Peripheral nerve hyperexcitability syndromes / 中华神经科杂志

Peripheral nerve hyperexcitability syndromes (PNHS) encompass a spectrum of a heterogeneous condition with clinical as well as electrophysiological manifestations of peripheral nerve hyperexcitability. The PNHS consist of Isaacs syndrome, Morvan syndrome and Cramp-fasciculation syndrome, which cause widespread symptoms and signs while without evident peripheral nerve disease. Probably the most well-known condition of PNHS is Isaacs syndrome, often called acquired neuromyotonia. Clinical symptoms of PNHS are characterized by muscle twitching, cramps, stiffness, and neuropathic pain. The electrophysiological findings that are very useful in the diagnosis of PNHS are spontaneous myokymic, neuromyotonic, and cramp discharges. An overview of the history, clinical manifestations, pathophysiology, electrophysiological findings and management of PNHS is presented.

Superior Oblique Myokymia Associated with Neurovascular Cross Compression

Superior oblique myokymia (SOM) is a rare disorder characterized by unilateral paroxysmal oscillopsia or diplopia. Recent studies revealed that SOM can be associated with neuro-vascular cross compression (NVCC) of the trunk of the trochlear nerve. Although it frequently occurs without any underlying systemic disease or concurrent neurologic sign, we need to consider this NVCC especially in cases with persistent disturbing symptoms. Hereby, we present two cases of SOM whose neuroimaging studies suggest NVCCs and, discuss recent update of the pathomechanism of SOM.

Two Cases Report of Periodic Movement of Extremities Successfully Treated with a Kampo Formulation Boibukuryoto / 日本東洋医学雑誌

A Kampo formulation boibukuryoto is originally described in the classic textbook “Kinkiyouryaku,” which indication is involuntary muscle movement (IMM) of extremities, similar to the movement of leaves of an elm tree. We experienced two cases of IMM successfully treated with boibukuryoto. This report presented the details of these two cases of IMM and the results of surface electromyogram (EMG). There has never been a report of boibukuryoto for the treatment of IMM. The results of EMG indicate that IMM may be associated with myokymia.

The Prevalence of Eyelid Myokymia in Medical Students.

Aims: To determine the prevalence and factors associated with eyelid myokymia (EM) in students attending Medical faculty. Study Design: Cross sectional survey. Place and Duration of Study: Medical faculty University of Tuzla and Department of Ophthalmology University Clinical Centre Tuzla, between December 2015. and January 2016. Methodology: We included 100 medical students, randomly selected by staff employed in student service of Medical faculty, from the list of students registered for different exams in December 2015. Before the survey all participants were informed about the signs and presentations of eyelid twitching and its possible significance. The survey was performed before and after the exams with students of third, fourth and fifth study year. It consisted of 18 questions regarding the presence of eyelid twitch, and influence of various factors on its frequency and intensity. Results: Forty four percent of students had signs of eyelid myokimia (EM) during short period of 7 days before the exams. Female students were more likely to have EM than male students (OR 2.46:1). Students of fifth study year were at more risk for development of EM than students of fourth and third year respectively (OR 1:1.5:2.67). Energy drinks consuming was a significant predictor for EM occurrence (P=.046). Students who reported to have reduced sleep during exam preparation have significantly more often symptoms of EM (P=.014) as well as individuals who claim to have been exposed to a greater amount of stress (P=.042). Conclusion: Eyelid myokymia is relatively common phenomenon among students of Medical faculty. It has higher incidence before exams, during the period of intense studying.

