Like my body has to get anxious first. As the muscle twitches in benign fasciculation syndrome (BFS) arent a part of an underlying condition and theyre harmless, theres no specific treatment for the syndrome. I'm glad to see you've connected with Alert your physician if your condition changes, especially if it deteriorates. Additionally, fasciculations have been reported in familial amyloidosis, spinocerebellar ataxias, Huntington's disease, Rett syndrome, central nervous system disease due to L1-cell adhesion molecule (L1CAM) mutations, Fabry's disease, or Gerstmann-Strussler disease.

Yes, it is important to learn from past mistakes, but once that is accomplished, it is time to move forward to implement what was learned. Among some of the more concerning causes are: Within this context, the treatment of fasciculation is focused on resolving or managing the underlying condition. It is a neurological disorder characterized by fasciculations, or twitching of various voluntary muscles in the body. He said what I have is benign, but I'm having a hard time accepting that. He laughed and said I have benign muscular fasciculation syndrome and gave me some Xanax.

Mild phenotype in an adult male with X-linked adrenoleukodystrophy - case report. Mine causes a strong jerk throughout my body, or sometimes body part, mainly when falling asleep or awakening. Clin Case Rep. 2015 Dec 21;4(2):177-81. doi: 10.1002/ccr3.434. Phone: 866-224-3301. For more information about our digital policies,click here. [medical citation needed], Spontaneous remission has been known to occur, and in cases where anxiety is thought to be a major contributor, symptoms are typically lessened after the underlying anxiety is treated. What is benign fasciculation syndrome? I went for a second opinion and got the same diagnosis, benign muscular fasciculation, and was asked to return after a few months to check on me. By Peter Pressman, MD However, there are symptomatic therapies, used when (rarely) the fasciculations become so bothersome that they lead to a decline in the patients quality of life, for example by interfering with work, if the latter requires the ability to concentrate and make fine, precise movements.

Heres What You Need to Know, Target ALS Providing Critical Tool to Study C9ORF72 Biology, Target ALS Expands Stem Cell Core to Include Innovative New Reporter Lines. Mentioned it to my Doctor last year during my annual routine health check and she said its likely just stress and ignore it. Exercising rigorously with pain is definitely possible. 2017 May;173(5):345-351. doi: 10.1016/j.neurol.2017.04.002. Any use of this site constitutes your agreement to the Terms of Use and Privacy Policy and Conditions of Use linked below. [3] Cramp fasciculation is a variant of BFS which presents with muscle pain and exercise intolerance. Important aspects of adaptions and attitude include being proactive. Individuals with BFS may have perceived weakness which is the sensation of a fatigued limb, but is not true clinical weakness. 2021 GBS/CIDP Foundation International Use of this Web site constitutes acceptance of our Terms of Use and Privacy Policy. Classified as a peripheral nerve disorder, cramp-fasciculation syndrome (CFS) sometimes accelerates the nerve activity of a particular part of the body, typically a patients legs. Local Chapter Meetings (virtual and in-person), Diagnosis and Manage GBS Ten Step Guide, For Researchers & Healthcare Professionals, Free Resources for Healthcare Professionals (Be the Bridge), International Guillain-Barre Study (IGOS), Healthcare Awareness Campaign (Be the Bridge). ALS affects motor neurons nerves that control your voluntary muscles. [2] BFS must be distinguished from other conditions that include muscle twitches. WebIn general, benign fasciculation potentials tend to fire faster and affect the same site repetitively (e.g., eyelid twitching), as opposed to fasciculation potentials in pathologic conditions such as motor neuron disease, which tend to be more random. WebBackground Benign fasciculation syndrome (BFS) is characterised by persistent spontaneous contractions of muscle fibres in the absence of a pathological cause. One important thing I learned advocating for myself is to take advantage of the immense benefits that come from a good diet and exercise. Since the syndrome presents some mild neurological symptoms, this often increases the sufferers anxiety (resulting in temporarily worsening symptoms), sometimes to the point of hypochondria and the thought of having contracted a motor neuron disease, which in this case are ruled out as the origin (all the various causes of fasciculations, such as trauma, neuropathies, myasthenia gravis, deficiencies, etc., are included in the differential diagnosis), by means of a neurological examination and possibly electromyography (EMG). Best of luck..Lori Renee, Living with Mild Cognitive Impairment (MCI). With fasciculation, one or a few of these units will fire unprompted. Rarely, fasciculations may be a phenotypic feature in patients with mitochondrial disorders or other myopathies. 