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muscular twitching of contiguous groups of muscle fibers

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/12/03 13:41:11」(JST)

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See also: Twitch (disambiguation) and Tremor

A fasciculation /fəˌsɪkjʉˈleɪʃən/, or "muscle twitch", is a small, local, involuntary muscle contraction and relaxation which may be visible under the skin or detected in deeper areas by EMG testing. They arise as a result of spontaneous depolarization of a lower motor neuron leading to the synchronous contraction of all of the skeletal muscle fibers within a single motor unit. Fasciculations can happen in any skeletal muscle in the body. Fasciculations have a variety of causes, the majority of which are benign, but can also be due to disease of the motor neurons. Fasciculations are commonly encountered in healthy people and are rarely bothersome. In some cases the presence of fasciculations can be annoying and interfere with quality of life. In such cases, where the remainder of the neurological exam is normal, and EMG testing does not indicate any additional pathology a diagnosis of benign fasciculation syndrome is usually made.^[1]

Risk factors

Pathological conditions

Neuromyotonia, also known as Isaacs' syndrome
Diseases of the lower motor neuron including:- Poliomyelitis, Spinomuscular atrophy or SMA group of diseases including Werdnig-Hoffman disease, Amyotrophic lateral sclerosis (ALS), Kennedy disease
Organophosphate poisoning (e.g. insecticides) or use of acetylcholinesterase inhibitors (commonly used in Myasthenia Gravis)
Benzodiazepine withdrawal
Magnesium deficiency
Myalgic Encephalomyelitis
Rabies

The most effective way to detect fasciculations may be surface electromyography (EMG). Surface EMG is more sensitive than needle electromyography and clinical observation in the detection of fasciculation in people with ALS.^[2]

Medications

Other risk factors may include the use of anticholinergic drugs over long periods, in particular ethanolamines such as Benadryl, used as an antihistamine and sleep aid, and Dramamine for nausea and motion sickness. Persons with benign fasciculation syndrome (BFS) may experience paraesthesia shortly after taking such medication; fasciculation episodes begin as the medication wears off.

Stimulants can cause fasciculations directly. These include caffeine, pseudoephedrine (Sudafed), amphetamines, and the asthma bronchodilators salbutamol (e.g. Proventil, Combivent, Ventolin). Medications used to treat attention deficit disorder often contain stimulants as well, and are common causes of benign fasciculations.

The depolarizing neuromuscular blocker, succinylcholine, causes fasciculations. It is a normal side effect of the drug's administration, and can be prevented with a small dose of a nondepolarizing neuromuscular blocker prior to the administration of succinylcholine, often 10% of a nondepolarizing NMB's induction dose.

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 70-80% of the adult population does not consume the recommended daily amount of magnesium,^[3] inadequate intake may also be a common cause. Treatment consists of increased intake of magnesium from dietary sources such as nuts (especially almonds) and bananas. Magnesium supplements may also be taken. However, too much magnesium may cause diarrhea, resulting in dehydration and nutrient loss (including magnesium itself, leading to a net loss, rather than a gain). Chelated magnesium can help reduce this effect.

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.^{[citation needed]}

There is no proven treatment for fasciculations in people with ALS. Among patients with ALS, fasciculation frequency is not associated with the duration of ALS and is independent of the degree of limb weakness and limb atrophy. No prediction of ALS disease duration can be made based on fasciculation frequency alone.^[4]

References

^ Blexrud MD, Windebank AJ, Daube JR (1993). "Long-term follow-up of 121 patients with benign fasciculations". Ann. Neurol. 34 (4): 622–5. doi:10.1002/ana.410340419. PMID 8215252.
^ "Strength, physical activity, and fasciculations in patients with ALS." Amyotroph Lateral Scler. 9(2):120-1. PMID 18428004.
^ Galan P, Preziosi P, Durlach V, Valeix P, Ribas L, Bouzid D, Favier A, Hercberg S (1997). "Dietary magnesium intake in a French adult population." Magnesium Research 10(4):321-8. PMID 9513928.
^ Mateen FJ, Sorenson EJ, Daube JR (2008). "Strength, physical activity, and fasciculations in patients with ALS." Amyotroph Lateral Scler. 9(2):120-1. PMID 18428004.

