Benign Fasciculation Syndrome (BFS) - also known as 'muscle fasciculation syndrome', 'benign fasciculation', 'fasciculation syndrome' - is an uncommon condition associated with involuntary muscle twitching. Although no drugs have been developed to treat it, there is evidence to show that antioxidant supplementation can alleviate BFS. 

BFS is a disorder of the nervous system characterized by the uncontrolled twitching (fasciculation) of voluntary muscle groups in various parts of the body that may or may not be associated with muscle cramps. Although it occurs more commonly in the muscles of the legs, arms and face, it can occur in any voluntary muscles, including those of the tongue. As its name suggests, it is a benign, somewhat irksome condition that, fortunately, does not progress to any other serious neurological disorder.

The fasciculation may be localized, occurring in only small groups of muscles – a twitching eyelid for instance; or it may be extensive and involve one or all of the limbs. The twitching may be intermittent or continuous and most people will experience a degree of BFS at sometime in their lives without realizing that they have this condition. For example, a simple facial 'tic' is a localized form of BFS.
However, most individuals will only be aware of the diagnosis of BFS when the symptoms become so widespread and persistent that they seek medical advice.

The muscle twitching found in BFS is similar to that seen in the more serious neurological disease, amyotrophic lateral sclerosis (ALS) - also known as Lou Gehrig's disease or motor neuron disease. Although fasciculation is a feature of both BFS and ALS, twitching in BFS usually ceases when the affected muscle is exercised while in ALS patients it persists whether the muscles are moving or at rest.
A diagnosis of BFS is usually made after a full neurological examination (including electromyography – EMG) has excluded other, more serious diseases.

Causes of BFS

Although the precise cause of BFS is unknown it may associated with several factors including acute viral illnesses, exercise, anxiety and drugs. Some authorities have suggested that exposure to insecticides could also be a causative factor as muscle fasciculation is a prominent symptom seen in organophosphate and other chemical poisoning.

Underlying pathology

Because the symptoms of BFS are similar to those of organophosphate poisoning it is thought that the root of the problem lies at the neuromuscular junction – the region where nerve meets muscle.

Acetylcholine is the neurotransmitter that conveys the signal from the nerve endings to muscle fibres causing them to contract. Immediately after acetycholine has stimulated the muscle receptors it is deactivated by the enzyme, acetylcholine esterase. If this enzyme is neutralized by a toxin such as an organophosphate insecticide, the acetylcholine continues to act on the muscle, causing cramps and fasciculation.

Although there are drugs to treat acute organophosphate poisoning some interesting research has shown that antioxidants may be able to prevent the muscle hyper-excitability that is associated with organophosphate toxicity. Researchers have postulated that, in addition to their direct toxic effects, pesticides induce oxidative stress by releasing large quantities of free radicals. Antioxidants given prior to exposure to organophosphates appear to prevent the onset of fasciculation by neutralizing the excess free radicals.

By extrapolating this knowledge it is not unreasonable to presuppose that antioxidants will also help to alleviate the muscle twitching associated with BFS.

Exercise and BFS
One of the triggering factors in a large proportion of BFS patients is prolonged exercise.

Free radicals are the waste products of the cell's energy production processes; therefore the longer and more intensely an individual exercises the greater the quantity of free radicals that will be produced by his body. It is for this reason that endurance athletes regularly subject themselves to free radical overload and oxidative stress.

As most cases of BFS are associated with prolonged exercise we can be almost certain that the muscle twitching is aggravated by oxidative stress and free radical interference at the neuromuscular junction. It makes sense, therefore, to use antioxidants to treat this disease. 

Treatment of BFS

Drug therapy
As BFS is a relatively uncommon, benign disease that is often self limiting, very little effort has been made to find a specific drug to treat it . Anecdotal reports have shown that some individuals benefit from either pharmaceutical or natural sedatives. However there are no clinical trials showing whether or not they are more effective than placebos.

Antioxidants
Antioxidants protect against Alzheimer's disease and Parkinson's disease and preliminary evidence suggests that they could be influential in treating other neurological conditions like BFS.

As prolonged physical activity produces large quantities of free radicals and exercise is such a strong precipitating factor for this condition, oxidative stress is almost certainly one of the underlying pathological factors contributing to BFS.

Vitamins and minerals
In order to neutralize as many different free radical species as possible oxidative stress is treated with a wide range of antioxidants. An adequate intake of essential nutrients, including the antioxidant vitamins and minerals, vitamins E, C, ß-carotene, selenium and zinc, should be supplemented with foods rich in plant-based antioxidants.

Spices
Spices are the richest food source of antioxidants and there is anecdotal evidence showing that spice supplements can be used to successfully treat BFS.  

To prevent exercise-induced fasciculation it is important to take the supplement on a daily basis as well as immediately before and after prolonged exercise.
A significant response should be evident within a few days to several weeks after starting treatment.

Those who have non-exercise induced BFS should also benefit from antioxidant supplementation as they may be under oxidative stress for reasons other than physical exertion.