Multidisciplinary Care for People With Neuromuscular Disorders

As advances in our understanding of neuromuscular disorders (NMD) and their treatment have continued, the complexity of management has increased. Many people living with NMD benefit from multidisciplinary approaches to care. Coordinating with other specialists is an important part of caring for these patients. In this issue of Practical Neurology, we feature 4 interfaces with other specialties: pulmonology, oncology, genetic counseling, and surgery.

Our understanding of genetic NMD continues to expand exponentially, and with genetic testing more accessible, accurate interpretation and application of the results is needed. Genetic counselor Jennifer Roggenbuck presents practical tips and resources for helping clinicians navigate Genetic Testing & Neuromuscular Disorders and provide appropriate counseling.

Next, Dr. Francis Huttinger shares a thorough report of the available data on EMG & Common Surgical Conditions of the Upper Limbs, covering use of EMG to support surgical indications and predict outcomes for carpal tunnel syndrome, cervical radiculopathy, and ulnar neuropathy at the elbow. This presentation can help inform decisions about who is most likely to benefit from surgical intervention.

Neurologists and oncologists have long shared the difficulty of neurologic complications of cancer (eg, chemotherapy-related neuropathies). The advent of immune checkpoint inhibitors (ICIs) has led to increasing need for such collaboration. ICIs have been used with increasing regularity over the last 10 years for treatment of various cancers, resulting in prolonged survival and increased immune-related adverse events. Dr. Meabh O’Hare and Dr. Amanda Guidon review the available data on diagnosing and treating Immune Checkpoint Inhibitor Neuromuscular Complications and offer expert advice where data is lacking in this developing field. There is an emphasis on working with oncologists and other team members because the clinical situation can be life-threatening for multiple reasons.

Muscular dystrophy, amyotrophic lateral sclerosis, and spinal muscular atrophy are examples of NMD that result in respiratory failure. Interventions including noninvasive ventilation can improve quality of life and survival. Dr. Hilda Metjian and Dr. Karin Provost explain the Respiratory Support for Neuromuscular Disorders, covering the physiology, diagnosis, and treatment of respiratory failure. They break down each stage of intervention for which neurologists, pulmonologists, and respiratory therapists should collaborate in the care of people living with respiratory failure due to NMD.

I hope this issue inspires neurologists to collaborate anew with other specialists for the benefit of people living with neuromuscular diseases. The adage better together is true.