Temporary paralysis I need your Insights

Jenny TipsforME

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@Lindberg I agree, my perception is what I experience dysautonomia connected. I wish it was taken more seriously.

The information does already exist about some PP SNPs it's just not included in the limited 23andme data. If you paid to get your whole exome done (I think now around £400) you can get more info. There's also the Personal Genome Project where you can get your data for free but you have to consent to it being publicly available online.
 

Jenny TipsforME

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In terms of the poll, the proximal weakness pattern is quite common for pwme here. About 40% get it. I realise that there's a flaw in how I chose the options though, because they may have also said they had weakness all over (this was also about 40%).
 
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I'm searching for some clues among my 23andme testresult - eventhough I know they don't test for PP or myotonia. I came across some mutations that I found interesting: RYR1 heterozyg (-3), CARS homozyg (1), SLC6A20 homozyg (0), SLC36A3 homozyg (0), ABCB6 heterozyg (-3), ABCC6 heterozyg (-3), CARD6 homozyg (-2), MTL5 homozyg (-3), NDUFV3 heterozyg (-4). Does anyone recognize these genes? @Jenny TipsforME @Valentijn? Is it something to look into further or not?
 
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Valentijn

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I came across some mutations that I found interesting:
I've got a little info regarding those genes and associated diseases below, but it depends on the specific SNP ("rs" number) which is mutated to determine if it can cause a disease. Most info comes from https://omim.org or wikipedia.

RYR1 heterozyg (-3)
This gene controls the release of calcium in skeletal muscles. It can cause disease when heterozygous, namely Central Core Disease and/or Congenital Neuromuscular Diseases with Uniform Type 1 Fiber.

Central Core Disease can hit at any age, and generally isn't progressive. Symptoms include proximal muscle weakness and skeletal problems (hip dislocation, scoliosis). It's diagnosed with a muscle biopsy.

CARS homozyg (1)
Mutations in this gene can cause childhood cancers. The "(1)", presumably a BLOSUM62 score, would mean that your particular mutation isn't particularly likely to cause problems with the gene.

SLC6A20 homozyg (0)
This gene can cause Iminoglycinuria, the excessive excretion of several amino acids, though a mutation scoring 0 isn't too likely to be a problem. It often doesn't cause any problems, thought might (theoretically?) be associated with some problems, the only relevant one being rather vague encephalopathy.

SLC36A3 homozyg (0)
This is a glycine transporter, but there's no obvious indications of associated diseases.

ABCB6 heterozyg (-3)
Some mutations on this gene can cause skin or eye problems when heterozygous. It can also result in familial pseudohyperkalemia, where stored blood samples will leak excess potassium, and might result in the appearance of a medical problem in lab samples which isn't really occurring in the body.

ABCC6 heterozyg (-3)
These gene can cause Pseudoxanthoma elasticum, but usually only if the mutation is homozygous. Symptoms typically involve the skin and/or eyes.

CARD6 homozyg (-2)
Little is known about this gene.

MTL5 homozyg (-3)
Little is known about this gene. Does something in testicles, so probably not relevant.

NDUFV3 heterozyg (-4)
This gene is involved in Complex I of the mitochondrial respiratory chain. Disruption to Complex 1 in mitochondrial DNA can cause diseases with symptoms very similar to ME/CFS. Assuming the -4 is the BLOSUM62 score, this must be a stop-gain nonsense mutation, which results in premature termination of the protein created by the gene, making it incomplete. Hence it could have a very big effect, depending on where the mutation is on the gene. There has been little research into this gene, so no mutations seem to have been flagged as pathogenic thus far.

For more information, include the "rs" numbers! :D
 

Jenny TipsforME

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BTW this has prompted me to have a look at my 23andme results again. I can't find NDUFV3.

However I did come across homozygous risk for EDS Type 6. This is recessive and I have both, only 16% population have this. https://livewello.com/snp/rs7529452

@Valentijn i have some understanding of genetic stuff but I can't work out how you're getting info on eg if it's a nonsense mutation etc. Most SNPs are said to be associated with disease but it seems to be more the case that they often vary with another SNP that is the cause, rather than doing anything themselves. Is this PLOD1 actually causal in EDS?

I have suspected I have EDS for a while. I know it overlaps with ME and POTS. I Had 2 hernia operations as a child. Doctors say knee problem related to loose ligaments (actually they said I have 3 different problems :rolleyes:). I injure myself quite easily. I don't have typical hyper mobility though.
 

Valentijn

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However I did come across homozygous risk for EDS Type 6. This is recessive and I have both, only 16% population have this. https://livewello.com/snp/rs7529452
There's no indication at that site that the SNP has any involvement with EDS. It's simply on a gene which is involved with EDS, but most SNPs on a gene don't cause problems.

