Expert neuromuscular disorder treatment
Dr. Robin Warner is a board-certified neurologist with advanced training in neuromuscular diseases and electromyography (EMG).
Get comprehensive, specialized care for ALS, neuropathy, myasthenia gravis, muscular dystrophy, and other neuromuscular conditions.
Currently offering in-person visits in New York City near Grand Central Terminal (Midtown East) and telemedicine appointments for patients located anywhere in New York State.
What we offer
Expert diagnosis
Comprehensive evaluation to identify your specific neuromuscular condition.
Treatment planning
Personalized treatment strategies tailored to your condition.
Ongoing management
Regular follow-ups to monitor progress and adjust care.
Coordination of care
Referrals for EMG, imaging, and other specialists as needed.
How Dr. Warner can help
As a board-certified neurologist with advanced training in neuromuscular diseases and EMG, Dr. Warner provides specialized expertise in diagnosing and managing neuromuscular disorders.
Specialized expertise
Advanced training in neuromuscular medicine and EMG from Hospital for Special Surgery/Weill Cornell/Memorial Sloane Kettering, providing deep expertise in these complex conditions.
Comprehensive evaluation
Thorough assessment including detailed history, neurological examination, and coordination of appropriate diagnostic testing including EMG when needed.
Personalized care
Development of individualized treatment plans based on your specific condition, symptoms, and goals, with ongoing management and adjustments as needed.
What to expect during your visit
- Detailed discussion of your symptoms and medical history
- Comprehensive neurological examination
- Review of any prior test results or imaging
- Assessment of family history
- Discussion of diagnostic testing options (including EMG if appropriate)
- Development of a treatment and management plan
- Education about your condition
- Coordination with other specialists (physical therapy, respiratory, etc.) as needed
Note: Some neuromuscular conditions may require in-person evaluation and EMG testing. Dr. Warner can provide initial evaluation via telemedicine and coordinate in-person testing when needed.
What are neuromuscular disorders?
Understanding neuromuscular disorders
Neuromuscular disorders are conditions that affect the nerves that control your voluntary muscles and the communication between your nervous system and muscles. These disorders impact the peripheral nervous system—the network of nerves that connects your brain and spinal cord to the rest of your body.
When nerve cells (neurons) become unhealthy or die, the communication between your nervous system and muscles breaks down. This can result in muscle weakness, muscle wasting (atrophy), and a variety of other symptoms that can significantly impact your daily life.
Neuromuscular disorders can affect muscles throughout your body, including those that control movement, breathing, swallowing, and other essential functions. The severity and progression of these conditions vary widely, from mild symptoms that progress slowly to more severe conditions that require ongoing medical management.
Key facts about neuromuscular disorders
- Scope: Affect the peripheral nervous system, muscles, and the connection between them
- Types: Include motor neuron diseases, neuropathies, myopathies, and neuromuscular junction disorders
- Inheritance: Some are inherited (genetic), while others are acquired
- Onset: Can appear at any age, from infancy to adulthood
- Progression: May be progressive, stable, or improve with treatment
- Treatment: Focuses on managing symptoms, slowing progression, and improving quality of life
Types of neuromuscular disorders
Neuromuscular disorders are categorized based on which part of the neuromuscular system is affected. Understanding the type helps guide diagnosis and treatment.
Motor neuron diseases
These conditions affect the nerve cells (motor neurons) that control voluntary muscle movement. When motor neurons degenerate or die, muscles weaken and waste away.
Examples include:
- Amyotrophic lateral sclerosis (ALS, also called Lou Gehrig's disease)
- Spinal muscular atrophy (SMA)
- Primary lateral sclerosis
Neuropathies
Neuropathies involve damage to the peripheral nerves themselves, affecting their ability to transmit signals between the brain, spinal cord, and the rest of the body.
Examples include:
- Peripheral neuropathy
- Chronic inflammatory demyelinating polyneuropathy (CIDP)
- Guillain-Barré syndrome
- Charcot-Marie-Tooth disease
Myopathies
Myopathies are muscle disorders that directly affect muscle tissue, causing weakness and sometimes muscle breakdown. They can be inherited or acquired.
Examples include:
- Muscular dystrophy
- Inflammatory myopathies (polymyositis, dermatomyositis, inclusion body myositis)
- Mitochondrial myopathies
- Metabolic myopathies
Neuromuscular junction disorders
These conditions affect the connection (synapse) between nerves and muscles, disrupting the transmission of signals that tell muscles to contract.
