Chart Comparing Periodic Paralyses

Submitted by deb on Sat, 07/02/2011 – 20:58

This chart allows comparison of the forms of primary periodic paralysis, symptoms, clinical and cardiac signs, effect of potassium, triggers and therapies. 

Form	Effect of K+	Age at onset	Triggers	Relieves	Attack Length	Myotonia?	Hypertrophy	Weakness between attacks	EKG during attacks	Therapies
Thyrotoxic HypoKalemic Periodic Paralysis	Relieves weakness	At any age, 85% males; usually in 20–40 year–old Asians, Native Americans	Hyperthyroidism (may be sub–clinical) ^ carbohydrate meal and exertion.	K+, Treat thyroid condition	Hours to days	No	No	Yes	During attacks ST depression, T wave flattens, U wave appears, sinus tachycardia	Methimazole, Propranolol, K+, until anti–thyroid treatment, radio-iodine 131 or surgery
Hypokalemic Periodic Paralysis	Relieves weakness	1-25 years	simple carbs, rest after exertion, sleep, strong emotion	K+, mild exercise	1-72 hours	only in eyelids	Yes	Yes, after age 35	ST depression, T flattens, U rises	Diamox, K+, K+ sparing diuretics
Andersen-Tawil Syndrome	Provokes weakness while relieving arrhythmia and/or weakness in some patients.	At any age	Varies from patient to patient, exercise, sleep, high K+ in some, low K+ in others.	Varies from patient to patient.	Varies	No	No	Yes	LQTc, ectopy, bigeminy, tachycardia, (in or out of attack)	Varies, usually beta blockers + treatment for weakness
Hyperkalemic Periodic Paralysis	Provokes weakness	First decade	Hunger, K+ in foods, rest after exercise, immobility	Sugar, mild exercise	5 min – 12 hours	In grip and exercised muscles	Yes	Yes	T tall “tented”, R falls, QRS/PR increases, P gone	K+ wasting diuretics, Diamox, Albuterol
Paramyotonia Congenita  (Pure form)	Provokes weakness	First two years	Exercise, K+	Sugar, rest	Minutes – days	Face, eyes, jaw, hands.	Worsens with cold and activity	Yes	May show signs of Hyperkalemia	K+ wasting diuretics, Paxil, Mexiletine
Paramyotonia Congenita von Eulenburg	Relieves weakness	First two years	Exercise, LOW K+	K+ rest	Minutes – weeks	May be absent at room temp.	Yes	Yes	May show signs of hypokalemia	Mexiletine, Paxil, K+
Acetazolamide– responsive Paramyotonia Congenita	Provokes pain and stiffness, No weakness	?	K+, activity	Diamox	?	Worse with Activity	Yes	?	?	Diamox
Myotonia Fluctuans	Provokes stiffness, NO weakness		K+	?		Mild, Varies			?	Diamox, K+ wasting diuretics
Myotonia Permanens	Provokes severe myotonia	?	K+	?	Constant	Severe, continuous	Marked	?	?	Diamox, K+ wasting diuretics