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A 40‐year‐old man was referred to the neuromuscular clinic with generalised fasciculations, raising the concerns for amyotrophic lateral sclerosis (ALS). Previously, he was a physically fit gym enthusiast without intercurrent medical problems. He was not prescribed medications and consumed supplements linked to his fitness program (Box 1). His presenting complaint was muscle twitching (Supporting Information video 1 and Supporting Information video 2), which evolved over an eight‐month period.

Over the next weeks, he noticed undulating movements (myokymia) and twitching of muscles in his feet. This lasted for hours and continued while asleep. The twitching became increasingly frequent and intense, progressing to involve his proximal limbs, trunk, neck, and facial muscles. He described intermittent cramping of abdominal muscles. Several months later, he developed allodynia and hyperaesthesia of his feet, described as a burning sensation over the soles. He also reported intermittent paraesthesia involving his feet, back and trunk.

This MJA medical education letter shares more.

Learning Outcomes

1. Explain key components of the medical education
2. List main findings
3. Explain the impact of high-dose of vitamin B to minimise the risk of general fasciculation syndrome.

Details

Author: Dhayalen Krishnan and Matthew C Kiernan

Article Type: Medical Education