great articles on BFS

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great articles on BFS

Postby javens on October 18th, 2002, 1:48 am

I thought that it would be a good idea to post any good articles or clinical info that we come across. Here's some that I've found.
From the Muscular Dystrophy Association:
Research & Program Services Department, MDA National Headquarters, Tucson, Arizona
Cramp-fasciculation syndrome is a distinct clinical entity caused by a hyperactivity of the motor nerves. Initially characterized in the medical literature in 1971, it typically presents with muscle aches, cramps, fasciculations, stiffness, and exercise intolerance. Fasciculations, or muscular twitching, is usually predominantly seen in the muscles of the shoulder and thigh. Serum levels of creatine kinase are usually normal, but may be minimally elevated. Muscle biopsy is most often normal, but may reveal mild neurogenic changes. The most useful diagnostic test, by far, is the nerve conduction velocity. While fasciculations may be the only abnormality seen on routine studies, spramaximal stimulation should produce showers of electrical potentials. Sodium channel blocking drugs have been proven effective in treating this benign condition.
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Postby javens on October 18th, 2002, 1:56 am

This is a compilation garnered from different sources regarding fasciculations:
Generally fasciculations (muscle twitchings) are characterized as benign or as a neuromuscular disorder. There are numerous other
causes including electrolyte, metabolic and rheumatic causes, but most fall into one category or the other. Along with these
fasciculations some people have a collection of symptoms that constitute a syndrome known as benign-cramp-fasciculation-syndrome.
This condition represents a hyperexcitability of the neuromuscular system. The main symptoms are fasciculations (muscle twitching) with muscle cramps and/or spasms, fatigue, migrating numbness, muscle aches and stiffness, and exercise intolerance. Clinically some patients
may or may not have mild increases in creatine kinase. Muscle biopsy may show mild neurogenic changes. Electrodiagnostic studies can show
peripheral nerve hyperexcitability. The anatomic site of origin for muscle fasciculations and cramps has been debated for many
years. Many authors have argued for a central origin of the abnormal discharges in the anterior horn cells. However some
evidence favors a very distal origin in the intramuscular motor nerve terminals. The factors giving rise to these discharges are not
well understood. It seems possible that the fasciculation syndromes are subtle autoimmune neuropathies triggered by a common virus. The
cause of these symptomatic fasciculations are unclear. In many cases patients report having a viral illness such as the flu, a
stomach virus or a herpes infection preceding this syndrome.
The Mayo Clinic in 1993 published a study in The Annals of
Neurology which was a long-term follow-up of 121 patients with 'benign' fasciculations. A subset of 19 patients recalled an acute
onset of fasciculations following a viral illness. 40% of those studied had been health care workers. NONE of the patients in this study developed ALS (or Lou Gehrig's Disease). Many patients harbor a concern over ALS but occurences are rare. The general course of these symptoms
are to vary with time. Remissions and exacerbations may occur for many years. The flare-ups are often associated with viral illness, stress or overexertion. However the relapses also become fewer with the passing of time. In one report Tegretol improved symptoms in 50% of the cases. The dose of Tegretol is the same as used for epilepsy: 100 mgs 3 to 4 times per day. The limitations of this drug are unsteadiness and drowsiness. Numerous other medications have not helped including
anti-inflammatories, prednisone, and neuropathic doses of amytriptyline. Many patients are told their fasciculations are benign (inconsequential?), but it still doesn't explain the cause or management of the symptoms. Despite a myriad of difficult symptoms, they get little relief from their doctors or medications. They are frequently treated like chronic fatigue patients or are dismissed as if it is all in their mind.
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Postby javens on October 18th, 2002, 2:00 am

Here's a quote from a neurologist at the cleveland clinic in response to a question about fasciculations all over the body.
"Even the fact you have symptoms in both arm and leg should be re-assuring. ALS most often starts in one or the other and the weakness is profound, not subjective. The odds are overwhelmingly in your favor you don't have it."
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Postby SusanSid on October 18th, 2002, 10:47 am

Javerns,
Thank you so much for sharing this information! It's great :P
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Postby javens on October 18th, 2002, 12:37 pm

This is from a medical journal and is written in medical terms...ie. kinda hard to read.

