Fasciculation

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.

Overview

A fasciculation (or "muscle twitch") is a small, local, involuntary muscle contraction (twitching) visible under the skin arising from the spontaneous discharge of a bundle of skeletal muscle fibers. Fasciculations have a variety of causes, the majority of which are benign, but can also be due to disease of the motor neurons.

Causes[1]

Life Threatening Causes

Common Causes

Causes by Organ System

Cardiovascular Dural arteriovenous fistula, Posterior inferior cerebellar artery syndrome
Chemical/Poisoning Organophosphate poisoning
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Albuterol, Ambenonium, Anticholinergic drugs, Benadryl, Caffeine, Corticosteroids, Diuretics, Dramamine, Pellagra, Pseudoephedrine, Salbutamol , Succinylcholine 
Ear Nose Throat No underlying causes
Endocrine Acute intermittent porphyria, Adult polyglucosan body disease, Hypocalcaemia
Environmental No underlying causes
Gastroenterologic Adult polyglucosan body disease
Genetic Brown-vialetto-van laere syndrome, Gangliosidosis gm2, type 1, Infantile neuroaxonal dystrophy, Kennedy disease, Spastic paraplegia 11, Werdnig-hoffman disease
Hematologic Hypocalcaemia, Magnesium deficiency 
Iatrogenic No underlying causes
Infectious Disease Botulism, Guillain-barre syndrome, Poliomyelitis, Postpoliomyelitis syndrome, Quaternary syphilis, Rabies, Syringomyelia
Musculoskeletal/Orthopedic Cervical spondylosis, Intervertebral disc herniation, Jokela type spinal muscular atrophy, Neuromyotonia, Spinal muscular atrophy, Spinocerebellar ataxia, Subacute combined degeneration of the cord, Welander distal myopathy
Neurologic Amyotrophic lateral sclerosis , Bell palsy, Brown-vialetto-van laere syndrome, Central pontine myelinosis, Fatigue, Friedreich ataxia, Guillain-barre syndrome, Hereditary sensorimotor neuropathy type 1, Infantile neuroaxonal dystrophy, Isaac syndrome, Kennedy disease, Motor neuron disease, Multifocal motor neuropathy, Multiple sclerosis, Myasthenia gravis, Neuromyotonia, Neuropathy, Peripheral neuropathy, Poliomyelitis, Posterior inferior cerebellar artery syndrome, Postpoliomyelitis syndrome, Progressive bulbar palsy, Progressive muscular atrophy, Spinal muscular atrophy, Spinocerebellar ataxia, Subacute combined degeneration of the cord, Transverse myelitis, Welander distal myopathy, Werdnig-hoffman disease
Nutritional/Metabolic Dehydration, Finnish type amyloidosis, Magnesium deficiency , Nutritional deficiency
Obstetric/Gynecologic Cervical myelopathy
Oncologic Syringobulbia
Ophthalmologic No underlying causes
Overdose/Toxicity Benzodiazepine withdrawal, Caffeine, Donepezil toxicity, Ethanolamines, Tacrine toxicity
Psychiatric Anxiety, Stress
Pulmonary Asthma
Renal/Electrolyte Dehydration, Diuretics, Renal disease
Rheumatology/Immunology/Allergy Myopathy
Sexual Quaternary syphilis
Trauma Intervertebral disc herniation, Strenuous exercise
Urologic Uremia
Miscellaneous No underlying causes

Causes in Alphabetical Order

Treatment

Inadequate magnesium intake can cause fasciculations, especially after a magnesium loss due to severe diarrhea. Over-exertion is another risk factor for magnesium loss. As much as 80% of the population does not get the recommended daily amount of magnesium; this may be a common cause. Treatment is with supplements or increased intake of foods rich in magnesium, especially almonds & other nuts, and bananas. Ironically, magnesium supplements may result in diarrhea and more magnesium loss, so dosage and timing (i.e. with meals) are important.

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.

References

  1. Blexrud MD, Windebank AJ, Daube JR (1993). "Long-term follow-up of 121 patients with benign fasciculations". Ann. Neurol. 34 (4): 622–5. PMID 8215252. doi:10.1002/ana.410340419. 

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