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Abraham A, Katzberg HD, Lovblom LE, Bril V. European Federation of Neurological Societies cutoff values significantly reduce creatine kinase sensitivity for diagnosing neuromuscular disorders. Muscle Nerve 2019; 60:748-752. [PMID: 31495916 DOI: 10.1002/mus.26701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 09/02/2019] [Accepted: 09/03/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Elevated creatine kinase (CK) level was redefined by the European Federation of Neurological Societies)EFNS(as 1.5 times the upper limit of normal. In the current study we sought to determine the sensitivity and specificity of CK testing for the diagnosis of neuromuscular disorders. METHODS Demographics and CK levels were retrospectively extracted from an electronic database for 234 patients with neuromuscular disorders. Sensitivity, specificity, and likelihood ratios and the area under curve were determined for each diagnosis and different cutoff CK values. RESULTS Using the EFNS cutoff values significantly reduced CK test sensitivity. Creatine kinase values >1000 IU/L showed a high likelihood (11.04) for myopathies and a low likelihood for polyneuropathies (0). DISCUSSION European Federation of Neurological Societies cutoff values significantly reduce CK sensitivity for diagnosing neuromuscular disorders. While low CK values cannot exclude a neuromuscular disease, values >1000 IU/L are associated with a high likelihood of myopathy.
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Affiliation(s)
- Alon Abraham
- Neuromuscular Diseases Unit of the Department of Neurology, Tel Aviv Sourasky Medical Center, the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hans D Katzberg
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - Leif E Lovblom
- Division of Endocrinology and Metabolism, Department of Medicine, Sinai Health System, Toronto, Canada.,Lunenfeld Tanenbaum Research Institute, University of Toronto, Toronto, Canada
| | - Vera Bril
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada.,Institute for Research and Medical Consultations, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Tahir F, Qadar LT, Khan M, Hussain H, Iqbal SU. Hoffmann's Syndrome Secondary to Pendred Syndrome: A Rare Case. Cureus 2019; 11:e4195. [PMID: 31106095 PMCID: PMC6504027 DOI: 10.7759/cureus.4195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Hoffmann's syndrome (HS) is a rare manifestation of hypothyroidism myopathy that presents with weakness, stiffness, and eventually pseudohypertrophy of muscles, especially calf muscles. We report a case of a 28-year-old male who presented with the history of generalized weakness with swelling in lower limbs and gradual progressive facial puffiness for the past few years. Physical examination of our patient showed diffuse bilateral pseudohypertrophy of deltoid and calf muscles with positive Gowers' sign (GS). Laboratory results of low serum thyroid hormones and muscle biopsy report confirmed the diagnosis of HS. Pendred syndrome (PS) is a genetic disorder leading to congenital bilateral sensorineural hearing loss with mild hypothyroidism. On account of his congenital bilateral sensorineural hearing loss and negative serum anti-thyroid peroxidase antibodies (anti-TPO Ab), PS was declared as the cause of HS in this case. Our patient showed excellent response to levothyroxine therapy with progressive improvement in his symptoms. We outlined this case due to its rarity.
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Affiliation(s)
- Faryal Tahir
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Laila Tul Qadar
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Maria Khan
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Hareem Hussain
- Surgery, Dow University of Health Sciences, Karachi, PAK
| | - Syed Umair Iqbal
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
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El-Moghazi Sultan H, El-Latef GA, El-Ghani HMA, El-Moez Heiba DA, Abdalla DM. Clinical and electrophysiological study of peripheral and central neuromuscular changes in connective tissue diseases in children. THE EGYPTIAN RHEUMATOLOGIST 2016; 38:233-239. [DOI: 10.1016/j.ejr.2015.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Kokotis P, Papadimas GK, Zouvelou V, Zambelis T, Manta P, Karandreas N. Electrodiagnosis and muscle biopsy in asymptomatic hyperckemia. Int J Neurosci 2015; 126:514-519. [PMID: 26000931 DOI: 10.3109/00207454.2015.1038534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Purpose/aim of the study: An increased serum level of creatine kinase (CK) in asymptomatic individuals is a diagnostic challenge, as it may be associated with either physiological conditions, such as exercise or even signal an ominous neuromuscular disease at a presymptomatic stage. The electromyogram (EMG) and the muscle biopsy play a key role in the evaluation of asymptomatic hyperckemia. The objective of this study was to investigate asymptomatic individuals with increased CK levels. MATERIALS AND METHODS We comparatively studied EMG, quantitative EMG and muscle biopsy in asymptomatic clinically normal individuals with repeatedly increased CK levels. RESULTS Conventional EMG was abnormal in 76% of patients, while quantitative EMG showed abnormal results in 88.9%. Muscle biopsy was diagnostic in 28%, one patient had neurogenic findings, 40% showed non-specific changes and 28% had normal results. CONCLUSIONS EMG and especially quantitative EMG are highly sensitive in detecting subclinical neuromuscular diseases, whereas muscle biopsy may better contribute in the final diagnosis. No strong correlations were found between histological abnormalities and electrophysiological data, but further research is needed.
