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1

Pharmacology of neuromuscular function. 2nd ed. London: Wright, 1990.

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2

Atherton, Philip J., and Daniel J. Wilkinson, eds. Neuromuscular Assessments of Form and Function. New York, NY: Springer US, 2023. http://dx.doi.org/10.1007/978-1-0716-3315-1.

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3

Vivian, Budnik, and Ruiz-Cãnada Catalina, eds. The Fly neuromuscular junction: Structure and function. 2nd ed. San Diego, Calif: Elsevier/Academic Press, 2006.

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4

Budnik, Vivian. The fly neuromuscular junction: Structure and function. 2nd ed. San Diego, Calif: Elsevier/Academic Press, 2006.

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5

Skeletal muscle: Form and function. Champaign, IL: Human Kinetics, 1996.

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6

Andrea, Melandri Bruno, Milazzo Giulio, Blank Martin 1933-, North Atlantic Treaty Organization. Scientific Affairs Division., and International School of Biophysics (20th : 1991 : Erice, Italy), eds. Bioelectrochemistry IV: Nerve muscle function : bioelectrochemistry, mechanisms, bioenergetics, and control. New York: Plenum Press, 1994.

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7

Raoul, Tubiana, ed. Restoration of function in upper limb paralyses and muscular defects. New York, NY: Informa Healthcare, 2008.

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8

Hans-Werner, Bothe, Samii Madjid, Eckmiller Rolf 1942-, and International Workshop on Neurobionics (1st : 1992 : Goslar, Germany), eds. Neurobionics: An interdisciplinary approach to substitute impaired functions of the human nervous system. Amsterdam: North-Holland, 1993.

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9

R, Dimitrijevic Milan, and Eccles, John C. Sir, 1903-, eds. Upper motor neuron functions and dysfunctions. Basel: Karger, 1985.

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10

Investigations, United States Congress House Committee on Veterans' Affairs Subcommittee on Oversight and. Applications of functional muscular stimulation: Hearing before the Subcommittee on Oversight and Investigations of the Committee on Veterans' Affairs, House of Representatives, Ninety-ninth Congress, second session, February 19, 1986. Washington: U.S. G.P.O., 1986.

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11

United States. Congress. House. Committee on Veterans' Affairs. Subcommittee on Oversight and Investigations. Applications of functional muscular stimulation: Hearing before the Subcommittee on Oversight and Investigations of the Committee on Veterans' Affairs, House of Representatives, Ninety-ninth Congress, second session, February 19, 1986. Washington: U.S. G.P.O., 1986.

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12

United States. Congress. House. Committee on Veterans' Affairs. Subcommittee on Oversight and Investigations. Applications of functional muscular stimulation: Hearing before the Subcommittee on Oversight and Investigations of the Committee on Veterans' Affairs, House of Representatives, Ninety-ninth Congress, second session, February 19, 1986. Washington: U.S. G.P.O., 1986.

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13

Standring, Janette. The development and evaluation of a muscle strength and functional assessment protocol foruse in the management of patients with neuromuscular diseases. Manchester: University of Manchester, 1994.

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14

Jean, Oliver, ed. Functional anatomy of the spine. 2nd ed. Edinburgh: Elsevier Butterworth-Heinemann, 2005.

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15

Nobel Symposium (76th 1989 Lidingö, Sweden). Cholinergic neurotransmission: Functional and clinical aspects : proceedings of Nobel Symposium 76. Amsterdam: Elsevier, 1990.

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16

Pharmacology of Neuromuscular Function. Elsevier, 1990. http://dx.doi.org/10.1016/c2013-0-06479-1.

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17

Bowman, William C. Pharmacology of Neuromuscular Function. Elsevier Science & Technology Books, 2013.

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18

McComas, Alan J. Neuromuscular Function and Disorders. Elsevier Science & Technology Books, 2013.

