SENA - South of England Neurosciences Association

Dr Muhammed Ameen Noushad

University Hospital Southampton

World Muscle Society Congress, Vienna

7-11 October 2025

I am grateful to have received the SENA bursary, which gave me the opportunity to share a uniquely challenging case at the World Muscle Society 2025 pre-congress teaching course. My patient was a 78-year-old woman who has endured two years of worsening head and neck pain, jaw stiffness, difficulty swallowing, and severe weight loss that ultimately required a feeding tube for nutrition. Despite thorough investigations across multiple specialties we were left without a clear diagnosis.

On examination, she showed marked tenderness and obvious weakness in the scalp and neck muscles, as well as trouble with mouth opening and moderate weakness in her upper legs. Blood tests showed ongoing inflammation, but all autoantibodies came back negative. A biopsy of her temporalis muscle revealed changes typical of a muscle disease and scattered macrophages, but there were no signs of inflammation that would suggest vasculitis, cancer, or an IgG4-related autoimmune condition.

With no definitive diagnosis, we began a cautious trial of corticosteroids, and she responded dramatically and her symptoms resolved, she regained normal function, and her inflammatory markers settled. We have since switched to steroid-sparing immunosuppression, and she continues to do well.

This case highlights the complexity and diagnostic uncertainty often faced in neuromuscular medicine, especially when cranial muscles and immune mechanisms are involved. Presenting at the congress allowed me to learn from international experts and discuss possible rare disease mechanisms, thanks to the support provided by SENA. It was an invaluable chance to exchange ideas and build new collaborations for future research into unsolved neuromuscular disorders.