Monsoon Fasciculation - Paralysis Syndrome: Possibly a new Myasthenic Syndrome

Background: Cases of quadriplegia, oculobulbar palsy and fasciculations are reported to two tertiary teaching hospitals of Hyderabad during monsoon season. Objective: To describe the clinical and electrophysiological features of cases of acute quadriplegia with oculobulbar palsy, fasciculations and myokymia reported during monsoon season. Materials and methods: All the patients with presentation of overnight onset rapidly progressive quadriplegia admitted in both teaching hospitals of Hyderabad, over the period of 11 years. All patients were subjected to routine biochemical tests and Electrodiagnostic tests. Patients were treated symptomatically along with invasive ventilator support when required. Results: A total of 97 such patients were identified. The clinical features observed were bilateral ptosis, external ophthalmoplegia, bulbar, facial, masticatory, axial and proximal muscle weakness. There were extensive fasciculations and myokymia. Respiratory insufficiency occurred at nadir of weakness. The electrodiagnostic tests showed normal motor, sensory conduction studies without any decrement on repetitive nerve stimulation tests. Concentric needle EMG showed fasciculation, fibrillation potentials and repetitive discharges with normal interference pattern. All patients made total functional recovery in a week time. Mortality was due to respiratory paralysis and its related complications. Conclusion: These unusual cases with typical clinical and electrophysiological features are not reported in the literature and might constitute “Monsoon Fasciculation - Paralysis Syndrome” possibly a new myasthenic syndrome of unknown etiology.