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. 

FormEffect of K+Age at onsetTriggersRelievesAttack LengthMyotonia?HypertrophyWeakness between attacksEKG during attacksTherapies
Thyrotoxic HypoKalemic Periodic Paralysis Relieves weaknessAt any age, 85% males; usually in 20–40 year–old Asians, Native AmericansHyperthyroidism (may be sub–clinical) ^ carbohydrate meal and exertion.K+, Treat thyroid conditionHours to daysNoNoYesDuring attacks ST depression, T wave flattens, U wave appears, sinus tachycardiaMethimazole, Propranolol, K+, until anti–thyroid treatment, radio-iodine 131 or surgery
Hypokalemic Periodic ParalysisRelieves weakness1-25 yearssimple carbs, rest after exertion, sleep, strong emotionK+, mild exercise1-72 hoursonly in eyelidsYesYes, after age 35ST depression, T flattens, U risesDiamox, K+, K+ sparing diuretics
Andersen-Tawil SyndromeProvokes weakness while relieving arrhythmia and/or weakness in some patients.At any ageVaries from patient to patient, exercise, sleep, high K+ in some, low K+ in others.Varies from patient to patient.VariesNoNoYesLQTc, ectopy, bigeminy, tachycardia, (in or out of attack)Varies, usually beta blockers + treatment for weakness
Hyperkalemic Periodic ParalysisProvokes weaknessFirst decadeHunger, K+ in foods, rest after exercise, immobilitySugar, mild exercise5 min – 12 hoursIn grip and exercised musclesYesYesT tall “tented”, R falls, QRS/PR increases, P goneK+ wasting diuretics, Diamox, Albuterol
Paramyotonia Congenita  (Pure form)Provokes weaknessFirst two yearsExercise, K+Sugar, restMinutes – daysFace, eyes, jaw, hands.Worsens with cold and activityYesMay show signs of HyperkalemiaK+ wasting diuretics, Paxil, Mexiletine
Paramyotonia Congenita von EulenburgRelieves weaknessFirst two yearsExercise, LOW K+K+ restMinutes – weeksMay be absent at room temp.YesYesMay show signs of hypokalemiaMexiletine, Paxil, K+
Acetazolamide– responsive Paramyotonia CongenitaProvokes pain and stiffness, No weakness?K+, activityDiamox?Worse with ActivityYes??Diamox
Myotonia FluctuansProvokes stiffness, NO weakness K+? Mild, Varies  ?Diamox, K+ wasting diuretics
Myotonia PermanensProvokes severe myotonia?K+?ConstantSevere, continuousMarked??Diamox, K+ wasting diuretics