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19

Manini, Todd. NEUROMUSCULAR AND FUNCTION ADAPTATIONS: NEUROMUSCULAR AND FUNCTION ADAPTATIONS FOLLOWING TRADITIONAL AND FUNCTIONAL RESISTANCE TRAINING IN PRE-CLINICALLY DISABLED OLDER ADULTS. LAP Lambert Academic Publishing, 2010.

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20

Budnik, Vivian, and Catalina Ruiz-Canada. Fly Neuromuscular Junction : Structure and Function: Second Edition. Elsevier Science & Technology Books, 2006.

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21

Theologis, Tim. Neuromuscular disorders. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199550647.003.0012.

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♦ Neurological disorders can be sensory, motor, or a combination of the two♦ Motor disorders may be flaccid or spastic, static or progressive♦ Splints may improve function but are not proven to prevent contractures♦ Botulinum toxin and tenotomy can be used to manage spasticity♦ Osteotomies may be needed to manage rotatory abnormalities♦ Sensory nerve abnormalities may cause Charcot joints.
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22

Neuromuscular Function and Disease: Basic, Clinical, and Electrodiagnostic Aspects, 2-Volume Set. Saunders, 2002.

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23

Hermans, Greet. Effects of Insulin and Glycaemic Management on Neuromuscular Function. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199653461.003.0042.

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Observational studies have indicated an association between stress-induced hyperglycaemia and neuromuscular complications in critically ill patients. This observation is further supported by electrophysiological findings from two randomized controlled trials which suggested that titrating insulin therapy to achieve a normal blood glucose has a beneficial effect on neuromuscular function, associated with a reduced need for prolonged mechanical ventilation. The underlying pathophysiological mechanisms explaining these clinical observations are not well understood. There is no clear evidence that insulin has anabolic effects on muscle nor that it provides mitochondrial protection. It is possible that the effect of insulin therapy reflects a protective action on peripheral nerves; however, this hypothesis awaits confirmation. Overall, the potential benefits on neuromuscular function must be considered in light of large-scale randomized trials which demonstrate equivalent or worse outcome in critically ill patients managed with intensive insulin therapy.
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24

Younger, David S. Motor System Disorders: Normal Physiology and Function and Neuromuscular Disorders. Elsevier, 2024.

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25

Understanding Neuromuscular Health and Disease: Advances in Genetics, Omics, and Molecular Function. MDPI, 2021. http://dx.doi.org/10.3390/books978-3-0365-1621-9.

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26

Hopkins, Philip M. Neuromuscular physiology in anaesthetic practice. Edited by Jonathan G. Hardman. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0007.

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The pharmacological interventions that constitute general anaesthesia are targeted at producing unconsciousness and an immobile patient even in response to noxious stimuli. Surgical anaesthesia also requires skeletal muscle relaxation, the degree of which depends on the site and nature of the surgical procedure. The anaesthetist therefore needs an advanced level of knowledge and understanding of the function of nerves, synapses, and muscle in order to understand, from first principles, how the drugs they use every day mediate their effects. Nerves and muscle cells are termed excitable cells because the electrical potential across their cell membranes (membrane potential) can be rapidly and profoundly altered because of the presence of specialized ion channels. Some drugs, such as local anaesthetics, act on ion channels involved in nerve conduction while many others act on synaptic transmission, the neurochemical communication between neurons or between a neuron and its effector organ. The neuromuscular junction is a synapse of specific interest to anaesthetists because it is the site of action of neuromuscular blocking drugs. This chapter covers the fundamentals of cellular electrophysiology, structure and function of key ion channels, and the physiology of nerves, synapses, and skeletal muscle.
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27

Skeletal Muscle: Form And Function. 2nd ed. Human Kinetics Publishers, 2005.

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28

(Editor), Bruno Andrea Melandri, Giulio Milazzo (Editor), and Martin Blank (Editor), eds. Bioelectrochemistry IV: Nerve Muscle Function-Bioelectrochemistry, Mechanisms, Bioenergetics and Control (Nato Science Series: A:). Springer, 1994.

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29

Orlikowski, David, and Tarek Sharshar. Epidemiology, diagnosis, and assessment of neuromuscular syndromes. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0243.