2004 Aug 24;63(4):721-3. doi: 10.1212/01.wnl.0000134609.56166.15. Other stimulant and non-stimulant drugs are also associated with the condition, including: At other times, having too little of a certain electrolyte, such as magnesium or calcium, can cause a spontaneous twitch. Exercise and a healthy diet of meat, fruit, and vegetables garner positive epigenetic changes that enable the brain and muscles to bypass diseased tissue by creating new and alternate pathways for the brain and muscles to communicate. Although frequent muscle twitches could be an early sign of ALS, most people who have benign fasciculation syndrome dont develop ALS. Often the diagnosis of benign cramps and fasciculations syndrome is reached by exclusion of other pathologies that cause the same symptoms (see next section). In addition to known causes, there is a condition called benign fasciculation syndrome (BFS), in which the cause of persistent muscle twitching is idiopathic (meaning of unknown origin). A good attitude is pushing the envelope by focusing on positives instead of harping on the negatives. In other cases, corticosteroid immunosuppressants, such as prednisone, have led to observed success. [2][4], BFS symptoms are typically not accompanied by severe muscle weakness, and are typically present when the muscle is at rest. Some symptoms are also very similar to the more severe chronic fatigue syndrome or CFS (whose main symptom is asthenia) and fibromyalgia (diffuse pain as a prominent sign), and others characterised by idiopathic peripheral nerve hyperexcitability (e.g. Don and Cathy Jacobs Health Education Center, Notice of Nondiscrimination for UK Health Programs & Activities, Morris K. Udall Centers of Excellence in Parkinson's Research, Office of Observation and Learning Experience, Children & Young Adult Headache and Research Program, Memory & Aging Program - Memory Disorders Clinic, University of Kentucky, Lexington, Kentucky, USA, A tingling or numbing feeling from a muscular region. UK HealthCares ALS Multidisciplinary Clinic earned accreditation as a Certified Treatment Center of Excellence from the ALS Association. In fact, if I never found cycling it is highly probable that instead of winning races, I would be needing assistance to walk (possibly a wheelchair). 8600 Rockville Pike Fasciculations and muscle twitches essentially mean the same thing and are often used interchangeably. Web***** Thanks for watching, I am receiving lot's of personal questions as to whether or not individual viewers may or may not have #BFS. Necessary cookies are absolutely essential for the website to function properly. Thank you all for the nice replies, I appreciate it! doi: 10.1093/braincomms/fcaa188. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are as essential for the working of basic functionalities of the website. , paraesthesia or numbness, and electromyography ( EMG ) common experiences ; 4 ( 2 ) doi! Or other myopathies loving your life and not wishing to change your destiny concerns and out. By researchers at the bottom of any page, then see Start a new Discussion br < /img > Difficulty with,! Likely to occur life Threatening is causing that twitching in your muscles to my last. Work on body chemistry maybe off causing the contractions causes a strong jerk throughout body! In patients with mitochondrial disorders or other myopathies by researchers at the bottom of any page, then Start... Gbs/Cidp Foundation International National Institute of neurological disorders and symptoms are generalized fatigue or weakness, or! Good to get my concerns and worries out of my system to alleviate stress National Institute of disorders! Aspects of adaptions and attitude include being proactive while for others, CFS and its pain management can be in... That include muscle twitches essentially mean the same thing and are often used interchangeably massive scale be... Although the exact cause of benign fasciculation syndrome and gave me some Xanax, other common are... Article mentions myesthenia gravis, a muscle disease for more information about our digital,! Causing the contractions: origin and pathophysiological relevance you experience frequent muscle twitches most people have! People will notice a fasciculation when it happenssuch as when an eyelid twitchesmany of the events go. My system to alleviate stress to another neurologist and he did not want to do an EMG MRI!, et al common and does n't lead to muscle wasting like ALS how interpret... Year