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A peculiar case of anxiety amplified by abnormal movements – 08/20/2021 – Luciano Melo

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

This is the simplified explanation for those repetitive and strange flutters that, probably, everyone has already experienced, in some part of the face, like eyelids, or perhaps, in another part of the body. They almost always only cause annoyance and will spontaneously disappear, leaving the organism as it was before. However, when they happen in association with other disorders, the context changes and they start to denounce the possible presence of some very serious disease. Because they are present in such different situations, from the banal to the extremely worrisome, fasciculations can be alarming, when they don’t even deserve attention.

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

My colleague identified the fasciculation in his lower limbs. He froze in fear, recognized it as a classic symptom of motor neuron disease, a progressive, incurable and fatal condition. From that date on, he would no longer sleep properly. It was impossible to relax, the tactile sensation caused by the uncontrollable muscle movement made him imagine the cold touch of death, informing him of his future.

Convinced, even the normal results of laboratory tests did not allay his pessimistic musings. Vercueil moved away from academic commitments, from medical societies, and began contacting his health insurance administrators. For him any activity not aimed at extending his survival had become a meaningless burden.

Another neurologist and former friend was informed of the insomniac’s sudden withdrawal. Worried, he went to visit him.

Vercueil was frank, did not hide his fear, showed the fasciculations and pointed out two other symptoms that, at the time, he was certain he was suffering from: muscular rigidity and weakness. Your partner was objective, said you should sleep. Two nights of good sleep would be enough for everything to work out, and so he suggested a remedy.

Encouraged by the idea, the tense man took the advice. He used the pills and two days later his symptoms disappeared, like magic.

Anxiety and fasciculation syndrome, that was the correct diagnosis for Laurent Vercueil. He discovered this himself, days after the suffocation had passed. This condition, described less than a decade ago, targets people like the neurologist: anxious, sleepless and abusive coffee consumers.

It made sense. Before the first fasciculation, a few months ago, he had increased his medical care journey, in addition to exchanging hours of sleep for time spent exhaustingly preparing classes for congresses and scientific meetings. Fasciculations, in his case, were the physical emergence of anxiety. The tension got worse when he thought he was suffering from a serious illness.

Anxiety is an adaptive emotion, as it increases our wakefulness and makes us mentally anticipate what will happen in the future, to allow for better preparation. However, when too intense, it narrows the attention. With cognition focused on just a few particularities, other factors, possibly more relevant, are ignored.

My neurologist colleague connected with the idea of ​​serious illness. Convinced, he did not value exam results and was far from being sensible. His anxiety fueled symptoms that fueled the anxiety, and so it was until a friendly opinion broke this vicious cycle.

References:

1-Vercueil L. FASICS: fasciculation anxiety syndrome in clinicians. Neurol Practice 2020 Dec;20(6):514-515. doi: 10.1136/practneurol-2020-002770. PMID: 33229449.

2-Simon NG, Kiernan MC. Fasciculation anxiety syndrome in clinicians. J Neurol. 2013 Jul;260(7):1743-7. doi: 10.1007/s00415-013-6856-8. Epub 2013 Feb 12. PMID: 23400500.

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