Acquired neuromyotonia following upper respiratory tract infection: a case report

Ibrahim Imam,C Oliver Hanemann,Simon Edwards

doi:10.4076/1757-1626-2-7952

Abstract

We present a 37-year-old male subject who presented with burning sensations in his hands and feet with generalised twitching of his limbs, trunk and face. His symptoms developed 2 weeks after an upper respiratory tract infection. There was associated facial flushing and disturbed night sleep but no memory impairment or generalised sweating. Examination showed generalised myokymia and fasciculations and electromyography revealed widespread continuous semi-rhythmic doublets and triplets of low frequency with interspersed silent periods. Anti voltage gated potassium channel antibodies, antinuclear antibodies, anti-acetylcholine receptor antibodies and the anti-neuronal antibodies anti Hu, anti Yo and anti Ri were all negative. His symptoms improved slightly on lamotrigine and amitriptyline.

Highlights

Neuromyotonia is a form of peripheral nerve hyperexcitability with spontaneous and continuous muscle fibre activity [1]
We present a case of acquired neuromyotonia following an upper respiratory tract infection and discuss the literature relevant to the case
Motor and sensory nerve conduction velocities were normal. He tested negative for anti voltage gated potassium channel (VGKC) antibodies, antinuclear antibodies and anti-acetylcholine receptor antibodies

Summary

Introduction

Neuromyotonia is a form of peripheral nerve hyperexcitability with spontaneous and continuous muscle fibre activity [1] It has variously been called undulating myokymia, Isaac’s syndrome and cramp-fasciculation syndrome [2]. Case presentation Our patient is a 37-year-old Caucasian man who presented with a fourteen-month history of a burning, painful sensation in his hands and feet. This developed about two weeks after an upper respiratory tract infection. Motor and sensory nerve conduction velocities were normal He tested negative for anti voltage gated potassium channel (VGKC) antibodies, antinuclear antibodies and anti-acetylcholine receptor antibodies. He reported further improvement in sensory symptoms on Lamotrigine but not in motor symptoms

Discussion

Maddison P

Findings

Diaz JH