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PubMed1999

Comparison of rocuronium and vecuronium pretreatment for prevention of fasciculations, myalgia and biochemical changes following succinylcholine administration.

BACKGROUND: The purpose of this study was to assess the effect of rocuronium pretreatment on the succinylcholine-induced fasciculations, myalgia and biochemical changes, and to compare it with vecuronium pretreatment. METHODS: We have studied 60 female patients undergoing minor elective surgery, in a prospective double blinded method. Three groups of 20 patients each was pretreated with either saline (control group), rocuronium 0.05 mg/kg (rocuronium group) or vecuronium 0.007 mg/kg (vecuronium group). Three min after the pretreatment, 1.5 mg/kg succinylcholine was injected. Single twitch responses to electrical stimulation were measured. Serum potassium and creatine kinase were respectively measured 5 min after succinylcholine and 24 h after operation. Fasciculations and myalgia on postoperative day 1 and day 2 were evaluated. RESULTS: The incidence of fasciculations was lowest in the rocuronium group, followed by the vecuronium group, and was highest in the control group. The incidence of myalgia on postoperative day 1 was lower in the rocuronium and vecuronium groups than the control group. The increase of serum creatine kinase was similar among the three groups, but there was no increase in serum potassium concentration in any group. No differences of the single twitch responses to electrical stimulation were found between the rocuronium and vecuronium groups. CONCLUSIONS: Rocuronium pretreatment was more effective in reducing fasciculations than was vecuronium pretreatment, but both were equally effective in preventing myalgia on postoperative day 1. This difference may reflect the differential activities of rocuronium and vecuronium at the neuromuscular junction. The increase of creatine kinase was not attenuated by any regimen.

Adult↗
PubMed2004

[Precurarization with rocuronium prevents fasciculations and biochemical changes after succinylcholine administration].

OBJECTIVE: To determine the efficacy of rocuronium to prevent fasciculations and biochemical changes after succinylcholine administration. PATIENTS AND METHODS: Prospective, randomized double-blind trial enrolling 60 ASA I-II patients scheduled for elective surgery under general anesthesia. The patients were assigned to 2 groups to receive either 0.06 mg x Kg(-1) of rocuronium or physiological saline solution 90 seconds before administration of 1.5 mg x Kg(-1) of succinylcholine. The incidence and severity of fasciculations and serum concentrations of potassium before anesthesia and 3, 5, and 20 minutes after succinylcholine administration were recorded. Other serum concentrations recorded were myoglobin, creatinine phosphokinase and lactate before anesthesia and 20 minutes after succinylcholine administration. RESULTS: The increases in potassium levels at 3 and 5 minutes (0.3 +/- 0.3 and 0.2 +/- 0.4 mmol x L(-1)) and in myoglobin levels at 20 minutes (38.9 +/- 31.7 ng x mL(-1)) were attenuated by precurarization with rocuronium. The incidence of fasciculations was significantly lower (p<0.001) and their severity significantly less (p<0.001) in patients who received rocuronium before administration of succinylcholine. CONCLUSIONS: Precurarization with rocuronium 90 seconds before succinylcholine administration reduces the incidence and severity of fasciculations and prevents increases in serum potassium and myoglobin concentrations.

Adolescent↗
PubMed1980

Does diazepam pretreatment prevent succinylcholine-induced fasciculations?--a double-blind comparison of diazepam and tubocurarine pretreatments.

To determine the effectiveness of diazepam pretreatment in preventing succinylcholine-induced fasciculations, 61 surgical patients were randomly allocated into three groups receiving either diazepam (0.05 mg/kg), d-tubocurarine (0.05 mg/kg) or saline in a double-blind fashion. Following the induction of anesthesia with fentanyl and thiopental, a bolus dose of succinylcholine (1 mg/kg was injected 5 minutes after the pretreatment drugs. Resulting fasciculations were then graded visually. Responses to electrical simulation of the ulnar nerve, somatic motor responses to laryngoscopy and endotracheal intubation, and changes in serum levels of potassium were also evaluated. Diazepam had no effect on frequency or intensity of succinylcholine fasciculations. Fasciculations were observed in 90% of the patients given placebo injections and in 95% of those given diazepam, but in only 16% of those given tubocurarine. Tubocurarine prolonged the onset and shortened the duration of the succinylcholine block and thus made intubation more difficult. Diazepam accelerated onset, but had no effect on duration of succinylcholine block. The twitch response following ulnar nerve stimulation disappeared after 84 seconds (p < 0.01 vs placebo) in patients given diazepam after 115 seconds in patients given tubocurarine, and after 106 seconds in those given placebo injections. The increase in serum potassium after succinylcholine was prevented by pretreatment with d-tubocurarine but not by diazepam.

