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Sansone VA. Episodic Muscle Disorders. Continuum (Minneap Minn) 2019; 25:1696-1711. [PMID: 31794467 DOI: 10.1212/con.0000000000000802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article reviews the episodic muscle disorders, including benign cramp-fasciculation syndrome, the periodic paralyses, and the nondystrophic myotonias. The core diagnostic criteria for a diagnosis of primary periodic paralysis, including clues to distinguish between the hypokalemic and hyperkalemic forms, and the distinctive elements that characterize Andersen-Tawil syndrome are discussed. Management of patients with these disorders is also discussed. RECENT FINDINGS Childhood presentations of periodic paralysis have recently been described, including atypical findings. Carbonic anhydrase inhibitors, such as dichlorphenamide, have recently been approved by the US Food and Drug Administration (FDA) for the treatment of both hypokalemic and hyperkalemic forms of periodic paralysis. Muscle MRI may be a useful outcome measure in pharmacologic trials in periodic paralysis. Genetic research continues to identify additional gene mutations responsible for periodic paralysis. SUMMARY This article will help neurologists diagnose and manage episodic muscle disorders and, in particular, the periodic paralyses and the nondystrophic myotonias.
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Lin FC, Fei F. [A case of normokalemic periodic paralysis]. Zhongguo Zhen Jiu 2013; 33:425. [PMID: 23885617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Shimizu F, Kanda T. [Internal medicine and neurological diseases: progress in diagnosis and treatment topics: VIII. Neurological manifestation due to endocrine metabolic disease]. Nihon Naika Gakkai Zasshi 2012; 101:2226-2231. [PMID: 22973694 DOI: 10.2169/naika.101.2226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Fumitaka Shimizu
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Japan
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Abstract
We describe a 37-year-old man with a 4-month history of episodic muscular weakness, involving mainly lower-limbs. Hypokalemia was documented in one episode and managed with intravenous potassium chloride. Hyperthyroidism was diagnosed 4 months after onset of attacks because of mild symptoms. The patient was subsequently diagnosed as having thyrotoxic periodic paralysis associated with Graves' disease. Treatment with propranolol and methimazol was initiated and one year later he remains euthyroid and symptom free. Thyrotoxic periodic paralysis is a rare disorder, especially among Caucasians, but it should always be considered in patients with acute paralysis and hypokalemia, and thyroid function should be evaluated.
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Affiliation(s)
- M J Barahona
- Department of Endocrinology, Hospital Sant Pau, S. Antoni M. Claret 167, 08025 Barcelona, Spain
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Li YW, Yu XH, Rao ZL. [A case report of normokalemic periodic paralysis]. Zhongguo Dang Dai Er Ke Za Zhi 2009; 11:316-317. [PMID: 19374821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Fontaine B. [Periodic paralysis: new pathophysiological aspects]. Bull Acad Natl Med 2008; 192:1543-1550. [PMID: 19445371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Periodic paralyses are neuromuscular disorders characterized by attacks of muscle weakness coinciding with changes in blood potassium levels. They are thus classified as hypokalaemic, normokalaemic or hyperkalaemic. Most forms are genetic, with autosomal dominant inheritance. These diseases are channelopathies, i.e. caused by mutations in ion channel genes. The culprit genes encode muscle sodium, calcium and potassium channels. Mutations in calcium or potassium channels cause periodic paralyses of the same type (hypokalaemic periodic paralysis or Andersen-Tawil Syndrome). In contrast, distinct mutations in the gene encoding the sodium channel can cause the entire range of periodic paralysis (hypokalaemic, normokalaemic or hyperkalaemic). The physiological consequences of mutations have been studied with patch-clamp techniques and electromyography. Generally speaking, mutations alter the excitability cycle of the muscle membrane, resulting in a loss of function (paralysis). Electromyographic studies have demonstrated a good correlation between symptoms and physiological parameters, giving rise to a classification that can help orient the molecular diagnosis. Work on the genetics and pathophysiology of periodic paralyses has helped to improve the diagnosis and management of these syndromes.
