An unusual case of sodium channel myotonia with transient weakness upon initiating movements which is characteristic in Becker disease.

Abstract

We reported a 32-year-old man who was a sporadic case of myotonic syndrome with muscle stiffness or transient weakness of limbs upon initiating movements after rest. On examination, he showed painless myotonia with warm-up phenomenon, Hercules-like hypertrophic musculature and myotonic discharges in EMG. The clinical findings resembled to those of Becker disease rather than Thomsen disease. But electrodiagnosis suggested sodium channel myotonia instead of chloride channelopathy. Genetic testing detected a novel missense mutation (p.V1166A) in the SCN4A gene but not in the CLCN1 gene. Transient weakness upon initiating movements is usually observed in Becker disease but rare in Thomsen disease, which is not reported in sodium channel myotonia so far. He was probably the first case of sodium channel myotonia with transient weakness upon initiating movements, which was confirmed by 10 Hz repetitive nerve stimulation test as depolarization block.

• Authors: Junpei Yamamoto, Keiichi Hokkoku, Yuki Hatanaka, Shunichi Sakoda, Jun-Hui Yuan, Masahiro Sonoo
• Journal: Rinsho shinkeigaku = Clinical neurology (Rinsho Shinkeigaku) Vol. 57 Issue 6 Pg. 287-292 (06 28 2017) ISSN: 1882-0654 [Electronic] Japan
• PMID: 28552867 (Publication Type: Case Reports, Journal Article)

Chemical References

• NAV1.4 Voltage-Gated Sodium Channel
• SCN4A protein, human

Topics

• Adult
• Electrodiagnosis
• Electromyography
• Genetic Testing
• Humans
• Male
• Movement (physiology)
• Muscle Weakness (complications, diagnosis, physiopathology)
• Mutation, Missense
• Myotonia Congenita (complications, diagnosis, genetics, pathology, physiopathology)
• NAV1.4 Voltage-Gated Sodium Channel (genetics)
• Transcutaneous Electric Nerve Stimulation