{ "vercy": "1.0-draft", "publication": { "status": "research-draft", "adjudicationStatus": "unreviewed", "publishableCanonical": false, "generatedAt": "2026-09-12T11:34:29Z", "providers": [ "Codex" ], "breadth": "recalled by Codex without web access - no source was read", "missingProviders": [], "pass": 2, "cost": { "grok": { "seconds": 20.1, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a09564-aea7-7732-95ba-f3dfc0ed99ec\n--------\nuser\nDescribe what is already known about one registered thing. Answer as JSON only, no prose around it.\n\nThing: neuromyotonia\nSense to describe: (none recorded)\nDomain code: INF.KNW\nAlso known as: (none)\n\n\nContext for this batch of 1001 things:\n# Batch 044: 1001 r", "usd": 0.0, "recall": true }, "codex": { "seconds": 71.1, "error": "Reading additional input from stdin...\nOpenAI Codex v0.153.4\n--------\nworkdir: R:\\02_PROJECTS\\02_Meta_Models_Platforms\\Ver.cy\\current\\thing-registry-backlog\nmodel: gpt-6-astra\nprovider: openai\napproval: never\nsandbox: read-only\nreasoning effort: none\nreasoning summaries: none\nsession id: 01a09564-aeac-7393-9f1e-f8f37bec6cca\n--------\nuser\nYou are drafting a Vercy meta-model for one registered thing. Answer as JSON only, no prose around it.\n\nThing: neuromyotonia\nRegistry id: vr.tr.neuromyotonia\nPlane / domain: INF / INF.KNW\nRegistry definition: (none recorded)\nNames folded into this entry: (none" } }, "enrichment": { "pass": 3, "engine": "claude", "producedAt": "2026-10-06T12:00:00Z", "ingestedAt": "2026-10-06T08:39:52+00:00", "fields": [ "agent_conduct", "ethics", "owners" ] }, "gate": { "passed": true, "version": "1.0", "at": "2026-10-07T10:10:31+00:00", "evidence": [ "completeness 1.00", "sense: Wikidata description", "2 live sources", "review by codex: pass" ] } }, "metaModel": { "id": "THING-Q520797", "registryId": "vr.tr.neuromyotonia", "name": "neuromyotonia", "version": "0.1.0-research.1", "entryKind": "thing", "family": "Thing Registry", "domain": [ "INF.KNW" ], "status": "research-draft" }, "canonicalUrl": "https://ver.cy/models/thing/q520797/", "model": { "registry_id": "vr.tr.neuromyotonia", "name": "neuromyotonia", "purpose": "Enable an agent to recognize neuromyotonia, assess the evidence and functional burden of peripheral nerve hyperexcitability, and support clinician-directed investigation and monitoring.", "definition": "Neuromyotonia is a peripheral nerve hyperexcitability disorder characterized by spontaneous, repetitive motor axon discharges that produce continuous muscle activity, stiffness, cramps, and delayed muscle relaxation.", "scope_statement": "This model owns the clinical concept of neuromyotonia under vr.tr.neuromyotonia, its supporting electrophysiological phenotype, causal attribution, and longitudinal assessment; the INF / INF.KNW placement represents knowledge about the condition.", "in_scope": [ "Persistent muscle overactivity attributed to peripheral motor nerve hyperexcitability", "Clinical and electrophysiological evidence supporting or challenging neuromyotonia", "Distribution, course, and functional consequences of stiffness, twitching, cramps, and impaired relaxation", "Evidence for acquired immune-mediated, inherited, or unresolved causes", "Neuromyotonia-specific treatment goals and response monitoring" ], "out_of_scope": [ "Primary muscle membrane myotonia and its underlying channelopathies", "Independent models of associated malignancies or systemic autoimmune disorders", "Full characterization of Morvan syndrome and autoimmune encephalitis", "General electromyography equipment and examination procedures", "Medication prescribing protocols and autonomous treatment selection" ], "distinguishing_features": [ "Require evidence of peripheral nerve hyperexcitability underlying persistent muscle overactivity; cramps or stiffness alone are insufficient. [Clinical reference](https://www.merckmanuals.com/professional/neurologic-disorders/peripheral-nervous-system-and-motor-unit-disorders/isaacs-syndrome)", "Differentiate nerve-origin impaired relaxation from muscle myotonia using the clinical examination and EMG waveform interpretation. [Clinical reference](https://www.merckmanuals.com/professional/neurologic-disorders/peripheral-nervous-system-and-motor-unit-disorders/isaacs-syndrome)", "Distinguish a documented neuromyotonic discharge from