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Blijham PJ, van Engelen BG, Drost G, Stegeman DF, Schelhaas HJ, Zwarts MJ. Diagnostic yield of muscle fibre conduction velocity in myopathies. J Neurol Sci 2011; 309:40-4. [DOI: 10.1016/j.jns.2011.07.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 07/17/2011] [Accepted: 07/20/2011] [Indexed: 12/12/2022]
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Huisman MHB, de Jong SW, van Doormaal PTC, Weinreich SS, Schelhaas HJ, van der Kooi AJ, de Visser M, Veldink JH, van den Berg LH. Population based epidemiology of amyotrophic lateral sclerosis using capture-recapture methodology. J Neurol Neurosurg Psychiatry 2011; 82:1165-70. [PMID: 21622937 DOI: 10.1136/jnnp.2011.244939] [Citation(s) in RCA: 190] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Variation in the incidence rate in epidemiological studies on amyotrophic lateral sclerosis (ALS) may be due to a small population size and under ascertainment of patients. The previously reported incidence decline in the elderly and a decrease in the male:female ratio in postmenopausal age groups have yet to be confirmed. METHODS ALS epidemiology in a large population based register in The Netherlands was studied between 1 January 2006 and 31 December 2009, and applied capture-recapture methodology in separate age and gender groups to adjust for the number of unobserved patients. RESULTS 1217 incident patients were observed, and a capture-recapture incidence of 2.77 per 100 000 person-years (95% CI 2.63 to 2.91). Prevalence on 31 December 2008 was 10.32 per 100 000 individuals (95% CI 9.78 to 10.86). The incident cohort had a higher median age at onset (63.0 vs 58.1 years) and more bulbar onset patients (30.0% vs 19.1%) compared with the prevalent cohort. Incidence and prevalence peaked in the 70-74 year age group followed by a rapid decline in older age. The male:female ratio in the premenopausal age group (1.91, 95% CI 1.32 to 2.79) was not significantly higher than that in the postmenopausal age group (1.50, 95% CI 1.34 to 1.67). CONCLUSION The marked difference in patient characteristics between incident and prevalent cohorts underscores the importance of including incident patients when studying susceptibility or disease modifying factors in ALS. The incidence decline in the elderly may suggest that ALS is not merely the result of ageing. Absence of a significant postmenopausal drop in the male:female ratio suggests that the protective role of female sex hormones in ALS is limited.
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Munneke MA, Stegeman DF, Hengeveld YA, Rongen JJ, Schelhaas HJ, Zwarts MJ. Transcranial direct current stimulation does not modulate motor cortex excitability in patients with amyotrophic lateral sclerosis. Muscle Nerve 2011; 44:109-14. [DOI: 10.1002/mus.22012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Arts IMP, Overeem S, Pillen S, Jurgen Schelhaas H, Zwarts MJ. Muscle changes in amyotrophic lateral sclerosis: a longitudinal ultrasonography study. Clin Neurophysiol 2011; 122:623-628. [PMID: 20810308 DOI: 10.1016/j.clinph.2010.07.023] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 07/24/2010] [Accepted: 07/27/2010] [Indexed: 12/25/2022]
Abstract
OBJECTIVE We performed a longitudinal study to assess structural muscle changes in amyotrophic lateral sclerosis (ALS) using ultrasonography. METHODS During a follow-up of 6 months, ultrasonography parameters (muscle thickness, echo intensity and fasciculations) were obtained from 6 muscle groups in 31 ALS patients, together with strength and scores on the revised ALS functional rating scale (ALSFRS-r). RESULTS At baseline, we found an increased echo intensity and decreased thickness, and these parameters correlated with lower strength. Moreover, ultrasound abnormalities were also detected in muscles with preserved strength. Longitudinal changes in echo intensity, muscle thickness and fasciculations showed large variations between patients. Rates of change in ultrasound parameters did not correlate with changes in ALSFRS-r or strength. CONCLUSION In patients with ALS ultrasound abnormalities can be found in muscles with preserved strength. The pattern of ultrasonographic muscle changes in ALS is highly variable and shows no evident correlation with functional measures. SIGNIFICANCE Ultrasonography is not suitable to monitor disease progression in ALS.
