Fasciculation

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Luke Rusowicz-Orazem, B.S.

Overview

A fasciculation (or "muscle twitch") is a small, local, involuntary muscle contraction (twitching) visible under the skin arising from the spontaneous discharge of a bundle of skeletal muscle fibers. Fasciculations have a variety of causes, the majority of which are benign, but can also be due to disease of the motor neurons.

Causes

Life Threatening Causes

• Benzodiazepine withdrawal
• Dehydration
• Donepezil toxicity
• Multiple sclerosis
• Organophosphate poisoning
• Quaternary syphilis
• Renal disease
• Tacrine toxicity

Common Causes

• Amyotrophic lateral sclerosis 
• Bell palsy
• Brown-vialetto-van laere syndrome,
• Central pontine myelinosis
• Fatigue
• Friedreich ataxia
• Guillain-barre syndrome
• Hereditary sensorimotor neuropathy type 1
• Infantile neuroaxonal dystrophy
• Isaac syndrome,
• Kennedy disease
• Motor neuron disease
• Multifocal motor neuropathy
• Multiple sclerosis
• Myasthenia gravis
• Neuromyotonia
• Neuropathy
• Peripheral neuropathy
• Poliomyelitis
• Posterior inferior cerebellar artery syndrome
• Postpoliomyelitis syndrome
• Progressive bulbar palsy
• Progressive muscular atrophy,
• Spinal muscular atrophy
• Spinocerebellar ataxia
• Subacute combined degeneration of the cord
• Transverse myelitis
• Welander distal myopathy
• Werdnig-hoffman disease

Causes by Organ System

Cardiovascular	Dural arteriovenous fistula, Posterior inferior cerebellar artery syndrome
Chemical/Poisoning	Organophosphate poisoning
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Albuterol, Ambenonium, Anticholinergic drugs, Benadryl, Caffeine, Corticosteroids, Diuretics, Dramamine, Pellagra, Pseudoephedrine, Salbutamol , Succinylcholine
Ear Nose Throat	No underlying causes
Endocrine	Acute intermittent porphyria, Adult polyglucosan body disease, Hypocalcaemia
Environmental	No underlying causes
Gastroenterologic	Adult polyglucosan body disease
Genetic	Brown-vialetto-van laere syndrome, Gangliosidosis gm2, type 1, Infantile neuroaxonal dystrophy, Kennedy disease, Spastic paraplegia 11, Werdnig-hoffman disease
Hematologic	Hypocalcaemia, Magnesium deficiency
Iatrogenic	No underlying causes
Infectious Disease	Botulism, Guillain-barre syndrome, Poliomyelitis, Postpoliomyelitis syndrome, Quaternary syphilis, Rabies, Syringomyelia
Musculoskeletal/Orthopedic	Cervical spondylosis, Intervertebral disc herniation, Jokela type spinal muscular atrophy, Neuromyotonia, Spinal muscular atrophy, Spinocerebellar ataxia, Subacute combined degeneration of the cord, Welander distal myopathy
Neurologic	Amyotrophic lateral sclerosis , Bell palsy, Brown-vialetto-van laere syndrome, Central pontine myelinosis, Fatigue, Friedreich ataxia, Guillain-barre syndrome, Hereditary sensorimotor neuropathy type 1, Infantile neuroaxonal dystrophy, Isaac syndrome, Kennedy disease, Motor neuron disease, Multifocal motor neuropathy, Multiple sclerosis, Myasthenia gravis, Neuromyotonia, Neuropathy, Peripheral neuropathy, Poliomyelitis, Posterior inferior cerebellar artery syndrome, Postpoliomyelitis syndrome, Progressive bulbar palsy, Progressive muscular atrophy, Spinal muscular atrophy, Spinocerebellar ataxia, Subacute combined degeneration of the cord, Transverse myelitis, Welander distal myopathy, Werdnig-hoffman disease
Nutritional/Metabolic	Dehydration, Finnish type amyloidosis, Magnesium deficiency , Nutritional deficiency
Obstetric/Gynecologic	Cervical myelopathy
Oncologic	Syringobulbia
Ophthalmologic	No underlying causes
Overdose/Toxicity	Benzodiazepine withdrawal, Caffeine, Donepezil toxicity, Ethanolamines, Tacrine toxicity
Psychiatric	Anxiety, Stress
Pulmonary	Asthma
Renal/Electrolyte	Dehydration, Diuretics, Renal disease
Rheumatology/Immunology/Allergy	Myopathy
Sexual	Quaternary syphilis
Trauma	Intervertebral disc herniation, Strenuous exercise
Urologic	Uremia
Miscellaneous	No underlying causes

Causes in Alphabetical Order

• Acute intermittent porphyria
• Adult polyglucosan body disease
• Adult sma
• Albuterol
• Ambenonium
• Amyotrophic lateral sclerosis 
• Anticholinergic drugs
• Anxiety
• Asthma
• Bell palsy
• Benadryl
• Benzodiazepine withdrawal
• Botulism
• Brown-vialetto-van laere syndrome
• Caffeine
• Central pontine myelinosis
• Cervical myelopathy
• Cervical spondylosis
• Corticosteroids
• Dehydration
• Diuretics
• Donepezil toxicity
• Dramamine
• Dural arteriovenous fistula
• Ethanolamines
• Fatigue
• Finnish type amyloidosis
• Friedreich ataxia
• Gangliosidosis gm2, type 1
• Guillain-barre syndrome
• Hereditary sensorimotor neuropathy type 1
• Hypocalcaemia
• Infantile neuroaxonal dystrophy
• Intervertebral disc herniation
• Isaac syndrome
• Jokela type spinal muscular atrophy
• Kennedy disease
• Magnesium deficiency 
• Motor neuron disease
• Multifocal motor neuropathy
• Multiple sclerosis
• Myasthenia gravis
• Myopathy
• Neuromyotonia
• Neuropathy
• Nutritional deficiency
• Organophosphate poisoning
• Organophosphates
• Pellagra
• Peripheral neuropathy
• Poliomyelitis
• Posterior inferior cerebellar artery syndrome
• Postpoliomyelitis syndrome
• Progressive bulbar palsy
• Progressive muscular atrophy
• Pseudoephedrine
• Quaternary syphilis
• Rabies
• Renal disease
• Salbutamol 
• Spastic paraplegia 11
• Spinal muscular atrophy
• Spinocerebellar ataxia
• Strenuous exercise
• Stress
• Subacute combined degeneration of the cord
• Succinylcholine 
• Syringobulbia
• Syringomyelia
• Tacrine toxicity
• Transverse myelitis
• Uremia
• Welander distal myopathy
• Werdnig-hoffman disease

Treatment

Inadequate magnesium intake can cause fasciculations, especially after a magnesium loss due to severe diarrhea. Over-exertion is another risk factor for magnesium loss. As much as 80% of the population does not get the recommended daily amount of magnesium; this may be a common cause. Treatment is with supplements or increased intake of foods rich in magnesium, especially almonds & other nuts, and bananas. Ironically, magnesium supplements may result in diarrhea and more magnesium loss, so dosage and timing (i.e. with meals) are important.

Fasciculation also often occurs during a rest period after sustained stress, such as that brought on by unconsciously tense muscles. Reducing stress and anxiety is therefore another useful treatment.