вот такие рекомендации в мире, не знаю как очные врачи решат на месте
If CK levels are not more than 1.5 times the upper limit of normal for gender and race, based on EFNS guidelines, observation with neurologic re-evaluation and repeat CK level testing in 3 to 6 months is suggested.
If CK levels are more than 1.5 times the upper limit of normal for gender and race, EMG should be performed to evaluate for disorders known to elevate CK levels, including motor neuron disorders, myotonic disorders, and myopathy.
In people who undergo EMG and have either myopathic or nonspecific findings, the next step is muscle biopsy with biochemical analysis and routine staining as well as staining for major histocompatibility complex 1 (MHC-1), dystrophin, sarcoglycan, dysferlin, α-dystroglycan, and Western blot for dystrophin, dysferlin, and calpain.
If these tests are nondiagnostic, genetic testing for LGMD, more common metabolic myopathies (eg, myophosphorylase, CPT2, myoadenylate deaminase deficiencies), and malignant hyperthermia susceptibility (eg, RYR1 and CACNA1S mutations) is recommended in the appropriate clinical context.
|