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1.
J Assoc Physicians India ; 71(12): 100-101, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-38736063

RESUMEN

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an acquired, immune-mediated neuropathy affecting peripheral nerves and nerve roots. It is characterized by symmetric weakness involving both proximal and distal muscles; it can be relapsing-remitting or progressive in course. The clinical manifestations of CIDP are various and may present with atypical features, like myokymia, tremor, or tremor-like phenomena, which may mislead the clinician in diagnosis.


Asunto(s)
Miocimia , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante , Humanos , Miocimia/diagnóstico , Miocimia/etiología , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/diagnóstico , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/complicaciones
2.
Muscle Nerve ; 63(6): 861-867, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-33675544

RESUMEN

INTRODUCTION: Myokymic discharges are classically associated with nerve injury from prior radiation but may occur in other neuromuscular disorders. Using quantitative analysis we aimed to identify the spectrum of conditions in which myokymic discharges are present and determine if there are electrophysiological features that distinguish postradiation from nonradiation causes of myokymia. METHODS: We reviewed the clinical history of all patients examined in our electromyography labs with myokymic discharges recorded from June 2017 to February 2020. Quantitative analysis of each myokymic discharge was performed using a custom MATLAB script, assessing features such as burst frequency, spikes per burst, and burst regularity. RESULTS: Eighty-eight distinct myokymic discharges (70 patients) were analyzed: 51 postradiation recordings from 35 patients and 37 recordings from 35 nonradiation patients. The diagnostic spectrum of nonradiation cases was diverse, with common causes being median neuropathy (n = 8), cervical (n = 7), and lumbar (n = 5) radiculopathy, and motor neuron disease (n = 5). On quantitative analysis, postradiation myokymia had an increased burst-to-silence ratio (median, 0.29; nonradiation, 0.08) and greater peak number (median, 15; nonradiation, 7). Except for one patient with hereditary peripheral nerve hyperexcitability, all patients who had two or more muscles demonstrating myokymic discharges belonged to postradiation group. CONCLUSIONS: Myokymic discharges can be seen in diverse neuromuscular conditions; most common in our cohort was chronic median neuropathy. Postradiation myokymia appears to have distinguishing morphological features when quantitatively analyzed compared with nonradiation cases.


Asunto(s)
Miocimia/etiología , Enfermedades del Sistema Nervioso Periférico/complicaciones , Traumatismos por Radiación/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Electromiografía , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Miocimia/fisiopatología , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Traumatismos por Radiación/fisiopatología , Adulto Joven
3.
Wilderness Environ Med ; 31(3): 354-357, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32826164

RESUMEN

A number of crotaline species have been associated with neurotoxic envenomation in North America. One clinical sign that can occur is myokymia: fine, involuntary, wave-like muscle movements occurring at regular intervals. We report an unusual scenario in which a single snakebite resulted in simultaneous envenomation of 2 patients. Both developed myokymia, with 1 having respiratory compromise. One patient also developed a hypersensitivity reaction to antivenom. Envenomation by the Grand Canyon rattlesnake, Crotalus oreganus abyssus, can produce significant neurotoxicity and resultant respiratory compromise. Antivenom may be helpful but can produce hypersensitivity reactions.


Asunto(s)
Antivenenos/efectos adversos , Venenos de Crotálidos/toxicidad , Crotalus , Hipersensibilidad/terapia , Miocimia/terapia , Mordeduras de Serpientes/patología , Mordeduras de Serpientes/terapia , Adulto , Animales , Arizona , Humanos , Hipersensibilidad/etiología , Masculino , Persona de Mediana Edad , Miocimia/etiología , Miocimia/patología , Miocimia/fisiopatología , Mordeduras de Serpientes/complicaciones , Mordeduras de Serpientes/fisiopatología
5.
Jpn J Clin Oncol ; 44(8): 736-42, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-24842865

