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Severe infantile hyperkalaemic periodic paralysis and paramyotonia congenita: broadening the clinical spectrum associated with the T704M mutation in SCN4A
  1. F Brancati1,
  2. E M Valente2,
  3. N P Davies3,
  4. A Sarkozy2,
  5. M G Sweeney3,
  6. M LoMonaco4,
  7. A Pizzuti1,
  8. M G Hanna3,
  9. B Dallapiccola2
  1. 1Department of Experimental Medicine and Pathology, “La Sapienza” University, Rome, Italy
  2. 2CSS Mendel Institute, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo and Rome, Italy
  3. 3Muscle and Neurogenetics Section, Institute of Neurology, London, UK
  4. 4Department of Neurology, Catholic University, Rome, Italy
  1. Correspondence to:
 Dr F Brancati, CSS Mendel Institute, Viale Regina Margherita, 261, 00198 Rome, Italy; 


The authors describe an Italian kindred with nine individuals affected by hyperkalaemic periodic paralysis associated with paramyotonia congenita (hyperPP/PMC). Periodic paralysis was particularly severe, with several episodes a day lasting for hours. The onset of episodes was unusually early, beginning in the first year of life and persisting into adult life. The paralytic episodes were refractory to treatment. Patients described minimal paramyotonia, mainly of the eyelids and hands. All affected family members carried the threonine to methionine substitution at codon 704 (T704M) in exon 13 of the skeletal muscle voltage gated sodium channel gene (SCN4A). The association between T704M and the hyperPP/PMC phenotype has been only recently revealed. Nevertheless, such a severe phenotype has never been reported so far in families with either hyperPP or hyperPP/PMC. These data further broaden the clinical spectrum of T704M and support the evidence that this mutation is a common cause of hyperPP/PMC.

  • hyperkalaemic periodic paralysis
  • paramyotonia congenita
  • human skeletal muscle sodium channel (SCN4A) gene
  • T704M mutation

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  • Funding: We gratefully acknowledge the financial support of the Italian Ministry of Health, the Wellcome Trust and the National Specialist Commissioning Advisory Group (NSCAG), UK.

  • Competing interests: none declared.