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©2013 UpToDate ® Print Email Algorithm for the diagnosis of metabolic myopathies In a patient with signs that raise the possibility of a metabolic myopathy, the constellation of clinical and laboratory features and the type of exercise inducing the symptoms may indicate the nature of the underlying biochemical defect and thus narrow down the laboratory investigation. CNS: central nervous system; PNS: peripheral nervous system. Reproduced with permission from: Darras BT, Friedman NR. Metabolic myopathies: A clinical approach, Part I. Pediatr Neurol 2000; 22:87. Copyright © 2000 Elsevier.