Miochimia

Miochimia, a form of involuntary muscle movement can be viewed on the skin as vermicular or continuii contractions. Miochimie word was used 100 years ago to describe the muscle contractions in small muscles of the hand continuii and legs. He used the term to describe multiple fibrillary myoclonia similar clinical manifestations.
This phenomenon is clinically characterized by tremor movements of the muscles involved classic without joint movement. Miochimia can be observed in muscles innervated by cranial or spinal nerves.Distribution may be regional or generalized depending on etiology.The condition can also be observed in healthy individuals, transient after strenuous exercise.
Most cases are not life threatening. Prognosis is dependent only basic etiologies. Miochimia is considered benign when it is detected in patients who performed exercise.
Pathogenesis and causesMiochimiei exact mechanism is not well known. Miochimia facial muscles is believed to originate from the facial nucleus or supranucleus contribution to the process. However this miochimiei in poliradiculopatie indicate the possibility of a distal event. Most doctors agree that miochimia in other parts of the body is generated by motor axons by distal axonal dysfunction secondary segmental demyelination.Miochimia is considered to be associated with the generation of spontaneous activity, including discharges miochimialike. Through this mechanism, spontaneous discharges can initiate activities related to episodic or fibers can directly stimulate efferent fibers near the lesion or to produce an infinite loop.
Signs and symptomsMiochimie patients may present with pain, cramps, spasms, weakness, stiffness or zvicniri. Sensory symptoms are reported rarely, if etiology not include sensory nerves. Discharges miochimice typical patient can be seen on the electromyogram.
Physical Exam:Miochimiei facial elements, focal segmental or other locations of the body and are generalized miochimiei different physical examination as potential etiologies.Facial Miochimia:Affected muscles shows fine movements, slow, undulating surface of the skin by activating the superficial muscle layers. Facial weakness may be present. Miochimice shows typical electromyogram discharges volleys of spontaneous rhythmic / semiritmice of a normal potential. These are followed by a period of silence, with repetition of potential secondary muscle identical discharges. Spontaneous activities are not altered by voluntary muscle activation.This type is most commonly miochimie. It is reported to be associated with inflammatory demyelinating diseases, cerebral neoplasms, Guillem-Barre syndrome or other intramedullary pontine lesions. It is reported in patients with a history of radiotherapy, with similar events plexopatiile brachial or lumbar.Focal or segmental Miochimia:These types of miochimie are observed mainly in the limbs or limb segments private. Electromyography is similar to facial miochimiei. Most patients shows a history of irradiation. Metastatic lesions rarely generates miochimie. Miochimia is reported at doses below 10 Gray of radiation.Miochimia generalized:It is described as a triad of miochimie, low-tendon reflexes and muscle stiffness. Syndrome is also called Isaac. Muscle weakness and atrophy with excessive sweating are commonly associated.Smooth and cardiac muscles is avoided. Sensory symptoms are rarely present. Muscle stiffness is different from that of myotonic clinical and electromyographic. Although both are exacerbated by cold, miochimia can be detected when the muscles are at rest and during sleep. Patients with myotonic are normal at rest. Stiffness is induced by mechanical stimulation.Gained form is associated with malignancy, timomul, myasthenia gravis, lymphomas and a variety of autoimmune diseases of the nervous system. Spinal anesthesia and peripheral nerve block does not abolish miochimia. Ll be described in patients with systemic diseases and after alcohol consumption, exposure to toxins, gold and penicillamine therapy.Miochimia eyelid:It is represented by spontaneous muscle contractions fascicular muscular atrophy without weakness. Implications of eye orbicular muscle. It is a benign condition, self-limiting and not associated with another condition. Rarely can occur as a precursor of hemifacial spasm, blepharospasm, Meige syndrome and facial contracture spastico-paresis. Contractions are intermittent and more apparent than the patient observer. Symptoms get better if the lid is pulled manually.
DiagnosisLaboratory studies:-Full blood count, creatinine kinaseThyroid-testing, Lyme titer, rheumatologic tests-Alcolemia serum and toxin levels in cases of sudden onset.
Imaging Studies:Neuroimaging studies with computed tomography or magnetic resonance imaging for certain regions are made after careful examination and if they locate a lesion studies electrodiagnostics intro particular area.Nerve conduction velocity and electromyographic studies are needed to quantify the neurogenic dysfunction / miogena. Can this plexopatiei detcta, mononeuropathies, polyneuropathy. I can confirm this or neuromiotonia miochimice electrical discharges.The information serves as a guide to treatment and diagnosis.Lumbar puncture with cerebrospinal fluid examination is performed for patients with poliradiculopatie, central nervous system demyelinating diseases of acute or chronic.The differential diagnosis is made with the following diseases: amyotrophic lateral sclerosis, partial epilepsy continue hemifacial spasm syndrome, Schwartz, Stiff Person syndrome, tardive dyskinesia, blepharospasm, facial myoclonus, McArdle disease, Meige syndrome, spasticity and tetanus.
TreatmentTreatment is targeted miochimiei depending on the etiology of substance. Most patients with facial or limb miochimie are not bothered by the condition itself. Aetiology of neurological symptoms that accompany the targets of treatment. For thyrotoxicosis secondary conditions, poisoning and alcohol withdrawal syndrome, miochimia disappears with resolution or improvement of medical conditions. Patients with radiation plexopatie requires no intervention. Miochimia observed in acute or chronic poliradiculopatiile improve with immunomodulatory therapy. Miochimia that develop after exercise resolves spontaneously within a few weeks.
Medical therapy with AEDs is indicated only for patients with debilitating symptoms. AEDs were used in miochimie risk of serious side effects. Phenytoin and carbamazepine have proven useful in treating patients with generalized miochimie, especially those with continuous muscle fiber activity syndrome described by Isaac. High drug levels are usually required to achieve satisfactory control of symptoms. We have tried other drugs such as benzodiazepines, but without significant benefit. It will monitor patients for adverse effects of phenytoin and carbamazepine.