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Kuiperij HB, Abdo WF, van Engelen BG, Schelhaas HJ, Verbeek MM. TDP-43 plasma levels do not differentiate sporadic inclusion body myositis from other inflammatory myopathies. Acta Neuropathol 2010; 120:825-6. [PMID: 21046407 DOI: 10.1007/s00401-010-0769-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 10/25/2010] [Indexed: 12/12/2022]
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de Bot ST, van den Elzen RTM, Mensenkamp AR, Schelhaas HJ, Willemsen MAAP, Knoers NVAM, Kremer HPH, van de Warrenburg BPC, Scheffer H. Hereditary spastic paraplegia due to SPAST mutations in 151 Dutch patients: new clinical aspects and 27 novel mutations. J Neurol Neurosurg Psychiatry 2010; 81:1073-8. [PMID: 20562464 DOI: 10.1136/jnnp.2009.201103] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND In the clinically and genetically heterogeneous group of the hereditary spastic paraplegias (HSPs), mutations in the SPAST gene are most frequently found and cause a pure autosomal dominant form. OBJECTIVE To provide the clinical and genetic characteristics of Dutch patients with HSP due to a SPAST mutation (SPG4). METHODS SPAST mutation carriers were identified through a comprehensive national database search. Available medical records were reviewed. RESULTS 151 mutation carriers carried 60 different changes in the SPAST gene, of which one was a known polymorphism, and 27 were novel. Missense mutations were most frequently found (39%). Clinical information was available from 72 mutation carriers. Age at onset ranged from 1 to 63 years with a bimodal peak distribution in the first decade and above age 30. The predominantly pure spastic paraplegia was accompanied by deep sensory disturbances and sphincter problems in almost 50%. An additional hand tremor was found in 10%. Patients with missense mutations and exon deletions did not reveal a distinctive phenotype. CONCLUSIONS Dutch SPAST mutation carriers show a broad mutation spectrum, with 27 novel mutations in the present series. A bimodal peak distribution in age at onset was found and an accompanying tremor as peculiar feature of SPG4. The pathogenicity of S44L, the first exon 4 mutation, and a possible autosomal recessive mode of inheritance are discussed.
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Delnooz CCS, Lefeber DJ, Langemeijer SMC, Hoffjan S, Dekomien G, Zwarts MJ, Van Engelen BGM, Wevers RA, Schelhaas HJ, van de Warrenburg BPC. New cases of adult-onset Sandhoff disease with a cerebellar or lower motor neuron phenotype. J Neurol Neurosurg Psychiatry 2010; 81:968-72. [PMID: 20798201 DOI: 10.1136/jnnp.2009.177089] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Sandhoff disease is a lipid-storage disorder caused by a defect in ganglioside metabolism. It is caused by a lack of functional N-acetyl-beta-d-glucosaminidase A and B due to mutations in the HEXB gene. Typical, early-onset Sandhoff disease presents before 9 months of age with progressive psychomotor retardation and early death. A late-onset form of Sandhoff disease is rare, and its symptoms are heterogeneous. As drug trials that aim to intervene in the disease mechanism are emerging, the recognition and identification of Sandhoff disease patients-particularly those with atypical phenotypes-are becoming more important. The authors describe six new late-onset Sandhoff cases demonstrating cerebellar ataxia or lower motor neuron (LMN) involvement combined with, mostly subclinical, neuropathy. Two different mutations were found: IVS 12-26 G/A and c.1514G-->A. In patients with either progressive cerebellar ataxia or LMN disease in the setting of a possibly recessive disorder, Sandhoff disease should be suspected, even when the onset age is over 45 years.
