Benign fasciculation syndrome

[FreakOutQueen]

Reading all your stories really makes me hopeful that this is what I have and not something more sinister. I keep trying to tell myself I am going to be okay. That the twitching is benign and the more I think about it, the worse it will get. But then my mind goes to the "what ifs" and I start to get so anxious. I'm going away next week for a week and I really don't want this to ruin my vacation. My spouse is about ready to strangle me. I can't talk about these symptoms with anyone because they think I'm crazy and I'm desperately trying to get in to see a neurologist before I go away...otherwise I have to wait until July 19th. I guess the passage of time without developing any weakness will start to reassure me that it is benign. It is crazy what our minds do to our bodies.

[nivekc251]

Working out really helped me because building muscle and strength contradicts ALS. I use to sit and worry and look up horror stories. It was like I was scared to try and do anything. I didn't wash my truck for a year lol. The best thing to do is keep busy don't sit and worry, doing that will kill you not the BFS lol you will be fine it's not a subtle disease and twitching doesn't mean anything sinister is going on it just means your twitching when u feel them just tell them to f*** off and don't let the ruin your day

[FreakOutQueen]

Thank you for the advice! I have a feeling I will be able to fully accept that it is benign once I get the "all clear" from my neurologist. Until then, I refuse to google anything because I inevitably find a story that scares me.

[Michelle1]

Yes best not to google twitching because the worst diseases always show up. I went on u tube the other day to view stories of bfs and they always jump to mind/als and I watched one I tube video and it scared me to death. I def need to stay off google. Trust the experts and if they say it's bfs then do your damn best to accept it.
I just hope and pray they settle down in time as I learn to accept and ignore them. I also get those body jerks just before drifting off to sleep. Sometimes fingers/toes move without me wanting them too. I have been stressed over the last year or so and think my body is over sensitised. So long as no muscle weakness (I often test my muscles i.e. Stand on my toes, heels, push pull) it's most likely bfs due to anxiety/stress. Yes your right how our brains can cause such worrying symptoms is beyond me but I'm finding the most I spend time dwelling on them the worse I'm becoming. Thanks all for sharing your experiences

[Josh1234]

Did anything trigger it or did it just start spontaneously?
Is it in all muscle groups?

Quite literally, head to toe. Tongue included.

[Michelle1]

Yes I get them on the tongue too, sometimes feel like I can choke just drinking water.
I get them in all muscle groups but worst in hands/feet/calfs.
Neurologist told me that's the most common places. He is obviously the Specailist and he didn't seem too concerned. I'm just hoping and praying they will calm down and go.

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https://en.m.wikipedia.org/wiki/Beni...ation_syndrome

---------- Post added at 17:36 ---------- Previous post was at 17:30 ----------

Benign fasciculation syndrome (BFS) is a neurological disorder characterized by fasciculation (twitching) of various voluntary muscles in the body. The twitching can occur in any voluntary muscle group but is most common in the eyelids, arms, legs, and feet. Even the tongue may be affected. The twitching may be occasional or may go on nearly continuously. Usually intentional movement of the involved muscle causes the fasciculations to cease immediately, but they may return once the muscle is at rest again.

Benign fasciculation syndrome
Bfs spasm.gif
Animated image of BFS in the upper eyelid of a 19-year-old male. Symptoms subsided several days later.
Classification and external resources
[edit on Wikidata]
Signs and symptoms Edit

The main symptom of benign fasciculation syndrome is focal or widespread involuntary muscle activity (twitching), which can occur at random or specific times (or places). Presenting symptoms of benign fasciculation syndrome may include:[1][2][3]

Fasciculations (primary symptom)
Blepharospasms (eye spasms)
Generalized fatigue
Muscle pain
Anxiety (which can also be a cause)
Exercise intolerance
Globus sensation
Paraesthesias[4]
Muscle cramping or spasms [5]
Other symptoms include:

