Review of the Diagnosis and Treatment of Periodic Paralysis

Muscle Nerve. 2018 Apr;57(4):522-530. doi: 10.1002/mus.26009. Epub 2017 Nov 29.


Periodic paralyses (PPs) are rare neuromuscular disorders caused by mutations in skeletal muscle sodium, calcium, and potassium channel genes. PPs include hypokalemic paralysis, hyperkalemic paralysis, and Andersen-Tawil syndrome. Common features of PP include autosomal dominant inheritance, onset typically in the first or second decades, episodic attacks of flaccid weakness, which are often triggered by diet or rest after exercise. Diagnosis is based on the characteristic clinic presentation then confirmed by genetic testing. In the absence of an identified genetic mutation, documented low or high potassium levels during attacks or a decrement on long exercise testing support diagnosis. The treatment approach should include both management of acute attacks and prevention of attacks. Treatments include behavioral interventions directed at avoidance of triggers, modification of potassium levels, diuretics, and carbonic anhydrase inhibitors. Muscle Nerve 57: 522-530, 2018.

Keywords: Andersen-Tawil syndrome; acetazolamide; channelopathies; dichlorphenamide; periodic paralyses; review; treatment.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Acetazolamide / therapeutic use
  • Andersen Syndrome / diagnosis*
  • Andersen Syndrome / therapy
  • Anti-Arrhythmia Agents / therapeutic use
  • Behavior Therapy
  • Carbonic Anhydrase Inhibitors / therapeutic use
  • Diuretics / therapeutic use
  • Diuretics, Potassium Sparing / therapeutic use
  • Humans
  • Hydrochlorothiazide / therapeutic use
  • Hypokalemic Periodic Paralysis / diagnosis
  • Hypokalemic Periodic Paralysis / therapy
  • Paralyses, Familial Periodic / diagnosis*
  • Paralyses, Familial Periodic / therapy
  • Paralysis, Hyperkalemic Periodic / diagnosis
  • Paralysis, Hyperkalemic Periodic / therapy
  • Potassium / therapeutic use


  • Anti-Arrhythmia Agents
  • Carbonic Anhydrase Inhibitors
  • Diuretics
  • Diuretics, Potassium Sparing
  • Hydrochlorothiazide
  • Acetazolamide
  • Potassium