RESUMEN

OBJECTIVE: Radiation-induced brachial plexus injury is a devastating complication that occurs after radiotherapy in the vicinity of the brachial plexus. Nasopharyngeal carcinoma, the most common type of cancer in Guangdong Province, is primarily treated with radiotherapy with subsequent side effects. However, radiation-induced brachial plexus injury is rarely reported in nasopharyngeal carcinoma. To draw attention to this correlation, we analyzed the clinical characteristics including the imaging findings of 10 patients suffering from radiation-induced brachial plexus injury for nasopharyngeal carcinoma. METHODS: We considered the patients' medical histories, analyzed their clinical characteristics, and monitored the long-term efficacy of treatment. RESULTS: The total irradiation dose of the nasopharynx ranged from 66.6 to 74 Gy, and that of the supraclavicular fossa ranged from 60 to 70 Gy. The mean latency was 8.2 ± 5.5 years. Seven patients initially complained of bilateral weakness, and three patients complained of isolated pain. The injuries of eight patients reached Grade 3 or worse. Magnetic resonance imaging showed a low signal on T1-weighted images and a high signal on short tau inversion recovery sequences in all cases. Swollen nerve fibers were clearly displayed in magnetic resonance diffusion tensor imaging. Electromyography showed myokymia in three patients. With conservative therapy, only one patient was temporarily relieved of pain, while the conditions of others were not ameliorated. CONCLUSIONS: Radiation-induced brachial plexus injury is a late but catastrophic complication in patients with nasopharyngeal carcinoma. Clinicians should be aware of radiation-induced brachial plexus injury when deciding on treatment and should give them regular follow-up post radiotherapy.


Asunto(s)
Plexo Braquial/lesiones , Neoplasias Nasofaríngeas/radioterapia , Traumatismos por Radiación/etiología , Radioterapia/efectos adversos , Adulto , Plexo Braquial/efectos de la radiación , Carcinoma , Electromiografía , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Miocimia/etiología , Carcinoma Nasofaríngeo , Estadificación de Neoplasias , Pronóstico , Dosis de Radiación
8.
Muscle Nerve ; 41(1): 107-9, 2010 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-20014246

RESUMEN

Myokymic discharges (MDs) are uncommonly recognized in amyotrophic lateral sclerosis (ALS). The electrophysiologic findings in 96 ALS patients were retrospectively reviewed. MDs were found in 5.2% of patients, in 0.81% of total muscles examined (8.2% cranial muscles vs. 0.15% limb muscles). The higher frequency of MDs in cranial muscles suggests a difference in the metabolic environment or other mechanism of instability of the anterior horn cells in the brainstem compared to the spinal cord.


Asunto(s)
Esclerosis Amiotrófica Lateral/complicaciones , Electromiografía/métodos , Contracción Muscular/fisiología , Músculo Esquelético/fisiopatología , Miocimia/diagnóstico , Anciano , Esclerosis Amiotrófica Lateral/diagnóstico , Esclerosis Amiotrófica Lateral/fisiopatología , Diagnóstico Diferencial , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Miocimia/etiología , Miocimia/fisiopatología , Estudios Retrospectivos
9.
Neurochirurgie ; 55(2): 272-8, 2009 Apr.
Artículo en Francés | MEDLINE | ID: mdl-19285325

RESUMEN

In this chapter we describe a variety of rare but clinically identifiable ocular motor syndromes, including ocular neuromyotonia, superior oblique myokymia, ocular motor synkinesis, third nerve palsy with cyclic spasms, and paroxysmal manifestations of multiple sclerosis. These syndromes share many characteristics. They result from neurogenic hyperactivity, causing episodic spasms of one or several extraocular muscles. The pathophysiology is not fully understood, but it usually includes both a focal and partial lesion of one of the ocular motor nerves and a central rearrangement of neuronal activity in the ocular motor nuclei. Treatment with membrane-stabilizing agents, such as carbamazepine, is usually effective to reduce the symptoms. The above-mentioned syndromes result from a number of different diseases. A proportion of apparently idiopathic cases may be related to a neurovascular compression syndrome.


Asunto(s)
Trastornos de la Motilidad Ocular/etiología , Trastornos de la Motilidad Ocular/terapia , Anticonvulsivantes/uso terapéutico , Humanos , Esclerosis Múltiple/complicaciones , Miocimia/etiología , Miocimia/terapia , Trastornos de la Motilidad Ocular/diagnóstico , Trastornos de la Motilidad Ocular/fisiopatología , Músculos Oculomotores/fisiopatología , Enfermedades del Nervio Oculomotor/diagnóstico , Enfermedades del Nervio Oculomotor/etiología , Enfermedades del Nervio Oculomotor/fisiopatología , Enfermedades del Nervio Oculomotor/terapia , Oftalmoplejía/diagnóstico , Oftalmoplejía/etiología , Oftalmoplejía/fisiopatología , Oftalmoplejía/terapia , Espasmo/complicaciones , Espasmo/etiología
10.
Clin Toxicol (Phila) ; 46(2): 117-21, 2008 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-18259958

