Concurrent fasciculations and oropharyngeal dysphagia (OD) can be presenting signs of motor neuron disease (MND); however, there are other causes for OD (neoplasms, surgery, and gastroesophageal diseases, among others). Fasciculations (anxiety, benign, or iatrogenic) are an uncommon side effect (<1%) of methylphenidate. A 30-year-old male noticed fasciculations in both gastrocnemii, reporting gradual cranial progression, culminating in diffuse fasciculations with facial involvement. One month later, he reported OD for solids and occasional cough for liquids. He denied weakness, fatigue, or weight loss. He has no relevant personal history, apart from attention deficit hyperactivity disorder diagnosed a year before and since then medicated with methylphenidate 40 mg id. He had no abnormal findings on neurological examination. Electromyography (EMG) and sinus CT were normal. Upper gastrointestinal (GI) endoscopy (EGD) showed reflux esophagitis grade C, which could explain OD, and he started esomeprazole 40 mg id. As there were no findings on EMG, an iatrogenic etiology for fasciculations was considered. He suspended methylphenidate for a month and, two months later, reported a substantial improvement in fasciculations and resolution of the OD with the introduction of esomeprazole.Two simultaneous symptoms do not mean they are related. In this specific case, OD was the first symptom of gastroesophageal reflux disease (GERD), and fasciculations happened as a side effect of methylphenidate. This must be taken into consideration, as it can represent a confounding factor making the differential diagnosis more difficult. To the best of our knowledge, there are no published articles similar to this case report.

Ineffective coughing affects bronchial hygiene and is a major contributor to respiratory complications after spinal cord injury (SCI). Mechanical insufflation-exsufflation (MIE) therapy increases inspiratory and expiratory flow to assist bronchial secretions clearance.We present a case of a 67-year-old cervical SCI patient with lung infection and partial atelectasis in the lower left lung, associated with difficult ventilator weaning. About one day after the beginning of MIE therapy, an improvement of the atelectasis was verified. The patient was extubated six days after the beginning of bronchial hygiene with MIE therapy and safely transitioned to non-invasive ventilatory support.