Cramp-fasciculation syndrome: a treatable hyperexcitable peripheral nerve disorder
Neurology 1991 Jul;41(7):1021-4 (ISSN: 0028-3878)

Estimation of the frequency of the muscular pain-fasciculation syndrome
and the muscular cramp-fasciculation syndrome in the adult population.
Eur Arch Psychiatry Clin Neurosci 1991;241(2):102-4 (ISSN: 0940-1334)

[Muscle cramps and fasciculations not always ominous: muscle cramp-fasciculation syndrome]
[Spierkrampen en fasciculaties niet altijd omineus: het spierkramp-fasciculatiesyndroom.]
Ned Tijdschr Geneeskd 1996 Aug 10;140(32):1655-8 (ISSN: 0028-2162)

"In three patients, men of 43, 44 and 55 years old with muscle cramps,
fasciculations and easy fatiguability of muscles, cramp-fasciculation
syndrome was diagnosed.
This is a benign disorder which has to be differentiated from amyotrophic
lateral sclerosis. Response to treatment (benzodiazepines or carbamazepine)
is good."
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Postby javens on October 18th, 2002, 12:40 pm

Cramp-fasciculation syndromes
Onset: Young to middle aged adults
-Thigh, Calf & Quadriceps
-Associated muscle pain & fasciculations
-Normal strength
-Treatments Normalize metabolic abnormalities
Quinine sulfate: 260 mg qhs or bid
Carbamazepine: 200 mg bid or tid
Phenytoin: 300 mg qd
Tocainide: 200 to 400 mg bid
Verapamil: 120 mg qd
Amitriptyline: 25 to 100 mg qhs
Vitamin E: 400 IU qd
Riboflavin: 100 mg qd
Diphenhydramine: 50 mg qd
Calcium: 0.5 to 1 g elemental Ca++ qd
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Postby Jake_the_twitch on October 18th, 2002, 3:06 pm

A psychiatrist's View on BFS

Berney Goodman, M.D.

One day, a young man, a psychiatrist in his early thirties, entered a neurologists
office, accompanied by his pregnant wife. The psychiatrist had for some months, noticed
twitching in the muscles of his legs and ripples of muscular activity cascading down his
calves. At first he had tried to ignore these twitches, but in time they increased in
frequency and could not be overlooked. Now he was convinced they were the symptoms of
Lou Gehrig's Disease, a slow, but progressive, degeneration of the nervous system that
leads to paralysis and an agonizing death.

The neurologist, a brilliant but gruff man in his sixties, listened intently to the
psychiatrist, but after a thorough neurological examination abruptly exclaimed in a
loud and disagreeable tone, "There's nothing wrong with you. Get out of here."

If the psychiatrist's muscular twitches had no medical cause, did they have a
psychological one? If so, what was going on in his head that resulted in those
alarming twitches? It seems to me that as a prospective father, he had been under a
particular stress: the anticipation of a first child. Until his wife's pregnancy, he
must have been the exclusive beneficiary of her care, attention, and love. Now he was
to share it with another child who was twitching and kicking in his wife's womb.

Though he must have expressed his joy to his wife and others, down deep he may have
suppressed negative feelings that he was now expressing, not in words, but in physical
language. The rippling of his leg muscles was his way of saying "I'm just as important
as that other twitcher."

This explanation may sound glib and crudely Freudian, but I have a special insight into
this patient's problem. You see, I am that psychiatrist In fact, that experience in the
neurologist's office and my attempts to clarify my thoughts about it profoundly affected
both my professional and personal life.

Professionally, I developed a lifelong interest in somatization, a process through which
people express emotional discomfort in a physical rather than verbal language. Instead
of words, this language consists of unwelcome physical sensations, symptoms, and
preoccupations with medical illness. For example, after a grueling day at the office or
an argument with a spouse, a headache or a stiff neck may express our feelings.

Somatization is a way of saying, "I am emotionally overwhelmed." In place of putting a
feeling of emotional discomfort into words such as "I'm feeling anxious because..."
or "I feel under the weather because...," we communicate through physical discomfort
or symptoms or worry about sickness. It is a common language, used by almost all of us
at one time or another. Somatization symptoms are not imagined or feigned. They are
genuinely, and often painfully, experienced.

From a personal point of view, it was sobering to realize that, despite my being
a psychiatrist, I was just as susceptible as the next person to expressing my emotional
discomfort in physical symptoms. In fact, 60 to 80 percent of Americans have at least
one somatization symptom per week. Research has provided powerful evidence that most of
us express emotional discomfort physically far more often than verbally.