a diagnosis of the whole syndrome; retain the sampled muscle and clinical context. [Observed focal case](https://pmc.ncbi.nlm.nih.gov/articles/PMC9003598/)", "Separate isolated fasciculations or cramps from a supported neuromyotonia phenotype by recording the specialist's clinical and electrodiagnostic reasoning." ], "characteristics": [ { "name": "Diagnostic standing", "kind": "state", "unit_or_values": "suspected | clinician-supported | disputed | alternative diagnosis favored", "why_it_matters": "Prevents symptoms or an isolated test result from becoming an unqualified diagnosis." }, { "name": "Anatomical distribution", "kind": "category", "unit_or_values": "focal | multifocal | generalized; named muscles and body regions", "why_it_matters": "Connects the clinical pattern to sampling adequacy and functional burden." }, { "name": "Neuromyotonic discharge evidence", "kind": "state", "unit_or_values": "detected | not detected in sampled muscles | equivocal | not assessed", "why_it_matters": "Preserves the distinction between a negative sample and absence of the condition." }, { "name": "Discharge characteristics", "kind": "measurement", "unit_or_values": "intraburst frequency in Hz, burst duration in ms, waveform description, muscle and examination date", "why_it_matters": "Makes the electrodiagnostic interpretation traceable without imposing an unsupported universal threshold." }, { "name": "Muscle overactivity burden", "kind": "measurement", "unit_or_values": "cramps per day, stiffness duration in minutes, and patient-rated interference with the scale identified", "why_it_matters": "Provides repeatable observations for follow-up without implying a validated composite score." }, { "name": "Antibody evidence", "kind": "relation", "unit_or_values": "antigen, assay, specimen, result, laboratory reference range and date", "why_it_matters": "Supports assessment of an immune-mediated cause while keeping assay findings distinct from causal conclusions." }, { "name": "Etiologic attribution", "kind": "category", "unit_or_values": "immune-mediated | inherited | other specified | unresolved; evidence and confidence recorded separately", "why_it_matters": "Avoids assuming that every neuromyotonia phenotype has the same cause." }, { "name": "Treatment response", "kind": "state", "unit_or_values": "improved | unchanged | worsened | mixed | unassessable; target, interval and concurrent changes specified", "why_it_matters": "Separates symptomatic change from evidence about mechanism." } ], "affordances": [ "Assemble clinical and EMG evidence into a reviewable neuromyotonia assessment", "Identify missing observations needed to distinguish nerve hyperexcitability from muscle myotonia or isolated cramps", "Link etiologic hypotheses to actual antibody, genetic, or associated-disease evidence", "Track muscle overactivity and its effects on walking, hand use, sleep, and daily activity", "Prepare clinician-review prompts when new systemic, autonomic, or cognitive features change the diagnostic context", "Compare clinician-directed interventions against explicit symptom and function targets" ], "agent_conduct": { "may": [ "Explain neuromyotonia, its symptoms and known associations, citing medical sources.", "Advise a person with persistent muscle twitching, stiffness or cramps to see a clinician." ], "must_not": [ "Diagnose neuromyotonia from symptoms.", "Recommend anticonvulsants, immune treatments or other drugs.", "Dismiss symptoms as anxiety alone without clinical assessment.", "Share a person's diagnosis without consent." ], "requires_human": [ "Any clinical decision on testing or treatment." ] }, "ethics": { "considerations": [ "Rare nerve disorders are often missed or dismissed for years.", "Some cases are linked to tumours, so careful assessment matters." ], "affected_parties": [ "Patients", "Families", "Neurologists" ] }, "owners": { "steward": "Nobody owns the condition; clinicians answer for each patient's care.", "master_systems": [] }, "what_it_is_for": [ "Neuromyotonia is encountered in neurological assessment of persistent muscle activity, stiffness, cramps and impaired relaxation.", "Clinical evaluation and electrophysiological testing help characterize peripheral nerve hyperexcitability and investigate associated conditions." ], "standards_and_regulation": [ "The World Health