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At least 19 recordsLinked to original sources
PubMed1991

Estimation of the frequency of the muscular pain-fasciculation syndrome and the muscular cramp-fasciculation syndrome in the adult population.

A nationwide two-phase survey was carried out of the adult population of the Netherlands regarding fasciculation, muscle pain and muscle cramp. We conducted a population-based telephone interview with 780 Dutch adults, followed by a questionnaire covering more clinical details, filled out by 311 subjects, who had been interviewed by telephone previously. From these data the frequencies of fasciculation (men 50%, women 61%), muscle cramp (men 28%, women 42%) and muscle pain (men 48%, women 60%) in the Dutch adult population in 1988 were estimated. The combined occurrence of frequent fasciculation and frequent muscle cramp as well as of frequent fasciculation and frequent muscle pain was reported only sporadically. Although the muscular pain-fasciculation syndrome and the muscular cramp-fasciculation syndrome represent combinations of common neuromuscular phenomena, their occurrence in the general population proved to be rare. This finding supports their clinical identity as distinct motor unit hyperactivity syndromes rather than mere coincidences of fasciculation, muscle cramp and muscle pain.

Adult↗
PubMed1987

The monoclonal antibody 69A1 recognizes an epitope found on neurones with axons that fasciculate but not on those with non-fasciculating processes.

We have previously reported that the cell-type distribution and pattern of expression of the surface antigen recognized by the monoclonal antibody 69A1, suggests that it may be involved during the period of nerve fibre outgrowth and the formation of fibre bundles in the rat (Pigott & Kelly, 1986). In this current study, we have examined the expression of the epitope recognized by antibody 69A1 in regions of the rat central nervous system in which it is possible to distinguish between neurones with axons that fasciculate to form clearly defined fibre tracts and neurones with non-fasciculating processes. We have also examined antibody 69A1 labelling in several regions of the peripheral nervous system. We report that the 69A1 epitope is expressed on neurones with axons that fasciculate but is not found on neurones with short, non-fasciculating axons or on neurones without a morphologically identifiable axon. The antigen 69A1 has been purified and shown to be immunochemically closely related or identical to the L1 antigen.

Animals↗
PubMed1998

Fasciculation potentials: a study of amyotrophic lateral sclerosis and other neurogenic disorders.

We studied fasciculation potentials in amyotrophic lateral sclerosis (ALS), and in other neurogenic disorders, in strength and single-fiber electromyography-matched muscles. Benign fasciculations were studied in 3 normal subjects. Fasciculations were more stable and easier to recruit voluntarily in the early phase of ALS; later, fasciculations were more unstable, more complex, and less likely to be voluntarily recruited. Stable fasciculations, representing part of large, reinnervated motor units, and probably arising from distal axonal sprouts, usually had a higher firing rate than more complex and unstable fasciculations. In weak muscles in ALS, fasciculations were generally more unstable than in other neurogenic disorders. In normal-strength muscles fasciculations are less complex in ALS than in other disorders. Benign fasciculations have a high firing rate and normal morphologic parameters. In ALS fasciculations arise proximally early in the disease and distally in the later stages. Fasciculation may be important in excitotoxic cell death in ALS.

Adult↗
PubMed1982

Pathophysiology of fasciculations in ALS as studied by electromyography of single motor units.

Electromyographic potentials of fasciculations were studied in ten patients with amyotrophic lateral sclerosis (ALS). The EMG recordings were made from the extensor digitorum brevis muscle. The EMG recording was so selective that only one motor unit potential appeared on maximal voluntary effort and on supramaximal electrical stimulation of the peroneal nerve. In a series of fasciculations, the shapes of the EMG potentials varied, while in a series of voluntary twitch activations of electrical nerve stimulations the EMG potentials were mainly constant. Fasciculations were followed by antidromic impulses in the test unit axon as judged from collision tests, and they persisted after lidocaine blockades of the nerve to the muscle. The findings are compatible with a conclusion of distal multifocal triggering of fasciculation. Fasciculating motor units had voluntary firing properties close to those of normal low-threshold motor units. Widespread fasciculations were abolished by a nonparalytic dose of a synthetic curare derivative (Pavulon) and augmented by administration of neostigmine in two cases. The fasciculations in ALS thus have the same characteristics as experimental fasciculations evoked by cholinesterase inhibitors, and there is reason to believe that the underlying pathophysiological mechanism is similar in the two cases.

Amyotrophic Lateral Sclerosis↗
PubMed1996

Fasciculations: clinical, electromyographic, and ultrasonographic assessment.