@Valentijn i have some understanding of genetic stuff but I can't work out how you're getting info on eg if it's a nonsense mutation etc.
The data was probably from my Analyze My Genes downloadable program, so I recognized the numbers in parentheses as being from a BLOSUM62 chart. Basically BLOSUM62 ranks the predicted severity of mutations on a scale of -4 to 4, with 4 always being an identical amino acid being created (so no change at all), and -4 always being a premature end to the gene being able to create a protein.

Most SNPs are said to be associated with disease but it seems to be more the case that they often vary with another SNP that is the cause, rather than doing anything themselves.
No, most SNPs are not having an impact. And of the ones outside of coding and splicing control regions, even the ones having an impact are having a pretty small one. Pathogenic SNPs are the exception, not the norm.
 

Valentijn

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... but those look too common to really be a thing ....
This is an important point. SNPs which directly cause serious illness are pretty much never going to be above 2% prevalence rate, in the homozygous or heterozygous state required for it to cause a disease. Common SNPs really aren't interesting, except perhaps as contributing a slight predisposition to some condition.
 

Jenny TipsforME

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Except that some serious disease is above a 2% prevalence rate! Also the percentage of heritability would be relevant. ME has been said to have 50% heritability (if I understand, half of the variation is environmental). If a disease has eg 30% heritability I think it could be particularly useful to know if you have that vulnerability. If you also know the environmental triggers you could take precautions. This is in a way more useful than things which are basically entirely hereditary and you can't prevent.

I can't remember what it was for, something cardiovascular (and probably common), but in my results there was a risk that can be reversed by eating raw veg/fruit. Since I found out I've just upped my salads.
 

Jenny TipsforME

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Just preparing for my neurology appointment on Friday (does anyone else feel like this is preparing for an exam? I get really worried I'll forget relevant details).

This thread has got a little overwhelming, so here's a summary of suggestions:

enteroviruses in the brain become more active leading to symptoms, then less active reducing symptoms

ATS, which is a form of periodic paralysis, specifically a potassium channelopathy. This typically is handled by neurologist, but

periodic paralysis, this may be triggered by metabolic stress as well as by problems with dehydration, electrolytes or neuromuscular junctions

NMDA receptor autoimmune encephalitis

chronic inflammatory disease or an autoimmune response,

Normokalemic periodic paralysis, a variant form of hyperkalemic periodic paralysis?
http://hkpp.org/what-is-periodic-paralysis

numbness in my throat or what I think is early dyphagia

sort of chain reaction eg something (virus, heat etc) causes a POTS flare and then some disruption to sensory and motor areas of the brain.

acetylcholine auto antibodies

myasthenia gravis in which neuromuscular junctions malfunction

Antibodies to N-type calcium channels which will turn up on a paraneoplastic panel can also interfere with operation of neuromuscular junctions via a different mechanism.

chiari malformation

Type 2 episodic ataxia

Type 7 episodic Ataxia

risk SNPs for Acetylcholine autoantibodies which are associated with ME/CFS

If anyone is having temporary muscle weakness, this is a detailed document to check
http://neuromuscular.wustl.edu/mtime/mepisodic.html

I seem to have some genetic risk factors for Andersen Syndrome AKA Andersen–Tawil syndrome.

KCNJ5 FOR ANDERSEN-TAWIL SYNDROME,

13 hetero, 3 homo SNPs CACNA1S HYPOKALEMIC PERIODIC PARALYSIS

Getting tested for voltage gated calcium channel (VGCC Ab) and voltage gated potassium channels (VGKC Ab) antibodies might be worth looking into doing.

doctor I just met said "we usually call those episodes for Parkinsonism"

IVIG or Plasmapheresis is used to treat some with VGKC encephalitis

paraneoplastic syndrome (PNS) which can lead to all sorts of symptoms including dysautonomia/POTS

25% of those with POTS had alpha3 nicotonic acetylcholine receptor antibodies.

could be a channelopathy sodium/potassium/calcium issue more than vasodilation (I know the signals are interlinked). Ivabradine effects the Funny channel (If)

Some of the neuro exam tests I think I was fine on and others I couldn't do at all. I couldn't do the lying down raising legs straight one at all

couldn't do Heel to shin test – “run your heel down the other leg from the knee and repeat in a smooth motion”

spinal stenosis?

The temporary nature of your severe problems makes me suspect either autoantibodies which increase during flares, or an ion-channel disorder affected by electrolytes,

my difficulties walking are getting more severe around the house and seem to maybe be associated with starting midodrine

In the process of washing on Saturday I got hot water on my abdomen and that appeared to be the trigger for the (temporary paralysis) weakness coming on.

doctors seem to want to rule out if I have a primary muscle disorder.


Can you send blood to Cell Trend in Germany on your own?

