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Persistent unilateral tibialis anterior muscle hypertrophy with complex repetitive discharges and myalgia

Report of two unique cases and response to botulinum toxin

Departments of Neurology, University Clinics, Mainz, Germany (Drs. Nix and Hopf)
University of Texas, Houston, TX (Drs. Butler and Roontga)
West Virginia University, Morgantown, WV (Dr. Gutmann).

Unilateral enlargement of the tibialis anterior muscle associated with complex repetitive discharges occurred over several months in two patients and was preceded by pain and numbness in the lower leg. Neuroradiologic investigations excluded a compressive radiculopathy, but pharmacologic and neurophysiologic studies suggested a neurogenic basis for the muscle hypertrophy. Botulinum toxin A injection into the hypertrophied muscles led to a decreased muscle volume and cessation of muscle pain.

Address correspondence and reprint requests to Dr. Wilfred A. Nix, Department of Neurology, University Clinics, D-6500 Mainz, Germany.

Received March 28, 1991. Accepted for publication in final form August 9, 1991.

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