Widespread fasciculations are an important clinical sign in, for example, degenerative lower motor neuron diseases (LMND). Usually they are detected by clinical inspection and electromyography. Recently myosonography has been proposed for the detection of fasciculations. This prospective study compares the value of these three modes of examination in patients with degenerative LMND. Seventy healthy control persons and 34 patients (11 women, 23 men; aged 43-78 years; median age 60.5) with LMND were included in the study. All participants were subjected to thorough visual screening for the presence of fasciculations. Fourteen muscles were examined bilaterally by myosonography and a median of 8 muscles were screened electromyographically (only in the patients); the investigators were blinded to the other findings. Clinical inspection and ultrasonography exhibited fasciculations in up to 5 and 8 muscles, respectively, in 8 healthy persons. Ultrasonography demonstrated fasciculations in all patients, clinical inspection in all but 2, and electromyography in 26 of 33 patients (1 patient was not examined electromyographically). Comparing the three methods, clinical observation revealed fasciculations in 42%, electromyography in 39%, and ultrasonography in 67% of all muscles. Thus, ultrasonography was significantly more sensitive than the other techniques (P < 0.001). The interrater agreement (correlation coefficient) r in respect of the presence or absence of fasciculation was 0.71 for the clinical, 0.85 for the electromyographic and 0.84 for the myosonographic examinations. Ultrasonography and electromyography were more reliable than the clinical examination (P < 0.001 and P < 0.01, respectively). Our study indicates that ultrasonography is more sensitive than clinical and electromyographic examination in visualizing fasciculations in patients with LMND. Additionally, it is more reliable than clinical examination.

Adult↗
PubMedDate not supplied

Temporal correlation of succinylcholine-induced fasciculations to loss of twitch response at different stimulating frequencies.

STUDY OBJECTIVE: The present study was undertaken to determine the time courses of succinylcholine-induced fasciculations and adductor pollicis single-twitch responses at two stimulating frequencies. DESIGN: A prospective, randomized study. SETTING: The main operating room of a university teaching hospital. PATIENTS: Forty-four patients undergoing general anesthesia and requiring tracheal intubation. INTERVENTIONS: In 22 patients, anesthesia was induced with thiopental sodium, fentanyl, and midazolam and maintained with 70% nitrous oxide in oxygen prior to the administration of succinylcholine 1 mg/kg. In another 22 patients, end-tidal isoflurane 0.75% to 1% was included in the induction regimen. Patients in each group were randomly assigned to receive ulnar nerve stimulation at either 0.1 Hz or 1.0 Hz. MEASUREMENTS AND MAIN RESULTS: The times at which fasciculations were first noticed and no longer visible and the times to 25%, 50%, 75%, 90%, and 100% twitch depression were recorded. These times were compared for the two rates of neurostimulation. With single-twitch nerve stimulation at 1.0 Hz, 100% twitch depression occurred 6 +/- 16 seconds following the end of fasciculations, while at a stimulating frequency of 0.1 Hz, it occurred 52 +/- 32 seconds later (p less than 0.05). At the end of fasciculations, single-twitch depression of 50% or more was noted in only 19% of patients in the 0.1 Hz groups and in all patients in the 1.0 Hz groups (p less than 0.05). In the 0.1 Hz groups, 50% twitch depression occurred 19 +/- 27 seconds after the end of fasciculations, with more than three-quarters of the patients having achieved 50% twitch depression 30 seconds following the disappearance of fasciculations. The addition of isoflurane did not significantly alter any of these times. CONCLUSIONS: The data reveal that cessation of fasciculations may be an inaccurate clinical sign of the readiness for intubation and confirm that standardized methods of neurostimulation are necessary in the pharmacodynamic evaluation of neuromuscular blocking drugs. In settings where profound neuromuscular relaxation is not required, waiting at least 30 seconds beyond the disappearance of fasciculations should provide good intubating conditions.

Adolescent↗
PubMed1998

Surface EMG and myosonography in the detection of fasciculations: a comparative study.

