Editing Neuromyotonia (section)

== Diagnosis ==
Diagnosis is clinical and initially consists of ruling out more common conditions, disorders, and diseases, and usually begins at the general practitioner level. A doctor may conduct a basic neurological exam, including coordination, strength, reflexes, sensation, etc. A doctor may also run a series of tests that include blood work and MRIs.

From there, a patient is likely to be referred to a neurologist or a neuromuscular specialist. The neurologist or specialist may run a series of more specialized tests, including needle [[electromyography]] EMG/ and [[nerve conduction studies]] (NCS) (these are the most important tests), chest CT (to rule out paraneoplastic) and specific blood work looking for voltage-gated potassium channel antibodies, acetylcholine receptor antibody, and serum immunofixation, TSH, ANA ESR, EEG etc. Neuromyotonia is characterized electromyographically by doublet, triplet or multiplet single unit discharges that have a high, irregular intraburst frequency.  [[Fibrillation]] potentials and [[fasciculations]] are often also present with [[electromyography]].<ref name="Newsom-Davis">{{cite journal|vauthors=Newsom-Davis J, Mills KR |title=Immunological associations of acquired neuromyotonia (Isaacs' syndrome)|journal=Brain|year=1993|volume=116|issue=2|pages=453–469|doi=10.1093/brain/116.2.453|pmid=8461975}}</ref>

Because the condition is so rare, it can often be years before a correct diagnosis is made.

NMT is not fatal and many of the symptoms can be controlled. However, because NMT mimics some symptoms of [[ALS|motor neuron disease]] (ALS) and other more severe diseases, which may be fatal, there can often be significant anxiety until a diagnosis is made. In some rare cases, acquired neuromyotonia has been misdiagnosed as amyotrophic lateral sclerosis (ALS)<ref>{{cite journal |last1=Rowland |first1=Lewis P. |last2=Shneider |first2=Neil A. |title=Amyotrophic Lateral Sclerosis |journal=New England Journal of Medicine |date=31 May 2001 |volume=344 |issue=22 |pages=1688–1700 |doi=10.1056/NEJM200105313442207 |pmid=11386269}}</ref> particularly if fasciculations may be evident in the absence of other clinical features of ALS. However, fasciculations are rarely the first sign of ALS as the hallmark sign is weakness.<ref>{{cite journal |last1=Hirota |first1=Nobuyuki |last2=Eisen |first2=Andrew |last3=Weber |first3=Markus |title=Complex fasciculations and their origin in amyotrophic lateral sclerosis and Kennedy's disease |journal=Muscle & Nerve |date=2000 |volume=23 |issue=12 |pages=1872–1875 |doi=10.1002/1097-4598(200012)23:12<1872::AID-MUS12>3.0.CO;2-H|pmid=11102912 |s2cid=743517 }}</ref> Similarly, multiple sclerosis has been the initial misdiagnosis in some NMT patients. In order to get an accurate diagnosis see a trained neuromuscular specialist.

People diagnosed with benign fasciculation syndrome or enhanced physiological tremor may experience similar symptoms as NMT, although it is unclear today whether BFS or EPT are weak forms of NMT.

=== Types ===
There are three main types of NMT:{{citation needed|date=November 2015}}
* Chronic
* Monophasic (symptoms that resolve within several years of onset; postinfection, postallergic)
* Relapsing Remitting

=== Peripheral nerve hyperexcitability ===
Neuromyotonia is a type of peripheral nerve hyperexcitability. Peripheral nerve hyperexcitability is an umbrella diagnosis that includes (in order of severity of symptoms from least severe to most severe) [[benign fasciculation syndrome]], [[cramp fasciculation syndrome]], neuromyotonia and [[morvan's syndrome]]. Some doctors will only give the diagnosis of peripheral nerve hyperexcitability as the differences between the three are largely a matter of the severity of the symptoms and can be subjective. However, some objective EMG criteria have been established to help distinguish between the three.

Moreover, the generic use of the term ''peripheral nerve hyperexcitability syndromes'' to describe the aforementioned conditions is recommended and endorsed by several prominent researchers and practitioners in the field.<ref>{{Cite journal |doi = 10.1093/brain/awf178|pmid = 12135978|title = Phenotypic variants of autoimmune peripheral nerve hyperexcitability|journal = Brain|volume = 125|issue = 8|pages = 1887–1895|year = 2002|last1 = Hart|first1 = I. K.|last2 = Maddison|first2 = P.|last3 = Newsom-Davis|first3 = J.|last4 = Vincent|first4 = A.|last5 = Mills|first5 = K. R.|doi-access = free}}</ref>