Cramp fasciculation syndrome

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Cramp fasciculation syndrome (CFS) is a rare [1] peripheral nerve hyperexcitability disorder. It is more severe than the related (and common) disorder known as benign fasciculation syndrome; it causes fasciculations, cramps, pain, fatigue, and muscle stiffness similar to those seen in neuromyotonia (another related condition). [2] Patients with CFS, like those with neuromyotonia, may also experience paresthesias. [3] Most cases of cramp fasciculation syndrome are idiopathic. [4]

Contents

Cramp fasciculation syndrome is diagnosed by clinical examination and electromyography (EMG). [5] Fasciculation is the only abnormality [6] (if any) [7] seen with EMG. Cramp fasciculation syndrome is a chronic condition. [8] Treatment options include anti-seizure medications such as carbamazepine, immunosuppressive drugs and plasmapheresis. [4]

Signs and symptoms

Symptoms are very similar to those found in benign fasciculation syndrome and include: [9]

Diagnosis

The procedure of diagnosis for Cramp Fasciculation Syndrome (CFS) is closely aligned with the diagnosis procedure for benign fasciculation syndrome (BFS). The differentiation between a diagnosis of BFS versus CFS is usually more severe and prominent pain, cramps and stiffness associated with CFS.[ citation needed ]

Treatment

Treatment is similar to treatment for benign fasciculation syndrome.[ citation needed ]

Carbamazepine therapy has been found to provide moderate reductions in symptoms. [9]

Related Research Articles

Neuromyotonia (NMT) is a form of peripheral nerve hyperexcitability that causes spontaneous muscular activity resulting from repetitive motor unit action potentials of peripheral origin. NMT along with Morvan's syndrome are the most severe types in the Peripheral Nerve Hyperexciteability spectrum. Example of two more common and less severe syndromes in the spectrum are cramp fasciculation syndrome and benign fasciculation syndrome. NMT can have both hereditary and acquired (non-inherited) forms. The prevalence of NMT is unknown.

Morvan's syndrome is a rare, life-threatening autoimmune disease named after the nineteenth century French physician Augustin Marie Morvan. "La chorée fibrillaire" was first coined by Morvan in 1890 when describing patients with multiple, irregular contractions of the long muscles, cramping, weakness, pruritus, hyperhidrosis, insomnia and delirium. It normally presents with a slow insidious onset over months to years. Approximately 90% of cases spontaneously go into remission, while the other 10% of cases lead to death.

<span class="mw-page-title-main">Benign fasciculation syndrome</span> Involuntary muscle twitching in the voluntary muscles

Benign fasciculation syndrome (BFS) is characterized by fasciculation (twitching) of voluntary muscles in the body. The twitching can occur in any voluntary muscle group but is most common in the eyelids, arms, hands, fingers, legs, and feet. The tongue can also be affected. The twitching may be occasional to continuous. BFS must be distinguished from other conditions that include muscle twitches.

Myotonia is a symptom of a small handful of certain neuromuscular disorders characterized by delayed relaxation of the skeletal muscles after voluntary contraction or electrical stimulation, and the muscle shows an abnormal EMG.

Weakness is a symptom of many different medical conditions. The causes are many and can be divided into conditions that have true or perceived muscle weakness. True muscle weakness is a primary symptom of a variety of skeletal muscle diseases, including muscular dystrophy and inflammatory myopathy. It occurs in neuromuscular junction disorders, such as myasthenia gravis.

<span class="mw-page-title-main">Peripheral neuropathy</span> Nervous system disease affecting nerves beyond the brain and spinal cord

Peripheral neuropathy, often shortened to neuropathy, refers to damage or disease affecting the nerves. Damage to nerves may impair sensation, movement, gland function, and/or organ function depending on which nerves are affected. Neuropathies affecting motor, sensory, or autonomic nerves result in different symptoms. More than one type of nerve may be affected simultaneously. Peripheral neuropathy may be acute or chronic, and may be reversible or permanent.

<span class="mw-page-title-main">Fasciculation</span> Spontaneous, involuntary muscle twitch

A fasciculation, or muscle twitch, is a spontaneous, involuntary muscle contraction and relaxation, involving fine muscle fibers. They are common, with as many as 70% of people experiencing them. They can be benign, or associated with more serious conditions. When no cause or pathology is identified, they are diagnosed as benign fasciculation syndrome.

