title: EFNS guidelines on the diagnostic approach to pauci- or asymptomatic hyperCKemia.
abstract: OBJECTIVE
  To provide evidence-based guidelines to general neurologists for the assessment of patients with pauci- or asymptomatic hyperCKemia.
  
  
  BACKGROUND
  Recent epidemiologic studies show that up to 20% of 'normal' individuals have an elevated creatine kinase activity in the serum (sCK). The possibility of a subclinical myopathy is often raised, and patients may be unnecessarily denied treatment with statins.
  
  
  METHODS
  Electronic databases including Medline, the Cochrane Library and the American Academy of Neurology were searched for existing guidelines. Articles dealing with series of patients investigated for asymptomatic/pauci-symptomatic hyperCKemia and articles dealing with myopathies that can present with asymptomatic hyperCKemia were identified and reviewed.
  
  
  RESULTS
  The only guidelines found were those approved by the Italian Association of Myology Committee, and the only relevant articles identified describe class IV studies.
  
  
  CONCLUSIONS
  HyperCKemia needs to be redefined as values beyond 1.5 times the upper limit of normal (which itself needs to be appropriately defined). Pauci- or asymptomatic hyperCKemia with no apparent medical explanation may be investigated with a muscle biopsy if one or more of the following are present; the sCK is >or=3x normal, the electromyogram is myopathic or the patient is <25 years of age. In addition, women with sCK<3 times normal may be offered DNA testing because of the possibility of carrying a dystrophin mutation.
authors.affiliation: Clinical Neurosciences, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus. theodore@cing.ac.cy
authors.forename: T
authors.initials: T
authors.lastname: Kyriakides
authors.forename: C
authors.initials: C
authors.lastname: Angelini
authors.forename: J
authors.initials: J
authors.lastname: Schaefer
authors.forename: S
authors.initials: S
authors.lastname: Sacconi
authors.forename: G
authors.initials: G
authors.lastname: Siciliano
authors.forename: J J
authors.initials: JJ
authors.lastname: Vilchez
authors.forename: D
authors.initials: D
authors.lastname: Hilton-Jones
mesh_terms: D003402:Creatine Kinase / Q000097:blood*; D005260:Female; D006801:Humans; D009135:Muscular Diseases / Q000097:blood* / Q000175:diagnosis* / Q000201:enzymology; D012016:Reference Values
chemical_list: D003402:Creatine Kinase