Examples include:
- Myasthenia gravis
- Lambert-Eaton myasthenic syndrome (LEMS)
Signs and symptoms
The symptoms of neuromuscular disorders vary depending on the specific condition, which parts of the body are affected, and how advanced the condition has become. Many symptoms progress over time.
Muscle symptoms
- Muscle weakness
- Muscle twitching (fasciculations)
- Muscle cramps
- Muscle aches and pains
- Muscle loss (atrophy)
- Difficulty with movement
Sensory symptoms
- Numbness
- Tingling sensations
- Painful sensations
- Loss of sensation
- Burning or electric shock feelings
Functional problems
- Difficulty walking
- Balance problems
- Frequent falls
- Trouble with fine motor tasks
- Difficulty climbing stairs
Other common symptoms
- Vision problems: Droopy eyelids (ptosis), double vision, vision disturbances
- Swallowing difficulties: Trouble swallowing (dysphagia), choking, aspiration
- Speech problems: Slurred speech, difficulty talking, voice changes
- Breathing problems: Shortness of breath, difficulty breathing, respiratory weakness
- Fatigue: Excessive tiredness, muscle fatigue with activity
- Coordination issues: Clumsiness, difficulty with coordination
- Autonomic symptoms: Problems with blood pressure, heart rate, or digestion (in some conditions)
- Progressive weakness: Gradual worsening of symptoms over time
Note: Not everyone with a neuromuscular disorder will experience all of these symptoms. The specific symptoms depend on the type of disorder and which nerves or muscles are affected. Some symptoms may appear gradually, while others can develop more quickly.
Causes and risk factors
What causes neuromuscular disorders?
Neuromuscular disorders can have various causes, and in many cases, the exact cause may not be identified. Understanding the underlying cause helps guide treatment and provides insight into prognosis.
Genetic causes:
Many neuromuscular disorders are inherited, caused by mutations in specific genes that can be passed from parent to child. Examples include muscular dystrophy, Charcot-Marie-Tooth disease, and some forms of ALS. Genetic testing can help identify these inherited conditions.
Autoimmune causes:
Some neuromuscular disorders are autoimmune conditions, where the body's immune system mistakenly attacks healthy nerve or muscle tissue. Examples include myasthenia gravis, Guillain-Barré syndrome, and inflammatory myopathies.
Other causes:
Neuromuscular disorders can also be caused by viral infections, metabolic disorders, nutritional deficiencies, hormonal imbalances, exposure to certain toxins or medications, or may occur spontaneously without a clear cause.
Risk factors
Genetic factors:
- Family history of neuromuscular disorders
- Inherited genetic mutations
- Spontaneous gene mutations
Environmental factors:
- Exposure to certain toxins or chemicals
- Viral infections
- Certain medications
- Physical trauma or injury
Medical conditions:
- Autoimmune disorders
- Metabolic disorders
- Nutritional deficiencies
- Hormonal imbalances
- Diabetes (can cause peripheral neuropathy)
Age and gender:
- Some conditions are more common in certain age groups
- Some conditions affect men and women differently
Diagnosis
Diagnosing neuromuscular disorders requires a comprehensive evaluation, as symptoms can overlap between different conditions. An accurate diagnosis is essential for developing an effective treatment plan.
Clinical evaluation
The diagnostic process begins with a thorough medical history and physical examination. Your neurologist will ask about your symptoms, when they started, how they've progressed, and any family history of similar conditions.
The examination may include:
- Assessment of muscle strength and tone
- Testing of reflexes
- Evaluation of sensation
- Observation of muscle bulk and any signs of atrophy
- Assessment of coordination and balance
- Evaluation of cranial nerves (for vision, swallowing, speech)
Diagnostic tests
Electromyography (EMG) and nerve conduction studies:
These tests evaluate the electrical activity of muscles and how well nerves transmit signals. EMG can help distinguish between nerve and muscle problems and is often essential for diagnosis.
Blood tests:
May check for elevated muscle enzymes (CK), antibodies (for autoimmune conditions), genetic markers, or other indicators of neuromuscular disease.
Imaging studies:
MRI scans of the brain, spinal cord, or muscles may be ordered to look for structural abnormalities or inflammation.