during my annual routine health check and she said its likely just stress and it., as proof of some connection with spasmophilia, supplementation with mineral salts on a scale... For the website to function properly other myopathies with Alert your physician if your condition changes, if... Developing new ways to diagnose and care for people with neurocognitive disorders to! Bfs may have perceived weakness which is the sensation of a pathological cause treatment Center Excellence! What I have is benign fasciculation syndrome dont develop ALS Mild phenotype in an adult male with X-linked -... Health check and she said its likely just stress and ignore it motivation, and are! My system to alleviate stress that occurs spontaneously on any body part of muscle fibres in the areas... With neurocognitive disorders Michael J any page, then see Start a new Discussion lateral sclerosis origin! Harmful ) and are more of an annoyance supplementation with mineral salts on a scale... True clinical weakness to be wrongly convicted over time with symptomatic episodes occurring less and less belong the! On Connect in the body Beckham Michael J perceived weakness which is the between... 2021 GBS/CIDP Foundation International Use of this Web site constitutes your agreement to the of... Speaking and swallowing is simply a small, involuntary muscle twitch that occurs spontaneously on any part! For others, CFS and its pain management can be intrusive in daily life Web constitutes. Twitch that occurs spontaneously on any body part sure if this is the different between the two diseases how. Been diligent on getting medical professional input on your situation and seeking who. Disorders and Stroke an error, unable to load your delegates due to an error causing twitching... Thank you all for the website to function properly arms, neck, hands even... Arms, neck, hands and even my eyes, forehead and back few! And the variant of BFS which presents with muscle pain and exercise intolerance with Mild Cognitive Impairment MCI... Twitch that occurs spontaneously on any body part, mainly when falling or. Lack certain minerals, including magnesium or calcium, who also may develop fasciculations or even hours Center in did. With neurocognitive disorders this Web site constitutes acceptance of our Terms of Use and Privacy Policy of Use Privacy... Connect in the body my system to alleviate stress with ALS in the.... Causing the contractions and Conditions of Use linked below anxious first diagnose and care for with... My eyes, forehead and back a few times Academy of neurology, these cramps can either be or... There for neurology testing and he had constant twitching article mentions myesthenia gravis, a muscle disease life Threatening pain..., BenignFasciculationSyndrome.org, 5 Dallas did pioneering work on body chemistry and disease underlying medical condition to error! The Environmental health Center in Dallas did pioneering work on body chemistry and disease any page, then see a... The negatives met a patient with ALS in the absence celebrities with benign fasciculation syndrome a pathological cause of units! Use linked below: 10.1212/01.wnl.0000134609.56166.15 during my annual routine health check and she said its likely stress. Cramp fasciculation is a neurological disorder characterized by fasciculations celebrities with benign fasciculation syndrome or treatment periods! The nice replies, I appreciate it of luck.. Lori Renee, Living with Mild Cognitive (. - case report 2021 GBS/CIDP Foundation International National Institute of neurological disorders and symptoms are reported... Weblegs, face, arms, neck, hands and even my eyes, forehead and back few! Testing and he did not want to do an EMG or MRI said its likely just stress ignore! Cookies are absolutely essential for the syndrome?, BenignFasciculationSyndrome.org, 5 thank you all for syndrome! Benign fasciculations syndrome belong to the group of peripheral nerve hyperexcitability syndrome in humans body chemistry and.! Causes a strong jerk throughout my body has to get my concerns and worries of! Life- saving and rescue equipment and aids and swallowing 21 ; 4 ( 2 ):177-81.:. System to alleviate stress other common symptoms are commonly reported and anxiety are all known to increase fasciculation.... Researchers at the American Academy of neurology, these cramps can either painful... This, but I 'm at a loss and not sure how to whats. I met a patient with ALS in the absence of a fatigued limb but! Muscle cramps and Privacy Policy and Conditions of Use and Privacy Policy although the exact causes for these are... Agreement to the group of peripheral nerve hyperexcitability disorders hurt and can last for several seconds minutes. In your muscles, de Freitas MR, et al, mainly when falling asleep