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Shelly S, Dubey D, Mills JR, Klein CJ. Paraneoplastic neuropathies and peripheral nerve hyperexcitability disorders. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:239-273. [PMID: 38494281 DOI: 10.1016/b978-0-12-823912-4.00020-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Peripheral neuropathy is a common referral for patients to the neurologic clinics. Paraneoplastic neuropathies account for a small but high morbidity and mortality subgroup. Symptoms include weakness, sensory loss, sweating irregularity, blood pressure instability, severe constipation, and neuropathic pain. Neuropathy is the first presenting symptom of malignancy among many patients. The molecular and cellular oncogenic immune targets reside within cell bodies, axons, cytoplasms, or surface membranes of neural tissues. A more favorable immune treatment outcome occurs in those where the targets reside on the cell surface. Patients with antibodies binding cell surface antigens commonly have neural hyperexcitability with pain, cramps, fasciculations, and hyperhidrotic attacks (CASPR2, LGI1, and others). The antigenic targets are also commonly expressed in the central nervous system, with presenting symptoms being myelopathy, encephalopathy, and seizures with neuropathy, often masked. Pain and autonomic components typically relate to small nerve fiber involvement (nociceptive, adrenergic, enteric, and sudomotor), sometimes without nerve fiber loss but rather hyperexcitability. The specific antibodies discovered help direct cancer investigations. Among the primary axonal paraneoplastic neuropathies, pathognomonic clinical features do not exist, and testing for multiple antibodies simultaneously provides the best sensitivity in testing (AGNA1-SOX1; amphiphysin; ANNA-1-HU; ANNA-3-DACH1; CASPR2; CRMP5; LGI1; PCA2-MAP1B, and others). Performing confirmatory antibody testing using adjunct methods improves specificity. Antibody-mediated demyelinating paraneoplastic neuropathies are limited to MAG-IgM (IgM-MGUS, Waldenström's, and myeloma), with the others associated with cytokine elevations (VEGF, IL6) caused by osteosclerotic myeloma, plasmacytoma (POEMS), and rarely angiofollicular lymphoma (Castleman's). Paraneoplastic disorders have clinical overlap with other idiopathic antibody disorders, including IgG4 demyelinating nodopathies (NF155 and Contactin-1). This review summarizes the paraneoplastic neuropathies, including those with peripheral nerve hyperexcitability.
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Affiliation(s)
- Shahar Shelly
- Department of Neurology, Mayo Clinic, Rochester, MN, United States; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States; Department of Neurology, Rambam Health Care Campus, Haifa, Israel; Faculty of Medicine, Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Divyanshu Dubey
- Department of Neurology, Mayo Clinic, Rochester, MN, United States; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - John R Mills
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Christopher J Klein
- Department of Neurology, Mayo Clinic, Rochester, MN, United States; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States.
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Spagni G, Modoni A, Primiano G, Luigetti M, Sun B, Falso S, Monte G, Distefano M, Granata G, Evoli A, Damato V, Iorio R. Clinical, neurophysiological and serological clues for the diagnosis of neuromyotonia and distinction from cramp-fasciculation syndrome. Neuromuscul Disord 2023; 33:636-642. [PMID: 37422355 DOI: 10.1016/j.nmd.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/09/2023] [Accepted: 06/28/2023] [Indexed: 07/10/2023]
Abstract
Neuromyotonia and cramp-fasciculation syndrome diagnosis currently relies on neurophysiological examination. In this study we investigated the clinical features and neural antibody profile of patients with neuromyotonia and cramp-fasciculation syndrome to assess the diagnostic value of serological testing. Available sera from adult patients with electromyography-defined neuromyotonia and cramp-fasciculation syndrome were tested for neural antibodies by indirect immunofluorescence on mouse brain sections and live cell-based assays. Forty patients were included, 14 with neuromyotonia and 26 with cramp-fasciculation syndrome. Neural antibodies were detected in 10/10 neuromyotonia sera, most commonly against contactin-associated protein 2 (7/10, 70%), and in 1/20 (5%) cramp-fasciculation syndrome sera. Clinical myokymia, hyperhidrosis, and paresthesia or neuropathic pain were more common in neuromyotonia and mostly associated with contactin-associated protein 2 antibodies. Central nervous system involvement was present in 4/14 (29%) neuromyotonia patients. A tumor was detected in 13/14 (93%) neuromyotonia patients (thymoma, 13), and in 4/26 (15%) with cramp-fasciculation syndrome (thymoma, 1; other neoplasms, 3). Twenty-one/27 (78%) patients achieved a significant improvement or complete remission. Our findings highlight clinical, neurophysiological and serological clues that can be useful in the diagnosis of neuromyotonia and cramp-fasciculation syndrome. Antibody testing is valuable for neuromyotonia diagnosis, while its usefulness in cramp-fasciculation syndrome confirmation is limited.
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Affiliation(s)
- Gregorio Spagni
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Modoni
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Guido Primiano
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy; Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marco Luigetti
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy; Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Bo Sun
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Silvia Falso
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy; Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gabriele Monte
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy; Neuroscience Department, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy
| | - Marisa Distefano
- UOC Neurologia e UTN, Ospedale Belcolle, Strada Sammartinese, 01100 Viterbo, Italy
| | - Giuseppe Granata
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Amelia Evoli
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy; Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | - Valentina Damato
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Neurosciences, Drugs and Child Health, University of Florence, Florence, Italy
| | - Raffaele Iorio
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy; Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Abstract
PURPOSE OF REVIEW Autoimmune neuromyotonia encompasses a group of rare immune-mediated neurological disorders frequently associated with anti-contactin-associated protein-like 2 (CASPR2) antibodies and featuring clinical and electrical signs of peripheral nerve hyperexcitability (PNH). We aim to summarize the current knowledge on immune-mediated neuromyotonia, focusing on clinical presentations, pathophysiology, and management. RECENT FINDINGS Neuromyotonia is a major feature of several autoimmune neurological syndromes characterized by PNH with or without central neurological system involvement. Experimental and clinical evidence suggest that anti-CASPR2 antibodies are directly pathogenic in autoimmune neuromyotonia patients. SUMMARY Neuromyotonia, a form of PNH, is a major feature in several syndromes associated with anti-CASPR2 antibodies, including cramp-fasciculation syndrome, Isaacs syndrome, Morvan syndrome, and autoimmune limbic encephalitis. Diagnosis relies on the identification of motor, sensory, and autonomic signs of PNH along with other neurological symptoms, anti-CASPR2 antibody-positivity, and of characteristic electroneuromyographic abnormalities. Paraneoplastic associations with thymoma are possible, especially in Morvan syndrome. Patients usually respond to immune-active treatments, including steroids, intravenous immunoglobulins, plasma exchanges, and rituximab.