Surface electromyography (EMG) and muscle sonography both facilitate the detection of fasciculations. This study was conducted to evaluate the prevalence of fasciculations in 10 lower extremity muscles in 58 subjects 47 +/- 18 years of age without and 54 patients 52 +/- 15 years of age with various neuromuscular diseases (3 with inflammatory myopathy, 15 with lower motor neuron disease, 22 with acquired and 11 with hereditary motor and sensory neuropathy (HMSN), and 3 with adrenomyeloneuropathy). When each muscle was screened by means of myosonography for 10 seconds, fasciculations were found in up to 8 muscles in 11 control subjects (19%) and in up to 10 muscles in 41 patients (76%). Within the same recording period surface EMG revealed fasciculations in 5 control subjects (9%) and 30 patients (56%), whereas during a recording time of 20 minutes fasciculations were detected in 55 (95%) control subjects and all patients. An amplitude of 400 microV proved to be the optimum cutoff between fasciculations for healthy subjects and patients with neuromuscular disease (accuracy, 74%). Myosonography allowed differentiation of both groups with an accuracy of 79%. Surface EMG was more liable to artifacts than myosonography. The average interval between subsequent fasciculations cannot be used to differentiate patients with acquired and hereditary polyneuropathy and with lower motor neuron disease. Long-term surface EMG recording indicates fasciculations to occur in almost all patients with neuromuscular disease and the vast majority of healthy subjects. Muscle ultrasonography was more convenient and reliable than surface EMG in differentiating patients and healthy subjects.

Adult↗
PubMed1992

Voluntary activation and fiber density of fasciculations in motor neuron disease.

Two hundred voluntarily activated motor units and 211 fasciculations were recorded in the biceps of 10 patients with motor neuron disease with the Macro EMG technique. Twenty-two fasciculations, in nine of 10 muscles, had a potential of closely similar shape, amplitude, and area to that of a voluntary unit. Fasciculating units that could not be activated voluntarily had a higher mean number of spikes in their triggering single fiber potentials than units that could only be activated voluntarily, but statistically similar Macro EMG parameters. The mean number of single fiber spikes, and Macro EMG parameters, of fasciculations activated voluntarily, were similar to those of units that were only activated voluntarily. A positive correlation between fiber density and Macro EMG median amplitude and area in individual patients, and between number of single fiber spikes and Macro EMG amplitudes and areas in the pooled data, was found for fasciculations but not for voluntary units. At least 10% of fasciculations in patients with motor neuron disease may originate near or above the point of axonal branching and a proportion of those without evidence of voluntary activation may have a higher number of smaller muscle fibers, or more closely packed muscle fibers, of similar or greater size, than voluntarily activated motor units. Differences in the peripheral microanatomy of a number of fasciculation units not activated voluntarily may underlie ectopic impulse generation in the terminal axonal arborization, endplate zone, or muscle fibers of these units.

Electromyography↗
PubMed1992

Surface EMG in the recording of fasciculations.

The usefulness of multichannel surface recording of fasciculations was evaluated by a retrospective study of 116 patients with various neurological disorders. Eight channels of a conventional electroencephalograph were used with plate electrode recordings from the upper arms and legs. Wide-spread fasciculations (defined as five or more of the eight muscle groups) were recorded in 48 of 54 patients with motor neuron disease, spinal muscular atrophy or postpolio syndrome, but noted on routine clinical examination at presentation in only 6. Eleven of 23 patients with peripheral neuropathy or myelopathy had fasciculations in five or more leads compared to one clinically, and 3 of 39 with other neurological diseases had fasciculations electrically but in only one were they clinically observed. The method is a noninvasive and sensitive adjunct to clinical examination for detecting fasciculations. Its diagnostic value is limited by the relatively high incidence of fasciculations in neuropathies and myelopathies. However, this study suggests that "false negatives" are rare and that the diagnosis of motor neuron disease should be reconsidered when less than five leads shows fasciculations.

Adult↗
PubMed1997

Ultrasonographic assessment of the prevalence of fasciculations in lesions of the peripheral nervous system.

In previous studies, ultrasonography was a very sensitive method in detecting fasciculations. The present study was intended to examine the prevalence of ultrasonographically visible fasciculations in patients with neuromuscular diseases affecting the lower extremities. Ultrasonography of 9 muscles (rectus femoris, vastus lateralis, vastus intermedius, vastus medialis, sartorius, semitendinosus, tibialis anterior, gastrocnemius, and soleus muscles) was performed bilaterally in 70 adult healthy subjects and 172 patients with various neuromuscular diseases. Fasciculations were detected in 109 (63%) of 172 patients. The median value of affected muscles was 10 (range 1-18). Patients with spinal muscular atrophy (37/38, p < 0.001), hereditary motor and sensory neuropathy (24/25, p < 0.001), and lumbosacral radiculopathy with motor deficits (24/29, p < 0.001) exhibited fasciculations more frequently than did healthy volunteers. Radiculopathy with sensory deficits, lesions of either plexus or peripheral nerves, compartment syndrome, and myopathy were not associated with a significantly enhanced prevalence of fasciculations in the patient group compared to the control group. In summary, fasciculations are a frequent ultrasonographic sign in neuromuscular diseases. They are almost regularly found in patients with spinal muscular atrophy and those with hereditary motor and sensory neuropathy. Thus, the absence of fasciculations in ultrasonographic assessment should give cause for reconsidering these diagnoses.

