• 1 Division of Neurology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 2 Department of Medical Microbiology, University of Malaya, Kuala Lumpur, Malaysia
  • 3 Rheumatology Unit, Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
Neurology Asia, 2014;19(4):409-412.


We report a patient who presented with severe cold-induced allodynia and hyperhidrosis, and found to have acquired neuromyotonia (Isaacs syndrome) with high voltage-gated potassium channel (VGKC) antibody titre,positive contactin-associated protein 2 (CASPR2) and leucine-rich glioma-inactivated 1 (LGI1) antibodies. The patient also had positive anti-dsDNA and acetylcholine receptor (AChR) antibodies without clinical features of SLE or myasthenia gravis, suggesting a strong underlying autoimmune tendency. CT thorax showed no thymoma. Her symptoms improved with intravenous immunoglobulin infusion but recurred despite maintenance oral corticosteroids and carbamazepine. She has since been on regular IVIG infusions. Cold allodynia is an unusual presentation in acquired neuromyotonia.