Organization's ICD-10 includes neuromyotonia under G71.1, the category for myotonic disorders." ], "visual_identification": [ "Persistent fine muscle rippling or twitching at rest can suggest peripheral nerve hyperexcitability but is not specific to neuromyotonia.", "Stiff movement and delayed relaxation after contraction can support suspicion but overlap with other disorders.", "Visual observation alone cannot distinguish neuromyotonia reliably from other causes of stiffness or involuntary muscle activity." ], "failure_modes_and_hazards": [ "Persistent stiffness and cramps can impair mobility, sleep and daily activities.", "Impaired movement and relaxation can increase the risk of falls or task-related injury.", "Misclassification can delay appropriate neurological investigation and recognition of associated disease." ] }, "sources": [ { "id": "wikidata", "title": "Wikidata item Q520797: neuromyotonia", "url": "https://www.wikidata.org/wiki/Q520797", "url_status": "live", "what_it_supports": "identity and sense of the item", "checked_by": "wikidata-api" }, { "id": "wikipedia-en", "title": "Wikipedia: Neuromyotonia", "url": "https://en.wikipedia.org/wiki/Neuromyotonia", "url_status": "live", "what_it_supports": "general description of the item", "checked_by": "wikidata-api sitelink" } ], "structure": { "bundles": [ { "id": "syndrome-identity", "name": "Syndrome identity and boundaries", "description": "Establish what the neuromyotonia label denotes in the assessed record.", "rationale": "A syndrome diagnosis, an EMG finding, and an etiologic label must remain distinguishable.", "layers": [ { "id": "label-and-referent", "name": "Label and referent", "description": "Anchor terminology to the registered concept and the clinician's intended meaning.", "findings": [ { "id": "syndrome-versus-discharge", "name": "Syndrome versus discharge", "description": "Record whether neuromyotonia denotes the clinical syndrome, a localized manifestation, or an electrodiagnostic observation.", "questions": [ { "text": "Does the recorded term identify a clinical syndrome or only neuromyotonic discharges?", "kind": "definition", "id": "syndrome-versus-discharge-q01" }, { "text": "Who assigned the label, on what date, and with what supporting assessment?", "kind": "provenance", "id": "syndrome-versus-discharge-q02" } ] } ] }, { "id": "neighboring-phenotypes", "name": "Neighboring phenotypes", "description": "Make the evidence separating similar presentations explicit.", "findings": [ { "id": "myotonia-and-cramp-boundary", "name": "Myotonia and cramp boundary", "description": "Preserve the reasoning that distinguishes neuromyotonia from primary muscle myotonia and less specific cramp or fasciculation presentations.", "questions": [ { "text": "What examination and EMG observations support nerve-origin overactivity rather than muscle membrane myotonia?", "kind": "boundary", "id": "myotonia-and-cramp-boundary-q01" }, { "text": "What evidence supports neuromyotonia beyond cramps or fasciculations alone?", "kind": "boundary", "id": "myotonia-and-cramp-boundary-q02" } ] } ] } ] }, { "id": "muscle-overactivity-phenotype", "name": "Muscle overactivity phenotype", "description": "Describe where muscle overactivity occurs and what it prevents the person from doing.", "rationale": "An electrophysiological finding alone does not describe the condition's clinical burden.", "layers": [ { "id": "distribution-and-expression", "name": "Distribution and expression", "description": "Capture muscle-specific manifestations and their temporal pattern.", "findings": [ { "id": "resting-and-evoked-activity", "name": "Resting and evoked activity", "description": "Document observed twitching, stiffness, cramps, and impaired relaxation separately from patient-reported sensations.", "questions": [ { "text": "Which muscles show visible or palpable overactivity, and is the distribution focal, multifocal, or generalized?", "kind": "measurement", "id": "resting-and-evoked-activity-q01" }, { "text": "How do symptoms vary at rest, after voluntary contraction, and across the day?", "kind": "measurement", "id": "resting-and-evoked-activity-q02" } ] } ] }, { "id": "functional-consequences", "name": "Functional consequences", "description": "Relate muscle overactivity to specific limitations.", "findings": [ { "id": "stiffness-cramp-interference", "name": "Stiffness