Muscle fasciculations: Difference between revisions

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<embedvideo service="youtube" dimensions="400" alignment="right" container="frame" description="Muscle fasciculations in potassium [[channelopathy]] by vlivings. Muscle twitching can be a symptom of [[Myalgic Encephalomyelitis]].">https://www.youtube-nocookie.com/watch?v=A95YZd01k1c&autoplay=0</embedvideo>
<embedvideo service="youtube" dimensions="400" alignment="right" container="frame" description="Muscle fasciculations in potassium [[channelopathy]] by vlivings. Muscle twitching can be a symptom of [[Myalgic Encephalomyelitis]].">https://www.youtube-nocookie.com/watch?v=A95YZd01k1c&autoplay=0</embedvideo>
'''Muscle fasciculations''' or '''muscle twitches''' are small, rapid, involuntary contractions in [[skeletal muscle]]s that are too weak to move a limb.<ref name="McGee, 2018" /> Superficial [[muscle fasciculations]] are visible to the eye. Deeper muscle fasciculations are detected by [[electromyography]] (EMG) testing.<ref name="Mills">{{Cite journal|last=Mills|first=K R|author-link=|author-link2=|date=2005-06-01|title=The basics of electromyography|url=http://jnnp.bmj.com/cgi/doi/10.1136/jnnp.2005.069211|journal=Journal of Neurology, Neurosurgery & Psychiatry|language=en|volume=76|issue=suppl_2|pages=ii32–ii35|doi=10.1136/jnnp.2005.069211|issn=0022-3050|pmc=1765694|pmid=15961866|quote=|via=}}</ref> They result from an involuntary firing of a single motor neuron (nerve cell) and all its innervated muscle fibers.<ref name="Killian">Killian, J.M. (2010). Electromyography. 428-435. doi:10.1016/B978-0-323-05712-7.00026-X.</ref>
'''Muscle fasciculations''' or '''muscle twitches''' are small, rapid, involuntary contractions in that are too weak to move a limb.<ref name="McGee, 2018" /> Superficial [[muscle fasciculations]] are visible to the eye. Deeper muscle fasciculations may be invisible, and can be detected by [[electromyography]] (EMG) testing.<ref name="Mills">{{Cite journal | last = Mills | first = K R | date = 2005-06-01 | title = The basics of electromyography|url=http://jnnp.bmj.com/cgi/doi/10.1136/jnnp.2005.069211|journal=Journal of Neurology, Neurosurgery & Psychiatry|language=en|volume=76|issue=suppl 2|pages=ii32–ii35|doi=10.1136/jnnp.2005.069211|issn=0022-3050|pmc=1765694|pmid=15961866|quote=|via=}}</ref>  
 
Muscle fasciculations can occur in healthy people especially in the eyelid muscles, and are considered harmless, however, when fasciculations are accompanied by [[muscle weakness]] or [[muscle wasting]], these fasciculations may indicate a neurological dysfunction.<ref name="McGee, 2018">{{Cite book| first = Steven |last =McGee| title  = Chapter 61 – Examination of the Motor System: Approach to Weakness| date  = 2018| url  = https://www.sciencedirect.com/science/article/pii/B9780323392761000615 }}</ref>


==Prevalence==
==Prevalence==
*In a 2001 Belgian study, 58.5% of patients meeting the [[Fukuda criteria]] and 64.1% of patients meeting the [[Holmes criteria]], in a cohort of 2073 [[chronic fatigue syndrome]] patients, reported muscle fasciculations.<ref>{{Cite journal|last=De Becker|first=Pascale|author-link=Pascale De Becker|last2=McGregor|first2=Neil|author-link2=Neil McGregor|last3=De Meirleir|first3=Kenny|author-link3=Kenny De Meirleir|author-link4=|author-link5=|author-link6=|date=December 2001|title=A definition‐based analysis of symptoms in a large cohort of patients with chronic fatigue syndrome|url=https://onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2796.2001.00890.x?sid=nlm%3Apubmed|journal=Journal of Internal Medicine|volume=250|issue=3|pages=234–240|doi=10.1046/j.1365-2796.2001.00890.x|quote=|via=}}</ref>
A 2001 Belgian study of 2073 [[chronic fatigue syndrome]] patients found that 58.5% of patients meeting the [[Fukuda criteria]] for CFS and 64.1% of patients meeting the [[Holmes criteria]] reported muscle fasciculations.<ref name="DeBecker">{{Cite journal | last = De Becker | first = Pascale | authorlink = Pascale De Becker | last2 = McGregor | first2 = Neil | authorlink2 = Neil McGregor | last3 = De Meirleir | first3 = Kenny | authorlink3 = Kenny De Meirleir | date = December 2001 | title = A definition‐based analysis of symptoms in a large cohort of patients with chronic fatigue syndrome|url=https://onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2796.2001.00890.x?sid=nlm%3Apubmed|journal=Journal of Internal Medicine|volume=250|issue=3|pages=234–240|doi=10.1046/j.1365-2796.2001.00890.x|quote=|via=}}</ref>


