Hyperkalaemic periodic paralysis: management

Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .

Hyperkalaemic periodic paralysis: management. The test is done during 2-5 minutes of intermittent muscle contractions.

Electromyogram (EMG): McManis test

  • The test is done during 2-5 minutes of intermittent muscle contractions
  • There is an abnormal increase in the compound muscle action potential (CMAP)
  • This is followed by progressive abnormal reduction in the CMAP
  • The reduction is most marked in the first 20 minutes post-exertion
  • The test is also positive in other periodic paralyses

Preventative activities

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Things to avoid

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Treatment

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Anaesthetic management

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General management

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References

  1. Venance SL, Cannon SC, Fialho D, et al. The primary periodic paralyses: diagnosis, pathogenesis and treatment. Brain 2006; 129:8-17. 
  2. Finsterer J. Primary periodic paralyses. Acta Neurol Scand 2008; 117:145-158.
  3. McManis PG, Lambert EH, Daube JR. The exercise test in periodic paralysis. Muscle Nerve 1986; 9:704-710.
  4. Statland JM, Fontaine B, Hanna MG, et al. Review of the diagnosis and treatment of periodic paralysis. Muscle Nerve 2018; 57:522-530.
  5. Haider S, Siddiqui AD, Asad M, et al. Safety and efficacy of dichlorphenamide in patients with periodic paralysis: a systematic review and meta-analysis. Neuromuscul Disord 2026; 58:106300.
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