Angela Vincent's lab in the UK

I don't feel faint with it, I just can't walk normally and shuffle or can't move.

return blood flow to the heart

During the May paralysis my partner could see the pulse on the left side of my neck as if it was having to work hard (perhaps tricuspid regurgitation?).

tingling on the right side of my face

Another speculation suggested in terms of weakness with midodrine is my excitatory molecules provoke a stronger reaction in the same receptor. That is, midodrine fills up / activates alpha-1 receptors, but my natural neurotransmitters have a *stronger effect*.

non-standard cardiac insufficiency

previous day I could only manage one step but yesterday I could walk down and up them fine

In terms of general symptoms I'd actually been having a worse couple of days, lots of pain and ME like lymphatic type symptoms
but was then able to use the stairs without hesitation after a month of not being able to

There are other syndromes associated with the superior mesenteric artery (SMAS) or thoracic outlet (TOS), which cause poor blood flow to some parts of the body.

ME has fluctuated greatly over years, but it doesn't tend to suddenly improve
to me it doesn't fit a ME pattern

Transverse Myelitis

proximal weakness

mitchondrial myopathy

But I also get a different type of weakness sometimes which is more like frailty. In my head I label this as ME weakness, possibly because the first time I saw it was when my sister had severe ME. When like this I move slowly and my partner usually has to assist by sort of pushing from behind (I have some power but not enough). It seems qualitatively different. It is more like an old lady losing strength. The other type is like someone really struggling in rehab after an accident.

proximal weakness pattern is quite common for pwme here. About 40% get it.
 

Never Give Up

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Just preparing for my neurology appointment on Friday (does anyone else feel like this is preparing for an exam? I get really worried I'll forget relevant details).

This thread has got a little overwhelming, so here's a summary of suggestions:

to me it doesn't fit a ME pattern

So, here's another possibility for you:

Last August my son had a tilt table test with a transcranial Doppler ultrasound to measure blood flow to the brain. The test lasted 9 minutes. Around minute 7 or 8 his heart rate had increased by 80+ beats per minute, he was unable to speak, had whole body jerks, was no longer able to hold himself up(which was probably the paralysis symptom), etc. All of these symptoms perfectly correlated with a 35% decrease in blood flow to the brain.

The Neurologist added another diagnosis to his now formally documented POTS: Cerebral Hypoperfusion Syndrome.

He started taking Midodrine for this and found he was able to tolerate it if he took Nuun electrolytes with it. This treatment has greatly reduced the frequency of these episodes and brought the severity down to a mild level. It's not perfect, but it's much better.

What if you also have Cerebral Hypoperfusion Syndrome, but Midodrine just isn't the right drug for you?

Good luck on Friday!
 

Gingergrrl

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Just preparing for my neurology appointment on Friday (does anyone else feel like this is preparing for an exam? I get really worried I'll forget relevant details).

I totally relate and I prepared for a phone consult w/my doctor this week as if I was heading into a meeting that world peace depended on my research and preparation.

I view it as a full-time job and hoping it will eventually all pay off. I am at least 50% better now compared to 2015 but nowhere near a normal person or pre-illness levels. I believe that I will ultimately get better or I will die trying and there is no middle ground (for me).

I admire your perseverance and you should be very proud of your hard work and for not giving up. And please keep us posted b/c myself and people across the world are rooting for you!
 

Jenny TipsforME

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What if you also have Cerebral Hypoperfusion Syndrome
Oh I'm fairly sure I have cerebral hypoperfusion issues but I hadn't realised that's called a separate Syndrome. I just thought most people with POTS would have that as a symptom. I tend to lie down to do any difficult thinking!

@Gingergrrl yes I hope the effort pays off for us. Hard to know with ME associated issues if just resting in ignorance would get us better faster!
 

Jenny TipsforME

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@Lindberg that's a good paper, very systematic
I fit either

Pattern 1: Proximal “Limb-Girdle” Weakness
The most common pattern of muscle weakness in myopathies is symmetric weakness affecting predominantly the proximal muscles of the legs and arms, or the so-called “limb-girdle” distribution. The distal muscles are usually involved, but to a much lesser extent. Neck extensor and flexor muscles are also frequently affected. This pattern of weakness is seen in most hereditary and acquired myopathies and therefore, is the least specific in arriving at a particular diagnosis.

Or
PATTERN 9 EPISODIC WEAKNESS: DELAYED OR UNRELATED TO EXERCISE
  • Periodic paralysis
    • Ca++ channelopathies (hypokalemic)
    • Na++ channelopathies (hyperkalemic)
    • Andersen-Tawil syndrome
    • Secondary PP (thyrotoxicosis)
  • Other: Neuromuscular junction diseases
Which does actually indicate how good we've got on here as amateur medics as these were some of the initial suggestions!
 
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