Cramps, Weakness and Fasciculations

Fig. 15.1

(a, b) Appearance of the right hand 10 years following onset of weakness. There is relative preservation of muscle bulk.

Investigations

Blood tests were normal, including creatine kinase. IgG and IgM antiganglioside GM1 antibodies were negative.

CSF examination was acellular. Protein was normal (0.48 g/L), glucose 4 mmol/L. Oligoclonal bands were present in the CSF but not in the serum.

MRI of the brain and spine was normal.

Nerve conduction studies (Fig. 15.2) showed normal sensory conduction. There was evidence of conduction block in the left ulnar nerve, with absent F waves in the right and left ulnar nerves. There was mild prolongation of F waves in the right median nerve (33.9 ms), and absent F waves with slowing of conduction (23 m/s) in the left median nerve. There was evidence of conduction block in the right peroneal nerve and left posterior tibial nerve, and absent F waves in these nerves bilaterally.

Fig. 15.2

Nerve conduction study of the left ulnar nerve. There is slowing of motor conduction in the left forearm (38 m/s) and upper arm (26 m/s), with conduction block in the forearm, and normal conduction at the elbow (53 m/s)

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