==Symptom recognition==
==Symptom recognition==
The [[Canadian Consensus Criteria]] lists muscle fasciculations as a symptom of [[ME/CFS]] under the section ''Neurological/Cognitive Manifestations.''<ref>{{Citation| last1   = Carruthers       | first1 = Bruce M.           | authorlink1 = Bruce Carruthers  
The [[Canadian Consensus Criteria]] for ME/CFS lists muscle fasciculations as a possible symptom in the list of ''Neurological/Cognitive Manifestations''.<ref>{{Citation | last1 = Carruthers | first1 = Bruce M. | authorlink1 = Bruce Carruthers | last2 = Jain | first2 = Anil Kumar | authorlink2 = Anil Kumar Jain | last3 = De Meirleir | first3 = Kenny L. | authorlink3 = Kenny De Meirleir | last4 = Peterson | first4 = Daniel L. | authorlink4 = Daniel Peterson | last5 = Klimas | first5 = Nancy G. | authorlink5 = Nancy Klimas | last6 = Lerner | first6 = A. Martin | authorlink6 = Martin Lerner | last7 = Bested | first7 = Alison C. | authorlink7 = Alison Bested | last8 =Flor-Henry | first8 = Pierre | authorlink8 = Pierre Flor-Henry | last9 = Joshi | first9 = Pradip | authorlink9 = Pradip Joshi | last10 = Powles | first10 = AC Peter | authorlink10 = A C Peter Powles | last11 = Sherkey | first11 = Jeffrey A. | authorlink11 = Jeffrey Sherkey | last12 = van de Sande | first12 = Marjorie I. | authorlink12 = Marjorie van de Sande | title = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols| journal = Journal of Chronic Fatigue Syndrome | volume = 11 | issue = 2 | pages = 7-115 | date = 2003 | doi = 10.1300/J092v11n01_02}}</ref>
| last2   = Jain             | first2 = Anil Kumar         | authorlink2 = Anil Kumar Jain
| last3   = De Meirleir       | first3 = Kenny L.           | authorlink3 = Kenny De Meirleir
| last4   = Peterson         | first4 = Daniel L.         | authorlink4 = Daniel Peterson
| last5   = Klimas           | first5 = Nancy G.           | authorlink5 = Nancy Klimas
| last6   = Lerner           | first6 = A. Martin         | authorlink6 = Martin Lerner
| last7   = Bested           | first7 = Alison C.         | authorlink7 = Alison Bested
| last8   = Flor-Henry       | first8 = Pierre             | authorlink8 = Pierre Flor-Henry  
| last9   = Joshi             | first9 = Pradip             | authorlink9 = Pradip Joshi
| last10 = Powles           | first10 = A C Peter         | authorlink10 = A C Peter Powles
| last11 = Sherkey           | first11 = Jeffrey A.       | authorlink11 = Jeffrey Sherkey
| last12 = van de Sande     | first12 = Marjorie I.       | authorlink12 = Marjorie van de Sande
| title   = Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols| journal = Journal of Chronic Fatigue Syndrome   | volume = 11   | issue = 2   | page = 7-115
| date   = 2003| doi     = 10.1300/J092v11n01_02}}</ref>


==Notable studies==
== Possible causes==
Muscle fasciculations result from an involuntary firing of a single motor neuron (nerve cell) and all its innervated muscle fibers.<ref name="Killian">Killian, J.M. (2010). Electromyography. 428-435. doi:10.1016/B978-0-323-05712-7.00026-X.</ref>


