Resident Report 2/1 – Periodic Paralysis

Teaching Pearls:

  • Periodic Paralysis occurs as a result of genetic channelopathies that can cause bilateral UE and LE weakness
    • More pronounced in proximal vs distal muscle groups
    • No loss of bulbar muscle functions or respiratory muscles
    • Hypo or a-reflexic on exam
    • Evidence of hypokalemia on labs.
    • Seen in younger patients <20 years of age.
    • Symptoms occur during rest after strenuous exercise, high carbohydrate diet, fasting state
  • Primary acquired cause of periodic paralysis is due to thyrotoxicosis
    • Theorized to increased Na/K channels causing hyperpolarization, making it harder to reach threshold to set off action potential.
    • Classically seen in Asian young males
    • Seen in younger patients >20 years of age.
  • Differential Diagnosis
    • Myasthenia Gravis
      • Bulbar muscle involvement that gets worse with activity
    • GBS
      • Ascending motor and sensory involvement, symmetric
    • Tick Paralysis
      • Motor abnormalities, no sensory defect, asymmetric
    • Botulism
      • Bulbar involvement, spread in craniocaudal direction
    • Acute myelopathy
      • Motor involvement, hyperreflexic
  • Treatment
    • Treat underlying etiology of periodic paralysis
    • Behavioral modification
      • Avoid strenuous exercise and high carbohydrate meal intake
    • Oral medications
      • Consider acetazolamide
      • Consider spironolactone

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