Diseases » Febrile Seizures

Fasciculations

Fasciculations: Excerpt from Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series

Fasciculations are local muscle contractions representing the spontaneous discharge of a muscle fiber bundle innervated by a single motor nerve filament. These contractions cause visible dimpling or wavelike twitching of the skin, but they aren’t strong enough to cause a joint to move. They occur irregularly at frequencies ranging from once every several seconds to two or three times per second; infrequently, myokymia — continuous, rapid fasciculations that cause a rippling effect — may occur. Because fasciculations are brief and painless, they commonly go undetected or are ignored.

Benign, nonpathologic fasciculations are common and normal. They often occur in tense, anxious, or overtired people and typically affect the eyelid, thumb, or calf. However, fasciculations may also indicate a severe neurologic disorder, most notably a diffuse motor neuron disorder that causes loss of control over muscle fiber discharge. They’re also an early sign of pesticide poisoning.

Act Now: Begin by asking the patient about the nature, onset, and duration of the fasciculations. If the onset was sudden, ask about any precipitating events, such as exposure to pesticides. Pesticide poisoning, although uncommon, is a medical emergency requiring prompt and vigorous intervention. You may need to maintain airway patency, monitor vital signs, give oxygen, and perform gastric lavage or induce vomiting.

Assessment

History

If the patient isn’t in severe distress, find out if he has experienced any sensory changes, such as paresthesia, or any difficulty speaking, swallowing, breathing, or controlling bowel or bladder function. Ask him if he’s in pain.

Explore the patient’s medical history for neurologic disorders, cancer, and recent infections. Ask him about his lifestyle, especially stress at home, on the job, or at school.

Ask the patient about his dietary habits, especially recent intake of his foods and fluids, because electrolyte imbalances may also cause muscle twitching.

Physical examination

Perform a physical examination, looking for fasciculations while the affected muscle is at rest. Observe and test for motor and sensory abnormalities, particularly muscle atrophy and weakness, and decreased deep tendon reflexes. If you note these signs and symptoms, suspect motor neuron disease, and perform a comprehensive neurologic examination.

Pediatric pointers

Fasciculations, particularly of the tongue, are an important early sign of Werdnig-Hoffmann disease.

Medical causes

Amyotrophic lateral sclerosis

Coarse fasciculations usually begin in the small muscles of the hands and feet, and then spread to the forearms and legs. Widespread, symmetrical muscle atrophy and weakness may result in dysarthria; difficulty chewing, swallowing, and breathing; and, occasionally, choking and drooling.

Bulbar palsy

Fasciculations of the face and tongue commonly appear early. Progressive signs and symptoms include dysarthria, dysphagia, hoarseness, and drooling. Eventually, weakness spreads to the respiratory muscles.

Guillain-Barré syndrome

Fasciculations may occur, but the dominant neurologic symptom is muscle weakness, which typically begins in the legs and spreads quickly to the arms and face. Other findings include paresthesia, incontinence, footdrop, tachycardia, dysphagia, and respiratory insufficiency.

Herniated disk

Fasciculations of the muscles innervated by compressed nerve roots may be widespread and profound, but the overriding symptom is severe low back pain that may radiate unilaterally to the leg. Coughing, sneezing, bending, and straining exacerbate the pain. Related effects include muscle weakness, atrophy, and spasms; paresthesia; footdrop; steppage gait; and hypoactive deep tendon reflexes in the leg.

Poliomyelitis (spinal paralytic)

Coarse fasciculations, usually transient but occasionally persistent, accompany progressive muscle weakness, spasms, and atrophy. The patient may also exhibit decreased reflexes, paresthesia, coldness and cyanosis in the affected limbs, bladder paralysis, dyspnea, elevated blood pressure, and tachycardia.

Spinal cord tumors

Fasciculations may develop along with muscle atrophy and cramps, asymmetrically at first and then bilaterally as cord compression progresses. Motor and sensory changes distal to the tumor include weakness or paralysis, areflexia, paresthesia, and a tightening band of pain. Bowel and bladder control may be lost.

Syringomyelia

Fasciculations may occur along with Charcot’s joints, areflexia, muscle atrophy, and deep, aching pain. Additional findings include thoracic scoliosis and loss of pain and temperature sensation over the neck, shoulders, and arms.

Other causes

Pesticide poisoning

Ingestion of organophosphate or carbamate pesticides commonly produces acute onset of long, wavelike fasciculations and muscle weakness that rapidly progresses to flaccid paralysis. Other common effects include nausea, vomiting, diarrhea, loss of bowel and bladder control, hyperactive bowel sounds, and abdominal cramping. Cardiopulmonary findings include bradycardia, dyspnea or bradypnea, and pallor or cyanosis. Seizures, vision disturbances (pupillary constriction or blurred vision), and increased secretions (tearing, salivation, pulmonary secretions, or diaphoresis) may also occur.

Nursing considerations

Prepare the patient for diagnostic studies, such as spinal X-rays, myelography, computed tomography scan, magnetic resonance imaging, and electromyography (EMG) with nerve conduction velocity tests. Prepare the patient for laboratory tests such as serum electrolyte levels. Help the patient with progressive neuromuscular degeneration to cope with activities of daily living, and provide appropriate assistive devices.

Patient teaching

Teach the patient with stress-induced fasciculations effective stress management techniques. Refer him to physical therapy, occupational therapy, or home care services, as indicated.

Book Source Details

• Book Title: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

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More About This Book: Title: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-624-5

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