CONTINUUM: Lifelong Learning in Neurology:
doi: 10.1212/01.CON.0000440663.26427.f4
Review Articles

Toxic Myopathies

Mammen, Andrew L. MD, PhD

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Abstract

Purpose: This article reviews the most important muscle toxins, many of which are widely prescribed medications. Particular emphasis is placed on statins, which cause muscle symptoms in a relatively large proportion of the patients who take them.

Recent Findings: As with other toxic myopathies, most cases of statin-associated myotoxicity are self-limited and subside with discontinuation of the offending agent. Importantly, about 2% of the population is homozygous for a single nucleotide polymorphism, and these individuals have a dramatically increased risk of self-limited statin myopathy. Much more rarely, statins trigger a progressive autoimmune myopathy characterized by a necrotizing muscle biopsy and autoantibodies recognizing hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase, the pharmacologic target of statins.

Summary: In most cases, toxic myopathies resolve after the toxic agent is stopped. Recognizing that statins can cause an autoimmune necrotizing myopathy is important because patients with this form of statin-triggered muscle disease usually require immunosuppressive therapy.

© 2013 American Academy of Neurology

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