Clinical Trials as Topic↗
PubMed1998

Selective fasciculation and divergent pathfinding decisions of embryonic chick motor axons projecting to fast and slow muscle regions.

Proper motor function requires the precise matching of motoneuron and muscle fiber properties. The lack of distinguishing markers for early motoneurons has made it difficult to determine whether this matching is established by selective innervation during development or later via motoneuron-muscle fiber interactions. To examine whether chick motoneurons selectively innervate regions of their target containing either fast or slow muscle fibers, we backlabeled neurons from each of these regions with lipophilic dyes. We found that motor axons projecting to fast and slow muscle regions sorted into separate but adjacent fascicles proximally in the limb, long before they reached the muscle. More distally, these fascicles made divergent pathfinding decisions to course directly to the appropriate muscle fiber region. In contrast, axons projecting to different areas of an all-fast muscle did not fasciculate separately and became more intermingled as they coursed through the limb. Selective fasciculation of fast- and slow-projecting motoneurons was similar both before and after motoneuron cell death, suggesting that motoneurons specifically recognized and fasciculated with axons growing to muscle regions containing the appropriate muscle fiber type. Taken together, these results strongly support the hypothesis that "fast" and "slow" motoneurons are molecularly distinct before target innervation and that they use these differences to selectively fasciculate, pathfind to, and branch within the correct muscle fiber region from the outset of neuromuscular development.

Animals↗
PubMed1999

Secondary motoneuron axons localize DM-GRASP on their fasciculated segments.

Cell surface adhesion molecules are thought to play a necessary role in axon guidance and fasciculation in the developing nervous system. We have studied a potential adhesion molecule using the zn-5 monoclonal antibody, which recognizes the surfaces of zebrafish spinal motoneurons. We show that zn-5 recognizes zebrafish DM-GRASP. DM-GRASP is a cell adhesion molecule of the immunoglobulin superfamily that mediates homophilic adhesion and neurite outgrowth in vitro. It is necessary for correct axon routing and fasciculation in the Drosophila visual system. In zebrafish, primary motoneurons pioneer the peripheral motor nerve pathways, and the axons of secondary motoneurons follow the routes established by the primary motoneuron axons. We show that, of the two classes of zebrafish spinal motoneurons, only the later growing secondary motoneurons express DM-GRASP. The secondary motoneurons restrict DM-GRASP protein to their cell bodies and fasciculated segments of their axons. Expression of DM-GRASP is transient: The protein is present during the period of axonal growth and disappears after axons have reached their muscle targets. Thus, homophilic adhesion mediated by DM-GRASP may play a role in fasciculation of secondary motoneuron axons but not in pathfinding by the pioneer axons of the primary motoneurons or in guidance of secondary motoneuron axons to their targets.

Activated-Leukocyte Cell Adhesion Molecule↗
PubMed2004

The small GTPase Rac is involved in clustering of hippocampal neurons and fasciculation of their neurites.