RESUMEN

INTRODUCTION: Rattlesnake envenomation occasionally results in repetitive small-muscle fasciculations known as myokymia. We report the results of a retrospective inquiry of this phenomenon from a statewide poison center's database. METHODS: Data was obtained from a poison system database for the years 2000-2003, inclusive, for rattlesnake envenomation exposures coded as having fasciculations. RESULTS: A total of 47 cases were identified, and nine other cases were found from previously published literature. There was no consistent temporal pattern by monthly analyses in incidence or proportion of reported snakebites with myokymia. All four of the reviewed cases with myokymia of the shoulders were intubated and none without it were intubated. CONCLUSIONS: A review of four consecutive years of data revealed no pattern to correlate the incidence of fasciculations with the month. The development of respiratory failure associated with myokymia, sometimes despite antivenom, is a newly reported occurrence. Clinicians are reminded to monitor closely airway and inspiratory capacity in patients with severe myokymia.


Asunto(s)
Crotalus , Fasciculación/etiología , Centros de Control de Intoxicaciones/estadística & datos numéricos , Mordeduras de Serpientes/complicaciones , Adolescente , Adulto , Animales , Antivenenos/uso terapéutico , Ansiedad/tratamiento farmacológico , California/epidemiología , Niño , Preescolar , Bases de Datos Factuales/estadística & datos numéricos , Diazepam/uso terapéutico , Fasciculación/epidemiología , Femenino , Haloperidol/uso terapéutico , Humanos , Lorazepam/uso terapéutico , Masculino , Persona de Mediana Edad , Miocimia/tratamiento farmacológico , Miocimia/etiología , Agitación Psicomotora/tratamiento farmacológico , Agitación Psicomotora/etiología , Estudios Retrospectivos , Estaciones del Año , Mordeduras de Serpientes/epidemiología
11.
Surv Ophthalmol ; 63(4): 507-517, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29056504

RESUMEN

Superior oblique myokymia (SOM) is a rare condition of unclear etiology. We discuss the history, etiology, clinical features, differential diagnoses, management, and prognosis of SOM. We conducted a meta-analysis of all 116 cases published since SOM was first described in 1906. The age at examination was 17-72 years (mean: 42 years.) There was a right-sided preponderance in 61% of cases (P < 0.02) that was statistically significant in females (63%, P < 0.04) but not in males (59%, P = 0.18). The pathophysiology of SOM may be neurovascular compression and/or ephaptic transmission. Although various pharmacological and surgical approaches to SOM treatment have been proposed, the rarity of the condition has made it impossible to conduct clinical trials evaluating the safety and efficacy of these approaches. Recently, topical beta blockers have managed SOM symptoms in a number of cases, including the first case treated with levobunolol. Systemic medications, strabismus surgery, and neurosurgery have been used to control symptoms, with strabismus surgery carrying a moderate risk of postoperative diplopia in downgaze. Although there is no established treatment for SOM, we encourage clinicians to attempt topical levobunolol therapy before considering systemic therapy or surgery.


Asunto(s)
Miocimia , Enfermedades del Nervio Troclear , Antagonistas Adrenérgicos beta/uso terapéutico , Diagnóstico Diferencial , Humanos , Miocimia/etiología , Miocimia/fisiopatología , Miocimia/terapia , Músculos Oculomotores/cirugía , Factores de Riesgo , Enfermedades del Nervio Troclear/etiología , Enfermedades del Nervio Troclear/fisiopatología , Enfermedades del Nervio Troclear/terapia
12.
Pediatr Dermatol ; 24(6): 628-31, 2007.
Artículo en Inglés | MEDLINE | ID: mdl-18035984

RESUMEN

We report a 4-week-old male infant with intermittent asymptomatic bouts of vermicular movements of the skin (myokymia). Myokymia started at the age of 4 days. Attacks occurred approximately every 30-60 minutes and could be elicited by gently stroking the skin. Macroscopically no abnormalities typical for smooth muscle hamartoma such as hypertrichosis or hyperpigmentation were observed. Histologic examination of a skin biopsy specimen showed bundles of hyperplastic smooth muscle tissue within the reticular dermis which were associated with hair follicles. Karyotyping did not reveal any structural or numeric chromosomal anomaly. The findings led to the diagnosis of congenital smooth muscle hamartoma. On follow-up at the age of 24 months myokymia persisted, but with a marked reduction in the number of attacks per day. The phenomenon of myokymia results from neurally induced spontaneous contraction of dermal smooth muscles. It is also known as "pseudo-Darier's sign." While most of those affected previously reported had hypertrichosis or hyperpigmentation, this patient seems to be the first to present with myokymia alone.


