Periodic Paralysis

periodic paralysis, any of the forms of a rare disorder that is characterized by relatively short-term, recurrent attacks of muscle weakness. Usually the disorder is inherited; it occurs three times more often in males than in females.

Hypokalemic paralysis (often referred to as familial) is caused by mutations in the calcium channel gene on chromosome 1. It generally begins late in childhood or in adolescence. Onset of paralysis occurs most frequently at night during sleep. Attacks may take from several minutes to several hours to develop; they range in severity from general weakness to total paralysis. Typically, weakness in the legs is the first sign of onset, followed by weakness in the arms. Usually, only trunk and limb muscles are affected, and the affected person is able to speak and breathe. The heart is rarely involved. Attacks may come at intervals of days, months, or years. In later years a degeneration of muscle fibres may occur. Factors that seem to precipitate attacks include relaxation after periods of exertion or strenuous exercise. Mild exercise, however, may sometimes alleviate a mild attack. An attack of this type may last longer than 24 hours. During an attack, potassium levels in the blood are lower than normal. A form of hypokalemic paralysis that is associated with hyperthyroidism has been noted among Japanese and Chinese adult males. It is clinically similar to hypokalemia but carries a greater risk of cardiac involvement. Treatment of the hyperthyroidism prevents further attacks.

Hyperkalemic periodic paralysis begins in infancy and is characterized by more frequent but milder attacks that last minutes or hours; it may also be accompanied by mild myotonia (muscle spasm) of the tongue. This form of the disorder is caused by mutations in the sodium channel on chromosome 17. Individuals may exhibit a rise in potassium levels in the blood during an attack.

Normokalemia is another form of periodic paralysis. In this form of the disorder, the potassium level remains stable. Symptoms are generally more severe than those typical of hyperkalemia.

Treatment of hypokalemic periodic paralysis includes the administration of potassium chloride. In hyperkalemic periodic paralysis, short-term treatment involves injections of a calcium gluconate solution, and long-term treatment may include insulin and dialysis of the blood. Both hypokalemic and hyperkalemic periodic paralysis may respond to small doses of acetazolamide, a diuretic medication.