Diagnosis and Management of Muscle Disease

Neurologists and non-neurologists alike can no longer ignore diseases of the neuromuscular system. The old dogma that these disorders are both uncommon and untreatable has lost its validity. Recent technological advances have enabled us to study more precisely muscle and nerve anatomy, physiology and biochem- istry. Because of this progress, we are now recognizing new neuromuscular di- seases as well as diagnosing more subtle cases of myasthenia gravis, myotonia, and metabolic myopathies. Treatment of the neuromuscular diseases has also un- dergone dramatic change based on new discoveries in the fields of immunology and pharmacology. No longer are myotonia, periodic paralysis, and malignant hyperthermia untreatable medical curiosities. No longer are cases of steroid-un- responsive myositis given up as hopeless. Because of all these advances, non-sur- gical physicians and especially neurologists must update their knowledge regard- ing the neuromuscular disorders. This book, it is hoped, will help such clinicians in dealing with this task. Emphasis has been placed on the diagnosis and management of these disorders rather than on their pathophysiology. The more uncommon diseases and those of uncertain existence have been omitted purposely and left to the larger and more encyclopedic reference works. Chapter 1 discusses the clinical symptoms and signs of muscle disease and is designed to enable the reader to formulate a differential diagnosis on the basis of the patient's history and physical examination.