Fasciculations: A Condition to Keep An Eye On

It is a common trope in movies for a character to get so stressed his eye starts twitching involuntarily. Though it may be used to comedic effect, these twitches are very real, and feel like they are no laughing matter if they happen to you.

Caused by everything from running low on electrolytes after a workout to life-threatening terminal illnesses, fasciculations are spasms in your muscles that can be worrisome and annoying, but are rarely a cause for significant concern.

What are Fasciculations?

Most of us will go through life without needing to worry about the deeper problems of neuroscience. That said, many, many people will experience unexplained muscle twitches at some time in their life. These fibrillations typically occur in the eyelids or lower limbs, generally happen when you are at rest, and often go away on their own without treatment. Seventy percent of the time, these twitches, known as fasciculations, occur in otherwise healthy people, though they can also be a symptom of worrying motor neuron diseases.

Muscle twitches occur when there is interference in the signaling to a motor unit inside one of your muscles. This combination of nerve and muscle fibers is responsible for the contraction of a muscle to help your body move. Stimulants like caffeine, drugs such as Benydryl (diphenhydramine), or nicotine, can sometimes be the cause. Just like with muscle cramps, low electrolyte levels, particularly magnesium and calcium, can also cause dysfunction in how your muscles fire. Stress, depression, and anxiety are all known to increase fasciculation potential.

These twitches are most often diagnosed as benign fasciculation syndrome, or BFS. This term captures a range of specific causes of involuntary twitches and muscle spasms that do not have a serious or even a known cause. Any abnormality in how your muscles move can be worrying, though, and with fasciculations being a symptom of some serious neurological conditions, it pays to talk to your doctor to find out what is going on.

What Can Cause Fasciculations?

Fasciculations, or involuntary spasms common to the eyelids and legs, are caused by a wide range of factors. These include harmless, temporary causes like electrolyte imbalance, stress, or over-the-counter allergy medication. More serious causes can include multiple sclerosis, amyotrophic lateral sclerosis (ALS), or other neurological conditions.

The full range of potential causes of fasciculations is wide and varied. Many of these causes are from common stimulants or drugs you may encounter in daily life. A few of these include:

• caffeine
• Dramamine (dimenhydrinate)
• nicotine
• Benadryl (diphenhydramine)
• Ritalin (methylphenidate)3
• Sudafed (pseudoephedrine)
• beta-agonists

These drugs and stimulants are only responsible for a portion of the cases of BFS that are diagnosed every year. It turns out that while neurology may be the culprit, psychiatry is sometimes the route to finding a cure. Depression, anxiety, and extreme stress are often associated with the presence of fasciculations. Though stress and anxiety can be the cause of BFS, the twitching itself can be a cause of anxiety in its own right. While the twitching can be uncomfortable, wondering whether you are suffering from something more serious can be a cause of stress until you get a clear diagnosis to explain why you are experiencing spasms.

If working with a counselor or kicking your smoking habit do not cure your twitches, seeing a neurologist may be the answer. There are many different conditions and disorders of the nervous system that can affect the distal nervous system, potentially causing twitches in the lower limbs. These include:

• Moersch-Woltmann syndrome
• Lou Gherig’s disease (Amyotrophic lateral sclerosis)
• paraneoplastic syndrome
• Schwartz-Jampel syndrome
• spinal muscle atrophy
• paraneoplastic syndromes

Other causes of neurologic abnormality can come about by incidents in your daily life. It is possible that physical trauma could cause damage to the spinal cord. Other potential causes include rabies, which can be contracted from an encounter with an infected animal.

Are Fasciculations the First Sign of ALS?

Given the seriousness of amyotrophic lateral sclerosis, people naturally worry that any symptom of ALS could be the sign they have this very serious disease. While muscle fasciculations can be a symptom of ALS, there are other, more sure signs of disease progression to look for. Muscular atrophy, or a generalized weakness, is a sign of ALS that is far more worrying.

If you are concerned that your symptoms are the sign of something more serious, be sure to talk to a healthcare professional. There are conclusive tests that can be performed to determine whether ALS is the cause of your twitching. You may find out you are experiencing a lifestyle-induced form of BFS caused by something like over-the-counter drugs, smoking, stress, or even too much strenuous exercise.

Where and how your twitches occur is also an indication of what may be going on. The fasciculations associated with BFS often occur in the eyelids (known as myokymia) or in your lower motor neurons. ALS can cause broader effects in your peripheral neuropathy, with twitching and muscle weakness occurring throughout the body.

Diagnosing Fasciculations

There are many conditions that can cause or contribute to fasciculations. The majority of these are relatively harmless, but there are exceptions to this rule. Part of the challenge for clinicians treating patients who report muscle twitching is to properly differentiate between harmless occurrences of BFS and something that requires extensive medical treatment. Multiple sclerosis and amyotrophic lateral sclerosis (ALS) are two very serious and life-impacting conditions that can cause fasciculations.

While your doctor is unlikely to suggest a barrage of potentially expensive tests for a twitch of the eyelid, fasciculations still need to be taken seriously. If you are referred to a neurologist, there are several steps that can be taken to help narrow in on a diagnosis. Electromyography (EMG) is a process of testing the function of particular groups of nerves throughout the body. This can help identify the loss of signal to your muscles through denervation, which can be used in diagnosing ALS.

How are Fasciculations Treated?

When there is anything going wrong in your body, it is important to talk to your health care professional about it. Since twitches can be caused by too much stress or a genuinely worrying condition affecting your peripheral nerves, it is better to make sure you have been checked out by your doctor.

If it turns out you have a version of BFS, your doctor will work with you to eliminate the lifestyle habits or drugs you are taking that could be causing your twitching. In cases where psychological components play in, referring you to a counselor or psychiatrist may be the next step toward finding a cure.

In instances where damage to the spinal column or other nerves may be responsible, your neurologist will attempt to see if reinnervation is possible. If it turns out that you have one of the other neurological conditions that could involuntary movement of the muscles, your doctor will work with you to see what drugs or other treatments are available.

Even if your doctor is convinced you have BFS, a follow-up appointment will likely be scheduled to help ensure that treating the suspected cause has, in fact, brought about relief of your symptoms. If you have not improved, it is possible you may be referred to a neurologist for more testing to see if there is something more serious going on.

Like so many other conditions, the first step to finding answers is going to see your doctor. At TrustCare, we know that finding answers quickly, on your schedule, is essential. That is why we have locations open seven days a week to help you get the answers you need.