Neuromuscular

Neuromuscular diseases account for a significant proportion of acquired or genetic neurological disorders. They encompass all diseases affecting the peripheral nervous system.

From an anatomical perspective, they include diseases of the peripheral nerves in the broadest sense (motor neurons, spinal ganglia, myelin sheath, small peripheral nerve fibres, sensory or motor nerve fibres, the autonomic nervous system, etc.), diseases of the neuromuscular junction (myasthenia gravis, Lambert–Eaton syndrome) and diseases of the muscle (myopathies). Most of these diseases are rare and are generally characterised by a chronic course.

Professional and psychosocial impact

In most patients, neuromuscular diseases regularly result in the development of a disability that may have a significant professional and psychosocial impact. They may be associated with an acute, subacute or progressive risk to life, primarily affecting the respiratory and cardiac systems. They regularly require end-of-life care, with all the ethical issues that arise during these difficult times. Their management requires specific expertise at every stage of the disease, including the diagnostic phase. The need to centralise the care of patients with neuromuscular diseases is well established. This approach is implemented in many European countries. To this end, Neuromuscular Reference Centres (CRNMs) have been developed.

Extended multidisciplinary care

The Neuromuscular Reference Centre (CRNM) brings together a team of medical and paramedical experts in the field of neuromuscular diseases. It is intended to organise multidisciplinary consultations in coordination with the treating doctors and paramedical professionals. For many chronic diseases, centralising care in a specialised centre improves outcomes in terms of morbidity and mortality. Some of the objectives are to preserve autonomy and prevent complications. These two factors have an impact on the direct and indirect costs of the disease. Bringing together within a single entity all the expertise required for the diagnostic and therapeutic management of patients with rare, chronic and progressive diseases is therefore a rational approach. Patients are monitored by a specialised team dedicated to their condition. At the heart of treatment is an extended multidisciplinary approach bringing together adult and paediatric, medical and paramedical expertise in a wide range of fields, such as neurology, genetics, functional rehabilitation, anatomical pathology, cardiology, pulmonology, physiotherapy, occupational therapy, treatment of neuropathic pain, treatment of autoimmune diseases through immunomodulation, surgical treatments such as thymectomy in certain cases of myasthenia gravis, and scoliosis correction procedures for myopathies.

At Erasme Hospital, Dr Gauthier Remiche is the medical director of the Neuromuscular Reference Centre (CRNM).