Home > Publications > Consensus > EURO NMD Endorsed Consensus > 276th ENMC International Workshop: recommendations on optimal diagnostic pathway and management strategy for patients with acute rhabdomyolysis worldwide. 15th-17th March 2024, Hoofddorp, The Netherlands

276th ENMC International Workshop: recommendations on optimal diagnostic pathway and management strategy for patients with acute rhabdomyolysis worldwide. 15th-17th March 2024, Hoofddorp, The Netherlands

Authors:

Nick Kruijt 1 , Pascal Laforet 2 , John Vissing 3 , Salman Bhai 4 , Mads Godtfeldt Stemmerik 3 , Felix Kleefeld 5 , Nicol C Voermans 6 ; 276th ENMC workshop participants
Collaborators, Affiliations collapse
Collaborators

276th ENMC workshop participants: S Bhai 7 , F Fatehi 8 , V A Gupta 9 , A Ferreiro 10 , F Kleefeld 11 , N Kruijt 12 , P Laforet 13 , T Liewluck 14 , A Lucia 15 , G McMahon 16 , E Oates 17 , F O’Connor 18 , A Oldfors 19 , R Quinlivan 20 , G Ravenscroft 21 , S Riazi 22 , A Roos 23 , N Roux-Buisson 24 , B Schoser 25 , G Siciliano 26 , M Stemmerik 27 , J Vissing 28 , N Voermans 12
Affiliations

1 Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands.
2 Neurology Department, Raymond Poincaré Hospital, AP-HP, Nord-Est-Île-de-France Neuromuscular Reference Center, Garches, France.
3 Copenhagen Neuromuscular Center, 8077, Department of Neurology, University of Copenhagen, Rigshospitalet, Denmark.
4 University of Texas Southwestern Medical Center, Dallas, TX, USA; Neuromuscular Center, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian, Dallas, TX, USA.
5 Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin, and Berlin Institute of Health (BIH), Department of Neurology, Charitéplatz 1, 10117, Berlin, Germany.
6 Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands. Electronic address: Nicol.voermans@radboudumc.nl.
7 University of Texas Southwestern Medical Center, Dallas, USA.
8 Tehran University of Medical Sciences, Tehran, Iran.
9 Harvard Medical School, Boston, USA.
10 Pitié-Salpêtrière Hospital, Paris, France.
11 Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
12 Radboud University Medical Centre, Nijmegen, The Netherlands.
13 Raymond Poincaré Hospital, Garches, France.
14 Mayo Clinic, Rochester, USA.
15 Universidad Europea de Madrid, Madrid, Spain.
16 Brigham and Women’s Hospital, Boston, USA.
17 University of New South Wales, Sydney, Australia.
18 Uniformed Services University, Bethesda, USA.
19 University of Gothenburg, Gothenburg, Sweden.
20 National Hospital for Neurology and Neurosurgery, London, United Kingdom.
21 University of Western Australia, Nedlands, Australia.
22 University of Toronto, Toronto, Canada.
23 University Duisburg-Essen, Essen, Germany.
24 Université Grenoble Alpes, Grenoble, France.
25 Ludwig-Maximilians-University of Munich, Germany.
26 University of Pisa, Ospedale S. Chiara, Pisa, Italy.
27 Early-Career Researcher, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
28 University of Copenhagen, Rigshospitalet, Copenhagen, Denmark.

Highlights

A consensus on a formal definition of rhabdomyolysis was reached.
In the acute phase of rhabdomyolysis, assesment of risk of renal failure (McMahon Risk score) and need for hospital admittance should take place.
An underlying genetic susceptibility should be considered in case of the presence of one or more RHABDO-features.
Genetic testing should cover neuromuscular and metabolic diseases.
Patients should be supported in restarting physical activities.

Abstract

The 276th ENMC International Workshop on rhabdomyolysis brought together 21 experts to address the compelling need for standardized guidelines on the clinical approach of rhabdomyolysis. There was a general agreement that a diagnosis of rhabdomyolysis require that 1) clinical symptoms include severe muscle swelling, weakness and/or myalgia; 2) serum CK-levels exceed 10,000 IU/L in case of exertional, and >5000 IU/L in non-exertional rhabdomyolysis; 3) CK-levels reaching a maximum 1–4 days after the event and normalizing to baseline within 1–2 weeks of rest. In case of an underlying neuromuscular condition, CK-levels should exceed 5–10 times the patient’s baseline level. Treatment should be initiated only in case of high risk on acute kidney injury, which can be predicted by the McMahon score. Furthermore, recommendations on performing genetic testing were formulated and the use of the ‘RHABDO’- acronym was generally agreed upon as a tool to aid clinicians in deciding which patients require genetic testing. Moreover, recommendations on follow-up were made, with a particular emphasis on evaluation of physical and psychological sequelae. Patient representatives present during the workshop emphasized the importance of the current recommendations for future clinical guidelines on rhabdomyolysis.

01 May 2025

Neuromuscular Disord, volume 50, issue 105344, pages

Muscle Disease