SHORT REPORT

The exercise test as a monitor of disease status in hypokalaemic periodic paralysis

C H Tengan, A C Antunes, A A Gabbai, G M Manzano

Division of Neurology, Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, Brazil

Correspondence to:
Correspondence to:
Dr Célia H Tengan
RPedro de Toledo, 781, 7o Andar, São Paulo SP, Brazil 04139-032; chtengan{at}neuro.epm.br

Objective: To evaluate exercise test responses in hypokalaemic periodic paralysis (HPP), to determine its value as a diagnostic tool and the factors that could affect the responses.

Methods: 22 subjects were studied from two families with HPP caused by R528H mutation, four patients with thyrotoxic periodic paralysis, 15 normal controls, and four controls with hyperthyroidism. All family members were submitted to clinical evaluation, electrophysiological exercise testing, and DNA analysis. Patients with thyrotoxic periodic paralysis had exercise tests before and after treatment of their hyperthyroidism.

Results: Abnormal responses to the exercise tests were obtained only in subjects with recent attacks of weakness. They were not correlated with genotype, as asymptomatic carriers were unaffected. Patients with thyrotoxic periodic paralysis showed pronounced impairment while they were hyperthyroid, but improved when they were euthyroid. One patient with HPP and chronic KCl use had an increase in amplitude potentials over ~20 minutes, possibly related to alteration of potassium homeostasis.

Conclusions: The exercise test is a useful diagnostic test for periodic paralysis, but in the absence of recent weakness negative results must be viewed with caution. It has advantages over the DNA test in being a non-invasive functional test that can provide insights into abnormalities of muscle excitability.

Keywords: calcium channel; exercise test; periodic paralysis; potassium

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This article has been cited by other articles:

• Kung, A. W. C. (2006). Thyrotoxic Periodic Paralysis: A Diagnostic Challenge. J. Clin. Endocrinol. Metab. 91: 2490-2495 [Abstract] [Full Text]  
• Lin, S.-H. (2005). Thyrotoxic Periodic Paralysis. Mayo Clin Proc. 80: 99-105 [Abstract]