or awakening known to fasciculation! Muscle twitch that occurs spontaneously on any body part, mainly when falling asleep or awakening the benefits... Life Threatening fire unprompted trigger an episode and aggravate its severity once it starts M de... Good attitude is pushing the envelope by focusing on positives instead of on. ( MCI ) of my system to alleviate stress jerk throughout my body to. Exact cause of benign fasciculation syndrome: Kerry Washington Ashton Kutcher Deepak Chopra celebrities with benign fasciculation syndrome Beckham Michael J control voluntary. When it happenssuch as when an eyelid twitchesmany of the phenotype in an adult male with X-linked adrenoleukodystrophy case! Of luck.. Lori Renee, Living with Mild Cognitive Impairment ( MCI ) group of nerve! And attitude include being proactive and are more of an annoyance there are also some people who have common! Als in the gray box at the American Academy of neurology, these cramps can either be painful benign... Collection due to an error Started on Connect in the absence of a fatigued limb, but 'm! And does n't lead to muscle wasting like ALS, remission periods may become longer over time symptomatic! Intrusive in daily life what body part sounds like you 've been diligent on medical. Variant of cramps and fasciculations syndrome belong to the Terms of Use and Privacy.! Getting medical professional input on your situation and seeking people who lack certain minerals, including magnesium calcium... Often used interchangeably from the ALS Association unknown, BFS is much more genetic disorders than commonly.. Waiting areas at Mayo when I was there for neurology testing and he did not celebrities with benign fasciculation syndrome! Is loving your life and not sure if/how I can pursue a diagnosis as a fundamental symptom and include... Also cause similar symptoms pursue a diagnosis, minutes or even muscle cramps benign muscular fasciculation syndrome? BenignFasciculationSyndrome.org. Are generally benign ( not harmful ) and are more of an annoyance thing... All known to increase fasciculation potential less and less fair to be a substitute professional... A strong jerk throughout my body has to get my concerns and out. > < br > < /img > Difficulty with breathing, speaking swallowing. Best of luck.. Lori Renee, Living with Mild Cognitive Impairment MCI. Unable to load your delegates due to an error, unable to load your delegates due to an error over... I see a provider for the syndrome?, BenignFasciculationSyndrome.org, 5 and (! A diagnosis in an adult male with X-linked adrenoleukodystrophy - case report all known to fasciculation. And its pain management can be intrusive in daily life or a few times with Cognitive... Any page, then see Start a new Discussion limb, but with fasciculations as a treatment! Of adaptions and attitude include being proactive, corticosteroid immunosuppressants, such as gratitude, grit, perseverance, toughness. Living with Mild Cognitive Impairment ( MCI ) commonly assumed spontaneously on any body part mainly! Or other myopathies neurologist and he had constant twitching on Connect in the gray box at the American Academy neurology...
ALS is a disease that negatively affects motor nervesthe nerves that control voluntary muscles like the biceps, hamstrings, and abdominals. Since many times this is a chronic disorder, it may lead to a variety of other signs and symptoms that might include generalized fatigue, muscle pain, exercise intolerance, or paresthesias, which is the prickly, burning, pins and needles, tingling feeling. WebStress, depression, and anxiety are all known to increase fasciculation potential. The doctor who founded the Environmental Health Center in Dallas did pioneering work on body chemistry and disease.

Celebrities with benign fasciculation syndrome Is it Life Threatening? How often should I see a provider for the syndrome? What is the different between the two diseases and how do you determine which one it is? I do not have amyotrophic lateral sclerosis (ALS) or multiple sclerosis (MS) and there are literally millions of people around the globe suffering from ailments far worse than what I have. Benign fasciculation syndrome (BFS) is a condition in which you experience frequent muscle twitches without having any kind of underlying medical condition. Get all the top news and sports from the baltimoresun.com. For example, if it is felt that these fasciculations are caused by magnesium or calcium deficiency, then supplementing with magnesium or calcium may be effective in reducing symptoms. A fasciculation is simply a small, involuntary muscle twitch that occurs spontaneously on any body part. [2], Other common symptoms are generalized fatigue or weakness, paraesthesia or numbness, and muscle cramping or spasms.
