By Rabi Tawil, Shannon Venance
A brand new addition to the Neurology in perform sequence, Neuromuscular Disorders presents a medical consultant to the hard prognosis and administration of neuromuscular problems. As part of the sequence, a number of characteristic bins are highlighted all through. "Tips and tips" supply feedback on find out how to enhance results via useful strategy or sufferer wondering. furthermore, "Caution" caution containers provide important suggestion on how one can keep away from difficulties and 'Science Revisited' packing containers provide speedy reminders of the fundamental technological know-how rules beneficial for realizing the awarded thoughts.
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Here's the Fourth variation of the vintage textual content Electrodiagnosis in ailments of Nerve and Muscle: rules and perform. With every one next version, Dr. Kimura has equipped upon his wide event educating electromyography (EMG) worldwide and has transferred his wisdom to the e-book. it really is meant for clinicians who practice electrodiagnostic approaches as an extension in their medical exam, and should be of price to neurologists and physiatrists who're attracted to neuromuscular problems and noninvasive electrodiagnostic tools, quite these working towards electromyography (EMG).
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Additional resources for Neuromuscular Disorders
Prevention of osteoporosis Corticosteroids are first-line agents for the treatment of DM and PM. Osteoporosis has been considered the single most debilitating effect of chronic steroid use, and significant bone loss occurs in the first 3–6 months of their use. Calcium (>1 g/day) and vitamin D (400 IU/day) have long been recommended. Increasingly, bisphosphonates are started the same day as initiation of glucocorticoid therapy. Bisphosphonate therapy should be avoided or used cautiously in premenopausal women given their potential teratogenicity.
In a controlled trial comparing alternate-day with daily therapy in a muscle disease (Duchenne muscular dystrophy), no difference in side effects was seen with equivalent dosing of these regimens. Studies in other diseases have shown no difference for bone loss for daily in comparison to alternate-day therapy. Methotrexate Methotrexate is commonly used for steroidsparing effects. It has potential pulmonary toxicity, so it is important to exclude ILD in patients with DM or PM by chest CT scan, pulmonary function tests, and testing for anti-Jo-1 antibodies, and avoid its use if present.
2. ) Warfarin Lipid-lowering medications With virtually all the lipid-lowering drugs (statins, fibrates, bile acid-binding resins, and ezetimibe) implicated in muscle toxicity, many have theorized that cholesterol is critical to the skeletal muscle cell membrane and that lowering cholesterol may explain the class effect. This rationale seems to account for the potential myotoxicity of lipid-lowering drugs at a superficial level. However, direct evidence is lacking. In fact, human skeletal muscle cholesterol content increased after 8 weeks of simvastatin therapy (80 mg/day) and did not change in response to atorvastatin (40 mg/day).