Teaching Video NeuroImage: Clenched Fists as an Unusual Presentation of Focal Neuromyotonia

A 72-year-old woman with a history of asthma and bronchiectasis presented with a 7-year history of bilateral hand cramps, initially affecting the right, frequently resulting in clenched fists. Examination revealed clenched fists bilaterally in the resting state and pseudomyotonia with incomplete relaxation following active finger extension (figure 1, A–C; video 1). Myokymia and percussion myotonia were not observed. No weakness was elicited in the muscles. Needle EMG of the forearm flexors demonstrated bursts of spontaneous high-frequency waning discharges typical of neuromyotonia (figure 2; video 2). Significant clinical improvement was observed following treatment with botulinum toxin injections and oxcarbazepine (figure 1, D–F).

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