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Affiliation(s)
- Louis Comperat
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon
| | - Antoine Pegat
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon
- Electroneuromyography and Neuromuscular Diseases Unit, Pierre Wertheimer Hospital, Hospices Civils de Lyon
| | - Jérôme Honnorat
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon
- Synaptopathies and Autoantibodies (SynatAc) Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université Claude Bernard Lyon 1
| | - Bastien Joubert
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon
- Synaptopathies and Autoantibodies (SynatAc) Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université Claude Bernard Lyon 1
- Department of Neurology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
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Treatment and Management of Disorders of Neuromuscular Hyperexcitability and Periodic Paralysis. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00018-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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5
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Abstract
Peripheral nerve hyperexcitability (PNH) typically presents with complaints of muscle twitching, cramps, and muscle stiffness. Symptoms and signs indicating central and/or autonomic nervous system dysfunction also may be reported. An electroclinical spectrum exists, spanning from the milder cramp-fasciculation syndrome to more severe syndromes characterized by continuous muscle fiber activity. It is important to recognize that PNH may be an autoimmune phenomenon associated with antibodies targeting proteins of the voltage-gated potassium channel-complex and, in some patients, a paraneoplastic phenomenon. Symptomatic therapies include medicines that reduce neuronal excitability and in severe disease immunomodulatory treatments may be indicated.
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Affiliation(s)
- Spencer K Hutto
- Department of Neurology, Emory University School of Medicine, 12 Executive Park Drive Northeast, Room 150H, Atlanta, GA 30329, USA
| | - Taylor B Harrison
- Department of Neurology, Emory University School of Medicine, 12 Executive Park Drive Northeast, Room 150H, Atlanta, GA 30329, USA.
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6
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Demystifying the spontaneous phenomena of motor hyperexcitability. Clin Neurophysiol 2021; 132:1830-1844. [PMID: 34130251 DOI: 10.1016/j.clinph.2021.03.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/18/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
Possessing a discrete functional repertoire, the anterior horn cell can be in one of two electrophysiological states: on or off. Usually under tight regulatory control by the central nervous system, a hierarchical network of these specialist neurons ensures muscular strength is coordinated, gradated and adaptable. However, spontaneous activation of these cells and their axons can result in abnormal muscular twitching. The muscular twitch is the common building block of several distinct clinical patterns, namely fasciculation, myokymia and neuromyotonia. When attempting to distinguish these entities electromyographically, their unique temporal and morphological profiles must be appreciated. Detection and quantification of burst duration, firing frequency, multiplet patterns and amplitude are informative. A common feature is their persistence during sleep. In this review, we explain the accepted terminology used to describe the spontaneous phenomena of motor hyperexcitability, highlighting potential pitfalls amidst a bemusing and complex collection of overlapping terms. We outline the relevance of these findings within the context of disease, principally amyotrophic lateral sclerosis, Isaacs syndrome and Morvan syndrome. In addition, we highlight the use of high-density surface electromyography, suggesting that more widespread use of this non-invasive technique is likely to provide an enhanced understanding of these motor hyperexcitability syndromes.
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Hyperkinetic Movement Disorders. Neurology 2021. [DOI: 10.1007/978-3-030-55598-6_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
Muscle cramps, defined as a painful contraction of a muscle or muscle group, are a common symptom most people have experienced throughout their lifespan. In some cases cramps can be frequent, severe, and disabling, thus requiring medical assessment and intervention. Physiologic states such as pregnancy and exercise are associated with excessive muscle cramps, as are numerous medical and neurologic conditions, medications such as diuretics and statins, and peripheral nerve hyperexcitability syndromes. Treatment options for muscle cramps are limited, although recent studies have shown that mexiletine could be a safe and efficient alternative for patients with amyotrophic lateral sclerosis.
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Affiliation(s)
- Hans D Katzberg
- Toronto General Hospital / University Health Network, Krembil Brain Institute, University of Toronto, 200 Elizabeth Street, 5ES-306, Toronto, Ontario M6S 4E6, Canada.
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Alavi MS, Shamsizadeh A, Karimi G, Roohbakhsh A. Transient receptor potential ankyrin 1 (TRPA1)-mediated toxicity: friend or foe? Toxicol Mech Methods 2019; 30:1-18. [PMID: 31409172 DOI: 10.1080/15376516.2019.1652872] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Transient receptor potential (TRP) channels have been widely studied during the last decade. New studies uncover new features and potential applications for these channels. TRPA1 has a huge distribution all over the human body and has been reported to be involved in different physiological and pathological conditions including cold, pain, and damage sensation. Considering its role, many studies have been devoted to evaluating the role of this channel in the initiation and progression of different toxicities. Accordingly, we reviewed the most recent studies and divided the role of TRPA1 in toxicology into the following sections: neurotoxicity, cardiotoxicity, dermatotoxicity, and pulmonary toxicity. Acetaminophen, heavy metals, tear gases, various chemotherapeutic agents, acrolein, wood smoke particulate materials, particulate air pollution materials, diesel exhaust particles, cigarette smoke extracts, air born irritants, sulfur mustard, and plasticizers are selected compounds and materials with toxic effects that are, at least in part, mediated by TRPA1. Considering the high safety of TRPA1 antagonists and their efficacy to resolve selected toxic or adverse drug reactions, the future of these drugs looks promising.
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Affiliation(s)
- Mohaddeseh Sadat Alavi
- Division of Neurocognitive Sciences, Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Shamsizadeh
- Physiology-Pharmacology Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Gholamreza Karimi
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Roohbakhsh
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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Blackman G, Cherfi Y, Morrin H, Ellis CM, Bashford J, Ruths F, David AS. The Association Between Benign Fasciculations and Health Anxiety: A Report of Two Cases and a Systematic Review of the Literature. PSYCHOSOMATICS 2019; 60:499-507. [DOI: 10.1016/j.psym.2019.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 12/14/2022]
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11
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Huang K, Luo YB, Yang H. Autoimmune Channelopathies at Neuromuscular Junction. Front Neurol 2019; 10:516. [PMID: 31156543 PMCID: PMC6533877 DOI: 10.3389/fneur.2019.00516] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/30/2019] [Indexed: 12/22/2022] Open
Abstract
The neuromuscular junction, also called myoneural junction, is a site of chemical communication between a nerve fiber and a muscle cell. There are many types of channels at neuromuscular junction that play indispensable roles in neuromuscular signal transmission, such as voltage-gated calcium channels and voltage-gated potassium channels on presynaptic membrane, and acetylcholine receptors on post-synaptic membrane. Over the last two decades, our understanding of the role that autoantibodies play in neuromuscular junction disorders has been greatly improved. Antibodies against these channels cause a heterogeneous group of diseases, such as Lambert-Eaton syndrome, Isaacs' syndrome and myasthenia gravis. Lambert-Eaton syndrome is characterized by late onset of fatigue, skeletal muscle weakness, and autonomic symptoms. Patients with Isaacs' syndrome demonstrate muscle cramps and fasciculation. Myasthenia gravis is the most common autoimmune neuromuscular junction channelopathy characterized by fluctuation of muscle weakness. All these disorders have a high risk of tumor. Although these channelopathies share some common features, they differ for clinical features, antibodies profile, neurophysiological features, and treatments. The purpose of this review is to give a comprehensive insight on recent advances in autoimmune channelopathies at the neuromuscular junction.
