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Involvement of the esophagus in the cramp-fasciculation syndrome.

A 35-year-old male patient presented with symptoms of a cramp-fasciculation syndrome, but also reported difficulties swallowing. Esophageal manometry showed spontaneous nonperistaltic contractions, pathologically increased amplitudes and duration of the contractile complexes, and an asynchronous propagation. Electromyographic evidence of fasciculations in the sternocleidomastoid and pectoralis muscles was found. Apparently all types of peripheral motor fibers can be involved in this heterogeneous syndrome, including cranial motor nerves, the vagal nerve, and enteric motor fibers of the gastrointestinal tract.

Adult↗

The origin of fasciculations in motoneuron disease.

The collision technique was used to determine the origin of distal fasciculations in 25 motor units from 9 patients with amyotrophic lateral sclerosis and 6 with other diseases involving motoneurons. Fasciculations originated in the nerve proximal to the knee or elbow in 15 and distally in 2; multiple sites of origin were found in 8 motor units. The origin was not related to the presence or absence of electromyographic evidence for collateral sprouting or lesions in descending suprasegmental pathways.

Adult↗

The origin of muscle fasciculations and cramps.

The anatomic site of origin of muscle fasciculations and cramps has been debated for many years. Many authors have argued for a central origin of the abnormal discharges in the anterior horn cells. However, most of the evidence favors a very distal origin in the intramuscular motor nerve terminals. The factors giving rise to these discharges are not well understood. Fasciculations may be related to chemical excitation of motor nerve terminals, whereas cramps may result from mechanical excitation of motor nerve terminals during muscle shortening.

Fasciculation↗

Fasciculations due to verapamil in a patient with neuropathy.

A patient with pre-existing peripheral neuropathy developed generalized fasciculations under verapamil which ceased after discontinuation of the drug. It is suggested that the increase in acetylcholine (ACh) release at the neuromuscular junction by verapamil may trigger fasciculation in the state of regeneration at ACh-sensitive sites of axon terminals and immature axon sprouts.

Aged↗

Fasciculation-myokymic activity and prolonged nerve conduction block. A physiopathological relationship in radiation-induced brachial plexopathy.

Fourteen radiation-induced brachial plexus neuropathies in 12 patients suffering from cancer were studied. Neurophysiological evaluation showed a diffuse neurogenic lesion with muscular denervation signs associated with motor and sensory nerve conduction impairment of axonal type in the distal segments of the arm. Somatosensory evoked potentials were frequently abnormal, with absence of N9 in 9 out of the 10 extremities explored. The most characteristic findings were, however, the presence of fasciculation potentials--single and grouped--and myokymic discharges in 78.5% of cases (11 out of 14 plexuses), and a motor nerve conduction block on proximal stimulation, at the supraclavicular as well as cervical spine levels, in all of the cases. Both phenomena showed a high correlation when analyzed in the same neuromuscular territory. The 5 muscles with no voluntary activity and complete--or nearly complete--motor nerve conduction block were the ones with the most intense ectopic activities. The conduction blocks were present after long periods of illness in all cases and, in 2 of the cases, they persisted in successive explorations at intervals of 9 months and 2 years respectively. These data would support a probable cause-effect relationship between a persistent and prolonged motor nerve conduction block and the presence of fasciculation-myokymic type activities. One could even postulate that the infrequent neuropathies, in which both findings have been described as relevant features, have a similar physiopathological mechanism.

Action Potentials↗

Segmental fasciculations as a late sequel of spinal cord injury.

In two patients with a history of spinal cord injury many years ago fasciculations developed in muscles belonging to previously damaged segments. In both patients MRI of the cervical spine showed an area of abnormal signal intensity representing a cavity, near the level of the neurological abnormalities and the cord injury. During a 4-year follow-up period no new neurological or MRI abnormalities were detected. A hypothesis for the genesis of fasciculations following spinal cord injury is presented.

Adult↗

Genes necessary for directed axonal elongation or fasciculation in C. elegans.

The outgrowth of single axons through different cellular environments requires distinct sets of genes in the nematode C. elegans. Three genes are required for the pioneering circumferential outgrowth of identified motor neuron axons between the lateral hypodermal cell membrane and the basal lamina. Three other genes are required for the longitudinal outgrowth of these axons along preexisting axon bundles as well as for the fasciculation of axons within these neuron bundles. Five additional genes are required for circumferential outgrowth, longitudinal outgrowth, and fasciculation; mutations in three of these genes disrupt axon ultrastructure, suggesting that they function in axon formation rather than in axon guidance.

