The syndrome of myokymia was first described by Kny (1888) and Morvan (1890), the latter designating the condition as choree fibrillaire. Schultz, in 1895, gave it the name it now bears. The cardinal symptom con¬ sists in localized, wavelike muscular contractions without motor effect. While there is a symptomatic myokymia which occurs in a large variety of organic diseases of the nervous system, the so-called essential type develops in per¬ sons who have previously enjoyed good health, but who

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... ave, in most instances, been subject to a slight infection ; the condition disappears spontaneously. Neumark reports a case presenting some unusual features. The patient was a man, 65 years of age, who had been seen the first time fifteen years previ¬ ously, when a diagnosis of psychasthenia was made. Even then it was noted that the facies was mask-like; there was a constant wrinkling of the brow and fascicular contractions spreading over the entire face gave one the impression of slow, grimacing movements. The patient could bring these movements to rest, at will, for a short time, when the mask-like appearance became striking. A Chvostek II was noted; however, Trousseau's sign was absent; subsequently the patient developed attacks of unconsciousness. At the time of his examination, there was a tremor of the tongue and a fibrillary twitching along the edges, but no atrophy. Fascicular twitching was present over the entire face, but more marked on the left than on the right. There was still a continual wrinkling movement of the brow, which was aggravated by fatigue and by emotional disturbances. Aside from a sensation of tension there was no subjective sensory disturbance. In addition to the fibrillary tremor, there was a left-sided facial spasm. The mandible was somewhat atrophie; the scalp was thin, smooth, glistening and adherent; over the left mandible, a sclerodermie plaque was situated; and in addition, sclerodermie changes involved the hands and possibly the thigh. The hands were blue and cold and the lower extremities showed a marked cutis marmorata. There was a slight dorsal kyphosis. No sensory disturbances could be demonstrated objectively. The writer laid great stress on the fact that the movements about the face ceased entirely during sleep. Atrophie changes of the bones of the hands could be demonstrated by the roentgen ray. Aside from these symp¬ toms, the examination was practically negative. Neumark, in reviewing the reported cases of myokymia, found that the seat of the disturbance commonly involved the lower extremities, particularly the calves, although almost any muscle of the body might be involved. The etiologic factors given were overexertion, coryza, trauma, chronic lead poi¬ soning, syphilis, tuberculosis, chlorosis and the neuropathic habitus. Men were principally affected; age ranged from 11 to 65, and no type of occupa-Downloaded From: http://archneurpsyc.jamanetwork.com/ by a University of Manitoba User on 06/08/2015