Each year, 1.5 million Americans of all ages are treated for neuromuscular disorders. The broad spectrum of neuromuscular disorders encompasses diseases such as amyotrophic lateral sclerosis, peripheral neuropathy, myasthenia gravis, and myopathies. These often progressive nerve and muscle disorders can be debilitating to patients causing weakness, paralysis, respiratory distress, and intractable pain.
The specialists at Cleveland Clinic Florida are experts in the diagnosis and treatment of neuromuscular conditions. Symptoms of neuromuscular disorders often overlap and mimic those of several other neurological diseases. However, neurologists at Cleveland Clinic Florida are subspecialty trained and have the experience to make diagnoses can appear to be challenging. In addition to the patient’s neurological history and physical examination, our physicians rely on the latest diagnostic testing such as electrodiagnosis (e.g. EMG & NCTs, evoked potential tests); autonomic tests; and muscle, nerve and skin biopsies; and biochemical and genomic tests to achieve accurate diagnosis of nerve and muscle diseases.
Treatment of complex neuromuscular conditions requires unique medical expertise and specialized care. Our multi-disciplinary team of specialists provides treatment aimed at helping patients optimize their quality of life and minimize their disability.
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Neuromuscular disorders affect the functioning of the voluntary muscles, such as those in the arms and legs that are controlled by the nervous system. Many of these neuromuscular disorders are genetic, meaning there is a mutation in the patient’s genes that is hereditary. Genetic mutations can also be caused by an immunological or autoimmune disorder. The physicians at Cleveland Clinic Florida have the medical expertise to diagnose and treat a variety of neuromuscular disorders including:
The treatment of neuromuscular disorders, such as ALS and peripheral neuropathies, requires a multi-disciplinary team approach to care. Our specialists work closely to develop individualized treatment plans that aim to minimize disability and maximize each patient’s quality of life. Treatment options can include medication management, physical therapy, nutritional counseling, and the use of special equipment, such as wheelchairs, when indicated. Cleveland Clinic Florida physicians also collaborate with physicians in other specialties including endocrinology and internal medicine to treat other medical conditions, such as diabetes, which are sometimes identified as the underlying cause of a neuromuscular disorder.
Drug therapy is often used to effectively treat some muscle and nerve diseases. Immunosuppressive drugs can help ease the progress of the disorder by suppressing the inflammation of the muscles and relieving pain and twitching. Antidepressants and anticonvulsants may be prescribed to alleviate pain caused by the severed nerve connections.
Physical therapy can be beneficial for patients diagnosed with a neuromuscular disease to maintain strength and flexibility in their muscles and joints. For patients with ALS, physical therapy eases the discomfort of stiff joints, cramps and fluid retention. Our highly skilled therapists evaluate each patient and create a treatment plan aimed at improving mobility and preventing and reducing physical pain.
Patients with neuromuscular disorders may also benefit from nutritional counseling to encourage good nutrition. Our dieticians also work with ALS patients who have difficulty swallowing to develop dietary plans that provide alternative healthy food options.
Amyotrophic Lateral Sclerosis (ALS) often affects the breathing muscles such as the diaphragm and muscles between the ribs. This can result in breathing problems and respiratory failure for patients diagnosed with this disease. Our pulmonary team of specialists, including physicians and therapists, can diagnose early evidence of respiratory muscle weakness and provide treatment with breathing assistive devices such as:
- Suction machine to clear mouth and throat secretions
- Non-invasive ventilation
- Cough-assist device
- Flu vaccine and pneumovax (pneumonia vaccine)
Neuromuscular disorders can be difficult to diagnose as their symptoms sometimes overlap and mimic those of several other neurological diseases. In addition to a neurological history, physical examination, and specialized laboratory tests, the neuromuscular specialists at Cleveland Clinic Florida employ diagnostic tools such as autonomic testing, electrodiagnosis and muscle, nerve and skin biopsies to assist in the diagnosis of these disorders. Accurate diagnosis and prompt treatment of neuromuscular diseases can help minimize disability for patients and improve their overall quality of life.
- Electromyogram (EMG) – two part test that measures the electrical activity in your nerves and muscles at rest and during contraction. The nerve conduction study measures the ability of specific nerves to transmit electrical impulses, or signals, to muscles. The needle electrode exam measures the electrical activity in muscles along nerves.
- Evoked potential tests – tests that measure the electrical activity in the brain in response to stimulation of sight, sound, or touch.
- The Cardiovascular Autonomic Test with Tilt – evaluates the ability of a patient’s autonomic nervous system to control blood pressure and heart rate during different exercises such as deep breathing, the Valsalva maneuver and head-up tilt. This exam is used to evaluate patients with syncope or fainting.
- The Quantitative Sudomotor Axon Reflex Test (QSART) - used to assess the small nerve fibers, which are linked to the sweat glands. It is helpful in identifying some of the autonomic and small fiber neuropathies in addition to some types of pain disorders.
- The Quantitative Sensory Test (QST) - measures a patient’s responses to vibration and temperature sensations. The test can be useful to evaluate patients with polyneuropathy, such as small fiber neuropathy.
- The Thermoregulatory Sweat Test (TST) – assesses the body’s sweat reflex when stimulated by a warm and humid environment. The test utilized to diagnose neurological disorders such as small fiber neuropathy, diabetic polyradiculopathy, multiple system atrophy, central system disorders like Parkinson's disease, and pure autonomic failure.
Muscle, nerve and skin biopsies – a minor surgical procedure where a small incision is made to remove a sample of muscle, nerve, or skin for examination in a laboratory. Biopsies can be used to identify and diagnose various neuromuscular disorders.
Biochemical and Genetic tests – blood samples are taken to examine enzymes and specific genes associated with a particular nerve or muscle disease.
For more information about neuromuscular disorders, such as Amyotrophic Lateral Sclerosis (ALS), treatment options and support groups in your community, please visit one of the websites listed below: