Benign fasciculation syndrome

Benign fasciculation syndrome (BFS) is a neurological disorder characterized by fasciculation 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 is often affected. The twitching may be occasional or may go on nearly continuously. Any intentional movement of the involved muscle causes the fasciculations to cease immediately, but may restart once the muscle is at rest again. more...

Common features

In addition to twitching, patients with BFS often experience pain, paraesthesia, generalized fatigue, exercise intolerance, globus sensation and/or muscle cramping.

Another common feature of the disorder is a dramatic increase in the patient's level of anxiety, especially health-related anxiety. It's not uncommon for the patient to fixate on ALS, vCJD, or some other similarly fatal disorder, refusing to believe the BFS diagnosis.

Causes

Though twitching is sometimes a symptom of various serious diseases (spinal injury, muscular dystrophy, ALS), it is much more often due to more benign causes (BFS, over-exertion, etc), and virtually everyone will experience some episodes of benign fasciculation during their lifetime.

The precise cause of BFS is unknown, and, in fact, it's not known if it's a disease of the motor nerves, the muscles, or the neuromuscular junction. However, anxiety is cleary a major contributing factor in many cases, and a high level of psychological stress appears to be a factor in others. Another factor that seems to be common in many cases is a history of regular strenuous exercise. Attention deficit disorder or a related disorder may be a contributing factor, and people with essential tremor appear to have a greater than normal likelihood of developing BFS. In addition, there are likely other genetic and environmental factors that make the patient more susceptible to BFS.

There are some intriguing similarities between BFS and chronic organophosphate poisoning, but these similarities have not been explored. It may be that chronically elevated levels of stress hormones in the body cause damage similar to the damage caused by organophosphates.

Diagnosis

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) neuropathy, motor neuron diseases such as ALS, etc) 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), a completely normal EMG (or one where the only abnormality seen is fasciculations) largely eliminates more serious disorders and strongly suggests BFS.

The only commonly abnormal finding on examination by a neurologist is slightly brisk reflex action. Standard laboratory tests are unremarkable. Since a high degree of health anxiety is common with BFS, the presence of such anxiety tends to confirm the diagnosis.

Treatment

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.

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