Indeed, we all experience occurrences of somatization, whether or not we are aware of
them. For the most part, these are related to stress and are normal. We usually identify
the physical feelings as stress induced and may say, "I had such a bad day at the office,
my stomach is still tied up in knots," or "I'm tense and I feel it in my neck" These
sensations are usually relieved by a drink, a hot bath, a good dinner, exercise, or a
good night's sleep.

Likewise, when under pressure to complete a project, confront a new social situation, or
start a new job, we may experience heartburn, palpitations, or urges to go to the
bathroom frequently. In these forms of somatization, we are aware of the relationship
between stress and our physical sensations and do not impart medical significance to
them.

But sometimes if our symptoms persist, we conclude these changes must mean something
is physically wrong. We visit a doctor. And most often, the physician, having taken a
careful history and done some basic testing, calmly reassures us that there is nothing
physically wrong. Though certain illnesses are notoriously difficult to diagnose in
their early stages and doctors may lack the diagnostic skill to detect them, generally
speaking, when a thorough investigation finds no evidence of disease, a doctor can
reasonably attribute such symptoms to somatization.

When the somatization symptoms persist despite a physician's reassurances and, more
important, interfere with daily functioning, they require more serious attention. For
instance, if we continue to complain of the same symptoms and consult many specialists,
take days off from work, and preoccupy ourselves and our families with our complaints,
we may indeed have an emotional disorder and require psychiatric diagnosis and treatment
Those who have persistent somatization symptoms that markedly interfere with their
functioning have what we call somatoform disorders.

The commonest somatoform disorder is hypochondria. But isn't hypochondria what we
have been talking about all along? Not as far as doctors, particularly psychiatrists,
are concerned. Hypochondria is a particular variety of somatization in which the symptoms
have persisted for longer than six months and in which the person has unrealistic fears
of disease.

I am not talking here about psychosomatic illness either. In psychosomatic illness,
such as duodenal ulcer and ulcerative colitis, an identifiable physical illness is always
present; the pathology is recognizable to the naked eye, through instruments, or through
laboratory testing, or all three. In somatization, despite the reality of the pain
that people feel, they have no physical illness. Somatization also must not be confused
with the intermittent worries about illness we all have. Likewise, intense attention to
particular bodily functions, such as bowel habits, while common, is not somatization.

Somatization is not very well understood or recognized. Nonetheless, it constitutes a
major public health-care problem, adding significantly to health-care costs because
of the extensive and repetitive testing that patients, their physicians, and their
symptoms call for. A study done over 10 years ago put the bill for physicians seeing
people with somatization symptoms at $20 billion, or 10 percent of the nation's total
annual health-care outlay. We can easily assume that this figure has matched the
nation's rising healthcare costs since that time.

And, depending on which figures you believe, between 20 and 84 percent of people who
consult a doctor do so for some form of somatization. Hypochondria alone is said
to be present in 9 percent of patients who consult their family physicians.

Peering ahead, I think the number of people with somatization symptoms will increase
dramatically as we enter the next century. Their individual dramas will be played out
on a stage dominated by an increasingly stress-filled world and a backdrop of frequent
family disruption, rapid cultural change, and increased attention to, and care of, the
body.

Body awareness is at an all-time high. And although we cannot assume that our current
preoccupation with our body and its health will cause us to have more somatization
symptoms, I think that it may do so for those, like myself, who are already sensitized
and susceptible to it.

from, When the Body Speaks Its Mind, by Berney Goodman, M.D., reprinted by Psychology Today
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Postby StayingAboveIt on March 8th, 2004, 1:54 am

I hope I am not committing some sort of net- Faux Pas by dragging up this old post...

The post above sounds just like me! I know there is no proof that stress causes BFS...but does anyone feel like their BFS is only caused my stress?

My BFS started in a particularly stressfull point in my life, and during a vacation where i was virtually stress free I only twitched maybe 2 or 3 times....

any thoughts?

This "somatization" seems worth checking into...
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Postby Airmade on March 8th, 2004, 8:52 am

Jake_the_twitch wrote:A psychiatrist's View on BFS

Berney Goodman, M.D.

One day, a young man, a psychiatrist in his early thirties, entered a neurologists
office, accompanied by his pregnant wife. The psychiatrist had for some months, noticed
twitching in the muscles of his legs and ripples of muscular activity cascading down his
calves. At first he had tried to ignore these twitches, but in time they increased in
frequency and could not be overlooked. Now he was convinced they were the symptoms of
Lou Gehrig's Disease, a slow, but progressive, degeneration of the nervous system that
leads to paralysis and an agonizing death.