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Admission to ICU with severe limb weakness, or the occurrence of a respiratory or motor deficit, and failure to wean from mechanical ventilation while in the intensive care unit are common presentations of a neuromuscular disease. Neuromuscular diseases include neuronopathies, neuropathies, myasthenic syndromes, and myopathies. An accurate neurological examination and complementary investigations are necessary for both diagnosis and for evaluating the severity of the disease. Assessment of respiratory muscle function is a key step in deciding the need for mechanical ventilation and subsequently its weaning. Hypercapnia often indicates an impending respiratory arrest, but normocapnia, which can be seen in a patient with severe reduction in vital capacity is not reassuring. Hypoxaemia can be due to hypercapnia, pulmonary injury (atelectasis or pneumonia), or pulmonary embolism. Cardiac evaluation is important as cardiomyopathies are frequent in myopathies.
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30

Current Trends in Neuromuscular Research: Assessing Function, Enhancing Performance, An Issue of Physical Medicine and Rehabilitation Clinics. Saunders, 2005.

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31

Vassilakopoulos, Theodoros, and Charis Roussos. Respiratory muscle function in the critically ill. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0077.

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The inspiratory muscles are the diaphragm, external intercostals and parasternal internal intercostal muscles. The internal intercostals and abdominal muscles are expiratory. The ability of a subject to take one breath depends on the balance between the load faced by the inspiratory muscles and their neuromuscular competence. The ability of a subject to sustain the respiratory load over time (endurance) depends on the balance between energy supplied to the inspiratory muscles and their energy demands. Hyperinflation puts the diaphragm at a great mechanical disadvantage, decreasing its force-generating capacity. In response to acute increases in load the inspiratory muscles become fatigued and inflammed. In response to reduction in load by the use of mechanical ventilation they develop atrophy and dysfunction. Global respiratory muscle function can be tested using maximum static inspiratory and expiratory mouth pressures, and sniff pressure. Diaphragm function can be tested by measuring the transdiaphragmatic and twitch pressures developed upon electrical or magnetic stimulation of the phrenic nerve.
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32

Pitt, Matthew. Techniques used to test the neuromuscular junction in children. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198754596.003.0009.

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The tests used to measure the neuromuscular junction function in children are repetitive nerve stimulation (RNS) and single-fibre electromyography (SFEMG). The physiological changes which explain abnormalities in RNS are covered in this chapter as are those affecting jitter measurement when measured by SFEMG. Practical considerations of how to perform RNS in children are discussed, along with the reasons for using SFEMG in preference to RNS and the need to use stimulation techniques. Controversies concerning so-called stimulated SFEMG including needle selection, filter settings, and the origin of the potentials that are being sampled are all discussed. The term stimulated potential analysis using concentric needle electrodes (SPACE) is introduced to divert most if not all of these criticisms. Derivation of normative data from previous studies is described as well as the use of e-norm methodology on laboratory data. The chapter concludes with practical measures of how to analyse the data collected and reference is made to the cross-correlation technique for determining abnormalities.
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33

(Editor), Vivian Budnik, and Catalina Ruiz-Canada (Editor), eds. The Fly Neuromuscular Junction: Structure and Function, Volume 75: Second Edition (International Review of Neurobiology) (International Review of Neurobiology). Academic Press, 2006.

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34

(Editor), Vivian Budnik, and Catalina Ruiz-Canada (Editor), eds. The Fly Neuromuscular Junction: Structure and Function, Volume 75: Second Edition (International Review of Neurobiology) (International Review of Neurobiology). 2nd ed. Academic Press, 2006.

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35

Kelty, Jonathan D. Cold shock and rapid cold-hardening of pharate adult flesh flies (Sarcophaga crassipalpis): Effects on behavior and neuromuscular function following eclosion. 1995.

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36

Ramachandran, Manoj. The foot in childhood. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780199550647.003.013022.