== Possible causes==
Possible causes include:
Possible causes include:
*[[stress]] or [[anxiety]]
*[[stress]] or [[anxiety]]
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*poor sleep management or [[sleep apnea]]
*poor sleep management or [[sleep apnea]]
*dehydration  
*dehydration  
* electrolyte abnormalities<ref name="Leite2014">{{Cite journal|last=Leite|first=Marco Antonio Araujo|last2=Orsini|first2=Marco|last3=de Freitas|first3=Marcos R.G.|last4=Pereira|first4=João Santos|last5=Gobbi|first5=Fábio Henrique Porto|last6=Bastos|first6=Victor Hugo|last7=de Castro Machado|first7=Dionis|last8=Machado|first8=Sergio|last9=Arrias-Carrion|first9=Oscar|date=2014-08-08|title=Another Perspective on Fasciculations: When is it not Caused by the Classic form of Amyotrophic Lateral Sclerosis or Progressive Spinal Atrophy?|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4192433/|journal=Neurology International|volume=6|issue=3|pages=5208|doi=10.4081/ni.2014.5208|issn=2035-8385|pmc=4192433|pmid=25309711}}</ref><ref>{{Cite journal|last=Ramahi|first=A. A.|last2=Katirji|first2=B.|last3=Devereaux|first3=M.|date=2014-01-01|editor-last=Aminoff|editor-first=Michael J.|editor2-last=Daroff|editor2-first=Robert B.|title=Lower Motor Neuron Lesions|url=https://www.sciencedirect.com/science/article/pii/B9780123851574011593|language=en|location=Oxford|publisher=Academic Press|pages=918–922|isbn=978-0-12-385158-1}}</ref>
* Electrolyte abnormalities<ref name="Leite2014">{{Cite journal | last = Leite | first = Marco Antonio Araujo | last2 = Orsini | first2 = Marco | last3 = de Freitas | first3 = Marcos R.G. | last4 = Pereira | first4 = João Santos | last5 = Gobbi | first5 = Fábio Henrique Porto | last6 = Bastos | first6 = Victor Hugo | last7 = de Castro Machado | first7 = Dionis | last8 = Machado | first8 = Sergio | last9 = Arrias-Carrion | first9 = Oscar | date = 2014-08-08 | title = Another Perspective on Fasciculations: When is it not Caused by the Classic form of Amyotrophic Lateral Sclerosis or Progressive Spinal Atrophy?|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4192433/|journal=Neurology International|volume=6|issue=3 | pages = 5208|doi=10.4081/ni.2014.5208|issn=2035-8385|pmc=4192433|pmid=25309711}}</ref><ref name="Ramahi2014">{{Cite book | last = Ramahi | first = A.A. | last2 = Katirji | first2 = B. | last3 = Devereaux | first3 = M. | date = 2014-01-01 | editor-last = Aminoff|editor-first = Michael J.|editor2-last=Daroff| editor2-first = Robert B. | title=Lower Motor Neuron Lesions|url=https://www.sciencedirect.com/science/article/pii/B9780123851574011593|language=en|location=Oxford|publisher=Academic Press | pages = 918–922|isbn=978-0-12-385158-1}}</ref>
 
==Benign Fasciculation Syndrome==
Benign Fasciculation Syndrome (BFS) is a greater than normal occurrence of fasiculations that are not associated with disease.<ref name="Ramahi2014" />
{{Quote box|text=Fasciculations are only definitely pathological when occurring in conjunction with [[muscle wasting]] or [[paresis|weakness of the muscle]]. Physiological fasciculations are common in healthy, fit young adults, particularly in the distal lower extremity muscles.<ref name="Ramahi2014"/>|source=Lower Motor Neuron Lesions (2014) | title = Benign or pathological}}


==Illnesses causing muscle fasiculations==
==Illnesses causing muscle fasiculations==
While fasiculations can occur in healthy people, they can sometimes be caused by systemic or other diseases, especially in people without a family history of [[Amyotrophic lateral sclerosis|ALS]]. These include:
Muscle fasciculations can occur in healthy people especially in the eyelid muscles, and are considered harmless, however, when fasciculations are accompanied by [[muscle weakness]] or [[muscle wasting]], these fasciculations may indicate a neurological dysfunction.<ref name="McGee, 2018">{{Cite book | first = Steven |last =McGee| title = Chapter 61 – Examination of the Motor System: Approach to Weakness| date = 2018| url  = https://www.sciencedirect.com/science/article/pii/B9780323392761000615 }}</ref>
 
