Hypokalemic periodic paralysis, hyperkalemic periodic paralysis, and paramyotonia congenita may be distinguished based on clinical data. This series of 226 patients (127 kindreds) confirms some clinical features of this disorder with notable exceptions: In this series, patients without mutations had a less typical clinical presentation including an older age at onset, no changes in diet as a precipitant, and absence of vacuolar myopathy on muscle biopsy.
Of 21 patients with clinically definite hypokalemic, hyperkalemic, or normokalemic periodic paralysis, 15 (71%) had a greater than normal increase in compound muscle action potential amplitude during 2-5 minutes of intermittent strong voluntary contraction of the muscle. This increase was followed by a progressive decline in amplitude, which was greater than in a control population and which was most rapid during the first 20 minutes after exercise. The amplitude often decreased to a level below the preexercise level. A similar response was seen in six of nine patients with periodic paralysis secondary to disorders such as thyrotoxicosis. This test may have value in the identification of patients with periodic paralysis.
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