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It is however only rarely due to primary muscle disease and often referred from ligaments, joints, bones, the peripheral and central nervous system. A muscle biopsy should only be performed if this is likely to be diagnostically useful. At present no \u2018guidelines\u2019 exist.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>An <jats:styled-content style=\"fixed-case\">EFNS<\/jats:styled-content> panel of muscle specialists was set to review relevant studies from PubMed dating as far back as 1\/1\/1990. Only Class IV studies were available and therefore the recommendations arrived at are \u2018best practice recommendations\u2019 based on information harvested from the literature search and expert opinion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Muscle cramps should be recognized while drugs, infections, metabolic\/ endocrinological and rheumatological causes of myalgia should be identified from the history and examination and pertinent laboratory tests. A muscle biopsy is more likely to be diagnostically useful if myalgia is exertional and if one or more of the following apply: i) there is myoglobinuria, (ii) there is a second wind phenomenon, (iii) there is muscle weakness, (iv) there is muscle hypertrophy \/atrophy, (v) there is hyper<jats:styled-content style=\"fixed-case\">CK<\/jats:styled-content>emia (&gt;2\u20133\u00d7 normal), and (vi) there is a myopathic <jats:styled-content style=\"fixed-case\">EMG<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patients presenting with myalgia can be recommended to have a biopsy based on careful history and examination and on simple laboratory screening.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.12174","type":"journal-article","created":{"date-parts":[[2013,4,30]],"date-time":"2013-04-30T08:57:47Z","timestamp":1367312267000},"page":"997-1005","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["<scp>EFNS<\/scp> review on the role of muscle biopsy in the investigation of myalgia"],"prefix":"10.1111","volume":"20","author":[{"given":"T.","family":"Kyriakides","sequence":"first","affiliation":[{"name":"Clinical Neurosciences Cyprus Institute of Neurology and Genetics Nicosia Cyprus"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C.","family":"Angelini","sequence":"additional","affiliation":[{"name":"IRCCS Fondazione Ospedale San Camillo Venezia Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Schaefer","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Dresden Dresden Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.","family":"Mongini","sequence":"additional","affiliation":[{"name":"Neuromuscular Center S.G. 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