Idiopathic generalized myokymia (IGM) is a rare, heterogeneous, and poorly understood syndrome. We present analysis of 75 reported cases in the world literature. IGM affects men and women equally, with a mean age of onset 29 +/- 19 years. Patients' common presenting complaints are stiffness (60%), cramps (12%), weakness (12%), and muscle twitching (4%). Family history is positive in 30%. In addition to generalized clinical myokymia (92%), abnormal neurologic findings include: hyporeflexia (70%), weakness (45%), grip myotonia (39%), and calf hypertrophy (16%). Electrical activity consisting of spontaneous continuous motor unit activity and/or electrical myokymia was documented in all patients. When electrical myokymia was observed (66%), the grouped discharges where irregular and had an interburst frequency of 2-300 Hz. Both phenytoin and carbamazepine are effective treatments. We conclude that IGM has a wide spectrum of symptoms and severity and should be considered in all patients that present with stiffness, cramps, or muscle twitching. EMG greatly aids in diagnosis.

We examined 7 adults with brachial plexus injury following liver transplantation; they were among 120 transplants performed over a 10-month period (incidence, 5.8%). The lesion was right-sided in 5 patients, left-sided in 1, and bilateral in 1. The affected side correlated with the axillary veno-venous shunt in 3 lesions only. All noted weakness and sensory loss shortly after recovery from general anesthesia. The EMG examination indicated axonal lesions, and recovery was protracted.

We report 5 young women who developed femoral mononeuropathy (FMN) after placement in the lithotomy position. Three had uncomplicated vaginal deliveries and 2 underwent exploratory laparoscopies. EMG was performed on 3 patients. The lesions were localized to the inguinal ligament and probably demyelinating, accounting for their excellent prognosis. On reviewing the literature, however, we believe that lithotomy position can cause FMN, not only by nerve compression at the inguinal ligament, but also by stretching of the nerve by excessive hip abduction and external rotation.