Neuromuscular disease

Congenital nemaline myopathy (neuromuscular disorder)
Specialty| Neurology, neuromuscular medicine, physical medicine and rehabilitation
Causes| Autoimmune disorders,[1] genetic disorders,[2] environmental factors[3]
Diagnostic method| Muscle electrophysiology tests, genetic testing
Treatment| Depends on the disorder; many currently have no cure[2]

A neuromuscular disease is any disease affecting the peripheral nervous system (PNS),[lower-alpha 1] the neuromuscular junction, or skeletal muscle, all of which are components of the motor unit.[4] Damage to any of these structures can cause muscle atrophy and weakness. Issues with sensation can also occur.

Neuromuscular diseases can be acquired or genetic. Mutations of more than 500 genes have shown to be causes of neuromuscular diseases.[5] Other causes include nerve or muscle degeneration, autoimmunity, toxins, medications, malnutrition, metabolic derangements, hormone imbalances, infection, nerve compression/entrapment, comprised blood supply, and trauma.[6]

## Contents

* 1 Signs and symptoms
* 2 Causes
* 3 Diagnosis
* 4 Prognosis
* 5 See also
* 6 Notes
* 7 References
* 8 Further reading
* 9 External links

## Signs and symptoms[edit | edit source]

Symptoms of neuromuscular disease may include numbness, paresthesia, muscle weakness, muscle atrophy, myalgia (muscle pain), and fasciculations (muscle twitches).[2][7]

## Causes[edit | edit source]

Neuromuscular disease can be caused by autoimmune disorders,[1] genetic/hereditary disorders[2] and some forms of the collagen disorder Ehlers–Danlos syndrome,[8] exposure to environmental chemicals and poisoning which includes heavy metal poisoning.[3] The failure of the electrical insulation surrounding nerves, the myelin, is seen in certain deficiency diseases, such as the failure of the body's system for absorbing vitamin B-12.[3]

Diseases of the motor end plate include myasthenia gravis, a form of muscle weakness due to antibodies against acetylcholine receptor,[9][10] and its related condition Lambert–Eaton myasthenic syndrome (LEMS).[11] Tetanus and botulism are bacterial infections in which bacterial toxins cause increased or decreased muscle tone, respectively.[12] Muscular dystrophies, including Duchenne's and Becker's, are a large group of diseases, many of them hereditary or resulting from genetic mutations, where the muscle integrity is disrupted, they lead to progressive loss of strength and decreased life span.[13]

Further causes of neuromuscular diseases are:

Polymyositis

Inflammatory muscle disorders

* Polymyalgia rheumatica (or "muscle rheumatism") is an inflammatory condition that mainly occurs in the elderly; it is associated with giant-cell arteritis (It often responds to prednisolone).[14]
* Polymyositis is an autoimmune condition in which the muscle is affected.[15]
* Rhabdomyolysis is the breakdown of muscular tissue due to any cause.[16]

Tumors

* Smooth muscle: leiomyoma (benign)[17]
* Striated muscle: rhabdomyoma (benign)[18]

## Diagnosis[edit | edit source]

Diagnostic procedures that may reveal muscular disorders include direct clinical observations. This usually starts with the observation of bulk, possible atrophy or loss of muscle tone. Neuromuscular disease can also be diagnosed by imaging, various blood tests and using electrodiagnostic medicine tests[19] including electromyography[20] (measuring electrical activity in muscles) and nerve conduction studies.[21] Genetic testing is an important part of diagnosing inherited neuromuscular conditions.[19]

* Radiologic imaging in neuromuscular disorders

* Nerve conduction velocity (study)

## Prognosis[edit | edit source]

Prognosis and management vary by disease.[citation needed]

## See also[edit | edit source]

* List of neuromuscular disorders
* Motor neuron diseases
* Neuromuscular medicine

## Notes[edit | edit source]

1. ↑ Lower motor neurons originate in the anterior horn of the spinal cord, a part of the central nervous system. However, the anterior horn is also part of the motor unit. Diseases that affect the anterior horn are classified as neuromuscular.