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Veldink JH, Weikamp J, Schelhaas HJ, van den Berg LH. [Amyotrophic lateral sclerosis]. Ned Tijdschr Tandheelkd 2010; 117:380-382. [PMID: 20726497 DOI: 10.5177/ntvt.2010.08.10122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Amyotrophic lateral sclerosis is one of the most severe and disabling diseases of the nervous system. Amyotrophic lateral sclerosis leads to the progressive weakening of the muscles in the arms, legs, face, mouth and trunk. The onset of the disease is insidious, starting with weakness in the hands or feet or with slurred speech. The weakness worsens and patients pass away as a result of weakness of the respiratory muscles on average within 3 years of the onset of the disease. In the Netherlands, approximately 400 patients are diagnosed with amyotrophic lateral sclerosis every year. There is no diagnostic test for this neuro-muscular disease; the diagnosis is established by excluding other disorders that resemble amyotrophic lateral sclerosis. Only one drug is able to inhibit the progression of the disease to any extent: riluzole. Treatment, therefore, is mainly focused on supportive measures and those which enhance the quality of life optimally.
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van Dijk JP, Verhamme C, van Schaik IN, Schelhaas HJ, Mans E, Bour LJ, Stegeman DF, Zwarts MJ. Age-related changes in motor unit number estimates in adult patients with Charcot-Marie-Tooth type 1A. Eur J Neurol 2010; 17:1098-104. [PMID: 20443982 DOI: 10.1111/j.1468-1331.2010.03027.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kleine BU, Schelhaas HJ, van Elswijk G, Stegeman DF, Zwarts MJ. A prospective and blind study of the Triple Stimulation Technique in the diagnosis of ALS. KLIN NEUROPHYSIOL 2010. [DOI: 10.1055/s-0030-1250938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Fermont J, Arts IMP, Overeem S, Kleine BU, Schelhaas HJ, Zwarts MJ. Prevalence and distribution of fasciculations in healthy adults: Effect of age, caffeine consumption and exercise. ACTA ACUST UNITED AC 2010; 11:181-6. [DOI: 10.3109/17482960903062137] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Van Rooij FG, Schelhaas HJ, Lammers GJ, Verbeek MM, Overeem S. CSF hypocretin-1 levels are normal in patients with amyotrophic lateral sclerosis. ACTA ACUST UNITED AC 2010; 10:487-9. [PMID: 19922146 DOI: 10.3109/17482960802315024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Hypocretin (orexin) neurotransmission is not only crucially involved in the regulation of sleep and wake, but serves in multiple autonomic and cognitive functions as well. This is reflected in the widespread connections between the hypothalamic hypocretin neurons and the rest of the brain, such as dense projections to the frontal cortex. Both frontal cognitive impairment and autonomic disturbances have been described in ALS. Furthermore, in some ALS patients there may be sleep disturbances other than sleep related breathing disorders, including REM sleep behaviour disorder. In addition, a role for the hypocretin system in the regulation of motor functions has been suggested. Hypocretin defects have been described in several neurodegenerative disorders. We therefore speculated that the hypocretin system is also involved in ALS and measured hypocretin-1 levels in cerebrospinal fluid samples from 20 patients. All results were well within the normal range (>200 pg/ml) and individual values showed no correlation with age, gender and disease duration. We conclude that it is unlikely that the hypocretin system is involved in the degenerative process of ALS.
