Editorial Privilege, and the Continuum of Continuum

STEVEN L. LEWIS, MD, FAAN Muscle and Neuromuscular Junction Disorders p. 1576-1579 December 2022, Vol.28, No.6 doi: 10.1212/CON.0000000000001280


It is with extreme gratitude and a feeling of wistfulness that I present this issue of Continuum, the final issue under my 10-year editorship of this remarkable journal. It is perhaps fitting that my final issue is devoted to disorders of the neuromuscular junction and muscle, the “ends” of the motor nervous system; in addition, muscle disease in particular is arguably underemphasized in neurologic education and is an example of how Continuum is so well suited as a critical resource to ensure that topics such as this are always covered within its 3-year core curriculum. To accomplish the goal of this issue, I am indebted to our guest editor, Dr Michael K. Hehir II, who assembled such a well-organized and thorough set of topics and enlisted outstanding experts in the field to cover the diagnosis and management of the variety of neurologic disorders that present to us that affect the muscle and neuromuscular junction.

The issue begins with a discussion of the localization and diagnosis of neuromuscular weakness by Dr Nicholas J. Silvestri, an approach forming an underpinning of the articles that follow. The issue then covers disorders of the neuromuscular junction, starting with the main presynaptic neuromuscular junction disorders in the article by Dr Shruti M. Raja, who discusses the current diagnosis and management of Lambert-Eaton myasthenic syndrome and botulism. Next, Dr Hehir and Dr Yuebing Li review the current diagnostic considerations and the recently expanding management options for the postsynaptic disorder, myasthenia gravis.

The next set of articles cover the various forms of muscle disease. In the first of these articles, Dr Georgios Manousakis reviews the diagnosis and management of the various forms of inflammatory myopathies, many of which also have characteristic systemic manifestations. In the next article, Dr Namita A. Goyal discusses the clinical features, diagnosis, and management of inclusion body myositis, a disorder currently without clearly effective pharmacologic options. The next set of articles on muscle disease discuss the various forms of muscular dystrophy. In the first of these articles, Dr Bo Hoon Lee reviews the contemporary diagnosis and evolving management options (including the role of genetic-based treatments) for the dystrophinopathies, including both Duchenne and Becker muscular dystrophy phenotypes. Drs Nicholas E. Johnson and Jeffrey M. Statland then review the clinical features, diagnosis, and management of patients with the limb-girdle muscular dystrophies, including a detailed review of the evolving nomenclature for the many disorders that are categorized under this diagnostic umbrella. Dr Johanna I. Hamel next discusses the genetic basis, multisystem clinical features, and symptom management of myotonic dystrophy type 1 and myotonic dystrophy type 2. Dr Karlien Mul then reviews the clinical features, diagnosis, management, and the complex genetic basis for facioscapulohumeral muscular dystrophy.

Dr Mark A. Tarnopolsky next discusses the pathophysiology, clinical features, diagnosis, and management of the myopathies that occur due to disorders of metabolism, whether from glycogen storage diseases, fatty acid oxidation defects, or mitochondrial dysfunction. Dr Jaya R. Trivedi then reviews the pathophysiology, clinical features, diagnosis, and management of the muscle channelopathies, including the nondystrophic myotonias and the periodic paralyses. In a state-of-the-art and forward-thinking article, Drs Andrew R. Findlay and Conrad C. Weihl discuss the current and near-future role of genetic-based treatment strategies for muscular dystrophy and congenital myopathies.

In the final article of the issue, Drs Lauren B. Reoma, Avindra Nath, and Robert C. Griggs provide us with an extensive blueprint for how to incorporate experimental neurotherapeutics in our practices (whether community or academic), using the context of experimental therapeutics for neuromuscular disease as examples.

After reading the issue and taking the Postreading Self-Assessment and CME Test written by Drs James W. M. Owens Jr and Allyson R. Zazulia and edited by Dr Joseph E. Safdieh, associate editor of Continuum and associate editor of self-assessment and CME, readers may earn up to 20 AMA PRA Category 1 CreditsTM toward self-assessment CME or, for Canadian participants, a maximum of 20 hours toward the Self-Assessment Program (Section 3) of the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada. Additional credit can be obtained by listening to Continuum Audio interviews associated with this and other Continuum issues, available to all subscribers, and completing tests on the Continuum Audio web platform or mobile app. Continuum Audio is also accredited by the Royal College of Physicians and Surgeons of Canada. This issue also features Continuum articles read aloud, recordings read verbatim from the print articles. The audio files are available to all Continuum subscribers in the AAN’s Online Learning Center at continpub.com/CME and at the article level on ContinuumJournal.com.

