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September 8, 1978

Diagnosis of Neuropathic vs Myopathic Disease-Reply

JAMA. 1978;240(11):1141. doi:10.1001/jama.1978.03290110039014

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In Reply.—  Professor Rogoff correctly points out the value of electrodiagnostic testing in the diagnosis of strictly neuropathic vs myopathic disease states. While electrodiagnostic tests may differentiate pathogenesis in some patients with muscle weakness, these tests may not clearly separate those patients with diabetic amyotrophy from those with the multiplicity of neurologic, muscular, and end-plate abnormalities seen in patients with neoplasms. Therefore, use of the provisional term myopathy was justified by the clinical picture of profound proximal muscle weakness in an elderly man with a pancreatic mass. Subsequent events of the hospital course, as described, did not allow for performance of elective muscle biopsy or electromyography. Nevertheless, concern over the presence of an underlying malignant neoplasm would have made tumor search the primary goal, regardless of interpretation of electromyographic pattern.