I recently made the acquaintance of a woman, age 44, who suffers prolonged
episodes of painful fasciculations. Contractions begin in the calf and
over a period of minutes irradiate up the leg causing intense tetanic
contractions. The attacks are usually asymmetrical (usually the left side,
sometimes the right, and occasionaly both). I observed one attack and the
increasing frequency of contration of the gastrocnemius was palpable. The
muscle groups involved seem to include the hamstrings and the tensor fascia
lata and possibly the gluteus. The episode lasted for over 18 hours and in
subsequence conversations over the past three weeks she reports several
incidents lasting days. The attacks typically begin in the evening as she
falls asleep. She is also very sensitive to light touch which makes her
ill at ease, possibly nauseous, and may trigger attacks.
She is bright, trim, athletic, well muscled, and normally very active. Her
left side was traumatized in a boating accident possibly twenty years ago.
I am not clear on this but her mother was apparently abusive, possibly
physically as early as age 6. About 18 years ago she joined AA after 14
years of intense alcohol abuse. The attacks began about 8-10 years ago and
have been at times unrelenting. She states that Valium (5 mg) alleviates
the symptoms completely but sets off an addictive cycle that she
desparately wishes to avoid. Consequently, she has been into massage,
accupuncture, diet therapies, and nothing seems to work. I have suggested
she return to the states for medical attention, but she has no insurance
and chooses to live in the British Virgin Islands where a physician will
prescribe muscle relaxants which help but do not provide total or reliable
relief. The fatigue and pain seem not to have eroded her clarity of
thought but she is emotionally all over the place. Most likely because she
fears sleep and never knows when the next attack will occur.
It is my hope that some sound ideas on the pathogenesis of this condition
will persuade her to seek qualified medical assistance.
rlh
Richard Hall
Comparative Animal Physiologist
Division of Sciences and Mathematics
University of the Virgin Islands
St. Thomas, USVI 00802
809-693-1386
rhall at uvi.edu