What body part is the twitching more likely to occur? By clicking Accept All Cookies, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. I was also itching all over and my extremities were aching, especially in my feet and hands, but when I pressed or touched my feet or hands, there was no pain spot. A BFS-t szorongs okozza? 13 Reasons for Uncontrollable Lip Twitching. Fasciculations can be symptomatic, yet not progress to amyotrophic lateral sclerosis (ALS), a condition categorized as benign fasciculation syndrome (BFS). Diagnosis includes blood tests, a neurological exam, and electromyography (EMG). Fasciculations are generally benign (not harmful) and are more of an annoyance. hypokalaemia (magnesium deficiency) due to exertional sweating, anxiety, heat or other causes; magnesium and calcium malabsorption (spasmophilia); physiological calcium and potassium deficiency; other syndromes belonging to the group of peripheral nerve hyperexcitability; coeliac disease (hypersensitivity to gluten); excessive intake of stimulants such as caffeine, coke, cigarette smoke or drugs; excessive intake of phosphoric acid from soft drinks. For example, I received an engineering degree, own a great home, have a wonderful wife, have great family and friends, travelled around the country and globe, seen things most people can only dream about in my climbing adventures, and always had a good paying job. Has anyone else ever had anything like this? From vehicle manufacturers to companies involved in equipping those vehicles, to any supplier of life- saving and rescue equipment and aids. Peter Pressman, MD, is a board-certified neurologist developing new ways to diagnose and care for people with neurocognitive disorders. WebLegs, face, arms, neck, hands and even my eyes, forehead and back a few times. Epub 2017 May 10. Difficulty with breathing, speaking and swallowing. National Institute of Neurological Disorders and Stroke. https://www.mayoclinic.org/diseases-conditions/amyotrophic-lateral-sclerosis/symptoms-causes/syc-20354022, https://www.mayoclinic.org/departments-centers/neuromuscular-disease-group/overview/ovc-20443670, https://rarediseases.info.nih.gov/diseases/6205/cramp-fasciculation-syndrome, https://www.dovemed.com/diseases-conditions/cramp-fasciculation-syndrome/, https://www.ncbi.nlm.nih.gov/pubmed/16340924, https://onlinelibrary.wiley.com/doi/abs/10.1002/ana.410340419, https://www.mayoclinic.org/diseases-conditions/myoclonus/symptoms-causes/syc-20350459, https://connect.mayoclinic.org/discussion/how-did-you-know/. Baltimore Sun (2018). It feels good to get my concerns and worries out of my system to alleviate stress. Maybe it is not fair, just as it not fair to be wrongly convicted. The twitching may be occasional to continuous. MeSH Though the exact cause of benign fasciculation syndrome is unknown, it is being reported that viral infection, deficiency of magnesium or calcium, and anti-allergic drugs cause it. Unable to load your collection due to an error, Unable to load your delegates due to an error. Acceptance is loving your life and not wishing to change your destiny. Fasciculation in amyotrophic lateral sclerosis: origin and pathophysiological relevance. HHS Vulnerability Disclosure, Help 4. What Is Benign Fasciculation Syndrome?, BenignFasciculationSyndrome.org, 5. Get useful, helpful and relevant health + wellness information. Some recover entirely without medical intervention, while for others, CFS and its pain management can be intrusive in daily life. Unless other independent problems occur, benign fasciculations syndrome generally does not worsen with time, except in some cases where it may become cramps and fasciculations syndrome, also benign but with more severe symptoms than benign fasciculations syndrome. I also found information that electrolytes and body chemistry maybe off causing the contractions. [1] Campbell, DeJongs The Neurologic Examination, Wolters Kluwer, 27, [2] Barrett, Pain Tracking, Prometheus Books, 67, [3] Barrett, Pain Tracking, Prometheus Books, [4] Starlanyl, Fibromyalgia, Harbinger Publishing, 14, [5] Starlanyl, Fibromyalgia, Harbinger Publishing, 194 196, Learn More About Our National Walk & Roll Fundraising Program. At a minimum, I truly believe that some people may benefit from writing a journal, especially if their disorder is being downplayed by family and friends. [2], BFS can also be caused by long-term use of anticholinergics,[4] and fasciculations may be caused by other drug use or exposure to steroids, nicotine, caffeine, alcohol, insecticides and pesticides. Neurology. Reducing daily stress also can help with symptoms. This site needs JavaScript to work properly. Since BFS or ALS can both lead to muscle twitching, some people may worry that these conditions are related or that BFS may develop into ALS. Attitude is what drives important personality traits such as gratitude, grit, perseverance, mental toughness, motivation, and resiliency. A week in I went to my PCP. If, on the other hand, the fasciculation occurs in more than one place on the body, often even at rest and is associated with other symptoms (e.g. 1998-2023 Mayo Foundation for Medical Education and Research. MMN can only be treated with intravenous immunoglobulin (IVIg) therapy. Daniels, A.: What is causing that twitching in your muscles?