In hippocampal neurons cultured from brains of newborn rats, the glutamate receptor agonist N-methyl-D-aspartate induced the clustering of neuronal perikarya and the fasciculation of neurites. In addition, N-methyl-D-aspartate activated the small GTPase Rac1. Other stimuli of Rac activity, such as the Rho kinase inhibitors Y-27632, H-1152, and H89, as well as the cytotoxic necrotizing factor-1 from Escherichia coli, also caused neuronal clustering and neurite bundling. In neurons transiently transfected with dominant negative Rac1N17 neither N-methyl-D-aspartate nor Y-27632 induced clustering and fasciculation. In addition, the PI3-kinase inhibitors wortmannin and LY-294002 prevented these effects, as did a dominant negative form of p110PI3-Kgamma. Time-lapse microscopy showed that lethal toxin from Clostridium sordellii, which inhibits Rac, and wortmannin blocked the neuronal migration induced by Y-27632. In contrast, only lethal toxin reversed the clustering and fasciculation induced by pre-treatment with Y-27632. This effect of the toxin may be due to inactivation of Ras, since FTI-277, which prevents the farnesylation of Ras and thereby inactivates the GTPase, also dissolved the preformed clusters. We suggest that active Rac and a PI3-kinase synergistically induce neuronal migration, whereas a Ras isoform is responsible for the lasting attachment of neurons necessary for clustering and neurite fasciculation.

Amides↗
PubMed1977

The origin of the muscle fasciculation caused by funnel-web spider venom.

The origin of the fasciculation of skeletal muscle produced by funnel-web spider venom (FSV) has been examined in mouse phrenic nerve hemi-diaphragm preparations, FSV from male spiders at concentrations greater than 10(-6) g/ ml invariably produced muscle fasciculation which could be prevented by d-tubocurarine (14micron), tetrodotoxin (0.3 micron) or by increasing the external magnesium concentration or calcium concentration. Diphenyl hydantoin (3-6 X 10(-5) M) was able to reduce these fasciculations in some experiments. In curarized preparations, multiple end plate potentials (EPPs) in response to single stimuli and bursts of spontaneous EPPs were seen in the presence of FSV (10(-5) g/ml). Extracellular recordings from phrenic nerves in the presence of FSV (10(-5) g/ml) revealed additional components in compound action potentials elicited by single stimuli, and "spontaneous" electrical activity was observed in unstimulated nerves. This spontaneous activity was abolished by raising the divalent cation concentration in the bathing solution. These results suggest that a primary site of action of FSV is the surface membrane of nerve fibres and that muscle fasciculation arises as a consequence of spontaneous action potentials produced by the venom in motor nerves.

Action Potentials↗
PubMed1977

Comparative effects of nondepolarizing muscle relaxants on succinycholine-induced fasciculations and postoperative pain.

The effectiveness of pancuronium (1.0 to 1.5 mg), d-tubocurarine (3 mg), and gallamine (20 mg) administered three minutes before succinylcholine (1 mg/kg) in preventing muscle fasciculations and postoperative muscle pains was compared in 100 patients. Pretreatment with pancuronium abolished fasciculations and produced rapid and excellent muscle relaxation for endotracheal intubation. Both d-tubocurarine (dTc) and gallamine administered prior to succinylcholine (SCh) were inconsistent in prevention fasciculations. Muscle relaxation was significantly delayed in onset, shorter in duration, and was inadequate for intubation in the majority of patients. The 45% incidence of postoperative muscle pains in the control group decreased after pretreatment with gallamine, dTc, and pancuronium to 20%, 15%, and less than 5%, respectively. It was concluded from the present study that pancuronium is superior to dTc and gallamine for preventing SCh-induced fasciculations and postoperative muscle pains without compromising the muscle relaxation for intubation. However, pancuronium administered for pretreatment may significantly prolong the action of succinylcholine and caution is to be exercised in patients having short surgical procedures and when additional doses of muscle relaxants may be required.

Adolescent↗
PubMed2004

Differential requirements for semaphorin 3F and Slit-1 in axonal targeting, fasciculation, and segregation of olfactory sensory neuron projections.

The formation of precise stereotypic connections in sensory systems is critical for defining accurate internal representations of the external world; however, the molecular mechanisms underlying the formation of sensory maps are poorly understood. Here, we examine the roles of two structurally unrelated repulsive guidance cues, semaphorin 3F (Sema3F) and Slit-1, in olfactory sensory axon fasciculation, targeting, and segregation. Using sema3F-/- mice, we show that Sema3F is critical for vomeronasal sensory neuron axonal fasciculation and for segregation of these sensory afferents from the main olfactory system; however, Sema3F plays only a minor role in targeting of apical vomeronasal neuron axons to the anterior accessory olfactory bulb (AOB). In addition, we show that Sema3F is required for lamina-specific targeting of olfactory sensory axons within the main olfactory system. In contrast to Sema3F, Slit-1 is dispensable for fasciculation of basal vomeronasal neuron axons but is critical for targeting these axons to the posterior AOB. These results reveal discrete and complementary roles for secreted semaphorins and slits in axonal targeting, fasciculation, and segregation of olfactory sensory neuron projections.

