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Slowly progressive distal muscle weakness: neuropathy or myopathy?
  1. Yafit Nahari1,
  2. Ahmed Abbas2,
  3. Elizabeth Curtis1 and
  4. Saiju Jacob1
  1. 1 Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  2. 2 Department of Neurophysiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Dr Saiju Jacob, saiju.jacob{at}


Nonaka myopathy is an autosomal recessive and slowly progressive distal myopathy. It is part of a rare group of myopathies predominantly affecting the distal limb musculature. Over 150 cases have been reported across the Middle East, Japan and Europe. We report the case of a 33-year-old woman presenting with symmetrical upper and lower limb weakness, most severely affecting the distal muscle groups. After extensive neurological investigation including neurophysiology, muscle biopsy and genetic analysis, she was finally diagnosed with Nonaka myopathy and treated conservatively with physiotherapy.

  • neuromuscular disease
  • neuro genetics

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  • Contributors YN and AA wrote the initial draft. EC provided the microscopic pictures. SJ was responsible for patient care, making the diagnosis and took overall responsibility of the project, reviewed and edited manuscript/figures before final submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.