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♦ Congenital foot anomalies are common: most are minor and do not affect function♦ Postural problems must be differentiated from structural anomalies♦ An underlying neuromuscular aetiology should be considered♦ A pain-free, functional foot is the goal of treatment.
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37

Gerovasili, Vasiliki, and Serafim N. Nanas. Neuromuscular Electrical Stimulation: A New Therapeutic and Rehabilitation Strategy in the ICU. Oxford University Press, 2014. http://dx.doi.org/10.1093/med/9780199653461.003.0044.

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Many critically ill patients undergo a period of immobilization with detrimental effects on skeletal muscle, effects which seem most pronounced in the first days of critical illness. Diagnosis of intensive care unit muscle weakness (ICUAW) is often made after discontinuation of sedation when significant nerve and/or muscle damage may already have occurred. Recently, there has been interest in early mobilization during the acute phase of critical illness, with the goal of preventing ICUAW. Neuromuscular electrical stimulation (NEMS) is an alternative form of exercise that has been successfully used in patients with advanced chronic obstructive pulmonary disease (COPD) and chronic heart failure. NEMS is a rehabilitation tool that can be used in critically ill, sedated patients, does not require patient cooperation, and is therefore a promising intervention to prevent muscle dysfunction in the critically ill. When applied early during the course of critical illness, NEMS can preserve muscle morphology and function. Available evidence suggests that NEMS may have a preventive role in the development of ICUAW and could even contribute to a shorter duration of weaning from mechanical ventilation. Studies are needed to evaluate the long-term effect of NEMS and to explore NEMS settings and delivery characteristics most appropriate for different subgroups of critically ill patients.
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38

Shaibani, Aziz. Dyspnea. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199898152.003.0009.

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The most common causes of dyspnea are not neuromuscular but rather are cardiac and pulmonary. However, dyspnea is an important and serious manifestation of many neuromuscular disorders, and it may compound an underlying pulmonary or cardiac problem. The diaphragm is a skeletal muscle under the control ofperipheral nerves(phrenic nerves) and may be targeted by inflammatory neuropathies such as Guillain-Barrésyndrome(GBS), chronic inflammatory demyelinating polyneuropathy(CIDP), and brachial plexitis, myopathies such as acid maltase deficiency and muscular dystrophies, and neuromuscular disorders such as myasthenia gravis. Periodic measurement of pulmonary function isrecommended in neuromuscular clinics.
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39

Tubiana, Raoul, Caroline Leclercq, Alain Gilbert, and Rene Malek. Restoration of Function in Upper Limb Paralyses and Muscular Defects. Taylor & Francis Group, 2008.

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40

Tubiana, Raoul, Caroline Leclercq, Alain Gilbert, and Rene Malek. Restoration of Function in Upper Limb Paralyses and Muscular Defects. Taylor & Francis Group, 2008.

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41

Shaibani, Aziz. Dyspnea. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190661304.003.0009.

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The most common causes of dyspnea are not neuromuscular, but rather cardiac and pulmonary. However, dyspnea is an important and serious manifestation of many neuromuscular disorders, and it may compound an underlying pulmonary or cardiac problem. The diaphragm is a skeletal muscle under the control of a peripheral nerve and may be targeted by inflammatory neuropathies such as Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating polyneuropathy (CIDP), and brachial plexitis or myopathies such as acid maltase deficiency, muscular dystrophy (MD), and neuromuscular disorders such as myasthenia gravis (MG). Periodic measurement of pulmonary function is a recommended measure in neuromuscular clinics.
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42

Greenman, P. E. Concepts and Mechanisms of Neuromuscular Functions: An International Conference on Concepts and Mechanisms of Neuromuscular Functions. Springer London, Limited, 2012.

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43

Shaibani, Aziz. Dysphonia. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190661304.003.0008.