I would like to offer my sincere thank you to Dr Hehir for his remarkable work in organizing this outstanding issue, and for bringing such renowned experts on board to provide us with the most current information about the pathophysiology, genetics, diagnosis, and quickly evolving management strategies of our patients with disorders involving the neuromuscular junction and muscle.

In addition to this issue’s guest editor and contributors, there are so many others to thank here for their important roles in helping support my 10-year tenure as editor-in-chief of Continuum. Before I do so, though, I’d like to briefly summarize the evolution of this journal over the past 10 years:

  • The 3-year Continuum curriculum was updated from a previous 12 to now 15 core topic issues over every 3-year cycle. While still allowing 3 noncore topics every 3 years, this increase in core topics (in addition to some revision of the core topic titles) has ensured that all major topics in neurology are covered in each curricular cycle.
  • The editorial board was reconstituted with expert associate editors for CME and self-assessment, neuroimaging, practice, child neurology, and medicolegal issues; subspecialty experts; general neurologists; resident members; and an advanced practice professional representative.
  • A pharmacotherapeutics reviewer, Marketa Marvanova, PharmD, PhD, was added to the editorial board to review every medication dose in each issue. This critical enhancement to the editorial process has mitigated the risk of medication dosing errors occurring.
  • Only expert authors have been invited and allowed to write for Continuum for the past decade so that our readers are guided by content expert faculty with clinical experience and academic expertise in each topic.
  • Issues have been completely redesigned on the outside (with beautifully illustrated and colorful covers) and the inside (with improved readability).
  • Maximum credits for self-assessment continuing medical education (SA-CME) for each issue have increased over the past 10 years from 10 to 20, more appropriate for the many hours needed for the increased breadth and size of each issue.
  • Continuum is now increasingly and appropriately recognized for what it has evolved into, a peer-reviewed topic-based review article journal, rather than by its historical origin as a CME course.
  • Each issue of Continuum has been written with the busy practicing neurologist in mind (though equally applicable to the needs of neurologists at any level, including trainees, and in any setting), knowing that any neurologic disorder whether common or rare can present to any neurologist at any time, transcending artificial and divisive distinctions in “subspecialty.”
  • The number of paid subscriptions has nearly doubled over the past 10 years, from approximately 5000 to 9000 individual subscribers, not including its distribution to every junior member of the AAN and the worldwide readership in low- and lower-middle-income countries through the AAN’s partnership with the World Federation of Neurology.
  • Continuum’s easily navigable responsive mobile site, which I enjoyed designing, is saveable to any mobile device and the entire curriculum can be searched and any full-length article can be downloaded at any time, including at the point of care.
  • Each author is now instructed to include relevant information on health disparities as they relate to their assigned topic, ensuring that this information is included in every issue.

All of these enhancements to Continuum could not have occurred without such responsive and expert editorial board members and associate editors, all of whom played a role in the process, whether by a quick response to an email from me at any time of the day or night to help me adjudicate a question or concern that arose in relation to their areas of expertise or during open discussions at editorial board meetings. I want to especially thank my associate editor, Joe Safdieh, for his expert advice on any immediate issue that arose. Thank you also to our dedicated and talented team of multiple-choice question writers and Continuum Audio interviewers.

As our guest editors and authors always point out, the expert editorial team at the AAN is without peer. Our production editors, who throughout my tenure have included Katie Izzo, Debra Zoellner, Rebecca Oster Bach, Tonia Morrsink, and Justin Wesolowski, have been truly remarkable, and I want to thank them for their talent and expertise and for their patience and understanding when I have frequently suggested an additional layer of signoff from the article author or guest editor for seemingly minor edits.

I want to also thank the AAN Board of Directors and the AAN Presidents (currently Dr Orly Avitzur) and CEOs (Cathrine M. Rydell and Mary E. Post) I have been privileged to work with. Thank you also to Dr Robert C. Griggs, who led the search committee 11 years ago that led to my appointment to this position, and to my predecessor in this role, Dr Aaron E. Miller, who passed on such a well-oiled machine and great advice to me, and to my successor, Dr Lyell K. Jones Jr, to whom I’ve similarly enjoyed passing my advice and who I know will do great things in the evolution of Continuum.

Finally, it has been a distinct honor and privilege to work in such close collaboration with Continuum Managing Editor, Amanda Doering and AAN Executive Editor for Education and News Publications, Andrea Weiss. Their knowledge, advice, professionalism, camaraderie, devotion to this publication and our readers, and frankly their ability to put up with my idiosyncrasies, is forever appreciated and has been so critical to the increasing footprint and success of this publication.

In closing, I want to thank our readers throughout the world for their devotion to this journal and for their trust in me and our team in their search for the most up-to-date and expertly written information to learn what (to quote myself) “every neurologist needs to know, now” about the epidemiology, pathophysiology, clinical features, diagnosis, and management of the wide variety of common and rare disorders that each of us can encounter at any time.


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