and cramp interference", "description": "Establish reproducible measures of symptom interference and distinguish stiffness-limited activity from demonstrable weakness.", "questions": [ { "text": "How frequently do cramps occur, and how much do stiffness and impaired relaxation interfere with walking, grip release, or sleep?", "kind": "measurement", "id": "stiffness-cramp-interference-q01" }, { "text": "Is reduced performance explained by pain or stiffness, objective weakness, or an unresolved combination?", "kind": "boundary", "id": "stiffness-cramp-interference-q02" } ] } ] } ] }, { "id": "electrodiagnostic-evidence", "name": "Electrodiagnostic evidence", "description": "Make the evidence for peripheral nerve hyperexcitability inspectable.", "rationale": "Waveform interpretation and sampling context determine what an EMG report can support.", "layers": [ { "id": "discharge-identification", "name": "Discharge identification", "description": "Record the specialist's classification of spontaneous motor activity.", "findings": [ { "id": "waveform-classification", "name": "Waveform classification", "description": "Preserve neuromyotonic discharge findings alongside separately classified myokymic, fasciculation, and other activity.", "questions": [ { "text": "Were neuromyotonic discharges identified, and what waveform characteristics supported that interpretation?", "kind": "measurement", "id": "waveform-classification-q01" }, { "text": "Were myokymic discharges, fasciculations, or myotonic discharges distinguished explicitly in the report?", "kind": "boundary", "id": "waveform-classification-q02" } ] } ] }, { "id": "sampling-and-corroboration", "name": "Sampling and corroboration", "description": "Interpret results in light of tested muscles, concurrent treatment, and complementary observations.", "findings": [ { "id": "test-context", "name": "Test context", "description": "Attach examination conditions and nerve conduction findings to the diagnostic conclusion.", "questions": [ { "text": "Which symptomatic and asymptomatic muscles were sampled, and what symptom-suppressing treatments were being taken?", "kind": "provenance", "id": "test-context-q01" }, { "text": "Were stimulus-induced afterdischarges documented, absent, or not assessed?", "kind": "measurement", "id": "test-context-q02" }, { "text": "If clinical and electrodiagnostic findings disagree, what limitation or clinician-directed reassessment is recorded?", "kind": "action", "id": "test-context-q03" } ] } ] } ] }, { "id": "cause-and-associated-disease", "name": "Cause and associated disease", "description": "Separate phenotype recognition from evidence about why it occurred.", "rationale": "Causal attribution changes investigation and management, but cannot be inferred from the syndrome label alone.", "layers": [ { "id": "immune-evidence", "name": "Immune evidence", "description": "Record antigen-specific testing and the interpretation of positive, negative, or historical results.", "findings": [ { "id": "antibody-interpretation", "name": "Antibody interpretation", "description": "Capture CASPR2 and other relevant results with assay details; retain historical VGKC-complex wording without silently converting it into an antigen-specific result.", "questions": [ { "text": "Which antigen-specific antibodies were tested, using what assay, specimen, and laboratory interpretation?", "kind": "provenance", "id": "antibody-interpretation-q01" }, { "text": "Does a historical VGKC-complex result have documented antigen-specific follow-up?", "kind": "boundary", "id": "antibody-interpretation-q02" }, { "text": "What evidence supports or limits the clinician's immune-mediated attribution?", "kind": "boundary", "id": "antibody-interpretation-q03" } ] } ] }, { "id": "inherited-and-associated-context", "name": "Inherited and associated context", "description": "Keep inherited explanations and associated disorders linked to their independent evidence.", "findings": [ { "id": "etiologic-links", "name": "Etiologic links", "description": "Record family history, genetic interpretation, neuropathy, and associated disease evaluations without treating coexistence as proof of causation.", "questions": [ { "text": "Do onset, family history, neuropathy findings, or a clinically interpreted genetic result support an inherited