New EAN guideline published on diagnostic approach to oligo/asymptomatic hyperCKemia

by Theodoros Kyriakides, EAN Guideline Production Group member

Why the Guideline was developed

The prevalence of hyperCKemia in the general population may be as high as 1.3%. General practitioners, internists and neurologists are commonly asked to assess individuals with hyperCKemia, defined as persistent serum creatine kinase (CK) values above the upper limit of normal.

The vast majority are either oligo-symptomatic or asymptomatic. Such individuals may include those asked to have a serum CK prior to participating in regular sport activities or prior to starting a statin. Although CK is a marker of neuromuscular disease, many non-neuromuscular conditions can cause oligo- or asymptomatic hyperCKemia, including strenuous exercise, medications, and cardiac, endocrine, metabolic, and other disorders. Nevertheless, an underlying subclinical neuromuscular disease always remains a possibility.

Which patients with oligo/asymptomatic hyperCKemia should be investigated for a neuromuscular disease, and what evaluation strategies should be used? This new guideline, published in the European Journal of Neurology in February 2026, provides evidence-based recommendations to that effect.

Producing the Guideline

A group of fourteen European neuromuscular experts, a European Academy of Neurology methodologist, a patient representative and members of the EAN Guideline Production Group were all involved in the production of the Guideline.

The Guideline provides the most up-to-date diagnostic approach in persons aged older than 18 years, presenting with oligo/asymptomatic hyperCKemia. Important questions such as the level of hyperCKemia that needs to be investigated and the sequence of investigations, were answered by laboriously interrogating all the relevant literature up to May 2023, using PICOs and the GRADE methodology.

Recent years, have seen next generation sequencing and muscle MRI introduced in the investigation of neuromuscular disorders and these two non-invasive modalities have also been incorporated in a sequential step approach in investigating oligo/asymptomatic hyperCKemia.

Several rounds of voting took place in a time consuming Delphi process over several months. The final draft was submitted in April 2025 and accepted in November 2025.

In addition to the guideline recommendations, brief expert commentaries have been included in the paper, on pertinent issues that arise in managing patients with oligo/asymptomatic hyperCKemia. Such issues include the use of statins, exercise and anesthesia.

For the patient and caregiver

Up to 1.3% of the general population has a creatine kinase (CK) value above the upper limit of normal. Raised CK can be a marker of an underlying, undiagnosed muscle disease, but it can also be found in a number of other, unrelated medical conditions. It can be due to drugs (e.g., statins) or the result of exercise or physically demanding occupations. What is important is to define the CK level above which individuals should be investigated and the sequence of investigations that should be carried out, so that a correct diagnosis can be reached with the least inconvenience to the patient. An early diagnosis enables early management and family counseling.

Read the full guideline: EAN 2024 Guideline
on the Diagnostic Approach to Oligo/Asymptomatic HyperCKemia – Kyriakides –
2026 – European Journal of Neurology – Wiley Online Library

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