Hyperreflexia[2][6]
Muscle stiffness
Tremors
Itching
Myoclonic jerks
BFS symptoms are typically present when the muscle is at rest and are not accompanied by severe muscle weakness.[citation needed] In some BFS cases, fasciculations can jump from one part of the body to another. For example, it could start in a leg muscle, then in a few seconds jump to the forehead, then the abdomen, etc. While only one part of the body is affected at a time, hardly a beat is missed as it jumps from one area to the next. Because fasciculations can occur on the head, this strongly suggests the brain as the generator due to its exclusive non-dependence on the spinal cord. (Together, the brain and spinal cord comprise the central nervous system.)

Anxiety is often caused as a result of BFS, and a lot of sufferers have hypochondria as BFS mimics symptoms of much more serious diseases such as amyotrophic lateral sclerosis (ALS).

Causes Edit

The precise cause of BFS is unknown, and it is not known if it is a disease of the motor nerves, the muscles, or the neuromuscular junction. Though twitching is sometimes a symptom of serious diseases such as spinal injury, muscular dystrophy, Lyme disease, Creutzfeldt–Jakob disease (CJD), neurofibromatosis or amyotrophic lateral sclerosis (ALS), causes like BFS and over-exertion are more common. Mitsikostas et al. found that fasciculations "were slightly correlated to the body weight and height and to the anxiety level" in normal subjects.[7]

BFS can also be attributed to long term use of anticholinergics such as diphenhydramine and opiates such as morphine, but the latter case is usually when withdrawal symptoms are present.[citation needed]

Magnesium deficiency can cause both fasciculations and anxiety.[8] A vitamin D deficiency may also cause fasciculations, stemming from reduced ionized calcium in the blood (hypocalcemia).

Recent studies have found an association between widespread fasciculations and/or paresthesias with small fiber neuropathy in up to 82% of cases which have a normal EMG and nerve conduction study.[9][10]

Diagnosis Edit

Diagnosis of BFS is a diagnosis of exclusion, in other words, other likely causes for the twitching (mostly forms of neuropathy, such as borreliosis Lyme disease neuropathy, motor neuron diseases such as ALS) must be eliminated before BFS can be assumed. An important diagnostic tool here is the electromyography (EMG). Since BFS appears to cause no actual nerve damage (at least as seen on the EMG), patients will likely exhibit a completely normal EMG (or one where the only abnormality seen is fasciculations).

Another important step in diagnosing BFS is checking the patient for clinical weakness. Clinical weakness is often determined through a series of strength tests, such as observing the patient's ability to walk on his or her heels and toes. Resistance strength tests may include raising each leg, pushing forward and backward with the foot and/or toes, squeezing with fingers, spreading fingers apart, and pushing with or extending arms and/or hands. In each such test the test provider will apply resisting force and monitor for significant differences in strength abilities of opposing limbs or digits. If such differences are noted or the patient is unable to apply any resisting force, clinical weakness may be noted.

Lack of clinical weakness along with normal EMG results (or those with only fasciculations) largely eliminates more serious disorders from potential diagnosis.

Especially for younger persons who have only LMN sign fasciculations, "In the absence of weakness or abnormalities of thyroid function or electrolytes, individuals under 40 years can be reassured without resorting to electromyography (EMG) to avoid the small but highly damaging possibility of false-positives". "Equally, however, most subspecialists will recall a small number of cases, typically men in their 50s or 60s, in whom the latency from presentation with apparently benign fasciculations to weakness (and then clear MND) was several years. Our impression is that a clue may be that the fasciculations of MND are often abrupt and widespread at onset in an individual previously unaffected by fasciculations in youth. The site of the fasciculations, for example, those in the calves versus abdomen, has not been shown to be discriminatory for a benign disorder. There is conflicting evidence as to whether the character of fasciculations differs neurophysiologically in MND".[11]

Another abnormality commonly found upon clinical examination is a brisk reflex action known as hyperreflexia. Standard laboratory tests are unremarkable. According to neurologist John C. Kincaid:

