![]() ![]() 1 With regard to fasciculations potentials induced by drugs, Masland and Wigiton, 6 in a pioneering experimental study, concluded that neostigmine can cause fasciculation potentials by increasing the concentration of acetylcholine at the neuromuscular junction in felines. 5 Also healthy individuals can have fasciculations, although they are generally located in well-defined sites, such as the brachial distal third, the crural area and the eyelids. It is also important to consider that several conditions may trigger them, such as other diseases of the fore tip of the spinal cord (benign monomelic amyotrophy, progressive spinal muscular atrophies, Hirayama disease and others), neuromuscular junction disorders, electrolyte disorders, systemic diseases and use of certain medications. However they are known to be associated with a hypersensitivity of denervated muscles. This suggests that fasciculation potentials may originate anywhere in the axon, probably within the distal axonal arborization. Potential fasciculations may also persist after a distal nerve block. In short, it is incorrect to associate fasciculations directly to the injury of fore tip of the spinal cord, because the skeletal pathophysiological involvement can be quite broad. 3 No one knows whether the origin of ALS is central, in the first or second motor neurons, in the peripheral, or even in the terminal motor nerve − which is an even more intriguing aspect for experts. The presence of fasciculations, however, is not a sign of ALS when no other symptoms or signs of involvement of the fore tip and the pyramidal bundle are identified. Undoubtedly, this finding in a neurological examination is of concern, given its close relationship with amyotrophic lateral sclerosis (ALS), a disease that leads to a depletion of neurons in the fore tip and the pyramidal bundle. Some neurologists call them verminosis, because they look like worms moving below the dermis. The fasciculations can be defined as visible fast, fine, spontaneous and intermittent contractions of muscle fibers. ![]()
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