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Piepers S, Veldink JH, de Jong SW, van der Tweel I, van der Pol WL, Uijtendaal EV, Schelhaas HJ, Scheffer H, de Visser M, de Jong JMBV, Wokke JHJ, Groeneveld GJ, van den Berg LH. Randomized sequential trial of valproic acid in amyotrophic lateral sclerosis. Ann Neurol 2009; 66:227-34. [PMID: 19743466 DOI: 10.1002/ana.21620] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine whether valproic acid (VPA), a histone deacetylase inhibitor that showed antioxidative and antiapoptotic properties and reduced glutamate toxicity in preclinical studies, is safe and effective in amyotrophic lateral sclerosis (ALS) using a sequential trial design. METHODS Between April 2005 and January 2007, 163 ALS patients received VPA 1,500mg or placebo daily. Primary end point was survival. Secondary outcome measure was decline of functional status measured by the revised ALS Functional Rating Scale. Analysis was by intention to treat and according to a sequential trial design. This trial was registered with ClinicalTrials.gov (number NCT00136110). RESULTS VPA did not affect survival (cumulative survival probability of 0.72 in the VPA group [standard error (SE), 0.06] vs 0.88 in the placebo group [SE, 0.04] at 12 months, and 0.59 in the VPA group [SE, 0.07] vs 0.68 in the placebo group [SE, 0.08] at 16 months) or the rate of decline of functional status. VPA intake did not cause serious adverse reactions. INTERPRETATION Our finding that VPA, at a dose used in epilepsy, does not show a beneficial effect on survival or disease progression in patients with ALS has implications for future trials with histone deacetylase inhibitors in ALS and other neurodegenerative diseases. The use of a sequential trial design allowed inclusion of only half the number of patients required for a classic trial design and prevented patients from unnecessarily continuing potentially harmful study medication.
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Arts IMP, Pillen S, Schelhaas HJ, Overeem S, Zwarts MJ. Normal values for quantitative muscle ultrasonography in adults. Muscle Nerve 2009; 41:32-41. [PMID: 19722256 DOI: 10.1002/mus.21458] [Citation(s) in RCA: 274] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Schelhaas HJ, Arts IM, Overeem S, Houtman CJ, Janssen H, Kleine BU, Munneke M, Zwarts MJ. Measuring the cortical silent period can increase diagnostic confidence for amyotrophic lateral sclerosis. ACTA ACUST UNITED AC 2009; 8:16-9. [PMID: 17364430 DOI: 10.1080/17482960600864595] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We evaluated a modified measurement of the cortical silent period (CSP) as a simple procedure to add further confidence in the diagnostic work-up for ALS. Thirty-seven consecutive patients with a suspicion of having ALS were included together with 25 healthy volunteers, and followed until a final diagnosis (ALS versus 'ALS mimic') was reached. Using a CSP cut-off value of 200 ms for males and 150 ms for females, the following test characteristics were obtained for ALS versus ALS mimics together with controls: sensitivity for excluding ALS 0.83, specificity 0.56 (males) and sensitivity 0.81, specificity 0.82 (females). A CSP longer than the mentioned cut-off values should alarm the clinician for the presence of a disorder other than ALS.
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Brugman F, Veldink JH, Franssen H, de Visser M, de Jong JMBV, Faber CG, Kremer BHP, Schelhaas HJ, van Doorn PA, Verschuuren JJGM, Bruyn RPM, Kuks JBM, Robberecht W, Wokke JHJ, van den Berg LH. Differentiation of hereditary spastic paraparesis from primary lateral sclerosis in sporadic adult-onset upper motor neuron syndromes. ACTA ACUST UNITED AC 2009; 66:509-14. [PMID: 19364936 DOI: 10.1001/archneurol.2009.19] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To study whether clinical characteristics can differentiate sporadic presentations of hereditary spastic paraparesis (HSP) from primary lateral sclerosis (PLS). Differentiation between these diseases is important for genetic counseling and prognostication. DESIGN Case series. SETTING Tertiary referral center. PATIENTS One hundred four Dutch patients with an adult-onset, sporadic upper motor neuron syndrome of at least 3 years' duration. Hereditary spastic paraparesis was genetically confirmed in 14 patients (7 with SPG4 and 7 with SPG7 mutations). RESULTS All 14 patients with the SPG4 or SPG7 mutation had symptom onset in the legs, and 1 of the patients with the SPG7 mutation also developed symptoms in the arms. Of the other 90 patients, 78 (87%) had symptom onset in the legs. Thirty-six patients developed a PLS phenotype (bulbar region involvement), 15 had a phenotype that was difficult to classify as similar to HSP or PLS (involvement of legs and arms only), and 39 continued to have a phenotype similar to typical HSP (involvement of the legs only). Median age at onset was lower in patients with the SPG4 or SPG7 mutation (39 [range, 29-69] years), but there was considerable overlap with patients with the PLS phenotype (52 [range, 32-76] years). No differences were found in the features used by previous studies to distinguish HSP from PLS, including evidence of mild dorsal column impairment (decreased vibratory sense or abnormal leg somatosensory evoked potentials), symptoms of urinary urgency, or mild electromyographic abnormalities. CONCLUSIONS In most patients with a sporadic adult-onset upper motor neuron syndrome, differentiation of sporadic presentations of HSP from PLS based on clinical characteristics is unreliable and therefore depends on results of genetic testing.
