Neuromuscular Clinic

Internationally renowned for metabolic clinical expertise, the Neuromuscular Center receives referrals from around the world.

Our Focus

The primary focus of the Neuromuscular Center are diseases of muscle metabolism in which muscles are unable to use normal fuel to produce energy.

  • Many patients suffering from metabolic myopathies present with lifelong exercise intolerance and fatigue, and frequently are seen by many doctors before a correct diagnosis is made.
  • Metabolically affected patients may exhibit symptoms often mis-attributed to motivational/psychological factors, non-neuromuscular diseases, and/or inflammatory myopathies.
  • In addition, metabolic defects are often misdiagnosed due to misinterpretation of laboratory data.
  • Patients may have a defect in one, or more, of the metabolic pathways that normally supply energy to working muscle.
  • The muscles simply "run out of gas," and patients may present exercise intolerance, pain, weakness, and/or cramps related specifically to the increased energy demands of exercise.
  • Severe metabolic defects may result in rhabdomyolysis (a condition in which skeletal muscle breaks down rapidly).
  • Accurate diagnosis of metabolic myopathies requires recognition of compatible patient history, combined with appropriate diagnostic testing, in order to discover where, and to what extent, breakdown occurs.

Metabolic Disorders Treated

Glycolytic Disorders (glycogen or glucose breakdown defects) include:

Lipid Disorders (long chain fatty acid breakdown defects) include:

Mitochondrial Myopathies

Rhabdomyolysis

Our Services

Exercise testing performed by the Neuromuscular Center includes:

  • Ischemic or aerobic forearm exercise testing
    • Squeezing and releasing a handgrip device while blood samples are drawn.
      • The blood samples are analyzed to measure accumulation of metabolites released by the muscles into the blood stream.
      • Additional data is gathered for analysis by exercise physiologists and physicians.
  • Bicycle exercise testing
    • Exercise on a stationary bicycle measures the effects of exercise stress on the body.
      • Data will be collected before, during, and after 20 minutes of exercise.
      • Collected data consists of air and blood samples, blood pressure, heart rate, heart rhythm, and cardiac output.
      • During different intervals, breathing is through a snorkel-type mouthpiece.
      • Collection of expired air allows measurement of the quantity of oxygen used by the body.
      • Breathing a small concentration of harmless gases allows measurement of cardiac output.
  • Venous catheter placement
    • As some tests require blood sampling, a thin plastic tube is inserted into a vein to facilitate sample collection.

Biochemical blood testing performed by the Neuromuscular Center includes:

  • Creatine kinase (CK or CPK) - used to identify muscle breakdown
  • Ammonia - aids in the diagnosis of defects in muscle glycogenolysis
  • Lactate - aids in the diagnosis of defects in muscle glycogenolysis
  • Pyruvate - useful for diagnosing metabolic blocks in skeletal muscle metabolism

Biochemical muscle testing performed by the Neuromuscular Center includes:

  • Muscle biopsy - a small piece of muscle (less than the size of a pea) is removed from the thigh to measure enzymes involved in skeletal muscle contraction
    • Glycolytic enzyme panel (GEP) - enzymes involved in the metabolic pathways using glycogen or glucose and glycogen energy for contraction
    • Mitochondrial enzyme panel (MEP) - enzymes and markers for mitochondrial metabolic pathways

Histochemical muscle testing performed by the Neuromuscular Center includes:

  • Muscle biopsy - a small piece of muscle (less than the size of a pea) is removed from the thigh to diagnose neuromuscular disorders
    • The biopsy specimen is frozen immediately
    • Diagnostic review is performed subsequently using advanced microscopy

About the Center

A collaborative clinical program between:

  • Texas Health Dallas
  • UT Southwestern Medical Center
  • Institute for Exercise & Environmental Medicine

An integrated care team consisting of:

  • THD & UT Southwestern credentialed physician scientists
  • Experienced ICU/ER-trained critical care nursing personnel
  • Trained and experienced laboratory and technical staff

Scheduling

Please expedite patient scheduling by providing us:

  • Referral from physician
  • Face sheet/demographics
  • Insurance information
  • History and physical
  • Imaging (X-ray, MRI, bone scans, etc.)
  • Total radiation dose (if applicable)
  • Recent lab work (including A1C if patient is diabetic)
  • Current list of medications

Referrals

Please contact us:

Neuromuscular Center
Institute for Exercise and Environmental Medicine
7232 Greenville Avenue
Dallas, Texas 75231
Phone: 214-345-4619
Fax: 214-345-7105
Email: DebbieMoreno@texashealth.org

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