Muscle or nerve biopsy:
In some cases, a small sample of muscle or nerve tissue may be examined under a microscope to help make a diagnosis.
In some cases, Dr. Warner may refer you to other providers to perform these tests.
Additional diagnostic tools
- Genetic testing: To identify inherited conditions and specific gene mutations
- Lumbar puncture (spinal tap): To analyze cerebrospinal fluid for signs of inflammation or infection
- Pulmonary function tests: To assess breathing function if respiratory muscles are affected
- Electrocardiogram (EKG): To check heart function if cardiac muscle may be involved
- Swallowing studies: To evaluate swallowing function if dysphagia is present
- Repetitive nerve stimulation: Specialized test for neuromuscular junction disorders like myasthenia gravis
The specific tests ordered will depend on your symptoms, examination findings, and the suspected diagnosis. Not all tests are needed for every patient. In some cases, Dr. Warner may refer you to other providers to perform these tests.
Treatment
While many neuromuscular disorders don't have a cure, treatment focuses on managing symptoms, slowing disease progression, and improving quality of life. Treatment is highly individualized based on the specific condition and your unique needs. In some cases, Dr. Warner may refer you to other providers for specialized treatments.
Medications
Medications play an important role in managing neuromuscular disorders, though the specific medications depend on the condition being treated.
For autoimmune conditions:
- Immunosuppressive medications
- Corticosteroids
- Intravenous immunoglobulin (IVIG)
- Plasma exchange (plasmapheresis)
For specific conditions:
- Medications to improve nerve-muscle communication (for myasthenia gravis)
- Disease-modifying therapies (for some genetic conditions)
- Medications to manage symptoms like spasticity or fatigue
Rehabilitation and supportive care
Dr. Warner would refer you to other specialized providers for these treatments.
Physical therapy:
Helps maintain muscle strength and flexibility, improve mobility, and prevent complications like contractures. Exercises are tailored to your specific needs and limitations.
Occupational therapy:
Focuses on helping you maintain independence in daily activities, adapt to limitations, and use assistive devices when needed.
Speech therapy:
Can help with speech difficulties and swallowing problems, teaching techniques to improve communication and reduce aspiration risk.
Respiratory care:
For conditions affecting breathing, may include breathing exercises, cough assist devices, or non-invasive ventilation.
Other treatment approaches
Surgical interventions (uncommon):
- Surgery may be needed for certain conditions (e.g., thymectomy for myasthenia gravis)
- Orthopedic procedures to address complications
- Tracheostomy for severe breathing problems
Assistive devices:
- Braces or orthotics to support weak muscles
- Mobility aids (canes, walkers, wheelchairs)
- Communication devices for speech difficulties
Lifestyle modifications:
- Energy conservation techniques
- Pacing activities to avoid fatigue
- Nutritional support and dietary modifications
- Fall prevention strategies
Research and clinical trials:
- New treatments are being developed through research
- Clinical trials may offer access to experimental therapies
- Gene therapy and other advanced treatments are emerging
When to see a doctor
Schedule a consultation if:
- You're experiencing persistent muscle weakness
- You notice muscle twitching or cramping
- You have numbness, tingling, or pain in your limbs
- You're having difficulty walking or maintaining balance
- You're experiencing frequent falls
- You have trouble with fine motor tasks (buttoning, writing)
- You notice muscle wasting or loss of muscle bulk
- You have droopy eyelids or double vision
- You're having trouble swallowing or speaking
- You have shortness of breath or breathing difficulties
- Your symptoms are getting worse over time
Seek immediate medical attention if:
These symptoms may indicate a medical emergency:
- Sudden severe weakness, especially if it affects breathing
- Difficulty breathing or shortness of breath
- Sudden difficulty swallowing with risk of choking
- Rapid progression of symptoms
- Signs of respiratory failure
- Severe muscle breakdown (dark urine, severe muscle pain)
If you're experiencing any of these symptoms, call 911 or go to the nearest emergency department immediately.
Get started with expert neuromuscular care
Don't wait to get expert evaluation for neuromuscular symptoms. Early diagnosis and treatment can help manage symptoms and improve quality of life.
Schedule your neuromuscular consultation today
Get expert evaluation from a neurologist with specialized training in neuromuscular diseases.
Learn more about our fees and pricing.