous system or muscular diseases 5-Ways of detection *Clinical examination *Laboratory examination of blood cells *Radiology of the brain and spinal cord *Tests of the nervous system to ensure the safety of nerves and their ability to deliver nerve signals *Thyroid screening 6-Treatment Inadequate magnesium intake can cause fasciculations, especially after a magnesium loss due to severe diarrhea Over-exertion and heavy alcohol consumption are also risk factors for magnesium loss Treatment consists of increased intake of magnesium from dietary sources such as nuts (especially almonds), bananas, and spinach Magnesium supplements or pharmaceutical magnesium preparations may also be taken 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. 7-References [1] Denny-Brown, D., and J. B. Pennybacker. "Fibrillation and fasciculation in voluntary muscl- e." Brain 61.3 (1938): 311-312. [2] Rathjen, Fritz G., et al. "Membrane glycoproteins involved in neurite fasciculation." The Jou- rnal of Cell Biology 104.2 (1987): 343-353. .
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