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PERIPHERAL NERVE HYPEREXCITABILITY WITH ANTI–VGKC ANTIBODIES PRESENTING AS MUSICIAN'S DYSTONIA
  1. Christopher Kobylecki,
  2. Andrew Marshall,
  3. Jon Sussman,
  4. Hisham Hamdalla
  1. University of Manchester; Greater Manchester Neurosciences Centre

    Abstract

    A 57–year–old male presented with a six–year history of cramps in the left thumb, which initially occurred exclusively when playing the bass guitar. Examination revealed no focal wasting or fasciculations, and all reflexes were depressed. There was no tremor or dystonic posturing of neck, trunk or limbs, and writing was unaffected. When playing the guitar he developed sustained contraction of the left thumb, limiting his ability to play for long periods of time, but this did not occur in other positions or tasks. Nerve conduction studies showed normal motor, sensory and F–wave responses, but after–discharges were seen after 10 Hz repetitive stimulation. Needle EMG showed frequent fasciculations in distal upper and lower limb muscles, with no signs of active denervation. Antibodies to the voltage–gated potassium channel (VGKC) complex were positive (>100 pM), while CT thorax showed no evidence of thymoma. Botulinum toxin injections to left opponens pollicis relieved the cramps, but caused thumb weakness. Other drug treatments were ineffective or poorly tolerated. Peripheral nerve hyperexcitability has rarely been reported to cause abnormalities resembling focal dystonia, but this is the first case to our knowledge where the initial presentation was suggestive of task–specific dystonia. This case expands the phenotype of neurological syndromes associated with antibodies to the VGKC complex.

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