## References[edit | edit source]

1. ↑ 1.0 1.1 Kraker, Jessica; a. Zivkovic, Sasa (2011). "Autoimmune Neuromuscular Disorders". Current Neuropharmacology. 9 (3): 400–8. doi:10.2174/157015911796558000. PMC 3151594. PMID 22379454.
2. ↑ 2.0 2.1 2.2 2.3 "Neuromuscular Disorders: MedlinePlus". www.nlm.nih.gov. Archived from the original on 2016-04-08. Retrieved 2016-04-24.
3. ↑ 3.0 3.1 3.2 Swash, Michael; Schwartz, Martin S. (2013-03-14). Neuromuscular Diseases: A Practical Approach to Diagnosis and Management. Springer Science & Business Media. p. 86,196. ISBN 9781447138341.
4. ↑ Katirji, Bashar (2014). "Clinical Assessment in Neuromuscular Disorders". In Katirji, Bashar; Kaminski, Henry J.; Ruff, Robert L. (eds.). Neuromuscular disorders in clinical practice (Second ed.). New York. ISBN 978-1-4614-6567-6.
5. ↑ Dowling, JJ; Weihl, CC; Spencer, MJ (November 2021). "Molecular and cellular basis of genetically inherited skeletal muscle disorders". Nature Reviews. Molecular Cell Biology. 22 (11): 713–732. doi:10.1038/s41580-021-00389-z. PMID 34257452. S2CID 235822532.
6. ↑ Katirji, Bashar; Kaminski, Henry J.; Ruff, Robert L., eds. (2014). Neuromuscular disorders in clinical practice (Second ed.). New York. ISBN 978-1-4614-6567-6.
7. ↑ "Myopathy Information Page: National Institute of Neurological Disorders and Stroke (NINDS)". www.ninds.nih.gov. Archived from the original on 2016-04-27. Retrieved 2016-04-24.
8. ↑ Voermans, Nicol C; Van Alfen, Nens; Pillen, Sigrid; Lammens, Martin; Schalkwijk, Joost; Zwarts, Machiel J; Van Rooij, Iris A; Hamel, Ben C. J; Van Engelen, Baziel G (2009). "Neuromuscular involvement in various types of Ehlers-Danlos syndrome". Annals of Neurology. 65 (6): 687–97. doi:10.1002/ana.21643. PMID 19557868. S2CID 22600065.
9. ↑ Myasthenia Gravis at eMedicine
10. ↑ Hill, M (2003). "The Neuromuscular Junction Disorders". Journal of Neurology, Neurosurgery & Psychiatry. 74 (90002): ii32–ii37. doi:10.1136/jnnp.74.suppl_2.ii32. PMC 1765619. PMID 12754327.
11. ↑ Lambert-Eaton Myasthenic Syndrome (LEMS) at eMedicine
12. ↑ Kumar, Vinay; Abbas, Abul K.; Aster, Jon C. (2014-09-05). Robbins & Cotran Pathologic Basis of Disease. Elsevier Health Sciences. p. 382\. ISBN 9780323296359.
13. ↑ "Muscular Dystrophy Information Page: National Institute of Neurological Disorders and Stroke (NINDS)". www.ninds.nih.gov. Archived from the original on 2016-07-30. Retrieved 2016-04-24.
14. ↑ Liaison, Janet Austin, Office of Communications and Public. "Polymyalgia Rheumatica and Giant Cell Arteritis". www.niams.nih.gov. Archived from the original on 2016-05-25. Retrieved 2016-04-24.
15. ↑ Polymyositis at eMedicine
16. ↑ MedlinePlus Encyclopedia: Rhabdomyolysis
17. ↑ Leiomyoma at eMedicine
18. ↑ Rhabdomyomas at eMedicine
19. ↑ 19.0 19.1 McDonald, Craig M (2012). "Clinical Approach to the Diagnostic Evaluation of Hereditary and Acquired Neuromuscular Diseases". Physical Medicine and Rehabilitation Clinics of North America. 23 (3): 495–563. doi:10.1016/j.pmr.2012.06.011. PMC 3482409. PMID 22938875.
20. ↑ Darras, Basil T.; Jones, H. Royden Jr.; Ryan, Monique M.; de Vivo, Darryl C. (2014-12-03). Neuromuscular Disorders of Infancy, Childhood, and Adolescence: A Clinician's Approach. Elsevier. p. 488\. ISBN 978-0124171275.
21. ↑ Electromyography and Nerve Conduction Studies at eMedicine

