Paramyotonia Congenita: Another Form Of Periodic Paralysis

Paramyotonia Congenita: Another Form Of Periodic Paralysis

Paramyotonia Congenita is a form of Periodic Paralysis (PP). I have overlooked this form in my writings and in my book. I now want to describe and explain it, as it is an important form and can accompany all other forms of Periodic Paralysis; Hyperkalemic Periodic Paralysis, Hypokalemic Periodic Paralysis and Normokalemic Periodic Paralysis, but usually is seen with Hyperkalemic Periodic Paralysis. It may also occur or manifest as Hyperkalemic Periodic Paralysis and is believed to actually be a form of Hyperkalemic Periodic Paralysis.

Paramyotonia Congenita (PMC), also known as Eulenburg Disease, is a rare, hereditary mineral metabolic disorder, which is also called a channelopathy and it affects the muscles used in movement. Caused by certain triggers, the sodium channels close much too slowly and the sodium, potassium, chloride and water continue to flow into the muscles. The skeletal muscles can become stiff, tight, tense or contracted and weak. PMC is caused by mutations in the SCN4A gene, a voltage-gated sodium channel. There is a 100% penetrance. This means if one has one of the mutations for it, they have a 100% chance of having it. In the same family, some members may have mild forms and others may have more extreme cases. It is actually considered to be a form of Hyperkalemic Periodic Paralysis, however, the symptoms can appear from shifting of potassium into low or high ranges or even if potassium shifts within normal levels.  Symptoms can begin shortly after birth or during childhood or at anytime in early adulthood.

Myotonia is the prolonged or lengthy contraction, tensing or lack of relaxation of a muscle or group of skeletal muscles, which is relieved by exercise. For those with Paramyotonia Congenita, the contractions or tightness are not relieved by exercise. The symptoms or muscle tightness are brought on by triggers such as exercise or exertion, repeated movement and cold. It is also known that episodes are common in the early morning so sleeping in, in the morning, may cause episodes.  Hands, face and eyelids are often seen affected. It can be seen as simply a hand cramp while writing or the inability to let go of something being held in the hand like a door knob or the affects can be as significant as total body paralysis with contracted and tight muscles. The episodes can last for minutes, hours or days. There may also be intermittent flaccid paralysis as in the other types of Periodic Paralysis in which there is no muscle tone and the muscles are totally loose and slack. Because breathing muscles may be affected, shortness of breath may accompany episodes. Episodes may be mild or very severe and pain may be experienced even after the episode has ended. Individuals with PMC may appear to be stiff or look tense, even when not in an episode.

There is some difference of opinion as to whether PMC is a progressive condition, but more recent analysis and study of patients with it, indicates that some individuals may have some progressive and permanent muscle weakness.

Avoiding known triggers is the best treatment. Some individuals respond well to the common medications used for Periodic Paralysis, but the side effects can be worse than the symptoms. Because extremes of any type can cause episodes, moderation of everything and anything is important. A pH balanced diet can also be helpful because a high pH can cause symptoms and episodes to be eliminated or shortened. Also, due to the fact that episodes may be precipitated by low or high potassium, or even shifting within normal ranges, the levels of potassium must be evaluated individually for each person.

Individuals with  Paramyotonia Congenita/Hyperkalemic Periodic Paralysis are at great risk for Malingnant Hyperthermia, severe reactions to general anesthesia. Extreme care must be used if surgery is needed.
 
“General anaesthesia may trigger episodes of paralysis lasting for hours, in individuals with hyperkalemic periodic paralysis or paramyotonia congenita. For this reason, depolarizing muscle relaxants and acetylcholinesterase inhibitors are particularly unsuitable. In order to avoid complications the anaesthetist must be informed about the disorder in advance of surgery.”
 
http://www.socialstyrelsen.se/rarediseases/hyperkalemicperiodicparalysisa#anchor_1
http://rarediseasesnetwork.epi.usf.edu/cinch/learnmore/faqs.htm

http://www.mhaus.org/

http://www.mhaus.org/healthcare-professionals/be-prepared/associated-conditions

http://ptjournal.apta.org/content/81/3/945.full

 

 Until later…

References and more information:
http://en.wikipedia.org/wiki/Paramyotonia_congenita
http://mda.org/.../inherited-and.../paramyotonia-congenita
http://ghr.nlm.nih.gov/condition/paramyotonia-congenita
http://www.rarediseases.org/.../rar.../byID/907/viewAbstract

http://www.socialstyrelsen.se/rarediseases/hyperkalemicperiodicparalysisa#anchor_1

http://rarediseasesnetwork.epi.usf.edu/cinch/learnmore/faqs.htm

http://tulane.edu/som/departments/neurology/programs/clerkship/upload/wch17.pdf

http://medind.nic.in/iad/t05/i3/iadt05i3p217.pdf

http://en.wikipedia.org/wiki/Paramyotonia_congenita

http://en.wikipedia.org/wiki/Myotonia

http://www.merriam-webster.com/dictionary/myotonia