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Affiliation(s)
- P Kokotis
- a Department of Neurology, School of Medicine, Eginition Hospital , University of Athens , Athens , Greece
| | - G K Papadimas
- a Department of Neurology, School of Medicine, Eginition Hospital , University of Athens , Athens , Greece
| | - V Zouvelou
- a Department of Neurology, School of Medicine, Eginition Hospital , University of Athens , Athens , Greece
| | - T Zambelis
- a Department of Neurology, School of Medicine, Eginition Hospital , University of Athens , Athens , Greece
| | - P Manta
- a Department of Neurology, School of Medicine, Eginition Hospital , University of Athens , Athens , Greece
| | - N Karandreas
- a Department of Neurology, School of Medicine, Eginition Hospital , University of Athens , Athens , Greece
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Ghaoui R, Clarke N, Hollingworth P, Needham M. Muscle disorders: the latest investigations. Intern Med J 2014; 43:970-8. [PMID: 24004391 DOI: 10.1111/imj.12234] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 06/22/2013] [Indexed: 12/14/2022]
Abstract
Patients with muscle disorders can present a diagnostic challenge to physicians because of the different ways they can present and the large number of different underlying causes. Recognition of the 'myopathic phenotype' coupled with investigations usually including electrodiagnostic and histological investigations have been essential for diagnosing the underlying cause of a myopathy. Despite these standard investigations, some patients can remain undiagnosed. New tests including more specific antibody tests for immune-mediated myopathies and the introduction of next-generation sequencing promise to revolutionise diagnostic approaches for immune and inherited myopathies, but clinical expertise remains essential to choose the most appropriate tests and interpret the results. The aim of this review is to provide an overview of the different presentations to the neuromuscular clinic and the latest investigations that can be helpful in the diagnosis of muscle disorders.
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Affiliation(s)
- R Ghaoui
- Department of Neurology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
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A novel MYH7 mutation occurring independently in French and Norwegian Laing distal myopathy families and de novo in one Finnish patient. J Neurol 2011; 258:1157-63. [DOI: 10.1007/s00415-011-5900-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 12/29/2010] [Accepted: 01/03/2011] [Indexed: 12/19/2022]
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Thompson PD. Muscle cramp syndromes. HANDBOOK OF CLINICAL NEUROLOGY 2007; 86:389-396. [PMID: 18809011 DOI: 10.1016/s0072-9752(07)86019-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Meo SA, Azeem MA, Qureshi AA, Ghori GM, Al-Drees AM, Feisal Subhan MM. Dose response effect of cement dust on respiratory muscles competence in cement mill workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2006; 16:439-47. [PMID: 17164170 DOI: 10.1080/09603120601095951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Electromyography (EMG) of respiratory muscles is a reliable method of assessing the ventilatory muscle function, but still its use has not been fully utilized to determine the occupational and environmental hazards on respiratory muscles. Therefore, EMG of intercostal muscles was performed to determine the dose response effect of cement dust on respiratory muscles competence. Matched cross-sectional study of EMG in 50 non-smoking cement mill workers with an age range of 20 - 60 years, who worked without the benefit of cement dust control ventilation or respiratory protective devices. EMG was performed by using surface electrodes and chart recorder. Significant reduction was observed in number of peaks (p < 0.0005), maximum peak amplitude (p < 0.0005), peak-to-peak amplitude (p < 0.0005) and duration of response (p < 0.0005) in cement mill workers compared to their matched control. Cement dust impairs the intercostal muscle competence and stratification of results shows a dose-effect of years of exposure in cement mill.
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Affiliation(s)
- Sultan A Meo
- Department of Physiology, Faculty of Health and Medical Sciences, Hamdard University, Pakistan.
