MyologyMyology

In the 10 years since the release of the second edition of Myology, there have been an incredible number of discoveries with huge effect on the field of myology. Important among them have been the sequencing of the human genome and the widespread use of molecular and other techniques, including microarrays, siRNA (short interfering RNA), proteomics, and metabolomics, to name a few.

Some of the most dramatic of those advances are well documented in the third edition of Myology, including further understanding of nuclear RNA sequestration in myotonic dystrophy type 1, the huge proliferation of the number of known nuclear DNA mutations responsible for mitochondrial cytopathies, identification of a large number of protein mutations responsible for the limb girdle muscular dystrophies, recognition and understanding of the nuclear envelope–related myopathies, identification of a number of mutations responsible for congenital muscular dystrophy, and deeper understanding of the role of the extracellular matrix in a variety of myopathies.

In addition to these disease-specific advances, large steps have been taken toward understanding the fundamental genetic regulation of myogenesis, the role of numerous contractile and cytoskeletal proteins, the anatomy and physiology of neuromuscular transmission, and the process of excitation-contraction coupling. Each of these areas is comprehensively reviewed in several of the chapters of the textbook.

Editors Engel and Franzini-Armstrong have again brought together a number of world leaders in their respective areas, and the reader is left with a comprehensive overview of topics in myology supported by up-to-date references. The textbook remains essential for those in the area of myology and is an absolute must for any clinician who deals extensively with neuromuscular disorders (neurologists, physiatrists, rheumatologists, neuropathologists, and clinical geneticists). Much of volume 1 would stand alone nicely as a textbook on skeletal muscle biology, and it remains an outstanding resource for researchers, upper-level graduate students, and postdoctoral fellows studying skeletal muscle cell biology, molecular biology, or physiology. Volume 2 has a more disease-based focus on the clinical aspects of the major muscle disorders, with a few chapters covering neuromuscular transmission defects and four dealing with lower motor neuron diseases.

For those who own the secondedition, the thirdedition of Myology is well worth purchasing, because most of the chapters have been extensively rewritten to include novel discoveries, and there are several new chapters. New chapters in volume 1 include “Extraocular Muscles” and “Immune Mechanisms in Muscle Diseases.” New chapters in volume 2 include “Bethlem Myopathy,” “X-linked Vacuolar Myopathies,” “Myofibrillar Myopathies,” “Cardiomyopathies Associated With Muscular Dystrophies,” “Generalized Peripheral Nerve Hyperexcitability (Neuromyotonia),” and “Hereditary Inclusion Body Myopathies.” The chapter specifically dedicated to cardiac problems in muscle disease is a particularly valuable addition.

Although the textbook is outstanding, correction of a few minor problems might enhance future editions. The color plates are identical in both volumes and seem to be randomly inserted, rather than being placed in the relevant chapters. From a visual perspective, I found pictures of skin changes in dermatomyositis and polymyositis difficult to discern, as they are not in color. Some of the images in the chapters “Muscle Imaging” and “Facioscapulohumeral Muscular Dystrophy and Scapuloperoneal Disorders” are pixelated. Some of the images of myotonic dystrophy type 1 are not sharp and could be updated. In contrast, the quality and volume of pictures in the chapter “Ultrastructural Changes in Diseased Muscle” are impressive and are a must for neuropathologists who interpret muscle biopsies

A bit more discussion would be welcome in a few areas, including microarray and proteomic approaches to the discovery of pathogenetic mechanisms in the chapter “The Tools of Molecular Genetics and Their Application to the Study of Muscle Diseases,” the pros and cons of a properly performed needle muscle biopsy in “Muscle Imaging,” exercise and physiotherapy in “Inclusion Body Myositis,” and mechanisms and clinical issues related to statin myopathies in “Myoglobinuria” and “Myopathies Due to Drugs, Toxins, and Nutritional Deficiency.”

Overall, the two-volume Myology remains the gold standard for clinical myologists and an excellent reference for a variety of other clinicians and academicians who share an interest in skeletal muscle pathology and biology.