Why the study?
Do tocainide and hydrochlorothiazide improve muscular symptoms in a patient with paramyotonia congenita with hyperkalemic episodic paralysis?
Do tocainide and hydrochlorothiazide improve muscular symptoms in a patient with paramyotonia congenita with hyperkalemic episodic paralysis?
Tocainide and hydrochlorothiazide have distinct effects on different triggers of muscular weakness in paramyotonia congenita, suggesting two different underlying mechanisms.
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Suggests trigger-specific responses may guide therapy in paramyotonia congenita; leaves open confirmation of mechanisms and efficacy in controlled studies.
We investigated the effectiveness of tocainide and hydrochlorothiazide on muscular symptoms in a patient with paramyotonia congenita and episodic attacks of hyperkalemic paralysis. Generalized weakness was evoked by exercise and potassium loading. Myotonia and weakness were evoked by local muscle cooling. Tocainide prevented myotonia and weakness induced by cooling, but failed to prevent hyperkalemic weakness. Hydrochlorothiazide prevented hyperkalemic weakness, but did not influence symptoms evoked by cooling. These results suggest that, in this disorder, two different mechanisms cause muscular weakness.
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Ricker et al. (1983) studied this question.
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