Use of Video-oculography in the Diagnosis of Superior Oblique Myokymia

PURPOSE: Superior oblique myokymia is intermittent spontaneous contractions of the superior oblique muscle presenting as rapid and small-amplitude intorsions and depressions of the eye. The authors report a case of superior oblique myokymia that was objectively and quantitatively diagnosed with slit lamp examination and video-oculography and completely resolved with medical treatment. CASE SUMMARY: A 44-year-old woman presented with a seven-year history of intermittent oscillopsia which continued for few seconds. She had no history of head trauma or systemic ocular disease, and the anterior segment and fundus examination were unremarkable. Right eye intorsion lasting for a few seconds as detected by slit lamp examination. Eye movements were recorded using video-oculography, which showed a torsional nystagmus of 5 to 10 degrees with 2 to 5 vertical components in the right eye. Based on these findings, the patient was diagnosed with superior oblique myokymia. The patient was prescribed topical timolol ophthalmic solution, one drop twice per day, but the symptoms persisted. Timolol ophthalmic solution was stopped and replaced with carbamazepine, 200 mg twice a day, which resolved her symptoms. CONCLUSIONS: Slit lamp examination and video-oculography can be used as objective and quantitative diagnostic tools in order to confirmed a diagnosis and lead to proper treatment.

The pathogeny and electromyography of myokymia / 中华物理医学与康复杂志

Objective To research the pathogeny and the electromyographic characteristics of myokymia.Methods The clinical features and electromyography of 42 elderly patients with myokymia were examined. Results Symptomatic myokymia (SM) in 27 cases was caused by low salt syndrome, thyrotoxemia, urinaemia, chronic wasting diseases (such as carcinoma of the stomach or liver), brachial plexus neuropathy, lead poisoning, chronic inflammatory demyelinating polyradiculoneuritis, succinylcholine narcosis, restless leg syndrome or Isaac's syndrome.Symptomatic facial myokymia was caused by neoplasm of the brain stem or in posterior cranial fossa, multiple sclerosis or other causes. Primary myokymia ( PM ) in 15 cases involved idiopathic generalized and benign myokymia.Compared with PM, SM was more constant and powerful. Myokymia potential appeared in the electromyograms of 42 of the patients. The majority of patients with SM had accompanying myotonic discharge. Conclusion The pathogeny and electromyographic characteristics of symptomatic myokymia are different from the primary stage.

Two Cases of Delayed Post-radiation Lower Cranial Nerve Palsies

Radiation-induced lower cranial neuropathy shows a clinical presentation similar to tumor recurrence or amyotrophic lateral sclerosis. We experienced two patients with bulbar palsies several years after radiotherapy for nasopharyngeal cancer. Brain magnetic resonance imaging showed no evidence of tumor recurrence. Electrophysiologic studies demonstrated mild denervation changes and myokymic discharges in muscles innervated by cranial nerves. Bulbar palsies progressed for 1 year then became stable. We emphasize the importance of myokymic discharges in the differential diagnosis of radiation-induced cranial neuropathy as radiation plexopathies.

Therapeutic Effect of Botulinum Toxin Injection in Eyelid Myokymia Patients

PURPOSE: To evaluate clinical manifestations and effects of botulinum toxin in eyelid myokymia patients. METHODS: Between March 2001 and March 2005, botulinum toxin injection therapy was performed in 12 eyelid myokymia patients. We evaluated duration of disease, systemic disease, drug history, and range, grade, frequency of myokymia at the first visit. Botulinum injections were performed in patients with normal results of blood tests and neuroimaging tests. Improvement of symptoms, duration of effectiveness, and complications were evaluated after the botulinum toxin injection therapies. Data was analyzed with the Mann-Whitney U test. RESULTS: Improvement of symptoms was noticed in 10 patients (83.3%). Among the 10 patients, 5 patients were decided as cured patients because they did not require any retreatment. Range and grade of myokymia didn't affect on effect of treatment. Pain, edema, excessive tearing, and unnatural face were noticed as complications of treatment, but all complications disappeared 2 weeks after the treatment. CONCLUSIONS: Botulinum toxin injection therapy is noninvasive and effective treatment in benign eyelid myokymia patients without causal neurologic disease.

