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Nine years have elapsed since the second edition of this book was
published. In this time the principal advances in neuromuscular
diseases have been in the application of molecular genetics to
understanding the aetiology and pathogenesis of this group of
disorders. As a result many previously unrecognised disorders have
been charac terised. Some clinical syndromes, such as the limb
girdle dystrophies, have become better defined. In many such
instances the new genetic information has led to major advances in
knowledge of the biology of cell structures, for example, the
membrane structural and channel proteins. The clinical syndromes
themselves, and their patho logical and electrophysiological
characteristics, however, remain as important as ever, since they
constitute the clinical problem itself and, indeed, the database
from which all other concepts emerge. Knowledge of the
pathogenesis, genetics, and molecular biology of neuromuscular
disorders is essential both in developing and applying new
therapies and preventive measures, and in formulating genetic and
prognostic advice. However, this informa tion does not necessarily
always define clinically useful syndromes. Myotonia, for example,
is an electrophysiological finding in some syndromes in which it is
un detectable by clinical examination, although the phenomenon
itself was originally defined as a clinical entity. The limb girdle
muscular dystrophy syndromes can be defined by severity,
distribution of weakness, age of onset, sex distribution and other
characteristics and many of these can be better understood by study
of the under lying defect in cell structural proteins.
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