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Vasconcellos LFR, Peixoto MC, de Oliveira TN, Penque G, Leite ACC. Hoffman's syndrome: pseudohypertrophic myopathy as initial manifestation of hypothyroidism. Case report. ARQUIVOS DE NEURO-PSIQUIATRIA 2003; 61:851-4. [PMID: 14595495 DOI: 10.1590/s0004-282x2003000500027] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The frequency of myopathy in hypothyroidism ranges from 30 to 80%. The major symptoms related are weakness, muscular cramps and myalgia. The pseudohyperthrophic form is called Hoffman's syndrome. The electrophysiological study reveals myopathy, neuropathy or mixed pattern. Laboratorial investigation generally shows increased levels of muscle enzymes and low serum thyroid hormones, with thyrotrophic-stimulating hormone (TSH) elevated. The treatment consists in hormone replacement and the prognosis is good in most of the cases. We report an adult male who developed muscular cramps, myalgia, weakness, pseudohyperthrophy, associated with facial edema and alteration of his voice. The muscle enzymes were increased and T4 was undetectable with a raised level of TSH. The myopathy was the initial manifestation of hypothyroidism in this case.
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Mastaglia FL, Phillips BA, Cala LA, Meredith C, Egli S, Akkari PA, Laing NG. Early onset chromosome 14-linked distal myopathy (Laing). Neuromuscul Disord 2002; 12:350-7. [PMID: 12062252 DOI: 10.1016/s0960-8966(01)00287-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A dominantly inherited form of distal myopathy with onset in early childhood was first reported in a 4-generation Australian family in 1995. In the present report we provide further information on the clinical phenotype and natural history of this myopathy, and on the electromyogram and magnetic resonance imaging findings in affected individuals. The pattern of muscle involvement was similar to that in the 'tibial' forms of distal myopathy such as the Finnish (Udd) and Markesbery-Griggs types, with additional involvement of the finger extensors and of some more proximal limb and neck muscles. However, the age of onset was earlier than in these other myopathies and rimmed vacuoles were not found in biopsies from two affected individuals. Evidence of possible anticipation was found in one branch of the family. The gene locus for this myopathy had been mapped to 14q11.2-q13. The linkage region has been refined to a 24 cM region between D14S283 and D14S49 and mutations have been excluded in the PABP2 gene for oculopharyngeal muscular dystrophy which lies within this region.
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Affiliation(s)
- F L Mastaglia
- Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Australian Neuromuscular Research Institute, Nedlands, Australia
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Stålberg E, Falck B. The role of electromyography in neurology. ELECTROENCEPHALOGRAPHY AND CLINICAL NEUROPHYSIOLOGY 1997; 103:579-98. [PMID: 9546485 DOI: 10.1016/s0013-4694(97)00138-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A review is given of the role of electromyography (EMG) for diagnosis, pathophysiological description and monitoring of patients with disorders of the peripheral nervous system. Various EMG methods are presented and their principal differences are discussed. The usefulness of these methods varies depending on the pathology to be studied. With modern quantitative methods for analysis, EMG has become more sensitive and accurate and is therefore an important part in the evaluation of the neurologic patient. EMG results are usually combined with findings from other neurophysiological investigations (neurography, evoked potentials), histochemistry, biochemistry and most importantly with the clinical signs to give as complete a picture of the condition as possible. The usefulness of EMG depends on a number of factors other than the quality of the investigation as such. These aspects are discussed briefly.
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Affiliation(s)
- E Stålberg
- Department of Clinical Neurophysiology, University Hospital, Uppsala, Sweden.
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Abstract
Dermatomyositis, polymyositis, and inclusion body myositis are the major categories of idiopathic inflammatory myopathy. These inflammatory myopathies are distinct clinically, histologically, and pathogenically. Features of dermatomyositis and polymyositis can overlap with those of other autoimmune connective tissue diseases. In this article, the authors review the characteristic features of these myopathies, update the recent developments in this area, and provide a framework for treatment.
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Affiliation(s)
- A A Amato
- Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78284-7883, USA
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Abstract
The treatment of the immune-mediated inflammatory myopathies remains largely empirical. Corticosteroids are usually effective in polymyositis and dermatomyositis but may need to be combined with methotrexate or azathioprine in some patients. Intravenous immunoglobulin (IVIg) is effective as add-on therapy in some patients not adequately controlled with steroids or immunosuppressive agents, but further controlled trials of IVIg are necessary to define the indications and optimal dose regimens. Cyclophosphamide, cyclosporin, or chlorambucil may be effective in patients with refractory polymyositis or dermatomyositis. Low-dose whole body or lymphoid irradiation is a last option in severely disabled patients resistant to all other treatments. As a small proportion of patients with inclusion body myositis respond to corticosteroid or immunosuppressive therapy, a 3-6-month trial of such therapy is justified in this condition. More specific immunotherapy for these disorders awaits identification of the target antigens and further clarification of the immunopathogenetic mechanisms.
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Affiliation(s)
- F L Mastaglia
- Australian Neuromuscular Research Institute and Department of Medicine, Queen Elizabeth II Medical Centre, Perth, Australia
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