Yousaf MIK, Ghani MR, D’Aguiar Rosa T, Holiday V, Brown M, Hedera P. Treatment of segmental continuous hypertrophic myokymia of the limb with botulinum A toxin.
SAGE Open Med Case Rep 2022;
10:2050313X221137214. [PMID:
36406303 PMCID:
PMC9669671 DOI:
10.1177/2050313x221137214]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022] Open
Abstract
Myokymia is defined as fluctuating hyperexcitability of muscle fibers caused by
repetitive spontaneous contraction of motor units. Myokymia is generally benign
with self-resolution, although symptomatic treatment with benzodiazepines,
anticonvulsants, and muscle relaxants can be used. Botulinum toxins can also be
utilized, although they are mostly used for symptomatic facial myokymia. Here,
we report two patients who developed continuous myokymia, resulting in secondary
hypertrophy, stiffness, and discomfort in the affected muscles. The first
patient had a history of a tethered spinal cord and developed continuous
myokymia in the S1 and S2 radicular regions of the left leg. The second patient
underwent radiation therapy for lung cancer and developed brachial plexopathy
with abnormal activity in the muscles supplied by the musculocutaneous nerve in
the right arm. Both patients experienced sleep disturbance, focal discomfort,
and restlessness. The anticonvulsants and muscle relaxants were ineffective.
Chemodenervation with botulinum A toxin was initiated using either
onabotulinumtoxinA or abobotulinumtoxinA. Both patients experienced a
substantial reduction in myokymia, with ongoing reversal of muscle hypertrophy
and significant improvement in reported subjective symptoms. Treatment with
botulinum toxins can be highly effective in patients with symptomatic segmental
continuous hypertrophic myokymia and may be considered first-line therapy.
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