Osteopathic Manipulative Treatment in the Management of Isaacs Syndrome

Shanahan, Lisa; Do, Selena G. M. Raines, Mph,; Coggins, Rachel L.; Moore, Teanna; Carnes, Michael S.; Griffin, Laura J.

doi:10.7556/jaoa.2017.035

Cited by 2 publications

(2 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…and disagreement was resolved by consensus. This left us with a total of 61 case reports and 4 case series 14,16,30–91 (Fig. 1).…”

Section: Methodsmentioning

confidence: 99%

Systematic Review of the Clinical Characteristics and Management of Isaac Syndrome

Al-Chalabi,

Hegde,

Moore

et al. 2023

Journal of Clinical Neuromuscular Disease

View full text Add to dashboard Cite

Objectives: Isaac syndrome (IS) is a condition characterized by peripheral nerve hyperexcitability caused by voltage-gated potassium channel (VGKC)-complex antibodies. Muscle twitching, stiffness, hypertrophy, and dysautonomic characteristics, such as hyperhidrosis, are common manifestations. The syndrome can be autoimmune or paraneoplastic, with thymoma being a common cause of paraneoplastic IS. Furthermore, this condition could be handed down from one generation to another. However, there is limited information regarding outcomes, relapses, associated syndromes, associated malignancies (other than thymoma), and treatment options. Despite its rarity, there remains a need for effective management strategies for patients with IS. To address this gap, we conducted a systematic review to summarize the most common and effective treatments of IS in immunomodulatory agents and symptomatic medications, as well as to describe outcomes, relapses, and associated malignancies. Altogether, this review serves to guide clinical practice recommendations for IS and highlight areas for further research. Methods: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol to conduct a systematic review of cases reposted through the PubMed and Google Scholar databases. The terms “Isaac Syndrome” and “Acquired Neuromyotonia” were used. The Joanna Briggs Institute's critical appraisal tool was used to evaluate the quality of the included studies. Results: We identified 61 case reports and 4 case series, comprising a total of 70 patients with IS (mean age at onset: 42.5 ± 18 years, and 69% were males). Fourteen cases reported relapses. Thymoma was the most common malignancy associated with IS, followed by lymphoma. Among various serum antibodies, voltage-gated potassium channel-complex antibodies were the most reported antibodies elevated in IS (reported in 38 patients and elevated in 21 patients [55.2%]), followed by acetylcholine ganglionic receptor antibodies, which were reported in 30% of patients (n = 21) and were elevated in 5 cases. The most common electromyography findings were myokymic discharges (n = 22), followed by fasciculations (n = 21) and neuromyotonia (n = 19). For treatment, combining anticonvulsants such as carbamazepine with immunotherapy therapy showed the best results in controlling the symptoms. Among immunotherapy therapies, the combination of plasma exchange plus intravenous high-dose steroids achieved the best results in the acute treatment of IS ([n = 6], with improvement noted in 83.3% [n = 5] of cases). Among the symptomatic treatments with anticonvulsants, carbamazepine was the most efficacious anticonvulsant in treatment of IS, with an average effective dosing of 480 mg/day (carbamazepine was used in 32.3% of acute treatment strategies [n = 23], with improvement noted in 73.9% [n = 17] of cases). Conclusions: IS a rare neuromuscular syndrome that tends to affect middle-aged men. These patients should be screened for thymoma and other malignancies such as lymphomas. The management of IS symptoms can be challenging, but based on our review, the combination of multiple immunosuppressives such as IV steroids and plasmapheresis with anticonvulsants such as carbamazepine seems to achieve the best results.

show abstract

“…and disagreement was resolved by consensus. This left us with a total of 61 case reports and 4 case series 14,16,30–91 (Fig. 1).…”

Section: Methodsmentioning

confidence: 99%

Systematic Review of the Clinical Characteristics and Management of Isaac Syndrome

Al-Chalabi,

Hegde,

Moore

et al. 2023

Journal of Clinical Neuromuscular Disease

View full text Add to dashboard Cite

show abstract

“…While there is increasing evidence of the treatment effects of OMT, [15][16][17][18] the mechanisms underlying the benefits of osteopathic manipulation, along with neurophysiological mechanisms that may underlie somatic dysfunction, still remain to be fully elucidated. [19][20][21] The possibility for a central role of the SRO in somatic dysfunction was first intimated by the work of Denslow et al, 6 in their groundbreaking scientific investigations of the osteopathic lesion, but many years passed before Korr 4 fully addressed the importance of these proprioceptors in proposing a theory of segmental facilitation and somatic dysfunction involving SROs.…”

mentioning

confidence: 99%

Stretch Receptor and Somatic Dysfunction: A Narrative Review

Andrews¹

2019

Journal of Osteopathic Medicine

View full text Add to dashboard Cite

From its founding by Andrew Taylor Still, MD, DO, through the work of many contributors, one of the cornerstones of osteopathic medicine has been its ability to aid health by promoting neuromuscular homeostasis. As part of the understanding of osteopathic medicine since the time of Still, the proper functioning of stretch receptor organs (SROs) of skeletal muscle have been recognized as having a central role in this homeostasis. In doing so, the complexities of these numerous and vital sensors are described, including recent findings regarding their structure, function, and the nature of their neural connections. In their homeostatic role, SROs conduct information centrally for integration in proprioceptive and autonomic reflexes. By virtue of their integral role in muscle reflexes, they are putatively involved in somatic dysfunction and segmental facilitation. In reviewing some wellestablished knowledge regarding the SRO and introducing more recent scientific findings, an attempt is made to offer insights on how this knowledge may be applied to better understand somatic dysfunction.

show abstract

Osteopathic Manipulative Treatment in the Management of Isaacs Syndrome

Cited by 2 publications

References 12 publications

Systematic Review of the Clinical Characteristics and Management of Isaac Syndrome

Systematic Review of the Clinical Characteristics and Management of Isaac Syndrome

Stretch Receptor and Somatic Dysfunction: A Narrative Review

Contact Info

Product

Resources

About