Abstract
A 36-year-old man developed progressive limb pain, excessive sweating, and muscle cramps. He described transient strained voice only after drinking cold water (video 1). Examination revealed generalized myokymia and pseudomyotonia. EMG revealed multiple spontaneous, continuous high frequency doublet and triplet motor unit discharges. Nerve conduction studies and chest CT scan were normal. CASPR2 and LGI1 antibodies were negative. Autoimmune, paraneoplastic, and other etiologies were excluded clinically as well as through additional serologic (or blood) testing and imaging. Symptoms resolved completely after IV immunoglobulin and carbamazepine for treatment of pain.
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