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here u go Arron

PostPosted: December 10th, 2002, 11:43 pm
by Brian_B
this is the post I was talking about, if you want to add it to your bfs in a nutshell post you can.

know a neurologist from another forum(not BFS or medical forum for that matter, just a friends of mines forum) but anyway I asked him about twitches and this is what he wrote.

In answer to a question by one on this forum, I will write about fasciculations. These are sudden involuntary twitches or contractions of a group of muscle fibers, usually innervated by one motor neurone. In come cases a group of neurons may fire off.

The result is usually a barely visible muscle contraction. Sometimes just a brief indentation of a forearm or calf muscle is all that you see. They are more easily seen in the face, and small hand muscles. Fasciculations have many different causes some serious and many benign.

This is quite a coincidence. But I have benign fasciculations. I have had them for a couple of years now. Being a neurologist, when I first noticed them, I thought I had Lou Gehrig's Disease. Yet I had no weakness and no obvious muscle atrophy. Knowing that the first rule of medicine for doctors is to never diagnose oneself, I called a friend at the University Hospital in Seattle, where I was living then.

He did electromyography looking for "denervation". That is loss of motor neurones that changes the electrical patterns in muscles when an electrode is introduced. He checked each extremity, my face, and my tongue. I had none of the signs of denervaton (positive sharp waves, and fibrillations). I just had some fasciculations, spontaneous firing of a motor unit. A motor unit may consist of anywhere from 4 to 200 muscle fibres.

He noted my normal strength with a detailed exam, and my "normal EMG. He said that I did have benign fasciculations or Benign Fasciculation Syndrome. Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease) almost always has fasciculations. But it usually presents with atrophy of skeletal muscles in the arm, leg, or face. Soon muscle atrophy develops (muscles look wasted).

There are other things that can present with fasciculations apart from ALS or BFS. One common condition is cervical spondylosis (neck arthritis) with spinal cord compression. So a spinal MRI may be ordered in some cases.

Another condition Post is Poliomyelitis Muscular Atrophy Syndrome, which is a delayed late onset scattered muscle weakness with fasciculations, weakness, and atrophy. All of these folks have a history of severe Polio, usually severe enough to have been on the old "Iron Lung" machines in the 50s and 60s.

Fasciculations are sometimes seen in Mad Cow Disease (Creutzfeld-Jakob), which is more common over here than in your area. And fasciculations are only a minor aspect. These people suffer dementia, psychosis, seizures, incoordination, spasticity, and features that far overshadow the minor fasciculations.

Drugs of certain types can cause fasciculation. Alcohol may be a factor. Mestinon (Pyridostigmine), Statins (Cholesterol lowering drugs) also cause fasciculations. Potassium deficiency, Magnesium deficiency, Vit B12 deficiency, and certain calcium abnormalities may have fasciculations as part of their symptom complex.

I don't know how you were evaluated, but presumably your doctor called it BFS and therefore went through the elimination process. That may have included blood tests, a spinal MRI, as well as the EMG (electromyography.)

BTW, I still twitch. Mine are worse at night as I go to sleep, and in the morning when I first awaken. During active work, either they don't occur or I can't notice them. However, when I take a break like now to surf the Internet, I feel the twitches in my posterior calves, and the flexor muscles of my arms. At night the twitches are more common in my shoulders, chest wall, and thighs. Being naturally paranoid, I test my strength almost daily. I stand on my toes. I do a couple of squats, and hold a book in my hand while flexing my wrist upward. Fortunately I am still strong.

BTW, a recent report in a neuromuscular journal (forget which one), that followed people with only fasciculations but otherwise normal. Over 5 years none of them developed ALS. According to a Neuromuscular Disease specialising neurologist in Seattle, he has followed many people with fasciculations, and none of those with benign fasciculations (no denervation, no weakness) have ever gone on to develop ALS.

As far as treatment, my bias is that no treatment is the best treatment. The twitches are a minor nuisance and drug effects to suppress them would be worse than having twitches.