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Affiliation(s)
- Kun Huang
- Neurology Department, Xiangya Hospital, Central South University, Changsha, China.,Division of Neurogenetics, Center for Neurological Diseases and Cancer, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yue-Bei Luo
- Neurology Department, Xiangya Hospital, Central South University, Changsha, China
| | - Huan Yang
- Neurology Department, Xiangya Hospital, Central South University, Changsha, China
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12
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Abstract
Neuromyotonic and myokymic discharges are abnormal electrical muscular discharges caused by ectopic discharges from motor axons and represent the hallmarks of peripheral nerve hyperexcitability. Neuromyotonic discharges are specific for peripheral nerve hyperexcitability syndromes, whereas myokymic discharges may occur either focally or in a more generalized fashion in many other peripheral nerve disorders. Isaacs syndrome and Morvan syndrome are rare acquired peripheral nerve hyperexcitability disorders that share common clinical features and are often associated with elevated voltage-gated potassium channel-complex antibodies. Central nervous system symptomatology is more common in Morvan syndrome, which also overlaps with limbic encephalitis. Cramp-fasciculation syndrome, a more common syndrome, may represent a milder form of peripheral nerve hyperexcitability. Peripheral nerve hyperexcitability syndromes should be distinguished from stiff person syndrome, myotonic disorders, and rippling muscle disease. When severe, Isaacs syndrome and Morvan syndrome may be disabling but often respond to membrane-stabilizing drugs and immunomodulatory treatments. The electrophysiologic features of these disorders are described.
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Affiliation(s)
- Bashar Katirji
- Neuromuscular Center and EMG Laboratory, Neurological Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States.
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13
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A prospective study of benign fasciculation syndrome and anxiety. Muscle Nerve 2018; 58:852-854. [DOI: 10.1002/mus.26193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/05/2018] [Accepted: 06/09/2018] [Indexed: 01/08/2023]
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14
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Abstract
PURPOSE OF REVIEW This article provides a review of the clinical phenotypes and evaluation of peripheral nerve hyperexcitability syndromes. These rare diagnoses include cramp-fasciculation syndrome, Isaacs syndrome, and Morvan syndrome. Recent investigations have led to an understanding of the autoimmune underpinnings of these conditions and their specific associated antibodies. As the presentation of peripheral nerve hyperexcitability syndromes includes muscle stiffness, twitches, and spasms, which are also shared with certain central nervous system and myopathic conditions, the differential diagnosis of peripheral nerve hyperexcitability syndromes is reviewed. RECENT FINDINGS Peripheral nerve hyperexcitability syndromes share clinical and electrodiagnostic evidence of motor nerve instability; however, their clinical presentations are varied. Case reviews have helped us understand the spectrum of symptoms associated with the three peripheral nerve hyperexcitability syndromes reviewed here: cramp-fasciculation syndrome, Isaacs syndrome, and Morvan syndrome. More recently, research has focused on understanding the voltage-gated potassium channel complex antibodies as well as neoplasms associated with these conditions. SUMMARY The diagnosis of peripheral nerve hyperexcitability syndromes requires a high index of suspicion, support from the physical examination, familiarity with the spectrum of symptoms associated with peripheral nerve hyperexcitability syndromes, and recognition of diagnostic EMG features. Voltage-gated potassium channel complex antibodies are associated with these conditions. Optimum treatment and autoimmune pathogenesis remain areas of active research.
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15
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Abstract
PURPOSE OF REVIEW Peripheral nerve hyperexcitability (PNH) syndromes are divided into primary and secondary groups based on the presence or absence of demonstrable peripheral nerve disease. In this review, we systematically evaluate the evidence for current therapies and supportive managements based on autoimmune, paraneoplastic, and genetic components in pathophysiology reported in the literature. RECENT FINDINGS Current therapy options are based on symptomatic management as well as focusing the underlying immune/genetic/paraneoplastic pathology by immunosuppressants, chemotherapy, and surgery. Further research is desired to provide treatment options geared specifically towards addressing PNH. Supportive care can also be an area for future research.
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16
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Gupta A, First L, Swain CA. Successful Improvement of Pain Symptomatology in a Suspected Case of Cramp-Fasciculation Syndrome via Interventional Pain Treatment. J Pain Palliat Care Pharmacother 2018; 32:5-9. [PMID: 29775120 DOI: 10.1080/15360288.2018.1463343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Peripheral nerve hyperexcitability (PNH) syndromes are a rare set of neuromuscular disorders that include cramp-fasciculation syndrome (CFS) and Isaacs syndrome (IS). Successful treatment of these diseases has been achieved with antiepileptic medications; however, chronic pain symptoms can persist. We provide a case report of a 25-year-old female who has suffered from painful severe muscle spasms and fasciculations since childhood. With CFS as our working diagnosis, a treatment regimen using interventional pain techniques, including sympathetic chain blocks, ketamine infusions, and trigger point injections, resulted in a significant decrease in the patient's chronic pain symptoms. This case offers a novel application of interventional pain procedures and may help further our understanding of PNH syndromes.