Animals↗
PubMed1982

The origin of fasciculations.

A collision method in a single axon was used to determine the origin of 100 fasciculations in various lower motor neuron lesions. For 80% of the fasciculations, it was situated on the distal extremity of the axon regardless of the type of lesion, its duration, or the severity of the denervation. For several reasons, this proportion is underestimated. The fasciculations of distal origin were sometimes, associated with double discharges, the mechanism of production and clinical significance of which probably differ.

Axons↗
PubMed1997

Fasciculations, myalgia and biochemical changes following succinylcholine with atracurium and lidocaine pretreatment.

PURPOSE: To determine the attenuation in the incidence of myalgia, fasciculations and changes in serum potassium and creatinine kinase concentrations when atracurium and lidocaine were used in combination and separately as pretreatment before succinylcholine. METHODS: In a prospective, double blind randomized study, 80 ASA 1 patients 20-50 yr were assigned to one of four groups. Anaesthesia was induced with thiopentone and fentanyl. Group C received placebo pretreatment before 1.5 mg.kg-1 succinylcholine; Group A 0.05 mg.kg-1 atracurium three minutes before; Group L, 1.5 mg.kg-1 lidocaine 30 sec before; and group AL both atracurium and lidocaine. Serum potassium five minutes after succinylcholine, and creatinine kinase 24 hr after operation were measured and the increases from preinduction values were compared. Fasciculations and postoperative myalgia at 24 and 48 hr were recorded. Patients received iv meperidine or po paracetamol for postoperative analgesia. RESULTS: The increase in serum potassium concentration (0.36 +/- 0.23 mEq.l-1) was not attenuated by any regimen (P < 0.05). The incidence of fasciculations (P < 0.05) and the increase in creatinine kinase (P < 0.01) was less in the atracurium (40%; 20.93 IU.l-1) and atracurium-lidocaine (30%; 22.85 IU.l-1) than in the lidocaine (85%; 45.01 IU.l-1) and control (100%; 56.5 IU.l-1) groups. Postoperative myalgia on Days 1 and 2 was lowest (P < 0.05) in the atracurium-lidocaine group (5%; 0%) followed by the atracurium (35%; 25%) and lidocaine (30%; 35%) groups and highest in the control (75%; 65%). CONCLUSION: Atracurium and lidocaine individually reduce postoperative myalgia, with further decrease occurring when used together.

Adult↗
PubMed1987

Neuropathies with prolonged conduction block, single and grouped fasciculations, localized limb myokymia.

Fourteen patients presented prolonged conduction block (CB) related to hereditary neuropathy with liability to pressure palsies (n = 7), neuropathy with proximal multifocal persistent CB (n = 2), radiation plexopathy (n = 3) and chronic acquired polyneuropathy (n = 2). All subjects presented both single and grouped fasciculation potentials that resulted in visible limb myokymia in 9 patients. This ectopic activity was recorded only in muscles affected by the CB, was more important in severe or complete CB, and often arose from terminal branches of blocked axons. These fasciculations and grouped fasciculations therefore appear to be causally related to the CB. In the presence of localized myokymia, a prolonged CB should be suspected.

Chronic Disease↗
PubMed1979

Lack of correlation between spontaneous fasciculations and double discharges of voluntarily activated motor units.

We have studied the possible correlation between spontaneous fasciculations and double discharges or voluntarily activated motor units in myelopathies and other proximal neuropathies. Though both these phenomena are common in these diseases, they seem to have no correlation in individual muscles. It is concluded that spontaneous fasciculations and doubling of voluntarily activated motor unit potentials have different sites of origin or different mechanism. For example, if doubling reflects a disturbance of firing in the axon hillock, spontaneous fasciculations may originate in a more peripheral part of the motor axon.

