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小儿神经肌肉疾病。

Pediatric Neuromuscular Diseases.

机构信息

Division of Neurology, Department of Pediatrics, University of Nebraska College of Medicine, Omaha, Nebraska.

Paul and Sheila Wellstone Muscular Dystrophy Center and Department of Neurology, University of Minnesota Medical School, Minneapolis, Minnesota; Institute for Translational Neuroscience, University of Minnesota, Minneapolis, Minnesota.

出版信息

Pediatr Neurol. 2023 Dec;149:1-14. doi: 10.1016/j.pediatrneurol.2023.08.034. Epub 2023 Aug 29.

Abstract

The diagnostic and referral workflow for children with neuromuscular disorders is evolving, particularly as newborn screening programs are expanding in tandem with novel therapeutic developments. However, for the children who present with symptoms and signs of potential neuromuscular disorders, anatomic localization, guided initially by careful history and physical examination, continues to be the cardinal initial step in the diagnostic evaluation. It is important to consider whether the localization is more likely to be in the lower motor neuron, peripheral nerve, neuromuscular junction, or muscle. After that, disease etiologies can be divided broadly into inherited versus acquired categories. Considerations of localization and etiologies will help generate a differential diagnosis, which in turn will guide diagnostic testing. Once a diagnosis is made, it is important to be aware of current treatment options, as a number of new therapies for some of these disorders have been approved in recent years. Families are also increasingly interested in clinical research, which may include natural history studies and interventional clinical trials. Such research has proliferated for rare neuromuscular diseases, leading to exciting advances in diagnostic and therapeutic technologies, promising dramatic changes in the landscape of these disorders in the years to come.

摘要

神经肌肉疾病患儿的诊断和转诊流程正在不断发展,特别是随着新生儿筛查项目的扩展以及新疗法的出现。然而,对于那些出现潜在神经肌肉疾病症状和体征的患儿,解剖定位仍然是诊断评估的首要初始步骤,首先通过仔细的病史和体格检查进行引导。重要的是要考虑定位更可能是在下运动神经元、周围神经、神经肌肉接头还是肌肉。之后,可以将疾病病因大致分为遗传性和获得性两类。定位和病因的考虑将有助于生成鉴别诊断,进而指导诊断性检查。一旦做出诊断,了解当前的治疗选择也很重要,因为近年来已经批准了一些针对这些疾病的新疗法。家庭也越来越关注临床研究,其中可能包括自然史研究和干预性临床试验。这种研究在罕见神经肌肉疾病中大量涌现,为诊断和治疗技术带来了令人兴奋的进步,有望在未来几年内彻底改变这些疾病的治疗前景。

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