<span class="mw-page-title-main">Nerve conduction study</span> Diagnostic test for nerve function

A nerve conduction study (NCS) is a medical diagnostic test commonly used to evaluate the function, especially the ability of electrical conduction, of the motor and sensory nerves of the human body. These tests may be performed by medical specialists such as clinical neurophysiologists, physical therapists, physiatrists, and neurologists who subspecialize in electrodiagnostic medicine. In the United States, neurologists and physiatrists receive training in electrodiagnostic medicine as part of residency training and in some cases acquire additional expertise during a fellowship in clinical neurophysiology, electrodiagnostic medicine, or neuromuscular medicine. Outside the US, clinical neurophysiologists learn needle EMG and NCS testing.

<span class="mw-page-title-main">Stiff-person syndrome</span> Human medical condition

Stiff-person syndrome (SPS), also known as stiff-man syndrome, is a rare neurological disorder of unclear cause characterized by progressive muscular rigidity and stiffness. The stiffness primarily affects the truncal muscles and is characterised by spasms, resulting in postural deformities. Chronic pain, impaired mobility, and lumbar hyperlordosis are common symptoms.

<span class="mw-page-title-main">Neuromuscular disease</span> Medical condition

A neuromuscular disease is any disease affecting the peripheral nervous system (PNS), the neuromuscular junctions, or skeletal muscles, all of which are components of the motor unit. Damage to any of these structures can cause muscle atrophy and weakness. Issues with sensation can also occur.

<span class="mw-page-title-main">Chronic inflammatory demyelinating polyneuropathy</span> Medical condition

Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired autoimmune disease of the peripheral nervous system characterized by progressive weakness and impaired sensory function in the legs and arms. The disorder is sometimes called chronic relapsing polyneuropathy (CRP) or chronic inflammatory demyelinating polyradiculoneuropathy. CIDP is closely related to Guillain–Barré syndrome and it is considered the chronic counterpart of that acute disease. Its symptoms are also similar to progressive inflammatory neuropathy. It is one of several types of neuropathy.

Small fiber peripheral neuropathy is a type of peripheral neuropathy that occurs from damage to the small unmyelinated and myelinated peripheral nerve fibers. These fibers, categorized as C fibers and small Aδ fibers, are present in skin, peripheral nerves, and organs. The role of these nerves is to innervate some skin sensations and help control autonomic function. It is estimated that 15–20 million people in the United States have some form of peripheral neuropathy.

<span class="mw-page-title-main">Radiculopathy</span> Medical condition

Radiculopathy, also commonly referred to as pinched nerve, refers to a set of conditions in which one or more nerves are affected and do not work properly. Radiculopathy can result in pain, weakness, altered sensation (paresthesia) or difficulty controlling specific muscles. Pinched nerves arise when surrounding bone or tissue, such as cartilage, muscles or tendons, put pressure on the nerve and disrupt its function.

A paraneoplastic syndrome is a syndrome that is the consequence of a tumor in the body. It is specifically due to the production of chemical signaling molecules by tumor cells or by an immune response against the tumor. Unlike a mass effect, it is not due to the local presence of cancer cells.

<span class="mw-page-title-main">ALS</span> Rare neurodegenerative disease

Amyotrophic lateral sclerosis (ALS), also known as motor neurone disease (MND) or Lou Gehrig's disease in the United States, is a rare and terminal neurodegenerative disease that results in the progressive loss of motor neurons that control voluntary muscles. ALS is the most common form of the motor neuron diseases. Early symptoms of ALS include stiff muscles, muscle twitches, gradual increasing weakness, and muscle wasting. Limb-onset ALS begins with weakness in the arms or legs, while bulbar-onset ALS begins with difficulty in speaking or swallowing. Around half of people with ALS develop at least mild difficulties with thinking and behavior, and about 15% develop frontotemporal dementia. Motor neuron loss continues until the abilities to eat, speak, move, or, lastly, breathe are lost.

<span class="mw-page-title-main">Brody myopathy</span> Medical condition

Brody myopathy, also called Brody disease, is a rare disorder that affects skeletal muscle function. BD was first characterized in 1969 by Dr. Irwin A. Brody at Duke University Medical Center. Individuals with BD have difficulty relaxing their muscles after exercise. This difficulty in relaxation leads to symptoms including cramps, stiffness, and discomfort in the muscles of the limbs and face. Symptoms are heightened by exercise and commonly progress in severity throughout adulthood.

Multifocal motor neuropathy (MMN) is a progressively worsening condition where muscles in the extremities gradually weaken. The disorder, a pure motor neuropathy syndrome, is sometimes mistaken for amyotrophic lateral sclerosis (ALS) because of the similarity in the clinical picture, especially if muscle fasciculations are present. MMN is thought to be autoimmune. It was first described in the mid-1980s.

