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We describe a patient presenting with a combination of muscle fasciculations, paresthesias, hyperhidrosis, as well as insomnia, agitation and confusion. He went on to develop psychosis and respiratory failure requiring intensive care. Electromyography confirmed the presence of neuromyotonia and CSF showed mild pleocytosis. Routine testing for voltage-gated potassium channel complex (VGKC-complex) antibodies was highly positive, confirming the clinical diagnosis of Morvan's syndrome. The patient improved after treatment with intravenous immunoglobulin and methylprednisolone. Further investigation of the antigenic targets using immunohistochemistry and cell-based assays revealed that he had autoantibodies targeting Lgi1, Caspr2 and Contactin-2/Tag-1, all proteins known to be complexed with VGKC in peripheral nerves and CNS. This is the first case of Morvan's syndrome from Cyprus and illustrates the clinical features as well as the emerging complexity of antigenic targets involved in the pathogenesis., (Copyright © 2011 Elsevier B.V. All rights reserved.)

We describe a patient with the diagnoses of acquired neuromyotonia, cutaneous lupus erythematosus and alopecia areata, occurring many years after a thymectomy for myasthenia gravis associated with a thymoma. We review the current literature on autoimmune conditions associated with myasthenia gravis and thymectomy. To our knowledge, this combination of multiple autoimmune conditions has not been reported previously.

Ocular neuromyotonia is a rare clinical entity, which is characterized by spontaneous spasm of ocular muscles resulting in paroxysmal diplopia and strabismus. Inappropriate discharges from ocular motor neurons or axons with unstable cell membranes may cause the sustained contraction of their respective ocular muscles. In most cases, ocular neuromyotonia resulted from radiation therapy to the parasellar and sellar regions or compressive lesions on ocular motor nerves. Among 30 patients reported in the literatür only six patients were accepted as idiopathic. Here, we reported a patient with third nerve myotonia representing with spells of diplopia. No lesion was found and she was accepted as idiopathic ocular neuromyotonia.

Neuromyotonia is characterized by spontaneous and continuous muscle fibre activity leading to muscle cramps, pseudomyotonia, myokymia and weakness. Electromyographic recordings show typical findings. An auto-immune mechanism has been suggested in at least a subset of patients. Various therapies have been tried with different outcome. A patient with neuromyotonia responding well to high-dose immunoglobulin treatment is presented.