From the Guidelines
For fasciculations in the chest wall, I recommend starting with lifestyle modifications and employing anxiety management and distraction techniques, as these can help reduce symptoms. Reduce caffeine, alcohol, and nicotine consumption as these stimulants can trigger or worsen muscle twitching 1. Ensure adequate hydration by drinking 2-3 liters of water daily, as dehydration can exacerbate fasciculations. Manage stress through regular exercise, meditation, or deep breathing exercises, as anxiety often worsens these symptoms. Improve sleep quality by maintaining a consistent sleep schedule and creating a restful environment.
Key Considerations
- Employing anxiety management and distraction techniques when undertaking a task can be helpful, as suggested by the occupational therapy consensus recommendations for functional neurological disorder 1.
- Video recording interventions (with consent) can be useful to play back to the person to identify changes in symptoms, demonstrate changeability, highlight successes, and act as a reference point for replication of strategies outside of therapy 1.
- Some key strategies for functional movement symptoms, such as functional tremor, jerks, dystonia, and limb weakness, include techniques to encourage normal movement patterns and resting postures, which may be beneficial for fasciculations as well 1.
Additional Measures
If these measures don't help, magnesium supplements (200-400mg daily) may be beneficial as magnesium deficiency can contribute to muscle twitching. For persistent symptoms, consult a healthcare provider who might consider prescribing medications like low-dose benzodiazepines or beta-blockers to reduce the sensation. Fasciculations typically result from spontaneous discharges of motor neurons causing involuntary muscle contractions. While usually benign, especially in young healthy adults, persistent symptoms warrant medical evaluation to rule out underlying neurological conditions, though these are rare in the absence of other symptoms. The evidence from the provided studies, particularly the occupational therapy consensus recommendations 1, guides the approach to managing fasciculations by focusing on lifestyle modifications, anxiety management, and distraction techniques.
From the Research
Measures to Help Reduce Fasciculations
To address the left-sided pulsation in the chest suspected to be fasciculations, several measures can be considered:
- Electrodiagnostic Tests: Perform electrodiagnostic tests such as needle electromyography (EMG) to differentiate between myopathic and neuropathic disorders and to determine the nature and cause of the myopathy 2.
- Muscle Relax Relaxation Techniques: Although not directly mentioned in the studies, relaxation techniques such as deep breathing, progressive muscle relaxation, or meditation may help reduce muscle tension and alleviate fasciculations.
- Medical Evaluation: A thorough medical evaluation is necessary to rule out any underlying conditions that may be causing the fasciculations, such as myasthenic syndrome, myotonic syndrome, or periodic paralysis 2, 3.
- Lifestyle Modifications: Making lifestyle changes such as getting regular exercise, maintaining a healthy diet, and getting adequate sleep may help reduce stress and alleviate fasciculations.
Diagnostic Approach
The diagnostic approach to fasciculations involves:
- Needle EMG: Performing needle EMG to record motor unit potentials (MUPs) and detect abnormal electrical activity, such as fibrillation potentials or myotonic discharges 2, 3.
- Sensory Nerve Conduction Studies: Conducting sensory nerve conduction studies to disclose the coexistence of a sensory neuropathy 2.
- Functional Provocative Tests: Performing functional provocative tests, such as 3Hz repetitive nerve stimulation or repeated short exercise, to search for underlying conditions such as myasthenic syndrome or myotonic syndrome 2.