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Fasciculations – Causes, Treatment

Fasciculations are muscle twitches that refer to tiny, involuntary, local muscle contractions and relaxations which can be observed beneath the skin or found in deeper regions via EMG testing.

All of us are aware of the fact that fasciculations can be occasionally experienced by all individuals. The twitches may occur over a short periods and then vanish. It can be safely said that people with no episodes of fasciculations in their lifetime are hard to find. It is generally a harmless condition, unless it is experienced with a variety of other symptoms. Also, harmless fasciculations which occur continuously or frequent can be very discomforting and annoying.

Fasciculations may be caused due to a number of reasons such as underlying disorders which include Kennedy disease, fibromyalgia, Lyme disease, magnesium deficiency, lower motor neuron lesion, etc.

However, when no particular cause of fasciculations can be found, then the condition is known as benign fasciculation syndrome. It is thought to be a neurological disorder which involves the voluntary muscles of the body, particularly those occurring in the arms, face and legs. Such fasciculations may or may not be related to muscle cramps. The disorder may occur across the body or may be limited to only one specific region. It may also be noted that when the affected areas are voluntarily moved, then the fasciculations may temporarily stop, only to return later. A majority of these cases, however, do not result in health complications.

The treatment of fasciculations is aimed at finding the underlying cause and curing it. In certain cases, doctors may prescribe some types of beta-blockers or anti-epileptics for benign fasciculation syndrome. Even though, no particular medication or therapy has been found to completely cure the condition, harmless and idiopathic cases generally tend to resolve on their own.

Causes of fasciculations

Fasciculations can affect any area of the body, including the tongue. Benign fasciculation syndrome is considered as the most common cause of tongue fasciculations.

It is important to note that the tongue should be completely left within the mouth while verifying the presence of tongue fasciculations. Almost all tongues tend to fasciculation when they are stuck out, and in certain cases the tongue may twitch even when it rests on the floor of the oral cavity. Hence, one should not be too quick to self-diagnose a case of tongue fasciculation, which is best left to a physician.

As mentioned earlier, most instances of fasciculations are non-serious and only merely irritating. This can be explained in the fact that common causes of fasciculations include simple causes like excessive intake of caffeine, deficiency of a specific electrolyte like magnesium, consumption of medicines like asthma drugs or Benadryl, etc. It is common to observe occurrence of fasciculations while resting post extreme or strenuous exercising.

The serious causes of fasciculations include toxins, motor neuron diseases, rabies or other neurological problems.

Some of the diseases associated with fasciculations are discussed below:

  • Amyotrophic Lateral Sclerosis or ALS: It is a degenerative condition affecting the motor neurons in the central as well as the peripheral nervous systems. The degeneration of the motor neuron which passes from the spinal cord or brain stem to the muscles results in increased weakening and atrophy of the muscles innervated by it, and the occurrence of fasciculations. The symptoms of ALS can vary in different patients, with some becoming paralyzed while others slowly developing weaknesses. However, all patients ultimately lose control over every voluntary movement of the muscles, which also include respiratory muscles. The failure of the respiratory system is often the cause of fatalities in ALS patients.
  • Polio and Post Polio Syndrome: Polio causes symptoms like headache, fever and vomiting. It may be noted that less than one percent of polio patients get affected by paralytic polio, whose onset if mostly acute. The disease can affect the brainstem neurons resulting in tongue fasciculations and problematic speaking and swallowing. The nerve cells present in the spinal cord also get affected resulting in paralysis of the arms, legs and respiratory system muscles, in addition to twitches or fasciculations of the affected muscles. Decades after the first appearance of the disease, new neurological signs may occur in the survivors. Twenty five to 50 percent of such survivors get affected by post polio syndrome, which leads to symptoms such as fasciculations, muscle weakness, fatigue, muscle atrophy, joint pain, and cold intolerance. Post polio syndrome may be severe or mild, but generally not life threatening
  • Werdnig Hoffman Disease: It is an inherited disorder characterized by the degeneration of the motor neurons traveling from the spine to the muscles. It is also known as spinal muscular atrophy I and occurs in the initial few months post birth. Affected infants experience a bad sucking reflex, poor muscle tone, weak movements, and swallowing difficulties. Loss of muscle innervations can lead to fasciculations. Death of affected children usually occurs within two years.

Treatment of fasciculations

  • Fasciculations caused as a drug side effect can be overcome with a change of the prescription medications by the doctor
  • Caffeine induced cases can be stopped via reduction in caffeine intake
  • Treatment of underlying causes can limit the severity of fasciculations
  • Meditation, yoga and breathing techniques can help in the prevention and stoppage of fasciculations caused by elevated anxiety.

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