The Neuromuscular Program at UTMB offers a comprehensive approach to the diagnosis and treatment of acute and chronic, hereditary and acquired neuromuscular disorders, including post-traumatic injury of the nerves.

The program is led by Dr. Anish Bhardwaj, chair of the Department of Neurology, Dr. Glenn Smith, vice chair for clinical affairs, and Dr. Elena Shanina, director of the Electromyography (EMG) Laboratory.

Neuromuscular diseases affect the peripheral nervous system. The peripheral nervous system includes muscles, the nerve-muscle (neuromuscular) junction, peripheral nerves in the limbs, and the motor-nerve cells in the spinal cord.

Your nerve cells, also called neurons, send the messages that control these muscles. When the neurons become unhealthy or die, communication between your nervous system and muscles breaks down. As a result, your muscles weaken and waste away. The weakness can lead to twitching, cramps, aches and pains, and joint and movement problems. Sometimes it also affects heart function and your ability to breathe.

Neuromuscular disorders are rare acquired or inherited (genetic) conditions that affect some part of the neuromuscular system such as:

• the muscles
• the peripheral motor nerves (in arms, legs, neck and face)
• the neuromuscular junction where the nerves and muscles meet
• the muscle-controlling nerve cells (motor neurons) in the spinal cord

Diagnosis & Treatment

Our neurologists begin this process by reviewing your medical history and discussing your health with you at length. In finalizing a diagnosis, they can employ a variety of techniques, such as:

• Electromyography
• Blood tests
• Lumbar puncture (spinal tap)
• Imaging (e.g. magnetic resonance imaging, or MRI)
• Nerve and/or muscle biopsies

Comprehensive Care for the full spectrum of neuromuscular disorders, including:

• Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease, and associated disorders
• Myasthenia gravis and other neuromuscular junction disorders
• Muscular dystrophy
• Guillain-Barré syndrome
• Peripheral neuropathies
• Inflammatory and metabolic myopathies

We strive to offer the latest medications for all neuromuscular disorders. Our neurologists present your options and then work with you to determine the best course of action. The precise nature of your therapy depends on factors such as the disease, its stage of progression and your symptoms. Along the way, we make a special effort to educate family members about your condition so they can help care for you if necessary. Of course, many neuromuscular diseases lead to, or are related to, other health problems. So we work closely with other UTMB specialties to manage your overall well-being.

UTMB's state-of-the-art Electromyography (EMG) Lab is essential to the neuromuscular program’s diagnostic evaluations. EMG and nerve conduction studies are procedures that evaluate the health of the muscles, nerves, and neuromuscular connections. During an EMG, electrical activity of the muscle is recorded, while nerve conduction studies document how well nerves can conduct electrical signals. EMG results can reveal or rule out muscle disorders, and in combination with nerve conduction studies, help diagnose diseases of peripheral nerves, like carpal tunnel syndrome, disorders that affect the nerve root, like herniated disks, and ALS. Special testing will also help diagnose diseases of the neuromuscular junction, like myasthenia gravis.

In addition to electrodiagnostic testing, the UTMB EMG Lab is one of only a few labs in the United States with expertise in neuromuscular ultrasound. Dr. Shanina’s highly trained team utilizes high-resolution ultrasound to deliver images of muscles and nerves in fine detail, a technique that for some nerves is more precise than MRI. Ultrasound is used not only as part of the comprehensive assessment of patients with newly diagnosed or worsening neuromuscular problems, but also is useful in patients with nerve trauma, to help surgeons plan appropriate treatments.