Benign Fasciculation Syndrome (BFS) Constant Muscle Twitching

Neurological disorders are a diverse group of diseases affecting the brain, spinal cord and nerves. Many neurological symptoms are part of occasional experiences in normal healthy individuals and is not linked to any disease – like pain, dizziness, numbness, muscle twitches, cramps or even tremors. Some neurological disorders can be very mild, causing minimal discomfort, while some can be very serious, life-threatening or debilitating disorders. Benign fasciculation syndrome (BFS) is a less severe but annoying type of neurological disorder. It is sometimes referred as ‘muscle twitching syndrome’ or ‘fasciculation syndrome’ and involves the rapid contraction and relaxation of the muscles.

What is benign fasciculation syndrome (BFS)?

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Benign fasciculation syndrome is characterized by occasional or nearly continuous twitching of various skeletal (voluntary) muscles in the body. This type of muscle twitching can also be seen in association with serious disorders like spinal injury, multiple sclerosis (MS) or amyotrophic lateral sclerosis (ALS). This can sometimes make benign fasciculation syndrome patients extremely anxious about the twitching due to the similarity of symptoms.

Symptoms of Benign Fasciculation Syndrome

Benign fasciculation syndrome can affect individuals of any sex and any age. In some patients it has been found to develop following viral infections. It is characterized primarily by twitching (fasciculation) of various muscles of the body. These involuntary movements can affect any group of muscles including the muscles of arms, fingers, back muscles, legs or eyelids. Occasionally it can even affect muscles of the tongue.

Muscle Twitching in BFS

The twitches resemble those which can happen occasionally in healthy individuals, except that in benign fasciculation syndrome the twitch persists for long periods. The twitches usually develop when the muscle is at rest. These twitches disappear when the muscle is moved voluntarily. It may affect the same area again or more commonly it can migrate from one muscle to another.

Twitching is slightly more severe at night and exacerbates during periods of stress, exertion or infection. The symptoms may spontaneously improve in a few months or persist for several months to years. There can be periods of intense symptoms interspersed with periods of milder symptoms or symptom-free periods. With time the muscle twitching may get less intense and the duration of symptom-free period may increase.

Other Symptoms

  • Anxiety. Most patients with benign fasciculation syndrome are also seen to suffer from anxiety. There may be a history of anxiety even before BFS develops.
  • Pain. Some benign fasciculation syndrome patients can have pain during the muscle twitching. This may include muscle cramping due to repeated contractions.
  • Fatigue is common in benign fasciculation syndrome patients and can reduce the ability to undertake physical activity (reduced exercise tolerance). This is often mistaken for weakness associated with neurological disorders like ALS. Weakness is not present in BFS and if present, further investigation is required to exclude the possibility of other neurological disorders.
  • Other symptoms may include :
    • numbness
    • tingling or ‘pins and needles’ sensation
    • muscle stiffness

Amyotrophic lateral sclerosis (ALS) vs benign fasciculation syndrome (BFS)

  • ALS is a rare disease while benign fasciculation syndrome is more common.
  • ALS patients suffer primarily with weakness and also show fasciculations. Benign fasciculation syndrome patients primarily suffer from fasciculations and may suffer from fatigue.
  • The weakness in ALS is due to loss of muscle tissue and can be assessed clinically. The weakness in benign fasciculation syndrome is perceived weakness and cannot be clinically verified.
  • The twitch in benign fasciculation syndrome starts in one spot and usually migrates to other spots. In ALS the twitch starts at one spot to progress throughout the body with time.
  • The twitches in benign fasciculation syndrome occur in healthy muscle tissues while in ALS twitches are caused by dying muscle tissue. This can be differentiated with an EMG. In benign fasciculation syndrome the EMG remains normal. The EMG is abnormal in ALS.