Asunto(s)
Hamartoma/complicaciones , Músculo Liso/patología , Enfermedades Musculares/congénito , Miocimia/etiología , Hamartoma/congénito , Hamartoma/diagnóstico , Humanos , Recién Nacido , Masculino , Enfermedades Musculares/complicaciones , Enfermedades Musculares/diagnóstico
13.
Acta Neurol Taiwan ; 16(1): 33-6, 2007 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-17486731

RESUMEN

We report a 52-year-old man with slowly progressive dysarthria and dysphagia for about 11 years after radiation therapy of nasopharyngeal carcinoma. Neurological examination revealed atrophy and myokymia on the left side of the tongue and in the left mentalis muscles. Electrical discharges of myokymia and neuromyotonia were also observed in the aforementioned muscles, suggesting increased motor axonal membrane excitability involving the left hypoglossal nerve and the marginal mendibular branch of the left facial nerve. Magnetic resonance imaging of the brain did not show any evidence of tumor recurrence, indicating that irradiation probably plays an important role in pathogenesis. Focal myokymia with concomitant neuromyotonia in unilateral tongue and mentalis muscles could be an unusual delayed manifestation after radiation therapy.


Asunto(s)
Mentón/efectos de la radiación , Músculos Faciales/efectos de la radiación , Síndrome de Isaacs/etiología , Miocimia/etiología , Neoplasias Nasofaríngeas/radioterapia , Radioterapia/efectos adversos , Enfermedades de la Lengua/etiología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad
14.
Neurologist ; 22(1): 29-33, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-28009770

RESUMEN

INTRODUCTION: Morvan syndrome is a rare and complex autoimmune disorder affecting multiple sites of neuraxis. CASE REPORT: We present fulminant Morvan syndrome, developing on a background of chronic myasthenia gravis. A 54-year-old gentleman presented with fluctuating ophthalmoplegia and proximal muscles weakness of 7 years duration that remitted with pyridostigmine and prednisolone. He developed insomnia of 2 months duration, worsening of myasthenic symptoms and respiratory distress, dysautonomia, encephalopathy, and peripheral nerve hyperexcitability. Antibodies against contactin-associated protein (CASPR) 2 were detected in serum. Computed tomography of thorax showed a thymic mass. He received intravenous methyl prednisolone and plasmapheresis. Antibodies against CASPR and thymic lesion reduced with immunotherapy. However, he developed persistent hypotension and expired after 11 weeks of hospital stay. CONCLUSIONS: Clinical clues for diagnosis of Morvan syndrome and therapeutic changes faced by the treating team are highlighted in this report. Increased awareness and prompt testing for CASPR2 antibody is warranted so that early immunotherapy can be initiated.


Asunto(s)
Miastenia Gravis/diagnóstico , Miocimia/diagnóstico , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Miastenia Gravis/complicaciones , Miocimia/etiología
16.
World Neurosurg ; 107: 175-184, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-28826715

RESUMEN

OBJECTIVE: Gamma Knife radiosurgery (GKS) for the treatment of vestibular schwannoma (VS) introduces risks to the facial nerve and auditory perception and may involve post-treatment complications such as pseudoprogression, hydrocephalus, and other cranial neuropathies. This study of patients with VS who underwent GKS investigated radiosurgical results, focusing on post-treatment complications and identifying the factors that predict such complications. METHODS: We undertook a retrospective review of all VS patients treated with the Perfexion Leksell Gamma Knife between November 2007 and October 2010 at our institution. Patients who underwent at least 12 months of clinical and radiologic assessments before and after GKS were included. RESULTS: All 235 patients were included in the analyses reported here. The 5-year serviceable hearing and facial nerve preservation values were 73.9% and 94.3%, respectively. Following GKS, 43 patients (18.30%) showed pseudoprogression, 15 (6.38%) exhibited hydrocephalus, 22 (9.36%) showed trigeminal neuropathy, 14 (5.96%) showed vertigo, and 25 (10.64%) showed facial myokymia. According to multivariate analysis, solid tumor nature was significantly associated with pseudoprogression and patient age was significantly associated with hydrocephalus. Patients receiving margin doses ≥13 Gy had a significantly higher probability of loss of serviceable hearing. Patients with smaller tumors had a trigeminal nerve preservation rate comparable with patients harboring larger tumors. Patients receiving margin doses <13 Gy or older patients had a significantly higher probability of vestibular nerve dysfunction. CONCLUSIONS: Further prospective studies should be designed to provide further insight into the exact relationship between the predictive factors we investigated and post-treatment complications.


