title: Evidence-based guideline summary: diagnosis and treatment of limb-girdle and distal dystrophies [RETIRED]: report of the guideline development subcommittee of the American Academy of Neurology and the practice issues review panel of the American Association of Neuromuscular & Electrodiagnostic Medicine.
abstract: To review the current evidence and make practice recommendations regarding the diagnosis and treatment of limb-girdle muscular dystrophies (LGMDs).
  
  
  
  Systematic review and practice recommendation development using the American Academy of Neurology guideline development process.
  
  
  
  Most LGMDs are rare, with estimated prevalences ranging from 0.07 per 100,000 to 0.43 per 100,000. The frequency of some muscular dystrophies varies based on the ethnic background of the population studied. Some LGMD subtypes have distinguishing features, including pattern of muscle involvement, cardiac abnormalities, extramuscular involvement, and muscle biopsy findings. The few published therapeutic trials were not designed to establish clinical efficacy of any treatment.
  
  
  
  For patients with suspected muscular dystrophy, clinicians should use a clinical approach to guide genetic diagnosis based on clinical phenotype, inheritance pattern, and associated manifestations (Level B). Clinicians should refer newly diagnosed patients with an LGMD subtype and high risk of cardiac complications for cardiology evaluation even if they are asymptomatic from a cardiac standpoint (Level B). In patients with LGMD with a known high risk of respiratory failure, clinicians should obtain periodic pulmonary function testing (Level B). Clinicians should refer patients with muscular dystrophy to a clinic that has access to multiple specialties designed specifically to care for patients with neuromuscular disorders (Level B). Clinicians should not offer patients with LGMD gene therapy, myoblast transplantation, neutralizing antibody to myostatin, or growth hormone outside of a research study designed to determine efficacy and safety of the treatment (Level R). Detailed results and recommendations are available on the Neurology® Web site at Neurology.org.
authors.affiliation: From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
authors.forename: Pushpa
authors.initials: P
authors.lastname: Narayanaswami
authors.affiliation: From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
authors.forename: Michael
authors.initials: M
authors.lastname: Weiss
authors.affiliation: From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
authors.forename: Duygu
authors.initials: D
authors.lastname: Selcen
authors.affiliation: From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
authors.forename: William
authors.initials: W
authors.lastname: David
authors.affiliation: From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Raynor
authors.affiliation: From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Carter
authors.affiliation: From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Wicklund
authors.affiliation: From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Barohn
authors.affiliation: From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
authors.forename: Erik
authors.initials: E
authors.lastname: Ensrud
authors.affiliation: From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Griggs
authors.affiliation: From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
authors.forename: Gary
authors.initials: G
authors.lastname: Gronseth
authors.affiliation: From the Department of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department of Neurology (R.C.G.), University of Rochester Medical Center, NY; and the Department of Neurology (E.E., A.A.A.), Brigham and Women's Hospital/Harvard Medical School, Boston, MA.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Amato
mesh_terms: D003937:Diagnosis, Differential; D019317:Evidence-Based Medicine; D006801:Humans; D009136:Muscular Dystrophies / Q000175:diagnosis / Q000235:genetics / Q000503:physiopathology / Q000628:therapy; D049288:Muscular Dystrophies, Limb-Girdle / Q000175:diagnosis* / Q000235:genetics / Q000503:physiopathology / Q000628:therapy*