Skip to main content
SpringerLink
Log in

Toxic and Drug-Induced Myopathies

Clinical Scenario and Imaging

  • Living reference work entry
  • First Online:
Clinical Neuroradiology

  • 1527 Accesses

Abstract

Muscle is particularly susceptible to toxic effects of drugs or toxins due to its high metabolic activity and potential sites for disruption of energy-producing pathways.

Toxic and drug-induced myopathies describe a wide spectrum of clinical presentations caused by an even wider array of therapeutic agents, recreational and illicit drugs, or environmental or occupational toxins. The mechanisms of toxic myopathy are again almost as varied as the list of causative substances.

Failure to recognize the often iatrogenic nature of these myopathies with continuation of drug or toxin exposure may unnecessarily prolong patient morbidity and can lead to potentially fatal outcomes.

Diagnosis of toxic myopathy rests primarily on patient drug or environmental exposure history, laboratory studies (esp. serum creatine kinase), and electrophysiological studies. Clinical neuroradiology, relying primarily on MRI, will not reveal findings or patterns specific to any single toxic myopathy, but it can play a crucial role in establishing disease pattern for biopsy, elucidating complications (e.g., muscle necrosis), and disease monitoring.

Illustration of neuroradiological findings of all toxic agents is not practicable; therefore, the following chapter will focus on three major agents of toxic myopathy: statin-, glucocorticoid-, and alcohol-induced myopathy.

figure a

This publication is endorsed by: European Society of Neuroradiology (www.esnr.org).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Abbreviations

AIM:

Alcohol-induced myopathy

CK:

Creatine kinase

GIM:

Glucocorticoid-induced myopathy

SIM:

Statin-induced myopathy

STIR:

Short tau inversion recovery

TDIM:

Toxic and drug-induced myopathy

ULN:

Upper limit of normal

References

  • Abd TT, Jacobson TA. Statin-induced myopathy: a review and update. Expert Opin Drug Saf. 2011;10(3):373–87.

    Article  CAS  Google Scholar 

  • Christopher-Stine L. Statin myopathy: an update. Curr Opin Rheumatol. 2006;18:647–53.

    CAS  PubMed  Google Scholar 

  • Godlee F. Lessons from the controversy over statins. Lancet. 2017;389:1100–1.

    Article  Google Scholar 

  • Pereira RMR, de Carvalho JF. Glucocorticoid-induced myopathy. Joint Bone Spine. 2011;78:41–4.

    Article  CAS  Google Scholar 

  • Peters SA, Kley R, Tegenthoff M, et al. MRI in lipid-lowering agent-associated myopathy: a retrospective review of 21 cases. AJR Am J Roentgenol. 2010;194:W323–8.

    Article  Google Scholar 

  • Preedy VR, Ohlendieck K, Adachi J, et al. The importance of alcohol-induced muscle disease. J Muscle Res Cell Motil. 2003;14:55–63.

    Article  Google Scholar 

  • Schakman O, Gilson H, Thissen JP. Mechanisms of glucocorticoid-induced myopathy. J Endocrinol. 2008;197(1):1–10.

    Article  CAS  Google Scholar 

  • SEARCH Collaborative Group, Link E, Parish S, et al. SLCO1B1 variants and statin-induced myopathy – a genome-wide study. N Engl J Med. 2008;359:789–99.

    Article  Google Scholar 

Suggestions for Further Reading

  • Dalakas MC. Toxic and drug-induced myopathies. J Neurol Neurosurg Psychiatry. 2009;80:832–8.

    Article  CAS  Google Scholar 

  • Jain KK. Drug-induced myopathies. MedLink Neurology. Assessed Dec 2017.

    Google Scholar 

  • Mastaglia FL. Drug induced myopathies. Pract Neurol. 2006;6:4–13.

    Article  Google Scholar 

  • Mor A, Mitnick HJ, Pillinger MH, et al. Drug-induced myopathies. Bull NYU Hosp Jt Dis. 2009;67(4):358–69.

    PubMed  Google Scholar 

  • Simon L, Jolley SE, Molina PE. Alcoholic myopathy: pathophysiologic mechanisms and clinical implications. Alcohol Res. 2017;38(2):207–17.

    PubMed  PubMed Central  Google Scholar 

  • Valiyil R, Christopher-Stine L. Drug-related myopathies of which the clinician should be aware. Curr Rheumatol Rep. 2010;12:213–20.

    Article  Google Scholar 

  • Walsh RJ, Amato AA. Toxic myopathies. Neurol Clin. 2005;23(2):397–428.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Radiologie Herne, Herne, Germany

    Soeren Andrew Peters

  2. Department of Neurology and Clinical Neurophysiology, St. Marien-Hospital Borken, Borken, Germany

    Rudolf Andre Kley

  3. Department of Neurology, Heimer Institute for Muscle Research, University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany

    Rudolf Andre Kley

Authors
  1. Soeren Andrew Peters
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rudolf Andre Kley
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rudolf Andre Kley .

Editor information

Editors and Affiliations

  1. Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands

    Frederik Barkhof

  2. National Hosp.f Neurology & Neurosurgery, UCL National Hosp.f Neurology & Neurosurgery, London, UK

    Rolf Jager

  3. Division of Neuroradiology, University Hospital Vienna Division of Neuroradiology, Wien, Austria

    Majda Thurnher

  4. Department of Neuroradiology, Hospital Vall d’Hebrón Department of Neuroradiology, Barcelona, Spain

    Alex Rovira Cañellas

Section Editor information

  1. Dept. of Neuroradiology, Hannover Medical School, Hannover, Germany

    Mike Wattjes

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Peters, S.A., Kley, R.A. (2019). Toxic and Drug-Induced Myopathies. In: Barkhof, F., Jager, R., Thurnher, M., Rovira Cañellas, A. (eds) Clinical Neuroradiology. Springer, Cham. https://doi.org/10.1007/978-3-319-61423-6_4-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-61423-6_4-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-61423-6

  • Online ISBN: 978-3-319-61423-6

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Societies and partnerships

Search

Navigation