myokymia, fasciculation & denervation - facial nerve

Presentation: spontaneous twitching one side of face followed by unilateral facial weakness affecting upper and lower portions. Percussing over facial nerve elicits twitching. EMG shows myokymia, fasciculations, rare positive sharp waves, reduced recruitment with polyphasic motor units. Kimura gives a succinct explanation of myokymia: “Myokymic discharges, otherwise known as grouped fasciculation potentials, consist of two to eight consecutive spontaneous single motor unit discharges, occurring repetitive