explanation?", "kind": "provenance", "id": "etiologic-links-q01" }, { "text": "What evaluation for associated malignancy or autoimmune disease was undertaken, and why was it indicated?", "kind": "provenance", "id": "etiologic-links-q02" }, { "text": "Is each linked disorder considered causal, associated, incidental, or unresolved?", "kind": "boundary", "id": "etiologic-links-q03" } ] } ] } ] }, { "id": "course-and-clinical-action", "name": "Course and clinical action", "description": "Track changes that affect diagnostic review and clinician-directed care.", "rationale": "Longitudinal decisions need explicit treatment targets and recognition of features extending beyond muscle overactivity.", "layers": [ { "id": "extension-beyond-motor-symptoms", "name": "Extension beyond motor symptoms", "description": "Capture autonomic, sleep, and cognitive changes as findings needing their own interpretation.", "findings": [ { "id": "broader-syndrome-review", "name": "Broader syndrome review", "description": "Record whether associated features prompted assessment for a broader neurological syndrome, including Morvan syndrome, without automatically reclassifying the entry.", "questions": [ { "text": "Are sweating changes, other autonomic symptoms, marked sleep disturbance, or cognitive and behavioral changes present?", "kind": "measurement", "id": "broader-syndrome-review-q01" }, { "text": "Has a clinician assessed whether these features belong to neuromyotonia, a broader syndrome, treatment effects, or another condition?", "kind": "boundary", "id": "broader-syndrome-review-q02" }, { "text": "What documented change should trigger expedited clinical reassessment?", "kind": "action", "id": "broader-syndrome-review-q03" } ] } ] }, { "id": "intervention-and-follow-up", "name": "Intervention and follow-up", "description": "Evaluate interventions against muscle overactivity and function over a defined interval.", "findings": [ { "id": "targeted-response", "name": "Targeted response", "description": "Separate symptom suppression, treatment of a proposed cause, adverse effects, and changes in associated disease.", "questions": [ { "text": "What clinician-directed intervention was used, and did it target muscle overactivity, an attributed cause, or an associated disorder?", "kind": "action", "id": "targeted-response-q01" }, { "text": "How did cramps, stiffness, relaxation, and daily function change from the recorded baseline?", "kind": "measurement", "id": "targeted-response-q02" }, { "text": "What adverse effects, concurrent interventions, or natural fluctuations limit interpretation of the response?", "kind": "boundary", "id": "targeted-response-q03" } ] } ] } ] }, { "id": "evidence-and-external-alignment", "name": "Evidence and external alignment", "description": "What the world already says about this thing, gathered so the model can be checked against it.", "rationale": "A model that cannot be lined up against existing standards, identifiers and practice cannot be adopted by anyone who already uses them.", "layers": [ { "id": "reported-evidence", "name": "Reported evidence", "description": "Findings from the breadth pass, kept separate from the structural claims.", "findings": [ { "id": "evidence-confidence-notes", "name": "Check these first", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "This is a neurological condition, despite the supplied INF.KNW domain placement.", "The electromyographic frequency range is characteristic rather than a standalone diagnostic threshold.", "Recalled knowledge only; terminology, indexing, and subtype boundaries should be checked against specialist references." ], "questions": [ { "id": "evidence-confidence-notes-q01", "text": "Which of these check these first hold for the sense of neuromyotonia this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-kinds", "name": "Kinds and varieties", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Acquired neuromyotonia, including autoimmune forms", "Hereditary neuromyotonia" ], "questions": [ { "id": "evidence-kinds-q01", "text": "Which of these kinds and varieties hold for the sense of neuromyotonia this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-identifiers", "name": "Identifiers and schemes", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "scheme": "Medical Subject Headings (MeSH)", "value_or_pattern": "Neuromyotonia", "note": "Controlled vocabulary term for indexing biomedical literature; numeric identifier not supplied from recall." } ], "questions": [ { "id": "evidence-identifiers-q01", "text": "Which of these identifiers and schemes hold for the sense of neuromyotonia this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-real-world-use", "name": "Real-world use", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Clinical classification of peripheral nerve hyperexcitability syndromes.", "Electromyographic recognition of neuromyotonic discharges during investigation of muscle stiffness, twitching, and cramps.", "Recognition of acquired cases can prompt investigation for autoimmune or associated neoplastic disease." ], "questions": [ { "id": "evidence-real-world-use-q01", "text": "Which of these real-world use hold for the sense of neuromyotonia this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-measurements", "name": "Typical measurements", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "quantity": "Intraburst frequency of neuromyotonic discharges on needle electromyography", "typical_range": "Approximately 150-300", "unit": "Hz" } ], "questions": [ { "id": "evidence-measurements-q01", "text": "Which of these typical measurements hold for the sense of neuromyotonia this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-failure-modes-and-hazards", "name": "Failure modes and hazards", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ "Persistent stiffness and painful cramps can impair movement and daily activities.", "Continuous muscle activity may disrupt sleep and cause fatigue.", "Excessive sweating can accompany the motor symptoms.", "Some acquired cases are associated with thymoma or other neoplasms.", "Confusion with muscle membrane myotonia can misdirect diagnostic investigation." ], "questions": [ { "id": "evidence-failure-modes-and-hazards-q01", "text": "Which of these failure modes and hazards hold for the sense of neuromyotonia this model covers, and on what evidence?", "kind": "provenance" } ] }, { "id": "evidence-neighbours", "name": "Neighbouring kinds and how to tell them apart", "description": "Recalled without web access and unsourced; every item is a lead to verify.", "evidence": [ { "name": "Myotonia", "difference": "Myotonia arises from muscle membrane hyperexcitability; neuromyotonia arises from motor nerve hyperexcitability, with different characteristic electromyographic discharges." }, { "name": "Myokymia", "difference": "Myokymia describes rippling muscle activity with grouped electromyographic discharges; it can accompany neuromyotonia but does not by itself establish the syndrome." }, { "name": "Cramp-fasciculation syndrome", "difference": "A generally milder peripheral nerve hyperexcitability syndrome dominated by cramps and fasciculations, without the characteristic sustained neuromyotonic discharge pattern." }, { "name": "Morvan syndrome", "difference": "Combines peripheral nerve hyperexcitability with prominent autonomic and central nervous system manifestations, particularly severe insomnia and encephalopathy." }, { "name": "Isaacs syndrome", "difference": "Commonly used as a synonym for acquired neuromyotonia rather than a separate condition; usage varies." } ], "questions": [ { "id": "evidence-neighbours-q01", "text": "Which of these neighbouring kinds and how to tell them apart hold for the sense of neuromyotonia this model covers, and on what evidence?", "kind": "provenance" } ] } ] } ] } ] }, "openQuestions": [ "Which published diagnostic convention should govern the minimum clinical and electrodiagnostic evidence required for neuromyotonia?", "How should this registry represent the overlap between neuromyotonia, acquired neuromyotonia or Isaacs syndrome, and isolated neuromyotonic discharges without creating duplicate concepts?", "Which outcome measures are validated specifically for neuromyotonia, and what changes are clinically meaningful?", "What evidence should guide the extent and repetition of associated-malignancy evaluation for different phenotypes and antibody findings?", "How should negative antibody testing, limited EMG sampling, and concurrent symptom-suppressing treatment alter diagnostic confidence?" ], "statistics": { "bundles": 6, "layers": 11, "findings": 17, "questions": 32 } }