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Lack of function or malfunction of the vocal cords are not as common manifestations of neuromuscular disorders as dysarthria. It is typically seen in central diseases such as Parkinson disease. Certain muscle and nerve disorders affect the vocal cords, but in these cases, other features of these diseases make the diagnosis easy. Myasthenia gravis (MG) may present with intermittent hoarseness only early in the course of the disease. Consultation with an ear, nose, throat (ENT) specialist is recommended to characterize the type of cord pathology. Hysterical hoarseness and weakness are not unusual presentations to neuromuscular clinics. Unilateral vocal cord palsy is usually due to recurrent laryngeal nerve pathology.
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44

Dierdorf, Stephen F. Hypocalcemia/Hypercalcemia. Edited by Matthew D. McEvoy and Cory M. Furse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190226459.003.0038.

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Calcium is critical to many vital physiologic functions. These functions include cardiac rhythm and contractility, neuromuscular transmission, and skeletal muscle contractility. 45% of the calcium in the blood is ionized, which is more revalent to the physiologic function of calcium as opposed to the fraction that is bound. Serum ionized calcium levels are closely regulated by the parathyroid gland via calcium-sensing receptors and parathormone secretion. Low or high levels of calcium can result in life-threatening cardiac dysrhythmias and skeletal muscle weakness leading to respiratory failure. The anesthesiologist must be aware of the clinical conditions that place patients at risk for calcium abnormalities. This will allow for early recognition of the signs and symptoms, so that measurements can take place and rapid treatment can be given.
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45

Chiarandini, Paolo, and Giorgio Della Rocca. Post-operative ventilatory dysfunction management in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0362.

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Alterations in respiratory function and gas exchanges are frequently seen in patients during anaesthesia and in the post-operative period. Mechanical ventilation and drugs such as neuromuscular blocking agents can alter normal function of the respiratory system and cause damage to lungs. Protective ventilation strategies should always be adopted intra-operatively in mechanically-ventilated patients. A neuromuscular monitoring-guided use of decurarizating agents and post-operative adequate analgesia techniques are recommended to avoid post-operative residual curarization and pain. Pneumonia is the most frequent infective complication, but at the moment there are no recommended clinical tools (scoring systems) to identify patients at high. A fast-track surgical approach and early can decrease the risk. Early mobilization and prophylactic low molecular weight heparins use have a well-documented efficacy on prevention of pulmonary embolism. There is still no general consensus on the widespread use of early NIV in post-operative patients, although in selected high-risk patients it could help respiratory recovery and reduce complications.
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46

Abrams, Gary M. Parathyroid, Adrenal, Gonadal, and Pituitary Disease. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199937837.003.0187.

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Endocrine disorders can cause diverse changes in cognition and affect as well as changes in neuromuscular function that may simulate primary neurologic disease, and they generally require a specialized endocrine workup to make a diagnosis. For example, hypoparathyroidism, which may be congenital (e.g., DiGeorge syndrome or Kearns-Sayre syndrome) or disease-acquired (e.g., autoimmune hypoparathyroidism) can present as neuromuscular irritability or tetany due to hypocalcemia, the most distinctive features, which may manifest as carpopedal spasm or laryngospasm. Primary hyperparathyroidism is the most common cause of hypercalcemia and is usually due to oversecretion of PTH by a solitary adenoma of the parathyroid glands. This chapter covers most common primary endocrine disorders that can present as neurological disorders.
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47

Shaibani, Aziz. Pseudoneurologic Syndromes. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190661304.003.0022.

