What is benign fasciculation syndrome?

by Morgan.J / 07 February, 2013
Involuntary muscle twitching may cause anxiety, but is rarely cause for concern.
What is benign fasciculation syndrome?
Photo/Thinkstock


We’re often, quite rightly, cautioned against using the internet for a medical self-diagnosis, as it’s likely to present us with the worst-case scenario. On the other hand, Google can send us to places where even hypochondriacs will be reassured there is nothing wrong with them.

This is the experience of Angela Woods who, after an onset of twitching in her calf muscles and one hand, googled “twitching muscles” and was persuaded that she had a degenerative neurological disease. That was before she came across benign fasciculation syndrome and the website aboutbfs.com, and identified with and was consoled by both the psychological and physiological symptoms being described.

“It seems everybody there has a background of hypochondria, stress and anxiety,” she says, explaining that her twitching coincided with a stressful time and that she’s always had a tendency to hypochondria. “If you read the forums, they’ll tell you there’s nothing to worry about. And also they’ll tell you to get away from the computer.”

But what is benign fasciculation syndrome, and can Woods trust aboutbfs.com? Fasciculations are small involuntary muscle twitches. Sometimes they can be symptomatic of a serious disease. Mostly, they are something people commonly get and generally don’t even notice. Revealingly, however, they are most likely to bother people with some medical training. “Such as medical students, shortly after having a lecture on motor neurone disease,” says Chris Lynch, a neurologist at Waikato Hospital and senior lecturer at Waikato Clinical School, who adds that GPs are also susceptible.

There’s not a lot about benign fasciculation syndrome in the medical literature, and neurologists might be more likely to talk about benign fasciculation than benign fasciculation syndrome. Is it actually a disorder, or just a lot of twitching? “That’s more of a philosophical question, which you can’t really answer,” says Graeme Hammond-Tooke, clinical neurologist and professor of medicine at the Dunedin School of Medicine. “It doesn’t really cause you harm or discomfort, so it’s not really a dis order. What causes it is a bit uncertain – there might be something funny going on in the nerve terminals. But it would usually have to be something that is unpleasant and inconvenienced you in some way before you’d call it a disease.”

In short, benign fasciculation syndrome is real, it can be annoying, but it’s nothing serious – at least once you know that’s what you have. “I suppose it’s an issue, because if it’s not benign, it’s usually motor neurone disease, which is a terrible disease,” says Hammond-Tooke. “But most people don’t know about motor neurone disease so don’t think about it.” Except medical students and GPs or people exposed to those with such diseases, for whom the twitches can cause considerable distress.

Benign fasciculations most commonly occur in the calf muscles, but also around the eye and the forearm. It’s difficult to differentiate between those caused by a neuronal disease or by benign twitching, but if something serious is going on, the twitching is likely to be accompanied by other symptoms. “Such as loss of muscle function, or muscle structure over a short period of time,” says Lynch. “Or losing the ability to do something with your hand or your foot, maybe stumbling a bit – not in a way that one expects with age or loss of fitness.”

If you have symptoms other than muscle twitching, it might be worth getting checked out, if only to calm your nerves. Neurologists will usually be able to tell through a clinical evaluation whether the fasciculations are benign, and won’t need to do expensive tests. If they have any concerns or doubts, they can also use electromyography (EMG), a technique that detects the electrical signals generated by muscle cells and will reveal any abnormal activity.

But as Lynch notes, patients tend to have not only symptoms, but also a great deal of anxiety, and some won’t be reassured without tangible proof that they’re okay.

“If they are paralysed with fear and wanted the test, we might go down that path. But in most instances that I can recall, because of the character and distribution of the fasciculations, I didn’t need to do any tests. I’ve been able to say, ‘I think it’s benign; we can afford to wait.’”

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