Adolescent↗
PubMed1994

Waiting time after non-depolarizing relaxants alter muscle fasciculation response to succinylcholine.

The purpose of the study was to determine the effect of nondepolarizing muscle relaxants and waiting time on muscle fasciculations after succinylcholine in anaesthetized patients. Adult men and women, 60-80 kg, received pretreatment doses of atracurium 5 mg (n = 160), pancuronium 1 mg (n = 123), d-tubocurarine 3 mg (n = 97), or vecuronium 1 mg (n = 62). Waiting times between pretreatment and succinylcholine, 100 mg, ranged between 0.6 and 5 min. Data points (presence or absence of fasciculations and waiting time) were entered for each patient. Waiting time response curves were obtained between the logit transformation of the probability of no fasciculations and the log waiting time for each drug. Statistical differences between wait time response curves were determined by non-overlapping of the associated 95% confidence intervals. The frequency of muscle fasciculations was reduced with increased waiting time for all nondepolarizers tested. Following wait times of three, four and five minutes, the probability of not fasciculating was greatest with d-tubocurarine (90, 97 and 99%, respectively) and atracurium (89, 93 and 96%). Corresponding values for pancuronium were 70, 82 and 88% and for vecuronium were 74, 82 and 86%. Waiting times to prevent fasciculations in 80% and 90% of patients were shorter with d-tubocurarine (2.46 and 3.02 min, respectively) or atracurium (2.16 and 3.24 min) than pancuronium (3.77 and 5.35 min) or vecuronium (3.73 and 6.36 min).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Fasciculations and their F-response. Localisation of their axonal origin.

A fasciculation with an axonal origin may be followed by its own F-response. The time-lapse between these 2 potentials corresponds to the time for the antidromic wave to travel to the alpha-cell and to return to the trigger-point. This relatively stable interval may be compared with the difference between the latencies of the F- and M-responses of the same muscle evoked by distal nerve stimulation. This permits one to localise the origin of the fasciculation on the axon. This method showed that, of 201 fasciculations followed by their F-response, obtained in normal controls and in neurological patients, 97 and 89% respectively had their origin between the muscle and the stimulation site. In this series, the proportion of pathological fasciculations having an origin between the muscle and a point at half the M-latency, is similar to that found in a former study on unselected fasciculations using a collision method (Roth 1982). Comparison between these 2 studies therefore supports the concept that all or almost all fasciculations have an axonal origin.

Axons↗
PubMed1992

Rapid-sequence intubation of head trauma patients: prevention of fasciculations with pancuronium versus minidose succinylcholine.

INTRODUCTION: Fasciculations during rapid-sequence intubation may lead to increased intracranial pressure and emesis with aspiration. Standard rapid-sequence intubation requires a nondepolarizing blocking agent before succinylcholine administration. HYPOTHESIS: Prevention of fasciculations during rapid-sequence intubation of head trauma patients can be accomplished as safely and effectively with minidose succinylcholine as with a defasciculating dose of pancuronium. DESIGN: A prospective, randomized, double-blind study. SETTING: An inner-city county trauma center with 70,000 patient visits per year. PARTICIPANTS: Sequential adult head trauma patients requiring rapid-sequence intubation who had no contraindications to succinylcholine or pancuronium. INTERVENTIONS: Each head trauma patient requiring rapid-sequence intubation who met the inclusion criteria received standard rapid-sequence intubation maneuvers and lidocaine (1 mg/kg) IV. Patients were randomized to receive either minidose succinylcholine (0.1 mg/kg) or pancuronium (0.03 mg/kg) IV one minute prior to the full paralytic dose of succinylcholine (1.5 mg/kg) IV. Fasciculations were recorded using a graded visual scale. RESULTS: Of 46 patients, eight of 19 (42%) in the pancuronium group and six of 27 (22%) in the succinylcholine group experienced fasciculations. No statistically significant difference in fasciculations was detected between the two groups using chi 2 analysis. Complete relaxation of the cords was present in all but two patients, one in each group. No patient in either group experienced emesis or significant dysrhythmias. CONCLUSION: Pretreatment with minidose succinylcholine causes no greater incidence of fasciculations than pancuronium in rapid-sequence intubation of head trauma patients in an ED setting. Thus succinylcholine may be used as the sole paralytic agent in rapid-sequence intubation of head trauma patients.

