Cramp and fasciculation syndrome.
Introduction: peripheral nerve hyperexitability (PNH) is associated with a series of neuromuscular disorders and is clinically characterized by myalgia, muscle cramps or stiffness accompanied by involuntary movements of groups of muscle fibers (fasciculations and myokymias).
Disorders involving PNH include Acquired Neuromyotonia with hyperhidrosis (Isaacs’ syndrome) Acquired Neuromyotonia with sleep disorder syndrome (Morvan’s syndrome) and Cramp and Fasciculation Syndrome (CFS). In Isaacs’ and Morvan’s syndromes, neuromyotonic discharges and discharge outbreaks of high-frequency potential of a single motor unit, known as myokymias, occur spontaneously. When these discharges do not occur continuously, they manifest as fasciculations, seen in CFS. In this condition, the motor unit potentials may become more frequent after minimal voluntary activity or nerve stimulation.
Objective: To present the case of isolated cramp and fasciculation, aggravated by physical activity and responsive activity to carbamazepine. Case Report: A.S., 54 years of age, male, white, has been having muscles fasciculation in the arms, trunk and legs for a year. Patient also refers recent occurrences of cramps in the muscle of arms, legs and trunk, which aggravate after physical activity. Denies loss of strength and muscle atrophy. Electroneuromyography study showed no changes. Laboratory tests were conducted in order to evaluate thyroid function, electrolyte disorders and chest tomography, all examinations were normal. Treatment with carbamazepine was initiated, resulting in complete disappearance of symptoms.
Discussion: Although it is an alert symptom for Motor Neurone Disease (MND), fasciculation is part of regular physiology and can be caused by exercise, anxiety, caffeine and alcohol. In patients presenting fasciculation and evident weakness, motor neuron diseases become a likely diagnosis, devastating to the lives of patients. Fasciculations without weakness (and normal electroneuromyography) may be part of DNM mimicking diseases, an example of favorable evolution to CFS. Described by Tahmoush et al in 1991, this clinical syndrome characterized by disabling muscle cramps and fasciculations occurring in individuals without other symptoms. These symptoms respond favorably to the voltage-gated sodium channel blocker carbamazepine.
Treatment with carbamazepine resulted in complete disappearance of symptoms.
neuro, cramp, fasciculations, syndrome
unisc - Rio Grande do Sul - Brasil
andrei sanson dias