The
n e w e ng l a n d j o u r na l
of
m e dic i n e
Images in Clinical Medicine Lindsey R. Baden, M.D., Editor
Paraneoplastic Neuromyotonia
Efthimios Dardiotis, M.D., Ph.D. Styliani Ralli, M.D. University Hospital of Larissa Larissa, Greece edar@med.uth.gr
A
70-year-old man with coronary artery disease, chronic obstructive pulmonary disease, and a 40-pack-year smoking history presented to a neurologist with a 2-month history of muscle twitching and spasms, excessive sweating, and a 10-kg weight loss. The physical examination revealed myokymia (involuntary, undulating muscle twitching) and fasciculations (see video). Myokymia worsened with exercise and persisted during sleep. There was no muscle weakness, rigidity, atrophy, or delayed muscle relaxation after contraction. Needle electromyography showed characteristic neuromyotonic and myokymic discharges. Serologic testing for antibodies against the voltage-gated potassium channel complex was positive (396 pmol per liter; normal value,
n e w e ng l a n d j o u r na l
of
m e dic i n e
Images in Clinical Medicine Lindsey R. Baden, M.D., Editor
Paraneoplastic Neuromyotonia
Efthimios Dardiotis, M.D., Ph.D. Styliani Ralli, M.D. University Hospital of Larissa Larissa, Greece edar@med.uth.gr
A
70-year-old man with coronary artery disease, chronic obstructive pulmonary disease, and a 40-pack-year smoking history presented to a neurologist with a 2-month history of muscle twitching and spasms, excessive sweating, and a 10-kg weight loss. The physical examination revealed myokymia (involuntary, undulating muscle twitching) and fasciculations (see video). Myokymia worsened with exercise and persisted during sleep. There was no muscle weakness, rigidity, atrophy, or delayed muscle relaxation after contraction. Needle electromyography showed characteristic neuromyotonic and myokymic discharges. Serologic testing for antibodies against the voltage-gated potassium channel complex was positive (396 pmol per liter; normal value,
