Transient weakness and altered membrane characteristic in recessive generalized myotonia (Becker)

The isometric force of arm and leg muscles was studied in five unrelated patients with recessive generalized myotonia (Becker). The symptom of myotonia was present mainly in the legs, whereas transient weakness was the prominent symptom in the arms. Tocainide improved both symptoms, although it improved the stiffness more than the weakness. A specimen of intact muscle fibers was excised from the external intercostal muscle of one of the patients. The resting potential of the fibers was normal, but on injection of depolarizing current the fibers responded with repetitive action potentials. In normal interstitial fluid the current-voltage relationship was N-shaped, with a region of negative slope between -70 and -55 mV. Replacement of chloride by an impermeant anion changed this relationship very little, suggesting an abnormally small chloride conductance. The potassium current through the inward-going rectifier was larger than normal. The force of tetanic contractions of a rested bundle was not sustained but fell quickly to a plateau that increased with repeated stimulation. The relaxation of a rested tetanus was slow and accompanied by spontaneous electrical activity. In subsequent contractions the relaxation became faster and electrical after-activity decreased. However at 23 degrees C the speed of relaxation was always high despite a large amount of electrical after-activity. The electrical instability of the membrane and the transient weakness can be explained on the basis of the N-shaped membrane characteristic.