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The term functional has almost replaced psychogenic in the neuromuscular literature for two reasons. It implies a disturbance of function, not structural damage; therefore, it defies laboratory testing such as MRIS, electromyography (EMG), and nerve conduction study (NCS). It is convenient to draw a parallel to the patients between migraine and brain tumors, as both cause headache, but brain MRI is negative in the former without minimizing the suffering of the patient. It is a “software” and not a “hardware” problem. It avoids irritating the patient by misunderstanding the word psychogenic which to many means “madness.”The cause of this functional impairment may fall into one of the following categories:• Conversion reaction: conversion of psychological stress to physical symptoms. This may include paralysis, hemisensory or distal sensory loss, or conversion spasms. It affects younger age groups.• Somatization: chronic multiple physical and cognitive symptoms due to chronic stress. It affects older age groups.• Factions disorder: induced real physical symptoms due to the need to be cared for, such as injecting oneself with insulin to produce hypoglycemia.• Hypochondriasis: overconcern about body functions such as suspicion of ALS due to the presence of rare fasciclutations that are normal during stress and after ingestion of a large amount of coffee. Medical students in particular are targets for this disorder.The following points are to be made on this topic. FNMD should be diagnosed by neuromuscular specialists who are trained to recognize actual syndrome whether typical or atypical. Presentations that fall out of the recognition pattern of a neuromuscular specialist, after the investigations are negative, they should be considered as FNMDs. Sometimes serial examinations are useful to confirm this suspicion. Psychatrists or psychologists are to be consulted to formulate a plan to discover the underlying stress and to treat any associated psychiatric disorder or psychological aberration. Most patients think that they are stressed due to the illness and they fail to connect the neuromuscular manifestations and the underlying stress. They offer shop around due to lack of satisfaction, especially those with somatization disorders. Some patients learn how to imitate certain conditions well, and they can deceive health care professionals. EMG and NCS are invaluable in revealing FNMD. A normal needle EMG of a weak muscles mostly indicates a central etiology (organic or functional). Normal sensory responses of a severely numb limb mean that a lesion is preganglionic (like roots avulsion, CISP, etc.) or the cause is central (a doral column lesion or functional). Management of FNMD is difficult, and many patients end up being chronic cases that wander into clinics and hospitals seeking solutions and exhausting the health care system with unnecessary expenses.It is time for these disorders to be studied in detail and be classified and have criteria set for their diagnosis so that they will not remain diagnosed only by exclusion. This chapter will describe some examples of these disorders. A video clip can tell the story better than many pages of writing. Improvement of digital cameras and electronic media has improved the diagnosis of these conditions, and it is advisable that patients record some of their symptoms when they happen. It is not uncommon for some Neuromuscular disorders (NMDs), such as myasthenia gravis (MG), small fiber neuropathy, and CISP, to be diagnosed as functional due to the lack of solid physical findings during the time of the examination. Therefore, a neuromuscular evaluation is important before these disorders are labeled as such. Some patients have genuine NMDs, but the majority of their symptoms are related to what Joseph Marsden called “sickness behavior.” A patient with carpal tunnel syndrome (CTS) may unconsciously develop numbness of the entire side of the body because he thinks that he may have a stroke.
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48

Dinser, Robert, and Ulf Müller-Ladner. Skeletal muscle physiology and damage. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0055.

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This chapter summarizes muscle structure and physiology, the genesis and adaptions of muscle throughout life, and clinical assessment of muscle disease. The anatomical and molecular structure of muscle tissue is described, as well as the basic function of the neuromuscular junction, the energy metabolism of muscle tissue, and the mechanisms of fatigue. Key elements of embryological myogenesis, the adaptions of muscle to exercise and damage, and physiological ageing are depicted. A summary of the clinical analysis of muscle function including laboratory, electrophysiological, and imaging testing is provided.
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49

Dinser, Robert, and Ulf Müller-Ladner. Skeletal muscle physiology and damage. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199642489.003.0055_update_001.

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This chapter summarizes muscle structure and physiology, the genesis and adaptions of muscle throughout life, and clinical assessment of muscle disease. The anatomical and molecular structure of muscle tissue is described, as well as the basic function of the neuromuscular junction, the energy metabolism of muscle tissue, and the mechanisms of fatigue. Key elements of embryological myogenesis, the adaptions of muscle to exercise and damage, and physiological ageing are depicted. A summary of the clinical analysis of muscle function including laboratory, electrophysiological, and imaging testing is provided.
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50

Bhatnagar, Subhash C., Lippincott, Jozerowicz, Gilian B. Lieberman, Jeffrey L. Brown, and Darlene Hertling. Manual Therapy for Functional Mobility: A Neuromuscular Approach. Lippincott Williams & Wilkins, 2004.

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