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17
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Dubuisson NJ, Pesch V, Bergh PY. Cramp‐fasciculation syndrome associated with monofocal motor neuropathy. Muscle Nerve 2017; 56:828-832. [DOI: 10.1002/mus.25528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/08/2016] [Accepted: 12/19/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Nicolas J. Dubuisson
- Neuromuscular Reference CenterCliniques universitaires Saint‐Luc Avenue Hippocrate 10/13.11 1200 Brussels Belgium
- Department of NeurologyUniversity Hospitals St‐Luc, University of LouvainBrussels Belgium
| | - Vincent Pesch
- Department of NeurologyUniversity Hospitals St‐Luc, University of LouvainBrussels Belgium
| | - Peter Y.K. Bergh
- Neuromuscular Reference CenterCliniques universitaires Saint‐Luc Avenue Hippocrate 10/13.11 1200 Brussels Belgium
- Department of NeurologyUniversity Hospitals St‐Luc, University of LouvainBrussels Belgium
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18
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de Carvalho M, Kiernan MC, Swash M. Fasciculation in amyotrophic lateral sclerosis: origin and pathophysiological relevance. J Neurol Neurosurg Psychiatry 2017; 88:773-779. [PMID: 28490504 DOI: 10.1136/jnnp-2017-315574] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 03/20/2017] [Accepted: 03/29/2017] [Indexed: 12/11/2022]
Abstract
This review considers the origin and significance of fasciculations in neurological practice, with an emphasis on fasciculations in amyotrophic lateral sclerosis (ALS), and in benign fasciculation syndromes. Fasciculation represents a brief spontaneous contraction that affects a small number of muscle fibres, causing a flicker of movement under the skin. While an understanding of the role of fasciculation in ALS remains incomplete, fasciculations derive from ectopic activity generated in the motor system. A proximal origin seems likely to contribute to the generation of fasciculation in the early stages of ALS, while distal sites of origin become more prominent later in the disease, associated with distal motor axonal sprouting as part of the reinnervation response that develops secondary to loss of motor neurons. Fasciculations are distinct from the recurrent trains of axonal firing described in neuromyotonia. Fasciculation without weakness, muscle atrophy or increased tendon reflexes suggests a benign fasciculation syndrome, even when of sudden onset. Regardless of origin, fasciculations often present as the initial abnormality in ALS, an early harbinger of dysfunction and aberrant firing of motor neurons.
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Affiliation(s)
- Mamede de Carvalho
- Department of Neurosciences and Mental Health, Hospital de Santa Maria-CHLN, Lisbon, Portugal.,Institute of Physiology-IMM, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Matthew C Kiernan
- Bushell Chair of Neurology, Sydney Medical School, University of Sydney, Brain & Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Michael Swash
- Institute of Physiology-IMM, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.,Department of Neurology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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19
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Nirenberg MJ, Chaouni R, Biller TM, Gilbert RM, Paisán-Ruiz C. A novel TRPA1 variant is associated with carbamazepine-responsive cramp-fasciculation syndrome. Clin Genet 2017; 93:164-168. [PMID: 28436534 DOI: 10.1111/cge.13040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 04/15/2017] [Accepted: 04/19/2017] [Indexed: 12/31/2022]
Abstract
Cramp-fasciculation syndrome (CFS) is a rare muscle hyperexcitability syndrome that presents with muscle cramps, fasciculations, and stiffness, as well as pain, fatigue, anxiety, hyperreflexia, and paresthesias. Although familial cases have been reported, a genetic etiology has not yet been identified. We performed whole-exome sequencing followed by validation and cosegregation analyses on a father-son pair with CFS. Both subjects manifested other hypersensitivity-hyperexcitability symptoms, including asthma, gastroesophageal reflux, migraine, restless legs syndrome, tremor, cold hyperalgesia, and cardiac conduction defects. Most symptoms improved with carbamazepine, consistent with an underlying cation channelopathy. We identified a variant in the transient receptor potential ankyrin A1 channel (TRPA1) gene that selectively cosegregated with CFS and the other hypersensitivity-hyperexcitability symptoms. This variant (c.2755C>T) resulted in a premature stop codon at amino acid 919 (p.Arg919*) in the outer pore of the channel. TRPA1 is a widely distributed, promiscuous plasmalemmal cation channel that is strongly implicated in the pathophysiology of the specific hypersensitivity-hyperexcitability symptoms observed in these subjects. Thus, we have identified a novel TRPA1 variant that is associated with CFS as part of a generalized hypersensitivity-hyperexcitability disorder. These findings clarify the diverse functional roles of TRPA1, and underscore the importance of this channel as a potential therapeutic target.
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Affiliation(s)
- M J Nirenberg
- Department of Neurology, NYU School of Medicine, New York, New York
| | - R Chaouni
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - T M Biller
- Department of Neurology, NYU School of Medicine, New York, New York
| | - R M Gilbert
- Department of Neurology, NYU School of Medicine, New York, New York
| | - C Paisán-Ruiz
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York.,Departments of Psychiatry, Genetics and Genomic Sciences; Mindich Child Health and Development Institute; and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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Disorders of motor neurons manifested by hyperactivity. Rev Neurol (Paris) 2017; 173:345-351. [DOI: 10.1016/j.neurol.2017.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/06/2017] [Accepted: 04/07/2017] [Indexed: 12/12/2022]
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Küçükali CI, Kürtüncü M, Akçay Hİ, Tüzün E, Öge AE. Peripheral nerve hyperexcitability syndromes. Rev Neurosci 2016; 26:239-51. [PMID: 25719304 DOI: 10.1515/revneuro-2014-0066] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 11/04/2014] [Indexed: 11/15/2022]
Abstract
Peripheral nerve hyperexcitability (PNH) syndromes can be subclassified as primary and secondary. The main primary PNH syndromes are neuromyotonia, cramp-fasciculation syndrome (CFS), and Morvan's syndrome, which cause widespread symptoms and signs without the association of an evident peripheral nerve disease. Their major symptoms are muscle twitching and stiffness, which differ only in severity between neuromyotonia and CFS. Cramps, pseudomyotonia, hyperhidrosis, and some other autonomic abnormalities, as well as mild positive sensory phenomena, can be seen in several patients. Symptoms reflecting the involvement of the central nervous system occur in Morvan's syndrome. Secondary PNH syndromes are generally seen in patients with focal or diffuse diseases affecting the peripheral nervous system. The PNH-related symptoms and signs are generally found incidentally during clinical or electrodiagnostic examinations. The electrophysiological findings that are very useful in the diagnosis of PNH are myokymic and neuromyotonic discharges in needle electromyography along with some additional indicators of increased nerve fiber excitability. Based on clinicopathological and etiological associations, PNH syndromes can also be classified as immune mediated, genetic, and those caused by other miscellaneous factors. There has been an increasing awareness on the role of voltage-gated potassium channel complex autoimmunity in primary PNH pathogenesis. Then again, a long list of toxic compounds and genetic factors has also been implicated in development of PNH. The management of primary PNH syndromes comprises symptomatic treatment with anticonvulsant drugs, immune modulation if necessary, and treatment of possible associated dysimmune and/or malignant conditions.
