—I would like to thank Nelson and Davis for their bringing to our attention a recently published article regarding low carnitine palmityltransferase enzyme activity and proximal muscle weakness.1 In that case, the muscle biopsy specimen showed ragged red fibers and paracrystalline inclusions by electron microscopy. In both patients in our article,2 ragged red fibers were not seen on light microscopy, and electron microscopy studies did not show paracrystalline inclusions in the mitochondria.
Weinblatt ME. Carnitine Palmityltransferase Deficiency and Fixed Muscle Weakness-Reply. Arch Neurol. 1990;47(1):13. doi:10.1001/archneur.1990.00530010019011
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