Fasiculations can sometimes be caused by systemic or other diseases; these are typically nore common than [[amyotrophic lateral sclerosis|ALS]]. Illnesses that may cause fasiculations include:
*[[hyperthyroidism]]
*[[hyperthyroidism]]
*hypophosphatemia
*hypophosphatemia
*calcium disorders secondary to [[hyperparathyroidism]]
*calcium disorders secondary to [[hyperparathyroidism]]
*neuromuscular disorders<ref name="Preston2013">{{Cite book|last=Preston|first=David C.|author-link=|last2=Shapiro|first2=Barbara E.|author-link2=|date=2013-01-01|editor-last=Preston|editor-first=David C.|editor2-last=Shapiro|editor2-first=Barbara E.|title=Electromyography and Neuromuscular Disorders|url=https://www.sciencedirect.com/science/article/pii/B9781455726721000271|journal=|chapter=27 - Amyotrophic Lateral Sclerosis and its Variants|language=en|edition=3rd|location=London|publisher=W.B. Saunders|volume=|pages=417–431|doi=|isbn=978-1-4557-2672-1|pmc=|pmid=|access-date=|quote=|via=}}</ref>
*[[hypomagnesemia|low magnesium level]] (hypomagnesemia)
*neuromuscular disorders
*tongue fasiculations have been found in a third of patients with Amyotrophic Lateral Sclerosis<ref name="McGee, 2018" /><ref name="Preston2013">{{Cite book | last = Preston | first = David C. | authorlink = | last2 = Shapiro | first2 = Barbara E. | authorlink2 = | date = 2013-01-01 | editor-last = Preston | editor-first = David C.|editor2-last=Shapiro|editor2-first=Barbara E. | title=Electromyography and Neuromuscular Disorders|url=https://www.sciencedirect.com/science/article/pii/B9781455726721000271|journal=|chapter=27 - Amyotrophic Lateral Sclerosis and its Variants|language=en|edition=3rd|location=London|publisher=W.B. Saunders|volume= | pages = 417–431|doi=|isbn=978-1-4557-2672-1|pmc=|pmid=|access-date=|quote=|via=}}</ref>


==Benign Fasciculation Syndrome==
==Drugs linked to benign fasiculations ==
Fasciculations are only definitely pathological when occurring in conjunction with [[muscle wasting]] or [[paresis|weakness of the muscle]]. Physiological fasciculations are common in healthy, fit young adults, particularly in the distal lower extremity muscles.
*[[Mestinon]] (pyridostigmine) which is taken by some people with ME/CFS
*cholinesterase inhibitors other than pyridostigmine
*[[:Category:Central nervous system stimulants|central nervous system stimulants]] such as theophylline and lithium<ref name="Ramahi2014" />


==Potential treatments==
==Potential treatments==
Addressing any lifestyle factors such as excessive caffeine intake, and treating any disorders that are associated with the fasciculations.
==Notable studies==
*2001, A definition‐based analysis of symptoms in a large cohort of patients with chronic fatigue syndrome [https://onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2796.2001.00890.x?sid=nlm%3Apubmed (Full text)]


==Learn more==
==Learn more==

Latest revision as of 01:32, May 19, 2023

Muscle fasciculations in potassium channelopathy by vlivings. Muscle twitching can be a symptom of Myalgic Encephalomyelitis.

Muscle fasciculations or muscle twitches are small, rapid, involuntary contractions in that are too weak to move a limb.[1] Superficial muscle fasciculations are visible to the eye. Deeper muscle fasciculations may be invisible, and can be detected by electromyography (EMG) testing.[2]

Prevalence[edit | edit source]

A 2001 Belgian study of 2073 chronic fatigue syndrome patients found that 58.5% of patients meeting the Fukuda criteria for CFS and 64.1% of patients meeting the Holmes criteria reported muscle fasciculations.[3]

Symptom recognition[edit | edit source]

The Canadian Consensus Criteria for ME/CFS lists muscle fasciculations as a possible symptom in the list of Neurological/Cognitive Manifestations.[4]