Causes of Benign Fasciculation Syndrome

The exact cause of benign fasciculation syndrome is unknown. A muscle twitch can result from disease of the muscle, the nerve supplying the muscle or a problem at the junction where the nerve supplies the muscle cells (neuromuscular junction). In benign fasciculation syndrome, the exact site of the disease is not clear.

Anxiety, stress and physical exertion are significantly related to the severity of symptoms but are not the cause of BFS. It is believed that benign fasciculation syndrome is an autoimmune reaction to a viral infection. There may also be a link to :

  • use of certain drugs like anticholinergics like dimenhydrinate
  • withdrawal of opioids like morphine
  • chronic exposure to certain insecticides
  • deficiency of magnesium and certain micronutrients

Diagnosing Benign Fasciculation Syndrome

Patients typically whave a history of twitching that is worsened by anxiety or overexertion. Diagnosis of benign fasciculation syndrome is made by excluding other possible causes for muscle twitching like Lyme disease neuropathy, ALS, multiple sclerosis.

A detailed neurological examination in benign fasciculation syndrome can reveal brisk reflexes (hyperreflexia). Electromyography (EMG) is an important diagnostic tool. Since benign fasciculation syndrome is not associated with any real nerve damage, the EMG appears normal or a fairly normal. BFS should only be diagnosed once other neurological disorders have been excluded. A change in the symptoms, including development or progression of weakness should prompt repeat investigations including EMG to rule out ALS.

Treatment for BFS

There is no satisfactory definitive treatment for benign fasciculation syndrome. Some medication and measures that may be considered include :

  • anti-anxiety medication
  • reducing the use of stimulants – caffeine and nicotine
  • stress management
  • relaxation techniques including meditation

Several drugs and dietary supplements have been used with marginal benefits. This includes :

  • anti-epileptic drugs like carbamazepine or phenytoin
  • dietary supplements like magnesium
  • quinine
  • propranolol
  • verapamil

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  • moose

    I have been having a lot of muscle twitches lately. I was beginning to notice that I was having a lot around the beginning of 2014. I have experienced muscle twitching before, but I don’t remember it being this common.

    I have some twitching once every 2 hours at the least. I have it more than that usually. I need to move a little to make it stop, but moving also causes it for me sometimes. But they pop up while i’m sitting still too.

    I experience muscle twitching in almost any part of my body. My neck, arms, hands, torso, back, legs, feet, eyelids, and face. I notice them a lot while i’m sitting in class.

    I have also experienced random pain on parts of my body. A small spot would hurt on and off for about a minute and stop. That doesn’t happen as much as the muscle twitching though. I am concerned that I might have some kind of issue with my nervous system.

  • efra

    Moose. Your post is a little dated but if you’re still experiencing this I’ll interject some similar issues that I had. I had perceived weakness (I felt week) about 5 months ago. In my legs first which went away. Then my hands…started dropping things a lot. Month or so later I got twitching in my left hand between my index finger and thumb. I felt twitching all over my body but it was/is more prevailent in my hand. I was convinced I had ALS or MS or PD. Went thru all the routine test, EMG and nerve study. I was even twitching at the time of the exam. Found out all my tests were normal and I did not have clinical weakness. I was diagnosed with Benign Fasiculation Syndrome. This syndrome can hit anyone at any time. I consider myself to be somewhat anxious which makes this symdrome worse. If you don’t have real weakness and atrophy you may have the same thing. If you’re sitting in a classroom your probably younger than 50 which is typically when the bad nerve diseases hit. Try to relax. Get a nerve study done to rule things out and bring some peace to your mind. The fasiculations can be really scary, but they are very common. Good luck. Hope you find your results to be like mine.

  • Barbara

    Mine muscle spasm or twitch is by my left temple. It’s very annoying it feels like when you get a skipped heart beat but it’s like that at my temple. I have no headaches with it. I’m just sitting there and I can feel it move.

