Preface

It has been seven years since the publication of the first edition of this book. Much has changed, particularly in our knowledge of the imaging, genetic, and immunologic tools at our disposal that aid in our ability to understand and diagnose many neuromuscular disorders. We have attempted to read and consider as much of this information as possible and translate it into a text that attempts to bridge the gap between translational science and practical application at the bedside. Once again, we attempt to blend our understanding of evidence-based medicine with our personal experiences as "seasoned" clinicians to provide a resource that is of pragmatic value to others.

All chapters in the book have been rewritten, in many cases extensively with the assimilation of contemporary citations. We have chosen to divide a singular chapter on neuromuscular transmission disorders into two chapters, one devoted solely to autoimmune myasthenia and a second devoted to other disorders of the neuromuscular junction. In addition, we have expanded the book by the addition of three new chapters. Because immunomodulating treatments compose a large part of the therapeutic armamentarium of the neuromuscular clinician, Chapter 4 was created to describe the general principles of immunosuppressants and modulating treatments and the commonly used modalities. Although all successful neuromuscular clinicians require a fundamental understanding of physiatry, we have called on colleagues more knowledgeable than we, Drs. Sabrina Paganoni and Erik Ensrud, to enhance this book by writing chapters on the rehabilitation of neuromuscular diseases and on other disorders that may confound the clinician as neuromuscular mimics.

What remains unchanged, however, is the fundamental principle that optimal patient care depends on accurate diagnosis. Judicious use of tests, prescription of effective treatment(s) and avoidance of potentially harmful ones, recognition of potential comorbidities, and accurate patient counseling are all dependent on this principle. For the foreseeable future, the focal point of accurate diagnosis will be at the bedside and will depend on the skills of the master clinician who recognizes and formulates information. This book is written in respect of and support for this time-honored and effective clinical approach.