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With acknowledgment to Karen Morrison, Professor of Neurology, Head of the Department of Clinical Neurosciences, Honorary Consultant Neurologist, Institute of Biomedical Research, The Medical School, University of Birmingham. Lancashire Teaching Hospitals NHS Foundation Trust Neuro muscular Nurse Specialist 01772 523412 Sources of further information: www.lancsteachinghospitals.nhs.uk www.nhsdirect.nhs.uk www.patient.co.uk Lancashire Teaching Hospitals NHS Foundation Trust is not responsible for the content of external internet sites. English BENIGN FASCICULATIONS Information for patients Please ask if you would like help in understanding this information or need it in a different format Neurology Neurosciences Directorate Produced: October 2009 Review: October 2012 What is benign fasciculation syndrome (BFS)? What is the cause? Fasciculations are spontaneous, irregular, involuntary and painless brief twitches in a muscle. They may generate concern because of their known association with motor neurone disease (MND), although they are an uncommon presenting symptom of this condition. Studies of people with BFS, followed in some cases for over 30 years, show that none of them went on to develop MND or any other serious neurological disorder. The cause is unknown. The fasciculations represent spontaneous contractions of muscle fibres in a small part of a muscle and are thought to arise due to overexcitability in the nerve fibre. Most healthy people notice occasional fasciculations. Some will experience these more frequently than others. Diagnosis of benign fasciculation syndrome (BFS) is appropriate when individuals have prominent, frequent fasciculations occurring over months or years. Fasiculations may occur in any muscle but seem especially common in the eyelids, calves and other leg muscles. They may be provoked by stress, fatigue, exercise, alcohol or caffeine. Some drugs, including beta-agonists (used for asthma), D-penicillamine and levothyroxine therapy have also been associated with fasciculations. Sufferers may have minor cramping, tingling, muscle pain or fatigue in addition to painless fasciculations. Neurological examination is normal, with no reduction in muscle strength. Neurophysiological examination (if required) reveals fasciculations on needle electromyography, with no other abnormalities. One study reported an increased incidence of respiratory or gastrointestinal infection in the month before onset of fasciculations, suggesting that an immune response to such infection might result in nerve changes and fasciculations. Does it resolve or is there treatment? There is no treatment to reduce the fasciculations and reassurance that they are not sinister is usually the only therapy required. Awareness of fasiculations often comes and goes over time, and in some patients they may go away.