Animals↗

Fasciculations: what do we know of their significance?

Fasciculations are observed in patients with neurogenic disorders and in healthy individuals. Depending on the associated clinical symptoms and signs, they may signify the presence of a variety of disorders of the lower motor neuron. Divergent and occasionally conflicting opinions prevail regarding the aetiology, pathogenesis, clinical significance, neurophysiological characteristics and the physiological site of origin of fasciculations. In this review we examine the published literature and attempt to clarify these issues.

Amyotrophic Lateral Sclerosis↗

p190 RhoGAP is the principal Src substrate in brain and regulates axon outgrowth, guidance and fasciculation.

The Src tyrosine kinases have been implicated in several aspects of neural development and nervous system function; however, their relevant substrates in brain and their mechanism of action in neurons remain to be established clearly. Here we identify the potent Rho regulatory protein, p190 RhoGAP (GTPase-activating protein), as the principal Src substrate detected in the developing and mature nervous system. We also find that mice lacking functional p190 RhoGAP exhibit defects in axon guidance and fasciculation. p190 RhoGAP is co-enriched with F-actin in the distal tips of axons, and overexpressing p190 RhoGAP in neuroblastoma cells promotes extensive neurite outgrowth, indicating that p190 RhoGAP may be an important regulator of Rho-mediated actin reorganization in neuronal growth cones. p190 RhoGAP transduces signals downstream of cell-surface adhesion molecules, and we find that p190-RhoGAP-mediated neurite outgrowth is promoted by the extracellular matrix protein laminin. Together with the fact that mice lacking neural adhesion molecules or Src kinases also exhibit defects in axon outgrowth, guidance and fasciculation, our results suggest that p190 RhoGAP mediates a Src-dependent adhesion signal for neuritogenesis to the actin cytoskeleton through the Rho GTPase.

Animals↗

Local sites of low accommodation of peripheral motor axons and the pathogenesis of fasciculation in amyotrophic lateral sclerosis.

There is no generalized disturbance of accommodation of peripheral motor axons in amyotrophic lateral sclerosis. Local sites of reduced accommodation are found proximally and distally with apparent correlation to spontaneous fasciculation. The possible mechanism of fasciculation provoked by acetylcholine is discussed and it is suggested that the local sites of low accommodation represent nodal sprouts with growth cones in extra-muscular as well as intra-muscular parts of peripheral motor axons.

Amyotrophic Lateral Sclerosis↗

Motor neuropathy with proximal multifocal persistent conduction block, fasciculations and myokymia. Evolution to tetraplegia.

We describe a patient with chronic asymmetric motor neuropathy, which began in the upper extremity. The paretic muscles showed abundant fasciculations and myokymia but only little amyotrophy. Electrophysiologic examination revealed proximal multifocal persistent conduction block (CB) not located at the usual entrapment sites, and arrhythmic isolated or grouped fasciculation potentials originating distally on blocked axons. Over the years, new CBs developed, which led to tetraplegia, and amyotrophy slowly increased with progressive denervation. This patient differs from the cases of chronic acquired demyelinating polyneuropathy described in the literature by the absence of sensory deficit and the proximal location of CB.

Demyelinating Diseases↗

Cramps, muscle pain, and fasciculations: not always benign?

Fasciculation and cramps without weakness or muscle atrophy are recognized as a benign syndrome. The authors report a patient with cramp and fasciculation, which persisted for 1 year without abnormal motor unit morphology on EMG before progressive weakness, muscle atrophy, and EMG abnormalities developed. This observation raises the possibility that lower motor neuron hyperexcitability may precede motor neuron death in motor neuron disease.

Accidental Falls↗

Fasciculation. Electromyographic and clinical significance.

Fascicular twitching of muscles may be present as the result of compression of spinal roots or anterior horn cells, injuries of peripheral nerves or plexes or to motor neuron disease. Occasionally fasciculation may be of no clinical significance. Electromyography may be of great help in determining the extent of involvement and whether other manifestations of nerve damage are present. Final diagnosis, however, depends upon the history, physical examination and clinical evaluation, since fasciculation is present in a wide variety of conditions.

