As muscle disease afflicts individuals from infancy to old age, this issue of Continuum should be of compelling interest to both adult and pediatric neurologists. Faculty chair Anthony Amato, MD, has gathered expert colleagues to address the gamut of muscle disorders, including those of genetic, inflammatory, and toxic causes.
The variety of disorders that affect the terminal portion of the motor unit is staggering. Dr Carlayne Jackson gets the reader off to a critical start by providing the clinician with a systematic approach to patients with presumed muscle disease. Our understanding of muscular dystrophies has moved well beyond the purely descriptive terminology of bygone years. Dr Basil Darras next updates our comprehension of these disorders, emphasizing new genetic and biochemical information, as well as the clinical features. Few neurological subjects are as diverse and complex as the array of metabolic muscle diseases. Dr Ronan Walsh goes well beyond providing a catalog of these disorders to address mechanisms, genetics, clinical manifestations, and therapy.
Better understanding of the increasingly identified number of channelopathies has been an exciting development of the past decade. Dr David Saperstein offers a detailed and eloquent update on these relatively uncommon, but fascinating, disorders, which include nondystrophic myotonias and a variety of periodic paralyses. Inflammatory myopathies are among the more common muscle diseases encountered by most neurologists. Accurately recognizing these disorders and distinguishing among them is very important, as correct diagnosis has important treatment implications. Drs Amato and Steven Greenberg tackle this subject, emphasizing the differences among dermatomyositis, polymyositis, and inclusion body myositis. Inclusion body myositis, in particular, has been underrecognized and often misdiagnosed. Drs Amato and Greenberg help Continuum readers avoid this hazard and prevent the administration of ineffective and potentially dangerous treatment. In the final chapter, Dr Greenberg, with the assistance of Dr Amato, addresses the subject of statin myopathy. The cholesterol-lowering statins have become the most widely prescribed drugs in America. Hence, it behooves neurologists, as well as primary care physicians, to clearly understand the potential of these drugs to produce muscle disorders and maintain the vigilance necessary to recognize them early.
This issue of Continuum also features Dr Daniel Larriviere's analysis of an ethical dilemma relevant not only to muscle disorders, but also more generally to other clinical situations that neurologists will face. Readers should not neglect Dr Amato's informative patient management problems and the multiple-choice questions, which have been skillfully crafted by Drs Douglas Gelb and Ronnie Bergen to educate as well as test the reader.
We are grateful to Dr Amato and faculty for providing clear and concise information about a group of disorders that include relatively common, as well as some quite rare, diseases. After digesting this issue of Continuum, our readers will have much greater understanding of the clinical features of muscle disease, as well as the fascinating biology of this organ system.
Aaron E. Miller, MD