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Affiliation(s)
- Bertrand Fontaine
- Centre de référence des canalopathies musculaires, Fédération des maladies du système nerveux, INSERM, UMR 975, Université Pierre et Marie Curie, UMR S975, Groupe hospitalier Pitié- Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris
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Abstract
Hypokalemic paralysis associated with hyperthyroidism (TPP) is a well-known acute electrolyte and muscle function disorder. Lesser known is normokalemic periodic paralysis associated with hyperthyroidism. We describe two cases of young men with acute muscular paralysis and bilateral impairment of sensation over the lower legs who had normal plasma potassium concentrations. They were initially misdiagnosed as having Guillain-Barré syndrome or hysterical paralysis. However, thyroid function tests showed elevated serum T(3) and T(4) and markedly depressed thyroid-stimulating hormone findings consistent with hyperthyroidism. Control of the hyperthyroidism completely abolished their periodic paralysis. Thyrotoxic normokalemic periodic paralysis (TNPP) should be kept in mind as a cause of acute muscle weakness to avoid missing a treatable and curable condition.
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Affiliation(s)
- Chia-Chao Wu
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Sloet van Oldruitenborgh-Oosterbaan MM. [HYPP: hyperkalemic periodic paralysis in the horse]. Tijdschr Diergeneeskd 1999; 124:176-81. [PMID: 10188180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Hyperkalaemic periodic paralysis(HYPP) is characterized by intermittent episodes of muscular tremor, weakness, and collapse, and is probably caused by abnormal electrolyte transport in the muscle cell membrane. During an episode of HYPP, most animals are severely hyperkalaemic. HYPP is a hereditary disease and occurs only in American Quarter horses or crossbreds. Because these horses are now being imported into the Netherlands, HYPP should be included in the differential diagnosis of horses showing signs of muscle tremor, paresis, or paralysis. The present article reviews the literature on HYPP and describes a case showing typical signs of the disease.
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Abstract
Thyrotoxic periodic paralysis is a rare endocrine disorder most prevalent among individuals of Asian descent that presents as proximal muscle weakness, hypokalemia, and signs of hyperthyroidism. We present the case report of a patient with previously undiagnosed hyperthyroidism, protracted muscle weakness with transient exacerbations, and nocturnal onset of periodic paralysis affecting the upper and lower limbs.
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Affiliation(s)
- W A Walters
- Department of Emergency Medicine, Medical College of Pennsylvania Hospital and MCP-Hahnemann School of Medicine, Philadelphia 19129, USA
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Abstract
A 43-year-old woman presented at the age of 38 with joint pains and muscle stiffness. Tender points were found fulfilling ACR criteria (1) for fibromyalgia. She had well developed muscles and decreasing muscle power since the age of 35. Muscle pains increased after exercise. Her 10-year-old son had similar symptoms and one paralytic attack. Muscle pain and fatigue increasing with age were found by history in three close relatives. Forearm cold water test produced myotonia in both mother and son. Electromyography was normal and muscle biopsy showed minor unspecific changes. Biochemical investigation of muscle mitochondrial function was normal. Peroral potassium load test produced complete muscle paralysis at a potassium serum level of 5.0 mmol/l. Autosomal dominant hyperkalemic periodic paralysis was diagnosed. Frequent carbohydrate enriched meals, peroral bendroflumethiazide and restriction to submaximal exercise improved muscle and joint pain. Salbutamol peroral spray relieved the periodic weakness.
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Affiliation(s)
- F R Götze
- Department of Internal Medicine/Rheumatology, Sahlgren University Hospital/Ostra, Göteborg, Sweden
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Affiliation(s)
- L Ptácek
- Department of Neurology, Howard Hughes Medical Institute, University of Utah, Salt Lake City 84112, USA
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Nakamagoe K, Fujita T, Ohkoshi N, Mizusawa H, Shoji S. [A case of potassium-sensitive periodic paralysis with cardiac dysrhythmia]. Rinsho Shinkeigaku 1997; 37:239-42. [PMID: 9217424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The authors reported a case of potassium-sensitive periodic paralysis with cardiac dysrhythmia. The patient was a 21-year-old male and had periodic paralysis and asymptomatic cardiac dysrhythmia since the age of 12. His attacks worsened in frequency and intensity which brought him to our hospital at the age of 21. Physical examination on admission revealed slight dysmorphic features such as hypoplastic mandible and high-arched palate. He had slight proximal muscle atrophy with no myotonia. Electrocardiogram showed multifocal ventricular arrhythmia. The serum potassium levels during his paralytic attacks were normal or slightly decreased (3.6-4.2 mEq/l). Both potassium and glucose tolerance tests provoked paralytic attacks. Glucose tolerance test also aggravated his cardiac dysrhythmia. Acetazoramide administration improved his paralytic attack. Potassium-sensitive periodic paralysis with cardiac dysrhythmia can not be defined by the classification of periodic paralysis based on the serum potassium concentration. Provocative tests should be done to make a definite diagnosis and treatment should be done taking into consideration both paralytic attack and cardiac dysrhythmia.
