Editing Benign fasciculation syndrome (section)

==Diagnosis==
Benign fasciculation syndrome is a [[diagnosis of exclusion]]; that is, other potential causes for the twitching must be ruled out before BFS can be diagnosed. Diagnosis includes blood tests, a neurological exam, and [[electromyography]] (EMG).<ref name= Walter2015/>

Another step in diagnosing BFS is checking for clinical weakness or wasting, which are found in more serious conditions.<ref name= Carvalho2017/><ref name= Walter2015/> Lack of clinical weakness along with normal EMG results (in those with only fasciculations) largely eliminates more serious disorders from potential diagnosis.<ref name= Walter2015/><ref name= Turner2013/> In younger people with only [[lower motor neuron]] (LMN) fasciculations, no muscle weakness, and no thyroid abnormalities, Turner and Talbot (2013) state that "individuals under 40 years can be reassured without resorting to electromyography (EMG) to avoid the small but highly damaging possibility of false-positives".<ref name= Turner2013/>

According to Kincaid (1997), the diagnosis is made when there is no clinical finding of neurogenic disease; he first reassures patients that no "ominous disease seems to be present", and says, "I suggest that patients like this be followed for a year or longer with clinical and electromyographic exams at about 6-month intervals before one becomes secure in the diagnosis that the fasciculations are truly benign."<ref>{{cite journal |vauthors=Kincaid JC |title=Muscle pain, fatigue, and fasiculations |journal=Neurol Clin |volume=15 |issue=3 |pages=697–709 |date=August 1997 |pmid=9227959 |doi=10.1016/s0733-8619(05)70340-6 |type= Review}}</ref> Other publications recommend followups for four or five years before ruling the condition benign, although the percentage of individuals who progress to a more serious condition is very low.<ref name= Walter2015/>

===Classification===
Benign fasciculation syndrome and the variant cramp fasciculation syndrome "can be regarded as part of a larger spectrum of disease that also incorporates acquired auto-immune [[neuromyotonia]].<ref name= Carvalho2017/>

===Differential===
Other serious diseases that must be distinguished include [[motor neuron disease]]s (MND) such as [[amyotrophic lateral sclerosis]] (ALS),<ref name= Turner2013/> [[neuropathy]],<ref name=Carvalho2017>{{cite journal |vauthors=de Carvalho M, Kiernan MC, Swash M |title=Fasciculation in amyotrophic lateral sclerosis: origin and pathophysiological relevance |journal=J. Neurol. Neurosurg. Psychiatry |volume=88 |issue=9 |pages=773–779 |date=September 2017 |pmid=28490504 |doi=10.1136/jnnp-2017-315574 |s2cid=5320073 |type= Review}}</ref> and [[spinal cord disease]]s.<ref name= Carvalho2017/>

According to Turner and Talbot (2013), "the fasciculations of MND are often abrupt and widespread at onset in an individual previously unaffected by fasciculations in youth. The site of the fasciculations, for example, those in the calves versus abdomen, has not been shown to be discriminatory for a benign disorder. There is conflicting evidence as to whether the character of fasciculations differs neurophysiologically in MND."<ref name= Turner2013>{{cite journal |last1=Turner |first1=Martin R |last2=Talbot |first2=Kevin |title=Mimics and chameleons in motor neurone disease |journal=Practical Neurology |date=June 2013 |volume=13 |issue=3 |pages=153–164 |doi=10.1136/practneurol-2013-000557 |pmid=23616620 |pmc=3664389 }}</ref> It is "exceptionally rare for patients later diagnosed with ALS to present with fasciculations alone", and ALS is ruled out with a normal EMG and no evidence of muscle wasting.<ref name= Walter2015/>