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Therapeutic Implications of Peripheral Nerve Hyperexcitability in Muscle Cramping: A Retrospective Review. J Clin Neurophysiol 2016; 33:560-563. [PMID: 27258601 DOI: 10.1097/wnp.0000000000000291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
PURPOSE Muscle cramping due to peripheral nerve hyperexcitability (PNH) is poorly characterized. This retrospective study examines the prevalence of PNH and response to treatment. METHODS The Duke EMG Database was queried to identify patients with muscle cramping tested for PNH from 2010 to 2015. Peripheral nerve hyperexcitability was defined by compound muscle action potential after-discharges on repetitive nerve stimulation. Response to treatment was determined by the treating physician's clinical impression 6 months after diagnosis or last documented visit. RESULTS Seventy-two patients met inclusion criteria. Twenty-three (32%) patients had electrodiagnostic evidence of PNH. Of the patients with PNH, 74% had a good response to treatment whereas 37% of treated patients in the PNH-negative group (P = 0.0258). Carbamazepine and gabapentin were the most frequently used treatments with response rates of 70% and 77%, respectively. CONCLUSION Muscle cramps associated with PNH respond well to symptomatic treatment, particularly with carbamazepine and gabapentin.
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Poyraz M, Matur Z, Aysal F, Tüzün E, Hanoğlu L, Öge AE. Clinical, Electrophysiological, and Serological Evaluation of Patients with Cramp-Fasciculation Syndrome. Noro Psikiyatr Ars 2016; 54:183-186. [PMID: 28680318 DOI: 10.5152/npa.2016.14816] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 02/18/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Cramp-fasciculation syndrome (CFS) is a rare peripheral nerve hyperexcitability syndrome. There are only a few reports on clinical and serological profile of a CFS cohort that was followed up by a single outpatient clinic. METHODS Clinical, electrophysiological, and serological features of 6 CFS patients (5 men, 1 woman; 27-65 years old) were investigated. RESULTS All patients presented with cramps, fasciculations, muscle pain, and autonomic symptoms, and 2 also reported numbness and burning sensation in limbs, suggestive of neuropathic pain. Antibodies to uncharacterized voltage-gated potassium channel (VGKC)-complex proteins were found in 2 patients and to contactin-associated protein-like 2 (CASPR2) in 1 patient. None of the patients had a tumor. Most of the patients revealed prolonged after-discharges following tibial nerve stimulation. Nerve conduction studies and R-R interval variability tests were normal, whereas sympathetic skin responses were increased in amplitude in 3 seronegative patients. Five patients showed favorable response to carbamazepine or pregabalin treatment, whereas 1 VGKC-antibody-positive patient was resistant to carbamazepine and immunosuppressant treatment. CONCLUSION Neuropathic pain and VGKC-complex antibodies may be encountered in CFS patients. Although autonomic symptoms are commonly found in CFS, routine autonomic system tests which are done in electrophysiology laboratories might yield normal results.
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Affiliation(s)
- Mürüvvet Poyraz
- Department of Neurology, İstanbul Medipol University School of Medicine, İstanbul, Turkey
| | - Zeliha Matur
- Department of Neurology, İstanbul Bilim University School of Medicine, İstanbul, Turkey
| | - Fikret Aysal
- Department of Neurology, İstanbul Medipol University School of Medicine, İstanbul, Turkey
| | - Erdem Tüzün
- Department of Neurology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Lütfü Hanoğlu
- Department of Neurology, İstanbul Medipol University School of Medicine, İstanbul, Turkey
| | - A Emre Öge
- Department of Neurology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
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Tarulli A. Hyperkinetic Movement Disorders. Neurology 2016. [DOI: 10.1007/978-3-319-29632-6_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Cooper CB, Dolezal BA, Riley M, Verity MA, Shieh PB. Reverse fiber type disproportion: A distinct metabolic myopathy. Muscle Nerve 2015; 54:86-93. [PMID: 26600317 DOI: 10.1002/mus.24984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2015] [Indexed: 11/11/2022]
Abstract
INTRODUCTION In this investigation we characterized the physiological and metabolic responses to incremental exercise in 13 subjects with a predominance of type II fibers on muscle biopsy. METHODS Subjects underwent incremental exercise testing with measures of maximum oxygen uptake ( V˙O2 max), maximum heart rate (fc max), chronotropic index (fc / V˙O2 slope), maximum ventilation ( V˙emax), blood lactate, ammonia, and creatine kinase (CK) levels. Muscle fiber type was determined by myosin ATPase histochemistry. RESULTS Muscle biopsies showed more type II fibers (75%) in subjects compared with normal individuals (P < 0.01). Subjects exhibited normal V˙O2 max and end-exercise lactate, whereas ammonia and CK levels at maximum exercise were significantly higher. CONCLUSIONS Subjects with type II muscle fiber predominance exhibited exaggerated increases in ammonia and elevated CK levels during exercise. Predominance of type II fibers on muscle biopsy is the opposite finding of congenital fiber type disproportion; we suggest these patients be referred to as having "reverse fiber type disproportion." Muscle Nerve 54: 86-93, 2016.
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Affiliation(s)
- Christopher B Cooper
- Department of Medicine, UCLA Exercise Physiology Research Laboratory, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, 37-131 CHS, Los Angeles, California, 90095, USA.,Department of Physiology, UCLA Exercise Physiology Research Laboratory, David Geffen School of Medicine, University of California, Department of Medicine, Los Angeles, Los Angeles, California, USA
| | - Brett A Dolezal
- Department of Medicine, UCLA Exercise Physiology Research Laboratory, David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Avenue, 37-131 CHS, Los Angeles, California, 90095, USA.,Department of Physiology, UCLA Exercise Physiology Research Laboratory, David Geffen School of Medicine, University of California, Department of Medicine, Los Angeles, Los Angeles, California, USA
| | | | - M Anthony Verity
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Perry B Shieh
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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Chokroverty S. Differential Diagnoses of Restless Legs Syndrome/Willis-Ekbom Disease. Sleep Med Clin 2015; 10:249-62, xii. [DOI: 10.1016/j.jsmc.2015.05.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
Isaacs syndrome is a peripheral nerve hyperexcitability (PNH) syndrome that presents as continuous motor activity. Clinical findings include cramps, fasciculations, and myokymia. Electrodiagnosis plays a key role in diagnosis by demonstrating after-discharges on nerve conduction studies, and fasciculation potentials, myokymic discharges, neuromyotonic discharges, and other types of abnormal spontaneous activity on needle examination. Etiopathogenesis involves the interaction of genetic, autoimmune, and paraneoplastic factors, which requires a broad-ranging evaluation for underlying causes. Initial treatment is symptomatic, but immune therapy is often needed and can be effective. The purpose of this review is to describe the syndrome and its pathogenesis, assist the reader in evaluating patients with suspected Isaacs syndrome and distinguishing it from other disorders of PNH, and suggest an approach to management, including both symptomatic and immunomodulating therapy.
