Clinical evaluation of patients with neuromuscular disorders (NMD)

History

• Establish the temporal pattern of progression
• Family history of myopathy / neuropathy
• Obtain a detailed drug history - rule out iatrogenic NMD
  • Diuretics: hypokalemia, hypomagnesemia
  • Specific drugs that may induce or exacerbate NMD (see Drug considerations in NMD section)

Clinical examination

Evaluate and record all of the following:

• Vital signs
• Weakness localization: focal/multifocal vs generalized
• Weakness pattern: symmetric vs asymmetric
• Weakness distribution: proximal (predominantly myopatic) or distal/length dependent (predominantly neuropathic)
• Reflexes
• Involvement of cranial nerves
• Presence of dysautonomia
• Respiratory function. Assess the risk of imminent respiratory failure! (see Respiratory management in NMD section)

Basic laboratory investigation

• Complete blood count
• WBC differential - screen for eosinophilia
• Electrolytes, ionized Ca++ and Mg++
• BUN and creatinine
• ESR and CRP
• CPK
• Hepatic transaminases