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Metabolic myopathies: a practical approach
  1. James B Lilleker1,
  2. Yann Shern Keh1,
  3. Federico Roncaroli1,2,
  4. Reena Sharma3,
  5. Mark Roberts1
  1. 1 Greater Manchester Neurosciences Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK
  2. 2 Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
  3. 3 The Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, Salford, UK
  1. Correspondence to Dr Mark Roberts, Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford M6 8HD, UK; mark.roberts{at}


Metabolic myopathies are a diverse group of rare genetic disorders and their associated muscle symptoms may be subtle. Patients may present with indolent myopathic features, exercise intolerance or recurrent rhabdomyolysis. Diagnostic delays are common and clinicians need a high index of suspicion to recognise and differentiate metabolic myopathies from other conditions that present in a similar fashion. Standard laboratory tests may be normal or non-specific, particularly between symptomatic episodes. Targeted enzyme activity measurement and next-generation genetic sequencing are increasingly used. There are now specific enzyme replacement therapies available, and other metabolic strategies and gene therapies are undergoing clinical trials. Here, we discuss our approach to the adult patient with suspected metabolic myopathy. We outline key features in the history and examination and discuss some mimics of metabolic myopathies. We highlight some disorders of glycogen and fatty acid utilisation that present in adulthood and outline current recommendations on management.

  • metabolic disease
  • muscle disease
  • neuropathology, muscle
  • myopathy

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  • Contributors JBL created the initial draft. This was reviewed and updated by YSK. FR, RS and MER provided oversight and critical review of the manuscript. All authors approved the final version.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed. This paper was reviewed by Jon Walters, Swansea, UK.

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