FINDINGS IN 100 PATIENTS WITH UNEXPLAINED HYPERCKEMIA

Background: In outpatient clinics for neuromuscular diseases sometimes patients are presented because oi an raised actitivity of the serum c reatine kinase (CK) activity, accidentally detected. The purpose of th is study was to investigate, how many patients with an unexplained hyp erCKemia really suffer from a neuromuscular disease, and to present a adequate procedure for evaluating pathological CK activities. Patients and methods: In this retrospective study, clinical, electromyographic , and myopathological findings of 100 consecutive patients (38 women u nd 62 men, aged 19 to 78 years) with such an abnormality of unknown or igin are presented. Results: Only 41 patients really had no muscular t roubles and no signs of neuromuscular disorders at physical examinatio n. The CK of 12 patients turned to normal at follow-up examination. In 4 patients a so-called makro-CK was found. In 50 patients, in-depth e xaminations including a muscle biopsy were performed. In 10 patients, the increased CK-activity could be attributed to a complication of an already known basic disease, e. g. by confirming a myositis in case of proven connective tissue disease. In 14 patients, an independent musc le disease was proven: 3 degenerative, 5 metabolic or mitochondrial as well as 4 inflammatory myopathies. In 2 patients, a secondary myopath y in polyneuropathy was suspected to be the etiology of the increased CK activity. In 9 patients, well treatable disorders were discovered. In 34 patients, no muscle biopsy was performed and follow-up examinati ons were recommended. The ratio of the clarified diagnoses did not dep end on the level of the CK activity. Conclusion: Every hyperCKemia ind icates a thorough internal and neurological examination independently from the level of the enzyme activity. A scheme for examination in cas e of abnormal CK activity is proposed.