Waves in Extremities: A Rare Report of Isolated Isaacs' Syndrome.

Abstract

Isaacs' syndrome is a rare neuromuscular hyperexcitable syndrome with myriad manifestations ranging from motor and sensory to autonomic presentations, leading to diagnostic challenges. Among the commonest forms, a tetrad of stiffness, myokymia (muscle twitching at rest), weakness, and psuedomyotonia (delayed muscle relaxation) is almost always present. Herein, we report a case of a 16-year-old male who presented to the neurology consult service with intense wave-like pain in the lower extremities with desquamating rash and cold-induced allodynia. Investigations were significant for raised CK levels, positive autoimmune panel, and anti-voltage-gated potassium channel (anti-VGKC) antibody that is involved in 35% reported cases of Isaacs' syndrome, with electrodiagnostic studies peculiar for Isaacs syndrome with negative imaging results. He was followed up on a long cocktail course of immunosuppressive, anticonvulsive medications, and immunoadsorption plasmapheresis (IAP) for 11 months with complete remission.

• Authors: Syed Hamza Bin Waqar
• Journal: Cureus (Cureus) Vol. 11 Issue 5 Pg. e4687 (May 17 2019) ISSN: 2168-8184 [Print] United States
• PMID: 31338264 (Publication Type: Case Reports)