  • Hi Barbara. If it occurs every now and then and resolves on its own then it’s not really a cause for concern just yet. As mentioned many of these muscle twitches occur temporarily for no clearly identifiable reason but if you are uncertain then seek advice from your family doctor.

  • Barbara

    Hi thank you!! I went and saw one of the neurologist at my job. I get it more now but the dr thinks it’s fine. He says it can be my anxiety. Because everything else Is fine just my potassium is low. It is very annoying but I’m just coping and trying not to pay mind to it. Thank you for the response.

  • Grace C Ni Iomhair

    Hi, don’t know if it’s benign fasiculation I have. Had a lot of twitching especially at night. Now have it in my ear and it’s so irritating it keeps me up at night. Only notice it when there is a lull in the day and so noticeable at night. My aunt just passed with MS and my granny had it too but trying to not think too much into it

  • You’re welcome Barbara. All the best.

  • oge

    Hi I was very sick 3wks ago and shortly after I started having muscle twitching all over my body but more on my calf. I have done many blood tests all good. Dr even ordered aldolase test and it came back good. The Dr suggest I have anxiety and thinks it’s nothing to worry about. However the dr is willing to send me to a neurologist if symptoms persist. I am so worried and losing sleep for it.

  • Hi Oge. No reasons to worry about it just yet if your doctor is not concerned at this point in time. Rather wait and follow through with your doctor’s recommendations. You mention being sick but you don’t mention the exact illness. If this previous illness led to dehydration then that can cause symptoms like twitching. Anxiety is also another cause and worrying about your condition and losing sleep over it will just worsen your anxiety. Maybe see a psychologist to help you cope with your anxiety before considering medication. Ultimately if it is necessary to see a neurologist then do so as soon as your doctor advises.

  • oge

    Thanks for the reply. I am scheduled to see a neuRologist next week. I am praying all goes well. The twitching has reduced but when I do some chores and exert myself the twitches come back. It’s very worrisome. I have started anti depressant medication. Hopefully that would help. I get nerve pains on and off on my forearm. A few spasms on my calf too but no weakness.

  • Eddie Pfeiffer

    Have you found any cure for the fasciculation’s.

  • oge

    Just wanted to follow up on this thread. I had EMG and nerve studies done and they were normal. I also had an MRI of brain and it was normal. However the fasciculation has not stopped or reduced. It has even become worse. I twitch all over even deep inside my thigh. My blood work also looks very good. The neurologist says I should ignore the twitches. My PCP has just prescribed Lyrica to me and hoping it will help. recently, I started to have pain in my thigh muscles that last a few hours, then pain in my throat that last a day. chest pain that last a few days and just general body pain and fatigue. Is there any other medical test that you recommend I discuss with the neurologist when next I visit? I am on only 31yrs old. Thanks

  • alison

    hi ive been suffering with muscle twitches for a year and a half now its ruining the quality of my life it started in my legs and now its all over seen a neurolagist and am going to have nerve conduction tests and m.r.i scan ive been prescibed pregabalin only thing with these drugs they can cause loss of vision so ive not taken them im too scared and now im getting the odd muscle jerk i pray too god that my tests come back normal and this terrible condition will go away in time

  • Hi Alison. Hopefully this is nothing serious but the only way to know for sure is with further diagnostic investigation. It is only natural to be concerned by the side effects of any drug, however, it is important to ensure that you are not being overly-cautious. If you have not used the drug yet then you may be depriving yourself of the necessary treatment that could also help your doctor verify the underlying condition, based on your response or lack thereof to the drug. Speak to your doctor and pharmacist about your concerns with this specific drug.

  • alison

    thx i will take on board your comments

  • Maf

    Had my EMG today and results were nothing major wrong (lower back issues) I do have tingling in my hands and arms and finger twitching still happens. Hopefully I can reassure someone out there that you can have these symptoms but not have anything seriously wrong but always get checked out by a doctor. I’m seeing neurologists next week for follow up. Good Luck everyone