[Periodic paralysis: new pathophysiological aspects]. / Les paralysies périodiques: nouveaux aspects physiopathologiques.

Periodic paralyses are neuromuscular disorders characterized by attacks of muscle weakness coinciding with changes in blood potassium levels. They are thus classified as hypokalaemic, normokalaemic or hyperkalaemic. Most forms are genetic, with autosomal dominant inheritance. These diseases are channelopathies, i.e. caused by mutations in ion channel genes. The culprit genes encode muscle sodium, calcium and potassium channels. Mutations in calcium or potassium channels cause periodic paralyses of the same type (hypokalaemic periodic paralysis or Andersen-Tawil Syndrome). In contrast, distinct mutations in the gene encoding the sodium channel can cause the entire range of periodic paralysis (hypokalaemic, normokalaemic or hyperkalaemic). The physiological consequences of mutations have been studied with patch-clamp techniques and electromyography. Generally speaking, mutations alter the excitability cycle of the muscle membrane, resulting in a loss of function (paralysis). Electromyographic studies have demonstrated a good correlation between symptoms and physiological parameters, giving rise to a classification that can help orient the molecular diagnosis. Work on the genetics and pathophysiology of periodic paralyses has helped to improve the diagnosis and management of these syndromes.

[Current status of clinical and molecular-biological research on familial periodic paralysis].

Types of periodic paralysis seen in Japan are numerous: the one most frequently seen is hypokalemic periodic paralysis. Among them, approximately 50% are secondary to thyrotoxicosis. Number of families of familial hyperkalemic periodic paralysis have also been reported so far. Several cases of hyperkalemic periodic paralysis secondary to thyrotoxicosis have also been reported exclusively from Japan. As the pathogenesis of hypokalemic periodic paralysis, depolarization block induced by membrane permeability change in the face of hypokalemia triggered by excess insulin was strongly suggested and supported experimentally in part. Recent linkage analysis on familial hypokalemic periodic paralysis revealed that the abnormality is linked to a mutation in voltage-gated Ca channel. The difficulty remains how to explain the cause of hypokalemia which is almost always preceding the attack of periodic paralysis of this type. The cause of hyperkalemic periodic paralysis was shown to be the mutation in voltage-gated Na channel. Failure of inactivation of the channel causes an increase in inward sodium current which results in depolarization and accumulation of potassium. The explanation of the pathogenesis of paralysis is straight-forward when compared to that of hypokalemic periodic paralysis.

Channelopathies: the nondystrophic myotonias and periodic paralyses.

The term channelopathy does not indicate a new group of neuromuscular conditions, but a re-orientation of well- and long-known muscular conditions, the congenital myotonias, and the periodic paralyses. Although, in the past, they have overlapped clinically here and there, both groups were classified differently, as myotonias and as metabolic myopathies, respectively. The discovery of mutations in several ion channels has rewritten nosography of these disorders and procured a new term, the channelopathy-clinical, electrophysiological, and molecular genetic details of which are discussed in this chapter.

Sodium channel defects in myotonia and periodic paralysis.

Myotonias and periodic paralyses constitute a diverse group of inherited disorders of muscle in which the primary defect is an alteration in the electrical excitability of the muscle fiber. The ion channel defects underlying these excitability derangements have recently been elucidated at the molecular and functional levels. This review focuses on sodium channel mutations that disrupt inactivation and thereby cause both the enhanced excitability of myotonia (muscle stiffness due to repetitive discharges) and the inexcitability resulting from depolarization during attacks of paralysis.

The periodic paralyses.

These mysterious attacks of muscle weakness are difficult to treat because the different forms are hard to define, and potassium plays a different role in each one. New genetic probes should finally resolve these issues. In the meantime, attacks can be prevented in at least some patients. A multicenter study is now under way to determine the best treatment for each subtype.

Paramyotonia congenita and hyperkalemic periodic paralysis are linked to the adult muscle sodium channel gene.

The hyperkalemic periodic paralyses are a clinically heterogeneous group of autosomal dominant syndromes characterized by episodic paralysis associated with an elevated serum potassium level. Affected individuals in the same family tend to have homogeneous symptom complexes, although phenotypic variation is present among different families. For example, myotonia is absent in some pedigrees, present in others, and, in a third variant, paramyotonia congenita, myotonia coexists with cold-induced paralysis. Electrophysiological studies have demonstrated variant-specific abnormalities in skeletal muscle membrane sodium conductance. We tested the hypothesis that hyperkalemic periodic paralysis (without myotonia) and paramyotonia congenita are tightly linked to the tetrodotoxin-sensitive adult skeletal muscle sodium channel gene on chromosome 17q23-25 in two large pedigrees. The DNA polymorphisms detected in the growth hormone skeletal muscle sodium channel complex (GH1-SCN4A) and by flanking polymorphic markers (D17S74 and D17S40) demonstrated no recombinants between the disease phenotypes and this complex. Phenotypic variation in the hereditary hyperkalemic periodic paralyses may result from allelic heterogeneity at the tetrodotoxin-sensitive adult skeletal muscle sodium channel locus.

[A case of sporadic hypokalemic form of familial periodic paralysis]. / Przypadek sporadycznej, hipokaliemicznej postaci porazenia okresowego.

A case is reported of sporadic hypokalemic form of periodic paralysis, calling attention to the presence of certain rare signs, that is bilateral facial palsy and speech disturbances. The most modern reports on the aetiology and pathogenesis of periodic paralysis are discussed.

The periodic paralyses.

Patient history and examination often provide sufficient diagnostic clues to allow appropriate classification of the patient with one of the primary periodic paralyses. This article reviews these disorders, their treatment, and the use of provocative testing in their diagnosis. Dysfunction of the muscle membrane sodium channel may be a "final common pathway" pathogenetic mechanism for many of the periodic paralyses.

Genetic approaches to the nosology of muscular disease: myotonias and similar diseases.

Besides myotonic dystrophy some generalized myotonias exist, until now mostly diagnosed as "Thomsen's disease." It is questionable whether the dominant "myotonia congenita" is homogeneous. Surely there is at least one recessive type of generalized myotonia, which is also clinically different from Thomsen's disease. Paramyotonia congenita Eulenburg is a genetically independent type separated from paralysis periodica paramyotonia. Further diseases with myotonia and some other diseases of differential disgnostic importance with regard to myotonias are mentioned