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Affiliation(s)
- K Nakamagoe
- Department of Neurology, University of Tsukuba
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Affiliation(s)
- R C Griggs
- Department of Neurology, University of Rochester School of Medicine and Dentistry, New York 14642, USA
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Therby D, Guionnet B, Vaast P, Rajabally R, Krivosic-Horber R, Puech F. [Gamstorp's disease and pregnancy. A case report]. J Gynecol Obstet Biol Reprod (Paris) 1996; 25:832-5. [PMID: 9026513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Gamstorp's disease or hyperkaliemic periodic paralysis is a rare pathology leading to spells of generalized hypotonia due to hyperkaliema. It is hard to say how far pregnancy affects the course of the disease and what is the impact of the disease on pregnancy. We report a case of Gamstorp's disease during pregnancy and we insist on the fact that because it can be crippling during its acute phases, close surveillance is needed during pregnancy. Screening for malignant hyperthermia should be carried out. During labour, kaliemia level should be monitored repeatedly and the expulsion phase kept as short as possible if necessary by forceps delivery.
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Affiliation(s)
- D Therby
- Service de Gynécologie-Obstétrique et de Pathologie de la Reproduction, Hôpital Jeanne-de-Flandre, CHU, Lille
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Duyn RJ, van Haeringen H. [American Quarter Horses and HYPP]. Tijdschr Diergeneeskd 1995; 120:46-7. [PMID: 7839340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Hyperkalaemic periodic paralysis is a genetic disease that affects the American Quarter Horse population and is caused by a mutation. As a result of this mutation in a gene which codes for the sodium channel in muscle cells, severe muscle weakness can appear. Reliable DNA-tests can establish whether a horse is homozygous negative, heterozygous, or homozygous positive for this mutation. Therapy and prevention are discussed.
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Abstract
Thyrotoxic periodic paralysis (TPP) is an unusual complication of a fairly common disease affecting mostly Asian males. In the United States, there have been several reports of TPP in different ethnic populations and it appears that the incidence is approximately one-tenth of that found in Asian countries. Only six reports of TPP in African-Americans could be found in the literature; however, we are reporting four cases diagnosed within a 13-year period at our institution. We conclude that TPP may occur more often in Blacks than previously suspected and should be considered when patients present with unexplained hypokalemia, muscular weakness and rhabdomyolysis. The epidemiology, clinical manifestations, pathophysiology, and treatment of TPP are reviewed.
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Affiliation(s)
- R E Kilpatrick
- Department of Medicine, Louisiana State University Medical Center, Shreveport
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Muthusamy E. Hyperthyroidism with gynaecomastia, galactorrhoea and periodic paralysis. Singapore Med J 1991; 32:371-2. [PMID: 1788590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A 32 year old male thyrotoxic presenting with gynaecomastia, galactorrhoea and later complicated with hypokalaemic periodic paralysis is presented. The gynaecomastia and galactorrhoea resolved with treatment. To the best of the author's knowledge this combination of association in one patient has not been reported previously.
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Affiliation(s)
- E Muthusamy
- Department of Medicine, District Hospital, Penang, Malaysia
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Abstract
Thyrotoxic hypokalemic periodic paralysis is an uncommon but sometimes fatal disease in which early recognition and therapy may prevent untoward complications. The case of a 26-year-old Chinese man who presented to the emergency department with rapidly progressive profound weakness and severe hypokalemia (serum potassium, 1.2 mEq/L) is presented. The patient required endotracheal intubation, ventilatory assistance, and intravenous potassium administration. Emergency medical evaluation and management of this entity are discussed.
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Affiliation(s)
- D Miller
- Department of Medicine, Northwestern University Medical School, Chicago, IL
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Meana CR. [Familial periodic adynamia]. Arch Neurobiol (Madr) 1975; 38:355-404. [PMID: 1217944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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