Electromyography↗
PubMed2006

The C. elegans gene dig-1 encodes a giant member of the immunoglobulin superfamily that promotes fasciculation of neuronal processes.

The adhesion of growing neurites into appropriate bundles or fascicles is important for the development of correct synaptic connectivity in the nervous system. We describe fasciculation defects of animals with mutations in the C. elegans gene dig-1 and show that dig-1 encodes a giant molecule (13,100 amino acids) of the immunoglobulin superfamily. Five new alleles of dig-1 were isolated in a screen for mutations affecting the morphology or function of several classes of head sensory neurons. Mutants showed process defasciculation of several classes of neurons. Analysis of a temperature-sensitive allele revealed that dig-1 is required during embryogenesis for normal process fasciculation of one class of head sensory neuron. Partial sequencing of two alleles, RNA interference (RNAi) and rescuing experiments showed that dig-1 encodes a giant molecule of the immunoglobulin superfamily. DIG-1 protein contains many domains associated with adhesion, is likely secreted, and has some features of proteoglycans. dig-1 mutants were originally isolated due to their displaced gonads [Thomas, J.H., Stern, M.J., Horvitz, H.R., 1990. Cell interactions coordinate the development of the C. elegans egg-laying system. Cell 62, 1041-52]; thus, dig-1 alleles were also characterized for their effects on gonad placement. Mutant phenotypes suggest that DIG-1 may mediate cell movement as well as process fasciculation and that different regions of the protein may mediate these functions.

Alleles↗
PubMed1997

Motor neuron disease following generalized fasciculations and cramps.

We report a case of motor neuron disease in which fasciculations and cramps progressed generally before the development of muscle wasting. After involvement of the upper and lower motor neurons became clinically manifest, widespread fasciculations and cramps persisted and accompanied pseudotetany. The present case suggests that spinal cord pathology of motor neuron disease can cause the abnormal excitability of the motor neurons, resulting in the development of generalized fasciculations and cramps.

Disease Progression↗
PubMed1997

ECG-related fasciculation potential.

We report the observation of an unusual fasciculation potential (FP). This FP was time-locked to the electrocardiogram (ECG) in 87% of the discharges. The motor unit action potential (MUAP) of the FP was also elicited as H-reflex. As mechanism we propose spindle afferent discharges mechanically triggered by the arterial pulse, i.e. a reflex fasciculation. We suggest that such a heartbeat-related mechanism could explain synchronous fasciculations described by Norris (Arch. Neurol., 1965, 13: 495-500).

Action Potentials↗
PubMed2004

[Detection of fasciculations and other types of muscular hyperkinesias with ultrasound].

Muscular hyperkinesias can be visualized by means of ultrasound (US): Ultrasonographic detection of fasciculations has been best evaluated. However, so-called ripplings, myoclonias and choreatic hyperkinesias as well as tremores can also be visualized by US. Muscular US has proven as a precise imaging technique for the detection of fasciculations. Fasciculations are brief, localized muscle twitches, usually lasting for 0.2 - 0.5 seconds. Some myoklonias may present similar in US, others present with a longer duration. In addition, muscle US allows a very easy and reliable detection of tremor frequency. This article reviews the present ultrasonographic facilities in the detection of muscular hyperkinesias and gives future perspectives.

Fasciculation↗
PubMed1990

[Extensive, continuous fasciculations of the lower leg as an isolated symptom--a clinical and electromyography follow-up].

10 patients suffering from a widespread continuous fasciculation of the lower extremities without any other neurological signs and symptoms are presented. A follow up study of 6 of these patients could be done. The fasciculation potentials were polyphasic with changing shape from discharge to discharge and appeared irregularly in most of the muscles of the legs. In 5 patients no change of clinical and neurophysiological signs could be detected over the period of observation, whereas in one patient a sensory polyneuropathy was evident in course of time. The findings illustrate that a state of widespread continuous fasciculations without other signs and symptoms is not predicative for the development of a amyotrophic lateral sclerosis.

Adult↗