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Affiliation(s)
- Aiesha Ahmed
- Department of Neurology, Penn State Hershey Medical Center, EC 037, 30 Hope Drive, Hershey, Pennsylvania, 17033, USA
| | - Zachary Simmons
- Department of Neurology, Penn State Hershey Medical Center, EC 037, 30 Hope Drive, Hershey, Pennsylvania, 17033, USA.,Department of Humanities, Penn State Hershey Medical Center, Hershey, Pennyslvania, USA
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Abstract
ZusammenfassungHintergrund: Spontane, meist nächtliche Krämpfe der Muskulatur der Füße und Waden treten gelegentlich bis häufig bei ca. 40 % der Bevölkerung in Deutschland auf. Ursache sind meist lokale Durchblutungsstörungen als Folge einer Grunderkrankung, Trinkschwäche, Ernährungsstörungen, wie mangelnde Elektrolyt- oder Vitaminzufuhr.Eine abendliche Physiotherapie, wie Dehnungsübungen oder Anwendung eines Massagerollers zum Ausstreichen von Ödemen haben sich als wirksam erwiesen.Methode: Eine medikamentöse Prophylaxe, z. B. mit Chininsulfat, sollte nur dann zur Anwendung kommen, wenn alle anderen Maß-nahmen ausgeschöpft sind, im Übrigen sollte sorgfältig vorher das Nutzen-Risiko-Verhältnis abgewogen werden, da es selten zu gefährlichen unerwünschten Reaktionen kommen kann. Neu ist der Ansatz, das Säure-Basen-Verhältnis zu beeinflussen, um einer Übersäuerung des Muskels vorzubeugen. 70 Probanden wurden in die Anwendungsbeobachtung eingeschlossen.Ergebnisse: Die ersten Ergebnisse veranlassen zu einer optimistischen Beurteilung, um über die Aufnahme von Citrat- und Carbonatsalzen sowie Vitamin-B-Krämpfen vorzubeugen.
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30
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Neurogenic muscle cramps. J Neurol 2015; 262:1814-21. [DOI: 10.1007/s00415-015-7659-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 01/27/2015] [Accepted: 01/29/2015] [Indexed: 12/13/2022]
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31
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Ion channel dysfunction and peripheral nerve hyperexcitability. Clin Neurophysiol 2014; 126:1069-1070. [PMID: 25301769 DOI: 10.1016/j.clinph.2014.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 09/17/2014] [Indexed: 11/23/2022]
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32
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Brockington J, Gerik S. Atypical muscle spasms in an athletic adolescent. Clin Pediatr (Phila) 2014; 53:1209-11. [PMID: 24872336 DOI: 10.1177/0009922814536267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Susan Gerik
- University of Texas Medical Branch at Galveston, Galveston, TX, USA
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33
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Tzatha E, Chin RL. Small fiber abnormalities in skin biopsies of patients with benign fasciculations. J Clin Neuromuscul Dis 2014; 16:12-14. [PMID: 25137510 DOI: 10.1097/cnd.0000000000000047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To determine whether patients with benign fasciculations have evidence for axonal loss in skin biopsies. METHODS Epidermal sensory and sweat gland nerve fiber densities were quantified in skin biopsies of 11 patients with benign fasciculations and no other known cause for neuropathy. RESULTS Nine of the 11 patients (82%) had significantly reduced epidermal or sweat gland nerve fiber densities at the calf or thigh, in comparison with control values. CONCLUSIONS The presence of reduced epidermal and sweat gland nerve fiber density indicates the presence of axonal loss in patients with benign fasciculations.
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Affiliation(s)
- Efstathia Tzatha
- *Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY; and †Department of Neurology, Weill Cornell Medical College, New York, NY
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Sato A, Sakai N, Shinbo J, Hashidate H, Igarashi S, Kakita A, Yamazaki M. [An autopsy case of amyotrophic lateral sclerosis with prominent muscle cramps, fasciculation, and high titer of anti-voltage gated potassium channel (VGKC) complex antibody]. Rinsho Shinkeigaku 2014; 54:32-7. [PMID: 24429646 DOI: 10.5692/clinicalneurol.54.32] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The patient was a 55-year-old male who had prominent fasciculation and muscle cramps. Muscle weakness and atrophy of the trunk, respiratory system, and extremities gradually progressed. On the basis of these features, we diagnosed this patient as having amyotrophic lateral sclerosis (ALS), however, the upper motor neuron signs were not significant. Following the detection of the anti-voltage gated potassium channel (VGKC) complex antibody at 907.5 pM (normal < 100 pM) and repetitive discharge in a nerve conduction study, immunotherapy with intravenous immunoglobulin, methylprednisolone (mPSL), double filtration plasmapheresis (DFPP), ciclosporin, and rituximab was introduced. mPSL and DFPP showed only tentative effectiveness for fasciculation and muscle cramps, respectively. Thereafter, muscle weakness progressed. The patient died of type II respiratory failure at the age of 57 years, about 2 years after the onset of the disease. At autopsy, a histopathological diagnosis of ALS with lower-motor-predominant degeneration was made. Characteristic cellular features, including Bunina bodies in the remaining lower motor neurons and phosphorylated TAR DNA-binding protein 43-kDa (pTDP-43)-immunopositive inclusions in both upper and lower motor neuron systems, were evident. At present, an immunological role of the anti-VGKC complex antibody in the development of cramp-fasciculation syndrome has been speculated. In this ALS patient, the antibodies might be associated with pathomechanisms underlying the characteristic symptoms.
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Affiliation(s)
- Aki Sato
- Department of Neurology, Niigata City General Hospital
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35
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Efficacy of a massage roller combined with cooling lotion in the prevention of calf muscle cramps. PHLEBOLOGIE 2014. [DOI: 10.12687/phleb2167-2-2014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ZusammenfassungIn dieser offenen Anwendungsbeobachtung wurde an 208 Patienten über 4 Wochen geprüft, ob die Kombination des Massagerollers mit der Waden Massage Pflegelotion die Anzahl der Waden- und Fußkrämpfe senken kann. Zur Prophylaxe wurden täglich über mindestens 5 Minuten die betroffenen Muskeln ausgehend von der Großzehe in Rich-tung der Leiste mit dem Massageroller mit mäßig bis mittelstarkem Druck ausgerollt. Bei 151 Patienten zeigte sich eine deutliche Besserung, indem die Frequenz der Wadenkrämpfe um mehr als die Hälfte abnahm bzw. keine Wadenkrämpfe mehr auftraten. Auch die Krampflänge nahm durch Anwendung des Massagerollers bei einem aktuellen Wadenkrampf ab. Die Häufigkeit und Stärke wurde in einem Fragebogen dokumentiert. Schwangere, jüngere Patienten, solche mit Venenerkrankungen und Männer in jedem sowie Frauen im mittleren Alter profitierten von der Anwendung des Massagerollers am besten.