The neurologist, a brilliant but gruff man in his sixties, listened intently to the
psychiatrist, but after a thorough neurological examination abruptly exclaimed in a
loud and disagreeable tone, "There's nothing wrong with you. Get out of here."

If the psychiatrist's muscular twitches had no medical cause, did they have a
psychological one? If so, what was going on in his head that resulted in those
alarming twitches? It seems to me that as a prospective father, he had been under a
particular stress: the anticipation of a first child. Until his wife's pregnancy, he
must have been the exclusive beneficiary of her care, attention, and love. Now he was
to share it with another child who was twitching and kicking in his wife's womb.

Though he must have expressed his joy to his wife and others, down deep he may have
suppressed negative feelings that he was now expressing, not in words, but in physical
language. The rippling of his leg muscles was his way of saying "I'm just as important
as that other twitcher."

This explanation may sound glib and crudely Freudian, but I have a special insight into
this patient's problem. You see, I am that psychiatrist In fact, that experience in the
neurologist's office and my attempts to clarify my thoughts about it profoundly affected
both my professional and personal life.

Professionally, I developed a lifelong interest in somatization, a process through which
people express emotional discomfort in a physical rather than verbal language. Instead
of words, this language consists of unwelcome physical sensations, symptoms, and
preoccupations with medical illness. For example, after a grueling day at the office or
an argument with a spouse, a headache or a stiff neck may express our feelings.

Somatization is a way of saying, "I am emotionally overwhelmed." In place of putting a
feeling of emotional discomfort into words such as "I'm feeling anxious because..."
or "I feel under the weather because...," we communicate through physical discomfort
or symptoms or worry about sickness. It is a common language, used by almost all of us
at one time or another. Somatization symptoms are not imagined or feigned. They are
genuinely, and often painfully, experienced.

From a personal point of view, it was sobering to realize that, despite my being
a psychiatrist, I was just as susceptible as the next person to expressing my emotional
discomfort in physical symptoms. In fact, 60 to 80 percent of Americans have at least
one somatization symptom per week. Research has provided powerful evidence that most of
us express emotional discomfort physically far more often than verbally.

Indeed, we all experience occurrences of somatization, whether or not we are aware of
them. For the most part, these are related to stress and are normal. We usually identify
the physical feelings as stress induced and may say, "I had such a bad day at the office,
my stomach is still tied up in knots," or "I'm tense and I feel it in my neck" These
sensations are usually relieved by a drink, a hot bath, a good dinner, exercise, or a
good night's sleep.

Likewise, when under pressure to complete a project, confront a new social situation, or
start a new job, we may experience heartburn, palpitations, or urges to go to the
bathroom frequently. In these forms of somatization, we are aware of the relationship
between stress and our physical sensations and do not impart medical significance to
them.

But sometimes if our symptoms persist, we conclude these changes must mean something
is physically wrong. We visit a doctor. And most often, the physician, having taken a
careful history and done some basic testing, calmly reassures us that there is nothing
physically wrong. Though certain illnesses are notoriously difficult to diagnose in
their early stages and doctors may lack the diagnostic skill to detect them, generally
speaking, when a thorough investigation finds no evidence of disease, a doctor can
reasonably attribute such symptoms to somatization.

When the somatization symptoms persist despite a physician's reassurances and, more
important, interfere with daily functioning, they require more serious attention. For
instance, if we continue to complain of the same symptoms and consult many specialists,
take days off from work, and preoccupy ourselves and our families with our complaints,
we may indeed have an emotional disorder and require psychiatric diagnosis and treatment
Those who have persistent somatization symptoms that markedly interfere with their
functioning have what we call somatoform disorders.

The commonest somatoform disorder is hypochondria. But isn't hypochondria what we
have been talking about all along? Not as far as doctors, particularly psychiatrists,
are concerned. Hypochondria is a particular variety of somatization in which the symptoms
have persisted for longer than six months and in which the person has unrealistic fears
of disease.

I am not talking here about psychosomatic illness either. In psychosomatic illness,
such as duodenal ulcer and ulcerative colitis, an identifiable physical illness is always
present; the pathology is recognizable to the naked eye, through instruments, or through
laboratory testing, or all three. In somatization, despite the reality of the pain
that people feel, they have no physical illness. Somatization also must not be confused
with the intermittent worries about illness we all have. Likewise, intense attention to
particular bodily functions, such as bowel habits, while common, is not somatization.