Isaacs syndrome:a case report / 中国康复理论与实践

@#ObjectiveTo analyze the clinical features and pathogenesis mechanism of Isaacs syndrome.MethodsA case with Isaacs syndrome was reporttedResults and ConclusionIsaacs syndrome is characterized by the occurrence of spontaneous and continuous muscle fiber activity, associated with muscle cramps, pseudomyotonia and myokymia, stiffness and delayed relaxation of the muscle. The stiffness and myokymia are present at rest and during sleep. Isaacs syndrome has been recently suggested to be produced through an immune-mediated mechanism in which voltage-gated potassium channels may be targeted by auto-antibodies.

Idiopathic generalized myokymia:Diagnosis and treatment / 中国康复理论与实践

@#ObjectiveTo probe the clinical features,diagnosis and treatment of idiopathic generalized myokymia.MethodsSeven patients with idiopathic generalized myokymia were analysed retrospectively.ResultsAll 7 patients showed prominent myokymia characterized by undulating and vermicular movements spreading across the muscle surface. The myokymia in gastrocnemius muscles in all cases. The myokymia also appeared in both upper extremities in 5 patients,and in faces,waist,back,abdomen and all extremities in 2 patients. Muscle rippling movement was induced and increased by exercise,and persistent during sleep. The vermicular myokymia could be observed easily in the relaxation of the muscles. Electromyography tests showed myokymic discharges in 5 patients,but normal in 2 patients. 5 patients of them were cured with carbamazepine and phenytoin sodium.ConclusionThere are typical clinical features and effective treatment in the patients with idiopathic generalized myokymia.

Treatment with Botulinum Toxin A in Continuous Facial and Neck Myokymia: A case report

Myokymia is a clinical phenomenon characterized by undulating, vermicular, rippling and wavelike movements spreading across the muscle surface. Facial myokymia is an unusual complication of brainstem hemorrhage. It tends to occur in brainstem tumor or multiple sclerosis. We report a 51-year-old man with continuous facial and neck myokymia after brainstem hemorrhage, who revealed focal myokymic discharges in face, neck and pharyngolaryngeal muscles in-nervated by cranial nerve V, VII, X, and XI. After injection of 20-80 units of Botulinum toxin type A (Dysport ) to the left orbicularis oris, mentalis, mylohyoid and posterior belly of digastric muscles, amplitude of continuous myokymic discharges was markedly reduced. We recommend Botulinum toxin injection as a very effective therapeutic method in managing focal movement disorders.

The Effects of Thoracic Sympathetic Ganglion Block and Gabapentin in a Patient with Myokymia and Neuropathic Pain after a Thoracotomy / 대한마취과학회지

Myokymia is one of involuntary movement, which is characterized by undulatory muscle spasm, similar to the worm's crawl. Sometimes muscle pain, itchy sensation, dysautonomia and other symptoms are associated with it. Derangement of the peripheral or central nervous system after nerve or tissue damage is suspected as the source of impulse generators causing this symptom. We encountered a patient with neuropathic pain and myokymia after thoracotomy. Although several medications and nerve blocks have been applied, all have failed to provide symptom relief. We experienced improvement of the pain and involuntary movement with a thoracic sympathetic ganglion block and gabapentin.

A Case of Superior Oblique Myokymia

Superior oblique myokymia refers to a disorder characterized by involuntary torsional and vertical oscillation of one eye, lasting several seconds to minutes with an irregular interval. We report a 44-year-old woman with superior oblique myokymia, who presented with quivering sensation and oscillopsia of the left eye. Magnetic resonance imaging of the brain was normal. The involuntary eye movement and oscillopsia responded to carbamazepine.

A Case of Superior Oblique Myokymia

Superior oblique myokymia is an unusual disorder of ocular motility characterized by rapid, small ampulitude and rotary oscillations limited to one eye. Symptoms of monocular oscillopsia and torsional diplopia are experienced by the patient, and the cause remains obscure. We experienced a case of superior oblique myokymia that developed in a 53-year-old male. We report this unusual case with literature review.