Figure 1

Disease course in patients 1 and 2. Graphs show data for antibodies to P/Q-type voltage-gated calcium channels, compound muscle action potential amplitudes, incremental and decremental response over the course of the disease in patient 1 (A) and patient 2 (B). In both patients a repetitive nerve stimulation test was performed using the belly tendon technique over the abductor digiti minimi (supramaximal stimulation to record compound muscle action potential amplitudes at rest and after exercise for 30 seconds at 3-Hz stimulation). Mean skin temperature: 32°C; pathological decrement: ≥10% difference between first and fifth compound muscle action potential amplitudes; pathological increment: ≥100% compound muscle action potential amplitudes increase after exercise (Multiliner Vision electromyography system; VIASYS Healthcare, Höchberg, Germany). The P/Q-type voltage-gated calcium channel antibodies were analyzed by radioabsorption assay (Angela Vincent, John Radcliffe Hospital, Oxford, UK: upper limit of normal value <45pmol/L; MVZ Labor Prof. Seelig, Karlsruhe, Germany: upper limit of normal value <40pmol/L). Aza, Azathioprine; CMAP, Compound muscle action potential; 3,4 DMP, 3,4-diaminopyridine; IVIG, Intravenous immunoglobulins; Pred, Prednisolone; VGCC, Voltage-gated calcium channel.