In the absence of clinical and electromyographic findings of neurogenic disease, the diagnosis of benign fasciculations is made. I suggest that patients like this be followed for a year or longer with clinical and electromyographic exams at about 6-month intervals before one becomes secure in the diagnosis that the fasciculations are truly benign. My approach to treating fasciculations that appear to be benign is to first reassure the patient that no ominous disease seems to be present.[12]

Treatment Edit

Some degree of control of the fasciculations may be achieved with the same medication used to treat essential tremor (beta-blockers and anti-seizure drugs). However, often the most effective approach to treatment is to treat any accompanying anxiety. No drugs, supplements, or other treatments have been found that completely control the symptoms. In cases where fasciculations are caused by magnesium deficiency, supplementing magnesium can be effective in reducing symptoms.[13]

In many cases, the severity of BFS symptoms can be significantly reduced through a proactive approach to decrease the overall daily stress. Common ways to reduce stress include: exercising more, sleeping more, working less, meditation, and eliminating all forms of dietary caffeine (e.g. coffee, chocolate, cola, and certain over-the counter medications).

If pain or muscle aches are present alongside fasciculations, patients may be advised to take over-the-counter pain medications such as ibuprofen or acetaminophen during times of increased pain. Other forms of pain management may also be employed. Prior to taking any over-the-counter medications, individuals should initiate discussions with their health care provider(s) to avoid adverse effects associated with long-term usage or preexisting conditions.

Prognosis Edit

The prognosis for those suffering from diagnosed benign fasciculation syndrome is generally regarded as being good to excellent. The syndrome causes no known long-term physical damage. Patients may suffer elevated anxiety even after being diagnosed with the benign condition.[3] Such patients are often directed towards professionals who can assist with reductions and understanding of stress/anxiety, or those who can prescribe medication to help keep anxiety under control.

Spontaneous remission has been known to occur, and in cases where anxiety is thought to be a major contributor, symptoms are typically lessened after the underlying anxiety is treated. In a 1993 study by Mayo Clinic, 121 individuals diagnosed with benign fasciculation syndrome were assessed 2–32 years (~7 years average) after diagnosis.[1][14] Of those patients there were no cases of BFS progressing to a more serious illness, and 50% of the patients reported significant improvement in their symptoms at the time of the follow-up. Only 4% of the patients reported symptoms being worse than those present at the time of their diagnosis.

Taken from Wikipedia

[FreakOutQueen]

Interesting that Hypocalcemia can cause this. I just got told my calcium level was low a few days ago. I am wondering if this is what is causing my twitching/cramping. I am on a calcium supplement so we shall see!

[Michelle1]

Yes definitely worth treating if it's low. Wouldn't it be nice if it's treated by vitamin Suppliments. My magnesium was on the low end of normal so dr agreed to me supplementing it with magnesium tablets. I take 3 a day and they seem to help a bit with the muscle spasms.
Apparently low vit d can cause it too, so it is possibly not all anxiety, but I do find anxiety makes it worse so it's a bit of a vicious circle.

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Also I was on piriton an antihistamine for a number of years that's on the list of medications that can possibly trigger it (BFS can also be attributed to long term use of anticholinergics - taken from Wikipedia)

[br350]

I have an eyelid twitch that has been off/on for months. Sometimes the other eyelid twitches. From everything I've read this is considered benign and common and no Google hit ever mention more sinister causes. I don't have overall muscle twitches in other large muscle groups. I really do not want to do a neuro consult as my anxiety goes through the ROOF with doctor exam and testing. I just become nearly depersonalized during these things. I am hoping to just ride it out. I was alarmed to read above that it *could* be connected to ALS. :(

[nivekc251]

Twitching is not ALS . The sudden death of motor neurons is ALS. Eye twitching is the most common form of twitching and is benign. Try to ignore it and focus on distressing your mind and body. Get 7+ hours of sleep and avoid caffeine.