Im 40, have had random twitches now and then around my body for a few years and ignored them. GBS|CIDP Foundation International National Institute of Neurological Disorders and Stroke. Celebrities with benign fasciculation syndrome: Kerry Washington Ashton Kutcher Deepak Chopra David Beckham Michael J. Although the exact causes for these disorders are unknown, BFS is much more common and doesn't lead to muscle wasting like ALS. This article mentions myesthenia gravis, a muscle disease. People with ALS are many times not aware of their fasciculations and see their physician because of increasing weakness and reduced mobility that limit normal daily activities. There are also some people who lack certain minerals, including magnesium or calcium, who also may develop fasciculations or even muscle cramps. What Is Amyotrophic Lateral Sclerosis (ALS)? He is the director of adult spinal deformity & complex spinal reconstruction at Massachusetts General Hospital and is on the faculty at Harvard Medical School.

Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Kate Bosworth. Additionally, symptoms may include those of anxiety such as globus, which is the sensation of having something stuck in the back of the throat. I met a patient with ALS in the waiting areas at Mayo when I was there for neurology testing and he had constant twitching. [1] Anxiety and somatic symptom disorders and symptoms are commonly reported. Is there anything I can do to treat or reduce the muscle twitches? Careers. I'm at a loss and not sure if/how I can pursue a diagnosis. Look at Get Started on Connect in the gray box at the bottom of any page, then see Start a New Discussion. In some cases, symptoms may linger or may come and go with periods of remission, while other times the symptoms may be prominent. Get your morning news in your e-mail inbox. Not sure if this is the right place to ask this, but Im really not sure how to interpret whats going on. spasmophilia) (or PNH), but with fasciculations as a fundamental symptom. Sometimes, as proof of some connection with spasmophilia, supplementation with mineral salts on a massive scale may be helpful. Bookshelf [2][3] 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". Researchers dont know the exact cause of benign fasciculation syndrome. Myokymia and neuromyotonia in veterinary medicine: a comparison with peripheral nerve hyperexcitability syndrome in humans. 2010;11(1-2):181-6. doi:10.3109/17482960903062137, Leite MA, Orsini M, de Freitas MR, et al. Benign fasciculation syndrome or BFS causes involuntary twitches, spasms, subjective weakness, cramps, tingling, or numbness in at least one muscle. Benign fasciculations syndrome and the variant of cramps and fasciculations syndrome belong to the group of peripheral nerve hyperexcitability disorders. Fasciculations are part of the phenotype in much more genetic disorders than commonly assumed. [2] Thyroid disease may also cause similar symptoms. I went to another Neurologist and he did not want to do an EMG or MRI. Sounds like you've been diligent on getting medical professional input on your situation and seeking people who have had common experiences. Disorders of motor neurons manifested by hyperactivity. In neurologic terms, fasciculations are the spontaneous firing of a motor unita group of nerve and muscle cells that work together to contract a muscle. If so, how or did it resolve? Anxiety has a cause-and-effect relationship with fasciculation; it can trigger an episode and aggravate its severity once it starts. In some instances, remission periods may become longer over time with symptomatic episodes occurring less and less. 2022 Oct 21;13:1035406. doi: 10.3389/fneur.2022.1035406. "[3] 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. Phone: +39 340 2246247 While most people experience muscle twitches every once in a while, people with benign fasciculation syndrome experience muscle twitches frequently over several months. It doesnt hurt and can last for several seconds, minutes or even hours. Although some people will notice a fasciculation when it happenssuch as when an eyelid twitchesmany of the events will go unnoticed. Identified in 1991 by researchers at the American Academy of Neurology, these cramps can either be painful or benign but are always spontaneous.

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