{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:49:26Z","timestamp":1787014166495,"version":"build-2736575974"},"reference-count":32,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T00:00:00Z","timestamp":1769817600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T00:00:00Z","timestamp":1769817600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Recent epidemiological studies on the general population reveal that up to 1.3% have oligo\/asymptomatic hyperCKemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This guideline aims to provide updated, evidence\u2010based recommendations on investigating persons older than 18\u2009years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The guideline followed EAN standard operating procedures and was developed according to the GRADE methodology. Fourteen neuromuscular experts from the EAN neuromuscular group were joined by a methodologist and a patient representative. There are two types of recommendations: evidence\u2010based recommendations, based on published studies, and consensus statements if the quality of evidence is poor.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We recommend that: (1) Persistent oligo\/asymptomatic hyperCKemia with a CK &gt;\u20091.5 ULN be investigated (Consensus statement); (2) Neurogenic and non\u2010neuromuscular causes of hyperCKemia be excluded (Expert opinion); (3) A Dried Blood Spot (DBS) be done (Strong recommendation); (4) A NCS\/EMG to identify whether there is a myopathy or neuropathy be performed (Weak recommendation); (5) A resting lactate and fasting acyl\u2010carnitine assays, if a metabolic myopathy is suspected, be done (Consensus statement); (6) A skeletal muscle MRI be performed to guide\/interpret genetic testing (Strong recommendation); (7) NGS is recommended over sequential gene testing (Consensus statement); (8) NGS is recommended over muscle biopsy (Strong recommendation); (9) A muscle biopsy may be offered, if genetic testing is uninformative and one or more applies: a genetic variant of unknown significance (VUS), suspected metabolic myopathy, suspected inflammatory myopathy, abnormal muscle MRI, a CK \u2265\u20093 ULN, a family history of muscle disease or age, less than 25\u2009years (Expert opinion).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>An evidence\u2010based guideline is suggested for when and how to investigate adults with oligo\/asymptomatic hyperCKemia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ene.70493","type":"journal-article","created":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T17:46:12Z","timestamp":1769881572000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["EAN 2024 Guideline on the Diagnostic Approach to Oligo\/Asymptomatic HyperCKemia"],"prefix":"10.1111","volume":"33","author":[{"given":"T.","family":"Kyriakides","sequence":"first","affiliation":[{"name":"Department of Basic and Clinical Sciences University of Nicosia  Nicosia Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2372-4453","authenticated-orcid":false,"given":"K.","family":"Aleksovska","sequence":"additional","affiliation":[{"name":"European Academy of Neurology  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Angelini","sequence":"additional","affiliation":[{"name":"Department Neurosciences University of Padova  Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Z.","family":"Argov","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hadassah Medical Center and Faculty of Medicine Hebrew University of Jerusalem  Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9937-443X","authenticated-orcid":false,"given":"K. 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