Mutations in the adult human skeletal muscle Na+ channel a subunit cau
se the disease paramyotonia congenita. Two paramyotonia congenita muta
tions, R1448H and R1448C, substitute histidine and cysteine for argini
ne in the S4 segment of domain 4. These mutations, expressed in a cell
line, have only small effects on the activation of Na+ currents, but
mutant channels inactivate more slowly with less voltage dependence th
an wild-type channels and exhibit an enhanced rate of recovery from in
activation. Increase of extracellular pH made the rate of inactivation
of R1448H similar to that of R1448C, suggesting that this residue has
an extracellular location and that its charge is important for normal
inactivation. Analysis of single-channel data reveals that mutant cha
nnels inactivate normally from closed states, but poorly from the open
state. The data suggest a critical role for the S4 helix of domain 4
in coupling between activation and inactivation.