What treatment options are available for fasciculations?

Fasciculations are repetitive, involuntary movements of individual muscle fibers that occur frequently in ALS and can be distressing. Fasciculations (like muscle cramps) result from a disruption in the connection between motor nerves and muscle tissue.

Fasciculations require treatment only if they are perceived as bothersome. Frequent and generalized fasciculations (e.g., involving the chest and abdominal muscles) can interfere with daily activities and cause sleep disturbances. In such cases, pharmacological treatment may be appropriate. The medications baclofen and gabapentin can reduce fasciculations.

If treatment proves ineffective, treatment with cannabis-based medications should be considered. There are case reports of a reduction in fasciculations (and muscle spasms) following treatment with tetrahydrocannabinol and cannabidiol (THC:CBD). Treatment with THC:CBD is medically and administratively complex, as this class of medications is subject to the Narcotics Act and is available only upon submission of an application for coverage by health insurance.

Overall, treatment options for fasciculations are limited to a few medications. However, it is only in rare cases that the symptoms are experienced as so distressing that patients seek medication.