Asunto(s)
Neuroma Acústico/radioterapia , Radiocirugia/efectos adversos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Progresión de la Enfermedad , Enfermedades del Nervio Facial/etiología , Enfermedades del Nervio Facial/prevención & control , Femenino , Pérdida Auditiva/etiología , Pérdida Auditiva/prevención & control , Humanos , Hidrocefalia/etiología , Masculino , Persona de Mediana Edad , Miocimia/etiología , Tratamientos Conservadores del Órgano/métodos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Estudios Retrospectivos , Factores de Riesgo , Enfermedades del Nervio Trigémino/etiología , Vértigo/etiología , Adulto Joven
17.
J Am Vet Med Assoc ; 248(5): 532-7, 2016 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-26885596

RESUMEN

CASE DESCRIPTION A 5-year-old castrated male Maltese was evaluated for intermittent clinical signs of muscle cramping and abnormal movements of the skin of the right pelvic limb at the site where an infiltrative lipoma had twice been resected. After the second surgery, the surgical field was treated with radiation therapy (RT). The clinical signs developed approximately 14 months after completion of RT. CLINICAL FINDINGS When clinical signs were present, the right biceps femoris and semitendinosus muscles in the area that received RT were firm and had frequently visible contractions, and the skin overlying those muscles had episodic vermiform movements. Electromyography of those muscles revealed abnormal spontaneous activity with characteristics consistent with myokymic discharges and neuromyotonia. Magnetic resonance imaging of the affected leg revealed no evidence of tumor regrowth. The myokymia and neuromyotonia were considered secondary to RT. TREATMENT AND OUTCOME 4 U of Clostridium botulinum toxin type A (BoNT-A) neurotoxin complex was injected into the affected muscles at each of 6 sites twice during a 24-hour period (ie, 48 U of BoNT-A were administered). The clinical signs were completely resolved 10 days after BoNT-A treatment and were controlled by repeated BoNT-A treatment every 3 to 4 months for > 1 year. CLINICAL RELEVANCE To our knowledge, this is the first report of myokymia and neuromyotonia secondary to RT in a dog. For the dog of this report, injection of BoNT-A into the affected muscles was safe, effective, and easy to perform.


Asunto(s)
Toxinas Botulínicas Tipo A/uso terapéutico , Enfermedades de los Perros/tratamiento farmacológico , Síndrome de Isaacs/veterinaria , Miocimia/veterinaria , Fármacos Neuromusculares/uso terapéutico , Traumatismos por Radiación/veterinaria , Animales , Toxinas Botulínicas Tipo A/administración & dosificación , Enfermedades de los Perros/etiología , Perros , Electromiografía/veterinaria , Inyecciones Intralesiones/veterinaria , Inyecciones Intramusculares/veterinaria , Síndrome de Isaacs/tratamiento farmacológico , Síndrome de Isaacs/etiología , Masculino , Miocimia/tratamiento farmacológico , Miocimia/etiología , Fármacos Neuromusculares/administración & dosificación , Traumatismos por Radiación/tratamiento farmacológico
19.
Pediatrics ; 136(4): 732-9, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-26371189

RESUMEN

A 6-year-old girl presented with a history of leg pain and cramping that progressively worsened over a 2- to 3-week period of time. Her examination was notable for normal vital signs, limited range of motion of her left hip, and a limp. Inflammatory markers were slightly elevated, but the serum electrolytes, calcium, and magnesium, complete blood cell count and differential, and creatine kinase level were normal. She was hospitalized for further diagnostic evaluation and was noted to have abnormal muscle movements classified as myokymia (continuous involuntary quivering, rippling, or undulating movement of muscles). Electromyography confirmed the myokymia but did not reveal evidence of a myopathy or neuropathy, prompting additional evaluation for a systemic etiology.


Asunto(s)
Neuroblastoma/diagnóstico , Síndromes Paraneoplásicos del Sistema Nervioso/diagnóstico , Niño , Femenino , Humanos , Pierna , Calambre Muscular/etiología , Miocimia/etiología , Neuroblastoma/complicaciones , Síndromes Paraneoplásicos del Sistema Nervioso/complicaciones
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