Motor neuropathy associated with a facilitating myasthenic syndrome

We report a patient with progressive muscle weakness, areflexia, and no sensory loss. Electromyography revealed normal sensory nerve conductions, mild slowing of motor nerve conduction velocities, low amplitude compound muscle action potentials, a neuromuscular transmission defect characterized by prominent facilitation, and diffuse fibrillation potentials. Muscle biopsies showed acute denervation atrophy, and at autopsy, there was anterior horn cell loss and gliosis in the spinal cord. The findings suggest the coexistence of a motor neuropathy and a facilitating myasthenic syndrome.