Periodic Paralysis Syndromes
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Periodic Paralysis Syndromes

Classical Chinese medical texts frequently allude to sudden paralysis syndromes. I have always been curious about this, wondering what the Western medicine counterpart might be. One of my clues was the pathophysiology debate, in acupuncture school, as to whether hypo or hyperkalemia can result in paralysis syndromes. 

Years ago I watched one of those emergency room reality shows. A young male patient was experiencing the very rapid onset of weakness & paralysis starting with his extremities and rapidly progressing to the rest of his body. The physicians feared that the weakness/paralysis would reached his diaphragm and respiratory muscles before they could diagnose and treat him. Lab results revealed a critically low serum potassium level. Upon administering intravenous potassium, the patient’s neuromuscular status stabilized. They associated this episode of paralysis to a recent viral-sydrome. Many years later an acquaintance told me that his daughter was in the hospital experiencing a similar scenario. 

Non-familial Hypokalemic Periodic Paralysis is a disorder, along with Hyperkalemic Periodic Paralysis, and Thyrotoxic Periodic Paralysis (TPP), that causes intermittent (and unexpected) episodes of muscle spasm, pain & paraysis; or muscle weakness & paralysis  due to alterations in serum potassium levels. Susceptibility to these alterations in potassium level are due to genetic mutations (either inherited or congenital). Dugdale (2011) writes of Hypokalemic Periodic Paralysis,  "Attacks usually begin in adolescence, but they can occur before age 10. Attacks that do not begin until adulthood are rare in people with Hypokalemic Periodic Paralysis and are usually caused by other disorders… [It] may be triggered by high-carbohydrate, high-salt meals, or alcohol consumption… Acetazolamide prevents attacks in many cases".

Thyrotoxic Periodic Paralysis (TPP) occurs predominantly in males of Chinese, Japanese, Vietnamese, Filipino, Korean, and Tai descent,  with much lower rates in people of other ethnicities (Kung, 2006). Pun et al (1989)  write that hyperaldosteronism, barium poisoning, the side effect of glossypol (fertility regulating agent) used in China are other reasons why Hypokalemic Paralysis occurs more frequently in Orientals. This may be why sudden episodes of paralysis are frequently mentioned in classical Chinese medical text. 

The Periodic Paraysis Association (PPA), says there is both hyper and hypokalemic paralysis. Both related to genetics, and triggered by dietary intake of potassium, exercise & activity patterns, stress, and exposure to cold. I have not found anything directly associating post-viral syndrome with Hypoklaemic Periodic Paralysis. However, vomiting and/or diarrhea without adequate potassium replacement may obviously be a trigger.  Hypoklaemic Periodic Paralysis must be differentiated from other diseases that cause episodic muscle spasm, pain, weakness/paralysis: Andersen-Tawil Syndrome (includes arrhythmias), Paramyotonia Congenita, Potassium-Sensitive Myotonia, and Myotonia Congentia (PPA). PPA offers this video on periodic paralysis conditions, which are apparently not as uncommon as one would think.


Integrative  Medicine  Tip:  Potassium (K) is the main intracellular fluid (ICF) cation. Sodium (NA) is the main extra cellular fluid (ECF) cation. The ratio of ICF potassium to ECF potassium is maintained by the NA-K ATPase pump, which is influenced by acid-base balance among other things. The ratio of ICF potassium to ECF potassium maintains  intracellular electrical neutrality. and the resting potential of nerve cell impulses to cardiac and muscle tissues.  Thus, alteration in potassium levels (too high or too low) can lead to muscle pain & [spastic] paralysis; or muscle weakness & [flaccid] paralysis (Huether, 2010), respectively.


References 

Dugdale, D. (2011). Hypokalemic periodic paralysis. Medline Plus.
Heuther,  S. (2010). The cellular environment: Fluids and electrolytes, acids and bases. In
     McCance, K. & Huether, S. (Eds.), Pathophysiology: The biologic basis for disease in adults
     and children (6th ed.) (pp. 96- 125). St. Louis, MO: Mosby Elsevier. 
     of Clinical Endocrinolology 91(7), 2490–5.  doi:10.1210/jc.2006-0356PMID 16608889.
Periodic Paralysis Association (PPA). Frequently asked questions. Retrieved  from
     http://www.periodicparalysis.org/english/View.asp?x=471
Pun, K., Wong, C., Tsui, E., Tam, S., Kung, A., Chun-Lun Wang, C. (1989). Hypokalemic periodic
     paralysis due to the Sjögren syndrome in Chinese patients. Annals of Internal Medicine
     (110)5. 




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