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Liewluck T, Klein CJ, Jones LK. Cramp-fasciculation syndrome in patients with and without neural autoantibodies. Muscle Nerve 2013; 49:351-6. [DOI: 10.1002/mus.23935] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Teerin Liewluck
- Department of Neurology; Mayo Clinic; 200 First Street SW Rochester Minnesota 55905 USA
- Department of Neurology; University of Colorado School of Medicine; Anschutz Medical Campus Aurora Colorado USA
| | - Christopher J. Klein
- Department of Neurology; Mayo Clinic; 200 First Street SW Rochester Minnesota 55905 USA
| | - Lyell K. Jones
- Department of Neurology; Mayo Clinic; 200 First Street SW Rochester Minnesota 55905 USA
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Kyriakides T, Angelini C, Schaefer J, Mongini T, Siciliano G, Sacconi S, Joseph J, Burgunder JM, Bindoff LA, Vissing J, de Visser M, Hilton-Jones D. EFNS review on the role of muscle biopsy in the investigation of myalgia. Eur J Neurol 2013; 20:997-1005. [DOI: 10.1111/ene.12174] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 02/14/2013] [Indexed: 12/21/2022]
Affiliation(s)
- T. Kyriakides
- Clinical Neurosciences; Cyprus Institute of Neurology and Genetics; Nicosia Cyprus
| | - C. Angelini
- IRCCS Fondazione Ospedale San Camillo; Venezia Italy
| | - J. Schaefer
- Department of Neurology; University of Dresden; Dresden Germany
| | - T. Mongini
- Neuromuscular Center; S.G. Battista Hospital; University of Turin; Turin Italy
| | - G. Siciliano
- Department of Neuroscience; Neurological Clinic; University of Pisa; Pisa Italy
| | - S. Sacconi
- Centre de reference des Maladies nueuromusculaires; CNRS UMR6543; Nice University Hospital; Nice France
| | - J. Joseph
- St George's University of London at the University of Nicosia Medical School; Nicosia Cyprus
| | - J. M. Burgunder
- Departments of Neurology and Clinical Research; University of Bern; Inselspital; Bern Switzerland
| | - L. A. Bindoff
- Department of Neurology; Haukeland University Hospital; Bergen Norway
| | - J. Vissing
- Neuromuscular Clinic and Research Unit; Department of Neurology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - M. de Visser
- Department of Neurology; Academic Medical Center; Amsterdam The Netherlands
| | - D. Hilton-Jones
- Oxford Neuromuscular Centre; Department of Neurology; John Radcliffe Hospital; Oxford UK
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Fasciculation anxiety syndrome in clinicians. J Neurol 2013; 260:1743-7. [DOI: 10.1007/s00415-013-6856-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 01/21/2013] [Accepted: 01/24/2013] [Indexed: 10/27/2022]
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Shribman S, Patani R, Deeb J, Chaudhuri A. Voltage-gated potassium channelopathy: an expanding spectrum of clinical phenotypes. BMJ Case Rep 2013; 2013:bcr2012007742. [PMID: 23314449 PMCID: PMC3603777 DOI: 10.1136/bcr-2012-007742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Autoimmune voltage-gated potassium channelopathies represent a wide and expanding spectrum of neurological conditions. We present a case demonstrating the phenotypic heterogeneity of antivoltage-gated potassium channels (VGKC)-associated disorders. Such cases may easily be dismissed as functional disorders at first presentation. We propose that there must remain a high index of suspicion for antiVGKC-associated disorders in cases where there are transient neurological disturbances in atypical spatial and temporal distributions.
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Affiliation(s)
- Sam Shribman
- Department of Neurology, Queen's Hospital, Essex Centre for Neurological Sciences, London, UK
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40
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Hara K, Watanabe O, Shibano K, Ishiguro H. [Case of anti VGKC-complex antibody associated disorder presenting with severe pain and fasciculations predominant in unilateral upper extremity]. Rinsho Shinkeigaku 2012; 52:677-80. [PMID: 22989904 DOI: 10.5692/clinicalneurol.52.677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 21-year-old man complained of severe pain and muscle twitching localized in his right arm. Neurological examination showed muscle fasciculations in his right forearm but no myokymia or myotonia. Needle electromyography revealed fibrillation potentials in his biceps brachii muscle and extensor carpi radialis muscle at rest but no myokymic discharges. His serum anti-voltage-gated potassium channel (VGKC)-complex antibody level was significantly high (194.2pM; controls <100pM). Although anticonvulsant therapy relieved his pain, he was readmitted to our hospital because of severe pain in his left arm and both thighs three months later. A high-dose intravenous immunoglobulin (IVIG) therapy followed by steroid pulse therapy relieved his pain. This case with neither muscle cramp nor myokymia expands the phenotype of anti VGKC-complex antibody associated disorder.
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Affiliation(s)
- Kenju Hara
- Department of Neurology, Akita Red Cross Hospital
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41
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Hyperkinetic movement disorders. Neurology 2010. [DOI: 10.1017/cbo9780511933851.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Singh V, Gibson J, McLean B, Boggild M, Silver N, White R. Fasciculations and cramps: how benign? Report of four cases progressing to ALS. J Neurol 2010; 258:573-8. [DOI: 10.1007/s00415-010-5791-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 09/28/2010] [Accepted: 10/04/2010] [Indexed: 10/18/2022]
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Resolution of muscle cramps and fasciculations with treatment of sleep apnea. J Clin Neuromuscul Dis 2009; 11:66-7. [PMID: 19730026 DOI: 10.1097/cnd.0b013e3181aede82] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Goldman SB, Brininger TL, Antczak A. Clinical relevance of neuromuscular findings and abnormal movement patterns: a comparison between focal hand dystonia and upper extremity entrapment neuropathies. J Hand Ther 2009; 22:115-123; quiz 124. [PMID: 19278824 DOI: 10.1016/j.jht.2008.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Revised: 12/16/2008] [Accepted: 12/16/2008] [Indexed: 02/03/2023]
Abstract
NARRATIVE REVIEW: Patients with focal hand dystonia and upper extremity entrapment neuropathies may present with similar symptoms and risk factors making it difficult to distinguish between the two diagnoses. Evaluating for the presence of neuromuscular findings and abnormal movement patterns can help assist the hand therapist in identifying the presence of focal hand dystonia or peripheral motor axon involvement in the absence of pronounced muscle atrophy. The purposes of this review article are twofold. First, to describe selected neuromuscular signs and symptoms characteristic of patients presenting with repetitive overuse syndromes of the upper limb leading to either a nerve entrapment syndrome or a focal hand dystonia. The selected topics will be limited to an overview of ectopic neuronal activity with an emphasis on fasciculations, muscle spasms/cramps, and sensation (including pain). Second, the article will conclude with a brief synopsis of focal hand dystonia and compression neuropathies, highlighting general assessment and treatment principles.
