A special case of fear exacerbated by abnormal movements – 8/20/2021 – Luciano Melo

Fasciculations are contractions of a small part of a muscle caused by accidental electrical discharges created by just one of the many neurons that make up the same nerve.

This is the simplified explanation for this repetitive and strange flutter that everyone has probably experienced in one part of the face, like the eyelids, or perhaps another part of the body. They almost always only cause anger and disappear spontaneously, leaving the organism as it was before. However, when they appear in conjunction with other disorders, the context changes and they begin to denounce the possible presence of a very serious illness. Since they are present in so diverse situations, from the mundane to the extremely worrying, fasciculations can be alarming if they don’t even deserve attention.

The false warning sometimes affects those we least expect to be vulnerable. Just look at the example of Laurent Vercueil, a 47-year-old neurologist who defines himself as an ordinary man who leads an ordinary life. One night he was suddenly awakened by a strange feeling in his legs that lasted only a few minutes. To her sorrow, this strange thing came back intensely two weeks later.

My colleague identified the fasciculations in his lower limbs. He froze with fear, recognizing it as a classic symptom of motor neuron disease, a progressive, incurable, and fatal disease. From that day on, he wouldn’t sleep properly. It was impossible to relax, the tactile feeling caused by the uncontrollable muscle movement made him imagine the cold touch of death that informed him of his future.

Convinced, even the normal results of laboratory tests failed to appease his pessimistic reflections. Vercueil moved away from academic commitments and medical societies and contacted his health insurers. Any activity that was not aimed at prolonging his survival had become a meaningless burden for him.

Another neurologist and former friend was informed of the insomniacs sudden withdrawal. Worried, he went to see him.

Vercueil was open, not hiding his fear, showing the fasciculations and pointing out two other symptoms he was sure of at the time: muscle stiffness and weakness. Your partner was objective, said you should sleep. Two nights of good sleep would be enough for everything to work out, so he suggested a remedy.

Encouraged by the idea, the tense man accepted the advice. He took the pills and two days later his symptoms magically disappeared.

Anxiety and fasciculation syndrome, that was the correct diagnosis for Laurent Vercueil. He discovered it for himself days after the suffocation was over. Described less than a decade ago, this condition is aimed at people like the neurologist: anxious, sleepless, and abusive coffee users.

It made sense. Before the first fasciculation, a few months ago, in addition to exchanging sleep hours in exchange for strenuous class preparation for congresses and scientific conferences, he had extended his medical care trip. In his case, fasciculations were the physical emergence of fear. The tension grew worse when he believed he was suffering from a serious illness.

Fear is an adaptive emotion as it increases our alertness and makes us mentally anticipate what will happen in the future to allow for better preparation. However, if it is too intense, it restricts attention. Since cognition focuses on only a few specifics, other, possibly more relevant factors are ignored.

My neurologist colleague connected with the thought of a serious illness. Convinced, he didn’t care about exam results and was anything but sensible. His fear fueled symptoms that fueled the fear, and so it was until a friendly opinion broke this vicious circle.

References:

1-Vercueil L. FASICS: Fasciculatory Anxiety Syndrome in Clinicians. Neurol-Praxis 2020 Dec; 20 (6): 514-515. doi: 10.1136 / practneurol-2020-002770. PMID: 33229449.

2-Simon NG, Kiernan MC. Fasciculatory Anxiety Syndrome in Clinicians. J Neurol. 2013 July; 260 (7): 1743-7. doi: 10.1007 / s00415-013-6856-8. Epub 2013, February 12th. PMID: 23400500.

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