25yo with Widespread Fasciculations

[susan]

I have a patient 25 years old who complains of widespread fasciculations all over the body and tiredness (not weakness) in bilateral tibial anterior muscle, particurarly in the morning. He complains of cramps. His EMG, MRI and PEM were absolutely normal. I prescribed Fluvoxamin and Diazepam in order to treat a dubious disorder of anxiety. What do you think? Can I exclude esclude ALS or other diseases if these exams are normal? CA, K, MG, Na were was normal, too.Could be benign fasciculation sindrome?

 

[garymills]

seby,

to answer you first question, yes I think you can rule out als based on the results you listed. that said, I would like to know what the neuro that performed the emg thinks. EMG is such a subjective exam, with a lot of the results based on the interpertation and skill of the examiner. As for the symptoms you list, they are all consistent with BFS (benign fasciculation syndrome). So that may very well be the correct dx.

As for the anxiety angle, I would tend to not believe it is the cause of the fasciculations. I myself have been examined by two neuromuscular specialists, and they both said anxiety was not a cause of bfs. They did both however say that bfs indeed caused anxiety in most sufferers. However, it has been my experience that once a person gets their anxiety under control, acceptance and sxs of bfs becomes more bearable.

One last thing i would mention to you, since you are physician, is that the sxs you list can also be caused by adr's to certain rx meds. During my many months on this forum, I have read numerous reports by people suffering from bfs that have taken antibiotics in the quinolone class. I personally have linked my problems to the use of cipro, and there have been dozens of others that have as well. So you might want to inquire whether you patient has been treated with any of these drugs in recent history. You might also consider lyme as a possibility.

Take care,

Gary

 

[BoyyDavoMan]

If Seby is a doctor (and a neurologist as well), then he should contact Dr. Testa (his email is ) at the Ist. Nazl. Neurol. Carlo Besta, Dept. Neurol., Via Celoria 11, Milan, IT-20133 Italy. He is the contact author for the article "Survival of 793 patients with amyotrophic lateral sclerosis diagnosed over a 28-year period" by Testa D, Lovati R, Ferrarini M, Salmoiraghi F, Filippini G., published in the journal Amyotrophic lateral sclerosis and other motor neuron disorders, 5 (6), pp. 208-212, Dec. 2004.

He could also contact Dr. Fabio Monzani at the University of Pisa School of Medicine. He is the lead author of the article "" from the journal Clinical Endocrinology.

He could also contact Dr. Paul Maddison, who is listed as the contact for the article "" from the journal Brain.

He should read the article "", an ENS Teaching Review from the Journal of Neurology. Another article of interest would be ", another ENS Teaching Review from the Journal of Neurology.

There are other articles that he can read as well:

Blexrud, M. D., A. J. Windebank, and J. R. Daube, Long-term follow-up of 121 patients with benign fasciculations, Annals of Neurology, 34 (4), 622-625, October 1993.

Eisen, A., and H. Stewart, Comment: Not-so-benign fasciculations, Annals of Neurology, 35 (3), p. 375, March 1994.
Reply by Blexrud, M. D., A. J. Windebank, and J. R. Daube.

This should be a good starting point for him. I recommend that he subscribe to the , a searchable database of scientific journals. He should then be able to do some research into what the medical community has published. If he wants to get an idea of what BFS sufferers have to deal with, then all he has to do is read the postings in the forums.

 

[RipleyGates]

I care if Dr Seby is real because Dr Seby claimed to be real and it was his/her experience as a self proclaimed neurologist that prompted his/her original post.If the good Dr is a fraud than the post was a fraud. I believe both to be true.