## Further reading[edit | edit source]

* Wokke, John H. J.; Doorn, Pieter A. van; Hoogendijk, Jessica E.; Visser, Marianne de (2013-03-07). Neuromuscular Disease: A Case-Based Approach. Cambridge University Press. ISBN 9781107328044.
* Ambrosino, N; Carpene, N; Gherardi, M (2009). "Chronic respiratory care for neuromuscular diseases in adults". European Respiratory Journal. 34 (2): 444–451. doi:10.1183/09031936.00182208. PMID 19648521.

## External links[edit | edit source]

Classification|

* ICD-10: G70.9
* MeSH: D009468

|

External resources|

* Orphanet: 68381

* v
* t
* e

Diseases of muscle, neuromuscular junction, and neuromuscular disease

Neuromuscular-
junction disease|

* autoimmune
* Myasthenia gravis
* Lambert–Eaton myasthenic syndrome
* Neuromyotonia

Myopathy|

| Muscular dystrophy
(DAPC)|

| AD|

* Limb-girdle muscular dystrophy 1
* Oculopharyngeal
* Facioscapulohumeral
* Myotonic
* Distal (most)

|

AR|

* Calpainopathy
* Limb-girdle muscular dystrophy 2
* Congenital
* Fukuyama
* Ullrich
* Walker–Warburg

XR|

* dystrophin
* Becker's
* Duchenne
* Emery–Dreifuss

Other structural|

* collagen disease
* Bethlem myopathy
* PTP disease
* X-linked MTM
* adaptor protein disease
* BIN1-linked centronuclear myopathy
* cytoskeleton disease
* Nemaline myopathy
* Zaspopathy

Channelopathy|

| Myotonia|

* Myotonia congenita
* Thomsen disease
* Neuromyotonia/Isaacs syndrome
* Paramyotonia congenita

|

Periodic paralysis|

* Hypokalemic
* Thyrotoxic
* Hyperkalemic

Other|

* Central core disease

Mitochondrial myopathy|

* MELAS
* MERRF
* KSS
* PEO

General|

* Inflammatory myopathy
* Congenital myopathy

* v
* t
* e

Symptoms and signs relating to movement and gait

Gait|

* Gait abnormality
* CNS
* Scissor gait
* Cerebellar ataxia
* Festinating gait
* Marche à petit pas
* Propulsive gait
* Stomping gait
* Spastic gait
* Magnetic gait
* Truncal ataxia
* Muscular
* Myopathic gait
* Trendelenburg gait
* Pigeon gait
* Steppage gait
* Antalgic gait

Coordination|

* Ataxia
* Cerebellar ataxia
* Dysmetria
* Dysdiadochokinesia
* Pronator drift
* Dyssynergia
* Sensory ataxia
* Asterixis

Abnormal movement|

* Athetosis
* Tremor
* Fasciculation
* Fibrillation

Posturing|

* Abnormal posturing
* Opisthotonus
* Spasm
* Trismus
* Cramp
* Tetany
* Myokymia
* Joint locking

Paralysis|

* Flaccid paralysis
* Spastic paraplegia
* Spastic diplegia
* Spastic paraplegia
* Syndromes
* Monoplegia
* Diplegia / Paraplegia
* Hemiplegia
* Triplegia
* Tetraplegia / Quadruplegia
* General causes
* Upper motor neuron lesion
* Lower motor neuron lesion

Weakness|

* Hemiparesis

Other|

* Rachitic rosary
* Hyperreflexia
* Clasp-knife response

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