External links

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UpToDate Contents

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1. 筋萎縮性側索硬化症およびその他の運動ニューロン疾患の診断 diagnosis of amyotrophic lateral sclerosis and other forms of motor neuron disease
2. 末梢神経疾患および筋疾患の鑑別診断 differential diagnosis of peripheral nerve and muscle disease
3. 筋電図検査の概要 overview of electromyography
4. 筋力低下の評価における筋力検査 muscle examination in the evaluation of weakness
5. 筋萎縮性側索硬化症およびその他の運動ニューロン疾患の臨床的特徴 clinical features of amyotrophic lateral sclerosis and other forms of motor neuron disease

English Journal

Semi-automatic quantification of neurite fasciculation in high-density neurite images by the neurite directional distribution analysis (NDDA).

Hopkins AM1, Wheeler B2, Staii C3, Kaplan DL4, Atherton TJ5.Author information 1Department of Biomedical Engineering, Tufts University Science & Technology Center, 4 Colby Street, Medford, MA 02155, USA. Electronic address: Amy.Hopkins@Tufts.edu.2Department of Biomedical Engineering, Tufts University Science & Technology Center, 4 Colby Street, Medford, MA 02155, USA. Electronic address: Brandon.Wheeler@Tufts.edu.3Department of Physics and Astronomy, and Center for Nanoscopic Physics, Tufts University Science & Technology Center, 4 Colby Street, Medford, MA 02155, USA. Electronic address: Cristian.Staii@Tufts.edu.4Department of Biomedical Engineering, Tufts University Science & Technology Center, 4 Colby Street, Medford, MA 02155, USA. Electronic address: David.Kaplan@Tufts.edu.5Department of Physics and Astronomy, and Center for Nanoscopic Physics, Tufts University Science & Technology Center, 4 Colby Street, Medford, MA 02155, USA. Electronic address: Timothy.Atherton@Tufts.edu.AbstractBACKGROUND: Bundling of neurite extensions occur during nerve development and regeneration. Understanding the factors that drive neurite bundling is important for designing biomaterials for nerve regeneration toward the innervation target and preventing nociceptive collateral sprouting. High-density neuron cultures including dorsal root ganglia explants are employed for in vitro screening of biomaterials designed to control directional outgrowth. Although some semi-automated image processing methods exist for quantification of neurite outgrowth, methods to quantify axonal fasciculation in terms of direction of neurite outgrowth are lacking.
Journal of neuroscience methods.J Neurosci Methods.2014 May 15;228:100-9. doi: 10.1016/j.jneumeth.2014.03.006. Epub 2014 Mar 25.
BACKGROUND: Bundling of neurite extensions occur during nerve development and regeneration. Understanding the factors that drive neurite bundling is important for designing biomaterials for nerve regeneration toward the innervation target and preventing nociceptive collateral sprouting. High-density
PMID 24680908

Fasciculations, axonal hyperecitability, and motoneuronal death in amyotrophic lateral sclerosis.

Kuwabara S1, Shibuya K2, Misawa S2.
Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology.Clin Neurophysiol.2014 May;125(5):872-3. doi: 10.1016/j.clinph.2013.11.014. Epub 2013 Nov 28.
PMID 24345315

Complex fasciculation potentials and survival in amyotrophic lateral sclerosis.

Shimizu T1, Fujimaki Y2, Nakatani-Enomoto S3, Matsubara S2, Watabe K4, Rossini PM5, Ugawa Y3.Author information 1Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan. Electronic address: toshio_shimizu@tmhp.jp.2Department of Neurology, Tokyo Metropolitan Neurological Hospital, Tokyo, Japan.3Department of Neurology, Fukushima Medical University School of Medicine, Fukushima, Japan.4ALS/Neuropathy Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.5Institute of Neurology, Catholic University of The Sacred Heart, Rome, Italy.AbstractOBJECTIVE: We investigated the relationship between fasciculation potentials (FPs) and survival in patients with ALS.
Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology.Clin Neurophysiol.2014 May;125(5):1059-64. doi: 10.1016/j.clinph.2013.10.052. Epub 2013 Nov 28.
OBJECTIVE: We investigated the relationship between fasciculation potentials (FPs) and survival in patients with ALS.METHODS: In 85 ALS patients, we prospectively performed needle EMG in five to seven muscles of each patient. The shape of the detected FPs was analyzed by inspection, and FPs with &gt
PMID 24345314