Myotonia.
Synonyms:—Thomsen's disease; myotoma congenita.
Definition:—A congenital condition of the muscular structure without involvement of the nervous system, in which, with hypertrophy of the muscular fibers, there is a characteristic slowness in contractility or in relaxation after the muscles have contracted by voluntary action; a tendency for the muscles to remain in a condition of contraction.
Only a few cases of this disease are on record. It was first described by a physician named Thomsen, who was a sufferer from it. It occurs more frequently in men than in women, and while it is not directly traced to a nervous origin, the individuals suffering from it are more or less neurotic. It has shown itself after severe muscular exercise, after prolonged exposure to cold, and after extreme fright.
Symptomatology:—After a period of rest of the muscles, the patient finds that he is unable to contract the muscle promptly; its action is slow, and when the desired contraction is complete there is a tendency for the muscle to remain in a state of contraction. Because of lack of promptness in contractility or relaxation, the movements of the hands, arms and legs are materially interfered with. If the hand grasps an object, it cannot let go; walking becomes almost impossible; in attempting to walk the condition may be conspicuous at first, but as the efforts are repeated for some little time they will become less and less marked, until the walking becomes normal and the tendency has disappeared. If muscular movement continues, even in a mild form, there will be no return of the trouble. It appears after prolonged rest.
This condition includes all the voluntary muscles, except the masseters and the sphincters and the muscles of deglutition. It may be followed by some mental disturbance, which arises principally from anxiety concerning the condition. From this the patient may become despondent or irritable, and other nervous phenomena may show themselves. There are no constant changes in the reflexes, but there are marked alterations in the electric reactions.
The tendency to the condition is increased by mental excitement, by physical exhaustion, and by exposure to cold. It is decreased by mental tranquillity, rest and the application of heat. Pain, except an occasional cramping sensation, is seldom present.
Sufficient opportunity has not as yet been offered for a full study of the influence of treatment upon the condition. So far but little benefit has been obtained from any course adopted. These patients must lay out a plan of life for themselves in which, cold, nervous excitement and fatigue are entirely avoided. They should live in a warm climate, and largely out of doors. Medicine is of doubtful utility. Indications plainly pointing to a course of tonic treatment may arise. There may be cases in which the suggestions advised for the treatment of muscular atrophy may be applied, in whole or in part, to great advantage.
