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Abstract
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Background and Aims Continuous fasciculation, when occurring without weakness, is referred to as benign fasciculation. Although generally considered non-threatening, cases that persist can significantly impact an individual’s quality of life.
Methods This discussion presents the situation of a 36-year-old male patient who experienced unyielding twitching localized to his left sole for a duration of two years. His medical history was devoid of any notable neuromuscular diseases, and results from electromyography (EMG) testing were within normal parameters. However, nerve conduction studies highlighted an increase in nerve conduction velocity specifically in the lateral segment of the left peroneal nerve and the left tibial nerve. Attempts at pharmacological intervention did not yield any improvement in his condition. While a nerve block targeting the left tibial nerve managed to reduce the severity of the twitching, it failed to decrease its frequency or provide a lasting solution.
Results In search of a more effective treatment, botulinum toxin was administered via ultrasound guidance into the flexor hallucis and digitorum longus muscles. This approach resulted in a marked reduction in both the frequency and severity of the twitching, enabling the patient to resume his daily activities and achieve restful sleep without experiencing any adverse effects.
Conclusions Through this case, the efficacy of botulinum toxin injections as a treatment for intractable twitching is underscored, offering valuable insights into potential therapeutic strategies for similar clinical presentations.
Ultrasound examination of medial side of the thigh
Ultrasound guided botulinum toxin injection to the flexor digitorum longus muscle