Benign Fasciculation Syndrome (BFS)

What Is Fasciculation?

Fasciculation or muscle twitch is the involuntary contraction of small muscles in the body. Most people experience twitching in their eyelids. Muscle twitches are not painful and are usually not a cause for concern. But, it can be a symptom of some serious health conditions like amyotrophic lateral sclerosis (ALS) or otherwise known as Lou Gehrig’s disease. So, it is always better to get persistent muscle twitches evaluated by a medical professional.

What Is Benign Fasciculation Syndrome?

Persistent muscle twitches or numbness or tingling sensations in one or more muscles of the body is called benign fasciculation syndrome (BFS). Usually, the spasms seen in BFS do not cause sudden jerking or full contraction of the muscles, but they are strong enough for the person to feel them.

Muscle twitches occur when the motor units, which are the muscles and nerve fibers that work together to contract a muscle, get stimulated on their own. This causes involuntary, unexpected, and sudden fasciculations that are out of the brain’s control. BFS either lasts for a long period of time or keeps coming back regularly.

What Are the Symptoms of Benign Fasciculation Syndrome?

The primary symptom of BFS is muscle twitching, numbness, or tingling sensation. People with this condition may have twitches in their eyes, tongue, arms, thumb, feet, thighs, and calves. Some people also experience muscle cramps. The most common places where people experience twitching are in the calves and thighs. Fasciculations are more noticeable when the person is at rest.

The other common signs and symptoms include:

• Pain and weakness in the affected muscle.
• Blepharospasm - the abnormal contraction of the muscles present in the eyelids.
• Involuntary muscle spasms.
• Muscle stiffness.
• Fatigue (malaise).
• Anxiety.
• Exercise intolerance - the person might be unable to perform physical exercise.
• Muscle cramps.
• Dyspnea - shortness of breath.
• Myoclonic jerks - sudden and involuntary jerking of muscles.
• Itching.
• Hyperreflexia - overactive reflexes.

In some cases, these fasciculations can get transferred from one part to another part of the body. Meaning, if you have tremors in a leg muscle, it can jump to the abdomen in a few seconds.

What Causes Benign Fasciculation Syndrome?

The exact cause of BFS is still unknown, as it is a very rare condition. It was thought to be caused due to overactive nerves. Some of the conditions that have been associated with fasciculations are:

• Stress.
• Trauma.
• Anxiety.
• Depression.
• Alcoholism.
• Smoking.
• Viral infection.
• Fatigue.
• Strenuous exercise.
• Headache.
• Irritable bowel syndrome (IBS).
• Acidity.

Some medicines also cause muscle twitching, which subsides on stopping the medicine. The medicines that cause fasciculations are:

• Beta-blockers.
• Nortriptyline.
• High doses of corticosteroids.
• Chlorpheniramine.
• Diphenhydramine.
• Pseudoephedrine.

What Are the Other Conditions That Cause Muscle Twitches?

Some of the other health conditions that cause fasciculations are:

• Amyotrophic lateral sclerosis (ALS) - ALS is a progressive neurological disorder that results in loss of muscle control due to damage to nerve cells in the brain and spinal cord.
• Sleep apnea - It is a potentially dangerous condition where a person repeatedly stops and starts breathing during sleep. Snoring is its main symptom.
• Hyperthyroidism - A endocrine disorder where the thyroid gland produces thyroid hormone in excess.
• Peripheral neuropathy - Here, the nerves that carry signals to and from the brain and spinal cord to the rest of the body are damaged.
• Tourette syndrome - People with Tourette syndrome experience episodes of involuntary repetitive sounds and movements.
• Caffeine overdose - Consuming a lot of caffeine in a short period of time can result in symptoms such as abdominal pain, vomiting, seizures, etc.
• Too much or too little calcium in the blood.
• Some kidney diseases.
• Spinal muscular atrophy - A genetic condition characterized by atrophy or wasting of the skeletal muscles.
• Spinal injury.
• Rabies - A preventable viral disease that results in inflammation of the brain.
• Paraneoplastic syndrome - A rare nerve condition related to cancer.
• Schwartz-Jampel syndrome - A genetic neurological disorder.

How to Differentiate BFS From ALS?

BFS is commonly mistaken for ALS, as they share many similar symptoms. The symptom that is commonly used to tell them apart is muscle wasting. That is, the muscles in ALS get atrophied and shrink over time. This makes a person suffering from ALS progressively weaker. But this symptom is not commonly seen in BFS.

Fasciculations are common in both conditions, but in BFS, fasciculations are more widespread. Muscle twitching is commonly experienced at rest and stops once the person uses the muscle.

In ALS, fasciculations start in a particular place and then often spread to the surrounding areas. Both these conditions are different and are not connected.

How Is Benign Fasciculation Syndrome Diagnosed?

As mentioned earlier, fasciculations can be a symptom of many other health conditions, so it is crucial to diagnose the cause. Muscle twitches are evaluated primarily with electromyography (EMG). Here, the muscle response is recorded after stimulating a nerve with a small amount of electricity.

To rule out all other causes of twitching, the doctor might also perform the following tests:

• Blood test.
• Nerve tests.
• Neurological examinations.
• Psychiatric evaluation.

How Is Benign Fasciculation Syndrome Treated?

As of now, there is no treatment available to reduce benign fasciculation syndrome. They usually resolve on their own once the trigger is identified and eliminated. Some doctors prescribe medicines that decrease the nerve excitability, like:

• Carbamazepine.
• Gabapentin.
• Lamotrigine.
• Pregabalin.

Stretching and massage can help with muscle cramps. Prednisone, an immunosuppressive drug, is prescribed if no other treatment is effective.

If BFS is believed to be caused due to stress and anxiety, it is found that the following remedies might help:

1. Exercise - Exercise is shown to improve mood and reduce stress.
2. Limiting the intake of alcohol, drugs, and caffeine can make stress worse.
3. Consuming a healthy and balanced diet, which includes a lot of fruits and vegetables, helps the immune system to work properly even during stress.
4. Organize and think about your work and the things you need to do before you begin.
5. Take time off your busy schedule for your hobbies or things you like to do.
6. Meditation, yoga, and other breathing and relaxation techniques can also help.
7. Talk to your friend, family member, or anyone you trust about the thing that is bothering you.

BFS does not cause long-term physical damage, and there have been cases that reported spontaneous remission. Most patients get better when the underlying anxiety is addressed and treated. If your muscle twitches are getting worse with time or causing pain and discomfort, it is best to consult a doctor online. The doctor will suggest treatment options that might be best suited for you.