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Repetitive stimulation abnormalities in ‘epidemic neuromyasthenia’: identification and implications

Four convalescent patients with suspected 'epidemic neuromyasthenia' (ENM) from the Ridgmar district of Fort Worth, Texas, were studied electro- diagnostically 6 to 7 months after the onset of symptoms. Although all patients still complained of subjective weakness and fatigability, no objective weakness was noted. Electromyography of axial and limb muscles and nerve conduction studies of several peripheral nerves were normal. Repetitive stimu- lation studies of deltoid, thenar, and hypothenar muscles were performed. In three ofthe four patients, one or two of these muscles showed late post- exercise exhaustion (at 10 min after 'activation' by maximal isometric exercise or tetany). These findings, if confirmed, imply that the weakness and fatig-ability so prominent in ENM may be due to dys- function of the myoneural junction. (A full report of these observations will be published elsewhere.)