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Affiliation(s)
- Sarah B Goldman
- Military Performance Division, United States Army Research Institute of Environmental Medicine, 15 Kansas Street, Building 42, Natick, Massachusetts 01760, USA.
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46
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Defining normal duration for afterdischarges with repetitive nerve stimulation: a pilot study. J Clin Neurophysiol 2009; 26:45-9. [PMID: 19151616 DOI: 10.1097/wnp.0b013e3181968f00] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The presence of afterdischarges on repetitive nerve stimulation may be useful to diagnose cramp fasciculation syndrome, however, the presence and normal duration of afterdischarges has not been well-defined in the normal population and individuals with other neuromuscular diseases. The aim of this pilot study was to describe the distribution of afterdischarge durations in normal controls and patients with peripheral neuropathy. The estimated seventy-fifth percentiles of the afterdischarge durations following tibial nerve repetitive nerve stimulation at 2, 5, 10, and 20 Hz were 315, 688, 745, and 928 milliseconds for 18 normal patients, and 143, 31, 323, and 542 milliseconds for 18 peripheral neuropathy patients respectively. Afterdischarge durations were similar in peripheral neuropathy patients and controls. These findings suggest that afterdischarge durations of more than 500 milliseconds are common in normal controls without subjective cramps and patients with peripheral neuropathy, with some durations beyond 1,000 milliseconds. Therefore, the presence of afterdischarges on repetitive nerve stimulation should be interpreted with caution when evaluating patients for hyperexcitable nerve syndromes.
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Serratrice G. [Primary muscle cramps]. Rev Neurol (Paris) 2008; 164:416-25. [PMID: 18555873 DOI: 10.1016/j.neurol.2008.02.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2007] [Revised: 01/14/2008] [Accepted: 02/20/2008] [Indexed: 11/17/2022]
Abstract
Primary muscle cramps, without known cause, are very frequent especially in the elderly and during the night. They are different from secondary cramps. Likewise they are to be separated from several syndromes erroneously quoted as cramps. The pathophysiological mechanism seems due to result from an initial dysfunction in the distal part of the motoneuron. When the cramps are severe, differential diagnosis with amyotrophic lateral sclerosis may be difficult. Quinine is the best empiric treatment largely used in spite of moderate side effects.
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Affiliation(s)
- G Serratrice
- Service de neurologie et maladies neuromusculaires, Pr J. Pouget, hôpital la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France. georges.@medecine.univ-mrs.fr
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Vernino S. Peripheral nerve hyperexcitability and the neuromuscular junction. HANDBOOK OF CLINICAL NEUROLOGY 2008; 91:433-443. [PMID: 18631852 DOI: 10.1016/s0072-9752(07)01514-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Steven Vernino
- University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Khan SI, Burne JA. Reflex inhibition of normal cramp following electrical stimulation of the muscle tendon. J Neurophysiol 2007; 98:1102-7. [PMID: 17634341 DOI: 10.1152/jn.00371.2007] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Muscle cramp was induced in one head of the gastrocnemius muscle (GA) in eight of thirteen subjects using maximum voluntary contraction when the muscle was in the shortened position. Cramp in GA was painful, involuntary, and localized. Induction of cramp was indicated by the presence of electromyographic (EMG) activity in one head of GA while the other head remained silent. In all cramping subjects, reflex inhibition of cramp electrical activity was observed following Achilles tendon electrical stimulation and they all reported subjective relief of cramp. Thus muscle cramp can be inhibited by stimulation of tendon afferents in the cramped muscle. When the inhibition of cramp-generated EMG and voluntary EMG was compared at similar mean EMG levels, the area and timing of the two phases of inhibition (I(1), I(2)) did not differ significantly. This strongly suggests that the same reflex pathway was the source of the inhibition in both cases. Thus the cramp-generated EMG is also likely to be driven by spinal synaptic input to the motorneurons. We have found that the muscle conditions that appear necessary to facilitate cramp, a near to maximal contraction of the shortened muscle, are also the conditions that render the inhibition generated by tendon afferents ineffective. When the strength of tendon inhibition in cramping subjects was compared with that in subjects that failed to cramp, it was found to be significantly weaker under the same experimental conditions. It is likely that reduced inhibitory feedback from tendon afferents has an important role in generating cramp.
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Affiliation(s)
- Serajul I Khan
- School of Biomedical Sciences, University of Sydney, PO Box 170, Lidcombe, NSW 1825, Australia
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Abstract
Thirty years ago, antibodies against the muscle acetylcholine receptor (AChR) were recognized as the cause of myasthenia gravis. Since then, there has been great interest in identifying other neurological disorders associated with autoantibodies. Several other antibody-mediated neuromuscular disorders have been identified, each associated with an antibody against a ligand- or voltage-gated ion channel. The Lambert-Eaton syndrome is caused by antibodies against voltage-gated calcium channels and often occurs in patients with small cell lung cancer. Acquired neuromyotonia is caused by voltage-gated potassium channel antibodies, and autoimmune autonomic ganglionopathy is caused by antibodies against the neuronal AChR in autonomic ganglia. There is good evidence that antibodies in these disorders cause changes in synaptic function or neuronal excitability by directly inhibiting ion channel function. More recently, studies have identified ion channel antibodies in patients with certain CNS disorders, such as steroid-responsive encephalitis and paraneoplastic cerebellar ataxia. It remains unclear if antibodies can gain access to the CNS and directly cause ion channel dysfunction. Treatment of autoimmune channelopathies includes drugs that help restore normal neuronal function and treatments to remove pathogenic antibodies (plasma exchange) or modulate the immune response (steroids or immunosuppressants). These disabling neurological disorders may be dramatically responsive to immunomodulatory therapy. Future studies will likely lead to identification of other ion channel antibodies and other autoimmune channelopathies.
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Affiliation(s)
- Steven Vernino
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9036, USA.
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