Somatization is not very well understood or recognized. Nonetheless, it constitutes a
major public health-care problem, adding significantly to health-care costs because
of the extensive and repetitive testing that patients, their physicians, and their
symptoms call for. A study done over 10 years ago put the bill for physicians seeing
people with somatization symptoms at $20 billion, or 10 percent of the nation's total
annual health-care outlay. We can easily assume that this figure has matched the
nation's rising healthcare costs since that time.

And, depending on which figures you believe, between 20 and 84 percent of people who
consult a doctor do so for some form of somatization. Hypochondria alone is said
to be present in 9 percent of patients who consult their family physicians.

Peering ahead, I think the number of people with somatization symptoms will increase
dramatically as we enter the next century. Their individual dramas will be played out
on a stage dominated by an increasingly stress-filled world and a backdrop of frequent
family disruption, rapid cultural change, and increased attention to, and care of, the
body.

Body awareness is at an all-time high. And although we cannot assume that our current
preoccupation with our body and its health will cause us to have more somatization
symptoms, I think that it may do so for those, like myself, who are already sensitized
and susceptible to it.

from, When the Body Speaks Its Mind, by Berney Goodman, M.D., reprinted by Psychology Today


Excellent post and theory!!!
BUT IF SO, WHICH IS THE THERAPY?
I guess "not focusing too much" on fascics... well' I've done it... but still twitching 24/7!
May be a psicanalist? If someone ask me what do you feel your stress comes from... I'll answer:... from fasciculations!
Or SSRI drugs? (tried it with no results!)
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Postby Pole on March 8th, 2004, 9:05 am

I think that stress may be a factor which make twitches worse but that is not main reason of BFS. I think that main reason of benign fasciculations must be a kind of anomaly in nervous system (sodium, potassium chanells etc). It's too intensive to be due to thinking about it only!!!

regards
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Postby Jenn311 on March 8th, 2004, 10:18 am

That is a great article! Thanks for sharing. The kind of therapy you need for somataform disorders/somatization is called cognative behavioral therapy. It aims to change how you think and thus behave.

Jen :wink:
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Postby Airmade on March 8th, 2004, 3:25 pm

Jenn311 wrote:That is a great article! Thanks for sharing. The kind of therapy you need for somataform disorders/somatization is called cognative behavioral therapy. It aims to change how you think and thus behave.

Jen :wink:


Thak's Jen,
but do you feel that cognative behavioral therapy could help to reduce or stop twitching?

I think there must be an anomaly, as Pole says. Ok, what causes this anomaly is unknown, but it MUST BE an anomaly! I can't accept to be said by neuros ..."it's benign"... or ...."it doesn't need to be treated, it's not a patology" and ...go home!
I can understand that the cause of BFS is unknown, but if neurology doesn't have answers, then I have to find what's wrong with my system, in a way or another!
I feel and I know that all my strange symtoms are from some neurological disorder, but because most of us have been told by neurologists that we are "ok", then we should start to think that the cause (and may be the therapy) is not neurological at all. 30% of BFSrs can have been infected by a virus... or (again as Pole suggests) a disfunction in the sodium/potassium pump... I WANT TO KNOW IT AND DO SOMETHING TO INVESTIGATE AND RESOVE THE PROBLEM! As I already told in another post, I'm fed up of all this... AND I DON'T WANT TO DO NOTHING FOR IT! I'll keep on my own research and, of course, I'll let you know!

Thank you for understand my outburst. LYA (Love you all).

Airmade.
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Postby Jenn311 on March 8th, 2004, 4:09 pm

I do believe that there is some kind of organic cause for whatever it is we are experiencing. But I also believe that we can all attest to the fact that stress and fixation on our symptoms makes them much much worse. This would be what therapy would seek to reduce...the anxiety connection. I know once I stopped believing that I had some deadly disease (and this took a while....) I started feeling relief. I think many people on this forum have had similar experiences, or maybe there are some out there still going through the panic stage. In which case, I wish them the best! :D

I still twitch. And yes, sometimes I do get stressed or worried about it. Then I try my best to forget about them and they go away pretty quickly. So I think this is the benefit of therapy...working through our fear and training our minds not to go there.

ciao, jen
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