<span class="mw-page-title-main">Monomelic amyotrophy</span> Medical condition

Monomelic amyotrophy (MMA) is a rare motor neuron disease first described in 1959 in Japan. Its symptoms usually appear about two years after adolescent growth spurt and is significantly more common in males, with an average age of onset between 15 and 25 years. MMA is reported most frequently in Asia but has a global distribution. It is typically marked by insidious onset of muscle atrophy of an upper limb, which plateaus after two to five years from which it neither improves nor worsens. There is no pain or sensory loss associated with MMA. MMA is not believed to be hereditary.

Peripheral mononeuropathy is a nerve related disease where a single nerve, that is used to transport messages from the brain to the peripheral body, is diseased or damaged. Peripheral neuropathy is a general term that indicates any disorder of the peripheral nervous system. The name of the disorder itself can be broken down in order to understand this better; peripheral: in regard to peripheral neuropathy, refers to outside of the brain and spinal cord; neuro: means nerve related; -pathy; means disease. Peripheral mononeuropathy is a disorder that links to Peripheral Neuropathy, as it only effects a single peripheral nerve rather than several damaged or diseased nerves throughout the body. Healthy peripheral nerves are able to “carry messages from the brain and spinal cord to muscles, organs, and other body tissues”.

<span class="mw-page-title-main">Autosomal recessive axonal neuropathy with neuromyotonia</span> Medical condition

Autosomal recessive axonal neuropathy with neuromyotonia, also known as Gamstorp-Wohlfart syndrome, is a rare hereditary disorder which is characterized by progressive poly-neuropathy, neuromyotonia, myokymia, pseudo-myotonia, hand-foot contractures, and abnormal neuro-myotonic/myokimic activity visible on needle EMG. According to OMIM, around 52 cases have been reported in medical literature However; new cases have been reported since 2014.

References

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  2. Ropper, Allan H.; Brown, Robert H. (2005). "Disorders of Muscle Characterized by Cramp, Spasm, Pain, and Localized Masses". Adams and Victor's Principles of Neurology (8th ed.). New York: McGraw-Hill. pp. 1277–8. ISBN   978-0-07-141620-7.
  3. Hart, Ian K.; Maddison, Paul; Newsom‐Davis, John; Vincent, Angela; Mills, Kerry R. (2002). "Phenotypic variants of autoimmune peripheral nerve hyperexcitability". Brain. 125 (8): 1887–95. doi: 10.1093/brain/awf178 . PMID   12135978.
  4. 1 2 Lagueny, A (2005). "Cramp-fasciculation syndrome". Revue Neurologique. 161 (12 Pt 1): 1260–6. doi:10.1016/S0035-3787(05)85238-5. PMID   16340924.
  5. Washington University in St. Louis, Neuromuscular: Cramp-Fasciculation Syndromes, http://neuromuscular.wustl.edu/mother/activity.html#crampfas
  6. Tahmoush, AJ; Alonso, RJ; Tahmoush, GP; Heiman-Patterson, TD (1991). "Cramp-fasciculation syndrome: a treatable hyperexcitable peripheral nerve disorder". Neurology. 41 (7): 1021–4. doi:10.1212/wnl.41.7.1021. PMID   1648679. S2CID   28873053.
  7. TeleEMG website, Amyotrophic Lateral Sclerosis (ALS)/Motor Neuron Disease, Page 2 "EMG & Nerve Conductions | EMG F.A.Q : ALS - Page 2". Archived from the original on 2010-11-29. Retrieved 2010-10-27.
  8. de Entrambasaguas, Manuel; Ortega-Albás, Juan-José; Martínez-Lozano, María-Dolores; Díaz, José-Ramón (2006). "Bronchial involvement in the cramp-fasciculation syndrome". European Neurology. 56 (2): 124–6. doi:10.1159/000095703. PMID   16960453. S2CID   45080149.
  9. 1 2 Tahmoush, A. J.; Alonso, R. J.; Tahmoush, G. P.; Heiman-Patterson, T. D. (1991). "Cramp-fasciculation syndrome: A treatable hyperexcitable peripheral nerve disorder". Neurology. 41 (7): 1021–4. doi:10.1212/wnl.41.7.1021. PMID   1648679. S2CID   28873053.
  10. Allan H. Ropper; Robert H. Brown. "Chapter 55. Disorders of Muscle". Adams and Victor's Principles of Neurology (8th ed.). pp. 1277–1278.
  11. Hart, I.; Maddison, P.; Newsom-Davis, J.; Vincent, A.; Mills, K. R. (August 2002). "Phenotypic Variants of Autoimmune Peripheral Nerve Hyperexcitability". Brain. 125 (8): 1887–1895. doi: 10.1093/brain/awf178 . PMID   12135978.