Possible causes[edit | edit source]

Muscle fasciculations result from an involuntary firing of a single motor neuron (nerve cell) and all its innervated muscle fibers.[5]

Possible causes include:

Benign Fasciculation Syndrome[edit | edit source]

Benign Fasciculation Syndrome (BFS) is a greater than normal occurrence of fasiculations that are not associated with disease.[7]

Benign or pathological

Fasciculations are only definitely pathological when occurring in conjunction with muscle wasting or weakness of the muscle. Physiological fasciculations are common in healthy, fit young adults, particularly in the distal lower extremity muscles.[7]

Lower Motor Neuron Lesions (2014)


Illnesses causing muscle fasiculations[edit | edit source]

Muscle fasciculations can occur in healthy people especially in the eyelid muscles, and are considered harmless, however, when fasciculations are accompanied by muscle weakness or muscle wasting, these fasciculations may indicate a neurological dysfunction.[1]

Fasiculations can sometimes be caused by systemic or other diseases; these are typically nore common than ALS. Illnesses that may cause fasiculations include:

Drugs linked to benign fasiculations[edit | edit source]

Potential treatments[edit | edit source]

Addressing any lifestyle factors such as excessive caffeine intake, and treating any disorders that are associated with the fasciculations.

Notable studies[edit | edit source]

  • 2001, A definition‐based analysis of symptoms in a large cohort of patients with chronic fatigue syndrome (Full text)

Learn more[edit | edit source]

See also[edit | edit source]

References[edit | edit source]

  1. 1.0 1.1 1.2 McGee, Steven (2018). Chapter 61 – Examination of the Motor System: Approach to Weakness.
  2. Mills, K R (June 1, 2005). "The basics of electromyography". Journal of Neurology, Neurosurgery & Psychiatry. 76 (suppl 2): ii32–ii35. doi:10.1136/jnnp.2005.069211. ISSN 0022-3050. PMC 1765694. PMID 15961866.
  3. De Becker, Pascale; McGregor, Neil; De Meirleir, Kenny (December 2001). "A definition‐based analysis of symptoms in a large cohort of patients with chronic fatigue syndrome". Journal of Internal Medicine. 250 (3): 234–240. doi:10.1046/j.1365-2796.2001.00890.x.
  4. Carruthers, Bruce M.; Jain, Anil Kumar; De Meirleir, Kenny L.; Peterson, Daniel L.; Klimas, Nancy G.; Lerner, A. Martin; Bested, Alison C.; Flor-Henry, Pierre; Joshi, Pradip; Powles, AC Peter; Sherkey, Jeffrey A.; van de Sande, Marjorie I. (2003), "Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Clinical Working Case Definition, Diagnostic and Treatment Protocols", Journal of Chronic Fatigue Syndrome, 11 (2): 7–115, doi:10.1300/J092v11n01_02
  5. Killian, J.M. (2010). Electromyography. 428-435. doi:10.1016/B978-0-323-05712-7.00026-X.
  6. Leite, Marco Antonio Araujo; Orsini, Marco; de Freitas, Marcos R.G.; Pereira, João Santos; Gobbi, Fábio Henrique Porto; Bastos, Victor Hugo; de Castro Machado, Dionis; Machado, Sergio; Arrias-Carrion, Oscar (August 8, 2014). "Another Perspective on Fasciculations: When is it not Caused by the Classic form of Amyotrophic Lateral Sclerosis or Progressive Spinal Atrophy?". Neurology International. 6 (3): 5208. doi:10.4081/ni.2014.5208. ISSN 2035-8385. PMC 4192433. PMID 25309711.
  7. 7.0 7.1 7.2 7.3 Ramahi, A.A.; Katirji, B.; Devereaux, M. (January 1, 2014). Aminoff, Michael J.; Daroff, Robert B. (eds.). Lower Motor Neuron Lesions. Oxford: Academic Press. pp. 918–922. ISBN 978-0-12-385158-1.
  8. Preston, David C.; Shapiro, Barbara E. (January 1, 2013). "27 - Amyotrophic Lateral Sclerosis and its Variants". In Preston, David C.; Shapiro, Barbara E. (eds.). Electromyography and Neuromuscular Disorders (3rd ed.). London: W.B. Saunders. pp. 417–431. ISBN 978-1-4557-2672-1.