Adult↗
PubMed1979

Suxamethonium infusion rate and observed fasciculations. A dose-response study.

Suxamethonium chloride (Sch) was administered i.v. to 36 adult males at six rates: 0.25 mg s-1 to 20 mg s-1. The infusion was discontinued either when there was no muscular response to tetanic stimulation of the ulnar nerve or when Sch 120 mg was exceeded. Six additional patients received a 30-mg i.v. bolus dose. Fasciculations in six areas of the body were scored from 0 to 3 and summated as a total fasciculation score. The times to first fasciculation, twitch suppression and tetanus suppression were inversely related to the infusion rates. Fasciculations in the six areas and the total fasciculation score were related directly to the rate of infusion. Total fasciculation scores in the 30-mg bolus group and the 5-mg s-1 and 20-mg s-1 infusion groups were not significantly different.

Dose-Response Relationship, Drug↗
PubMed1988

Differential effects of neuromuscular blocking agents on suxamethonium-induced fasciculations and myalgia.

The effect of pretreatment with suxamethonium, gallamine or pancuronium on suxamethonium-induced fasciculations and myalgia was studied in a controlled, randomized and double-blind clinical trial. Both fasciculations and myalgia were assessed on a four-point rating scale. There was no significant correlation between fasciculations and postoperative muscle pain at 24, 48 or 72 h, and pretreatment with suxamethonium had no significant effect on fasciculations or myalgia. Gallamine had a more marked effect on fasciculations than pancuronium, and the decrease in the fasciculation score was statistically significant. In contrast, pancuronium had a greater effect on myalgia, and decreased postoperative muscle pain significantly at 24 and 48 h. These differences may reflect the differential activity of gallamine and pancuronium at the neuromuscular junction. Pretreatment had little or no effect on plasma potassium concentrations.

Adolescent↗
PubMed1984

Diazepam does not prevent succinylcholine-induced fasciculations and myalgia. A comparative evaluation of the effect of diazepam and d-tubocurarine pretreatments.

To determine the effectiveness of diazepam pretreatment in preventing succinylcholine (SCh)-induced fasciculations and body pains, 587 patients were randomly allocated to six groups. Patients in Group I received no pretreatment and served as controls. Patients in Groups II and III were pretreated with 0.05 mg/kg of diazepam either 4-5 min (Group II) or 8-10 min (Group III) prior to SCh administration. Patients in Groups IV and V received 0.1 mg/kg of diazepam either 4-5 min (Group IV) or 8-10 min (Group V) prior to SCh administration, while patients in Group VI were pretreated with 0.05 mg/kg of d-tubocurarine (dTc) 4-5 min prior to SCh. The succinylcholine dosage was 1.0 mg/kg in Groups I through V and 1.5 mg/kg in Group VI. Fasciculations, intubation conditions and postoperative body pains were evaluated in all groups. Fasciculations were seen in 90% of patients in the control group and 15% in the dTc pretreatment group, while diazepam was ineffective in altering the frequency or intensity of fasciculations. Conditions for intubation were judged to be clinically adequate in all groups. Body pains were seen in 33% of patients in the control group and 28-36% in diazepam-pretreated groups and in only 8% of patients in the dTc pretreatment group. There was no statistically significant difference in the incidence of body pains by virtue of site of operation, age, sex, and inpatient/outpatient status. It is concluded that the problem of postoperative myalgia is significant and that dTc pretreatment is the effective method for prevention of fasciculations and postoperative myalgia. Diazepam pretreatment was ineffective for the prevention of fasciculations and myalgia.

Anesthesia, General↗
PubMed1998

[Real time sonographic imaging of fasciculation].

We studied the clinical value of real time sonographic imaging of fasciculation in patients with neuromuscular diseases, which presented for 4 with amyotrophic lateral sclerosis (ALS), 2 with Kennedy-Alter-Sung syndrome, 1 with Kugelberg-Welander disease, and 1 with n-hexane neuropathy. The ultrasound image of fasciculation showed characteristic of each disease in several features. Analysis of sonographic image revealed that duration, size of fasciculation, and interval of fasciculation in Kennedy-Alter-Sung syndrome and Kugelberg-Welander disease, which is chronic progressive neuromuscular disorders, were longer than that in ALS, n-hexane neuropathy which are acute progressive disorders. We believe the fasciculation image may have significant implications with clinical course. Real time sonography offers a quantitative and qualitative means of investigating fasciculation and is effective to identify pathological information.

Amyotrophic Lateral Sclerosis↗