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EFNS Review/CME Article
EFNS review on the role of muscle biopsy in the investigation of myalgia
Article first published online: 30 APR 2013
© 2013 The Author(s) European Journal of Neurology © 2013 EFNS
European Journal of Neurology
Volume 20, Issue 7, pages 997–1005, July 2013
How to Cite
Kyriakides, T., Angelini, C., Schaefer, J., Mongini, T., Siciliano, G., Sacconi, S., Joseph, J., Burgunder, J. M., Bindoff, L. A., Vissing, J., de Visser, M. and Hilton-Jones, D. (2013), EFNS review on the role of muscle biopsy in the investigation of myalgia. European Journal of Neurology, 20: 997–1005. doi: 10.1111/ene.12174
- Issue published online: 10 JUN 2013
- Article first published online: 30 APR 2013
- Manuscript Accepted: 14 FEB 2013
- Manuscript Received: 8 FEB 2013
Myalgia, defined as any pain perceived in muscle, is very common in the general population and a frequent cause for referral to neurologists, rheumatologists and internists in general. It is however only rarely due to primary muscle disease and often referred from ligaments, joints, bones, the peripheral and central nervous system. A muscle biopsy should only be performed if this is likely to be diagnostically useful. At present no ‘guidelines’ exist.
An EFNS panel of muscle specialists was set to review relevant studies from PubMed dating as far back as 1/1/1990. Only Class IV studies were available and therefore the recommendations arrived at are ‘best practice recommendations’ based on information harvested from the literature search and expert opinion.
Muscle cramps should be recognized while drugs, infections, metabolic/ endocrinological and rheumatological causes of myalgia should be identified from the history and examination and pertinent laboratory tests. A muscle biopsy is more likely to be diagnostically useful if myalgia is exertional and if one or more of the following apply: i) there is myoglobinuria, (ii) there is a second wind phenomenon, (iii) there is muscle weakness, (iv) there is muscle hypertrophy /atrophy, (v) there is hyperCKemia (>2–3× normal), and (vi) there is a myopathic EMG.
Patients presenting with myalgia can be recommended to have a biopsy based on careful history and examination and on simple laboratory screening.