{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T06:26:03Z","timestamp":1787120763827,"version":"build-2736575974"},"reference-count":30,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>We report a 63\u2010year\u2010old Palestinian man with seronegative Morvan syndrome presenting with the complete clinical triad: continuous neuromyotonia with visible myokymia, severe insomnia consistent with agrypnia excitata phenotype (2\u20133\u2009h\/night; Insomnia Severity Index [ISI] 24\/28, validated Arabic version), tachycardia (118\u2009bpm), profuse diaphoresis, and 13\u2010kg weight loss. Electromyography (EMG) demonstrated characteristic myokymic (40\u2013150\u2009Hz) and neuromyotonic (&gt;\u2009150\u2009Hz) discharges across 12 muscles without denervation. Brain MRI, CSF analysis, and comprehensive malignancy screening were unremarkable. Validated cell\u2010based assays confirmed seronegativity for CASPR2 and LGI1 in both serum and CSF. A phenotype\u2010supported diagnosis was pursued integrating the clinical triad, electrophysiological confirmation, and systematic exclusion of mimics. Combined immunotherapy (intravenous methylprednisolone, prednisone taper, azathioprine) and symptomatic treatment (carbamazepine, melatonin) resulted in marked clinical improvement at 6\u2009months: Medical Research Council (MRC) sum score 48\u2009\u2192\u200958\/60, creatine kinase (CK) 928\u2009\u2192\u2009185\u2009U\/L, ISI 24\u2009\u2192\u20094, and sleep restored to 7\u20138\u2009h\/night, with no significant adverse effects. This case illustrates a phenotype\u2010supported diagnostic approach applicable in resource\u2010limited settings where first\u2010line biological therapies are unavailable.<\/jats:p>","DOI":"10.1002\/ccr3.73196","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T09:29:09Z","timestamp":1784712549000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Seronegative Morvan Syndrome Presenting With Agrypnia Excitata and Peripheral Nerve Hyperexcitability: A Phenotype\u2010Supported Diagnostic and Therapeutic Approach in a Resource\u2010Limited Setting"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-9721-6249","authenticated-orcid":false,"given":"Hatem Mousa","family":"Taha","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Health Sciences, An\u2010Najah National University  Nablus Palestine"},{"name":"Department of Internal Medicine Palestine Medical Complex  Ramallah Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3972-9459","authenticated-orcid":false,"given":"Khaled Hatem","family":"Taha","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences, An\u2010Najah National University  Nablus Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/124.12.2417"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awq213"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002917"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2012.99"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(15)00401-9"},{"key":"e_1_2_15_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.23577"},{"key":"e_1_2_15_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awf178"},{"issue":"10","key":"e_1_2_15_9_1","article-title":"Morvan Syndrome With Seronegative Autoimmune Encephalitis Treated Successfully With Immunotherapy","volume":"12","author":"J\u00f8rgensen L. 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