Anterior Horn Cells↗

Urticaria and lip fasciculation may be prodromal signs of brain malignancy.

The association of urticaria and cancer usually is seen with lymphoreticular system malignancies. Recalcitrant intra-nostril pruritus has been associated with fourth-ventricle tumors of the brain. Rarely, urticaria has been described with cancer of the lung, usually small-cell adenocarcinoma. We describe a girl who suffered with chronic urticaria for 3 months before lip fasciculation began to be observed. CT scan revealed a brain tumor adjacent to the cerebellum, which was diagnosed as astrocytoma grade II. Because of the location, the tumor was not operable, but after one course of radiotherapy, both the urticaria and lip fasciculation disappeared.

Astrocytoma↗

A study of different doses of atracurium to prevent suxamethonium-induced fasciculations.

Pretreatment with 3 different doses of atracurium (0.035 mg/kg, 0.05 mg/kg, 0.07 mg/kg) was investigated in order to determine the optimal dose that would prevent suxamethonium-induced fasciculations with minimal side effects to the patient and without significant antagonism of suxamethonium block. A total of 80 patients was studied. There were 20 patients in each of three atracurium groups while a fourth group of 20 patients served as control. Atracurium reduced the incidence of fasciculations from 100% observed in the control to between 0 and 40% in the atracurium groups. The optimal dose of atracurium appears to be 0.05 mg/kg, using a pretreatment interval of 3 minutes. Routine pretreatment of all patients is not mandatory, but it is recommended whenever the side-effects of suxamethonium are particularly undesirable, as in ocular laceration, raised intracranial pressure, full stomach and in very muscular patients.

Adult↗

Pharmacologic excitability of rat motor nerve endings: the effect of adrenalectomy on neostigmine-induced fasciculations.

Neostigmine-induced muscle fasciculations, quantitated as fasciculatory muscle action potentials, served as an indirect in vivo indicator of motor nerve ending (MNE) excitability. By this method, MNE excitability was depressed in adrenalectomized rats compared to matched intact controls. Daily or continuous administration of the mineralocorticoids aldosterone or desoxycorticosterone acetate restored MNE excitability toward normal; corticosterone, the endogenous corticosteroid having both mineralo- and glucocorticoid activity, was variably effective. There was a strong negative correlation (r = -0.95) between log plasma [K+]and the fasciculatory response to neostigmine. Dietary restriction of K in adrenalectomized rats lowered plasma [K+]to near normal and significantly increased MNE excitability. This effect of adrenalectomy on MNE excitability was further demonstrated by recording directly the neostigmine-induced repetitive neural discharges responsible for the muscle fasciculations. In adrenalectomized animals, neostigmine-induced neural discharges were reduced in intensity; restoration of neostigmine responsiveness was attained by lowering plasma [K+]through dietary restriction. Stimulus strength-duration relationships for both ventral and dorsal roots disclosed deficits in axonal excitability after adrenalectomy. These returned toward normal when plasma [K+]was lowered by K withdrawal from the diet. From these studies, it is concluded that 1) in adrenalectomized rats, peripheral nerve excitability, including the unmyelinated endings of motor nerve, is depressed; 2) mineralocorticoids play a significant role in restoring MNE excitability in these animals; 3) mineralocorticoid-induced changes in MNE excitability relate to the lowering of an elevated plasma [K+].

Action Potentials↗

Diffuse fasciculations induced by D-penicillamine.

Diffuse fasciculations developed in a patient with rheumatoid arthritis who had received D-penicillamine for 6 months. Fasciculations disappeared after discontinuation of the drug but recurred on rechallenge. This reversible neuromuscular irritability has been reported with gold therapy but not with D-penicillamine.

Arthritis, Rheumatoid↗

Effect of diazepam pretreatment on succinylcholine-induced muscle fasciculation in the dog.

The efficacy of diazepam in attenuation of succinylcholine-induced muscle fasciculations was studied in the dog. Dosage levels of 0.11, 0.22, 0.55, or 1.1 mg of diazepam/kg of body weight were studied in 4 groups of 5 dogs each; another group of 5 dogs served as a control. There was no difference in the occurrence or severity of succinylcholine-induced muscle fasciculations between dogs given diazepam and nontreated controls. Using serum potassium as a quantitative index of physiologic effects of muscle depolarization, differences could not be detected between treated and nontreated dogs.

Animals↗