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Brugman F, Scheffer H, Schelhaas HJ, Nillesen WM, Wokke JHJ, van de Warrenburg BPC, van den Berg LH. Seipin/BSCL2 mutation screening in sporadic adult-onset upper motor neuron syndromes. J Neurol 2009; 256:824-6. [PMID: 19252810 DOI: 10.1007/s00415-009-5009-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Revised: 11/25/2008] [Accepted: 12/03/2008] [Indexed: 10/21/2022]
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Fermont J, Arts I, Overeem S, Kleine B, Schelhaas HJ, Zwarts M. Prevalence and distribution of fasciculations in healthy adults: Effect of age, caffeine consumption and exercise. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/17482960903062137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Titulaer MJ, Wirtz PW, Kuks JBM, Schelhaas HJ, van der Kooi AJ, Faber CG, van der Pol WL, de Visser M, Sillevis Smitt PAE, Verschuuren JJGM. The Lambert-Eaton myasthenic syndrome 1988-2008: a clinical picture in 97 patients. J Neuroimmunol 2008; 201-202:153-8. [PMID: 18644631 DOI: 10.1016/j.jneuroim.2008.05.025] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Revised: 05/20/2008] [Accepted: 05/21/2008] [Indexed: 02/06/2023]
Abstract
BACKGROUND Neuromuscular symptoms in patients with Lambert-Eaton myasthenic syndrome (LEMS) and a small cell lung cancer (SCLC) develop more rapidly than in LEMS patients without a SCLC. We studied how this clinical information, which is readily available at the first consultation, can be used to predict the presence of SCLC. PATIENTS AND METHODS In our study we included 52 LEMS patients with SCLC and 45 non-tumor patients (NT-LEMS). We interviewed patients using a structured checklist and reviewed their clinical records. We compared frequency and onset of symptoms during the course of LEMS. RESULTS In the first six months, over half the SCLC-LEMS patients had developed seven separate symptoms, while NT-LEMS patients developed only two symptoms. Proximal leg weakness and dry mouth were early symptoms in both groups. Rapid involvement of proximal arm muscles (p=0.0001), distal arm muscles (p=0.0037), distal leg muscles (p=0.0002), dysartria (p=0.0091) and the presence of erectile dysfunction (p=0.007) were found significantly more often in SCLC-LEMS patients in both cohorts. Cerebellar symptoms, although present in 9% of LEMS patients, were almost exclusively related to SCLC-LEMS. CONCLUSION A rapidly progressive course of disease from onset in LEMS patients should raise a high suspicion of SCLC. Special attention should be paid to involvement of upper extremities, involvement of distal arm and distal leg muscles, to erectile dysfunction and probably ataxia in order to discriminate between SCLC-LEMS and NT-LEMS.
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Voermans NC, Minnema M, Lammens M, Schelhaas HJ, Kooi AVD, Lokhorst HM, van Engelen BG. Sporadic late-onset nemaline myopathy effectively treated by melphalan and stem cell transplant. Neurology 2008; 71:532-4. [PMID: 18565829 DOI: 10.1212/01.wnl.0000310814.54623.6f] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Ørngreen MC, Schelhaas HJ, Jeppesen TD, Akman HO, Wevers RA, Andersen ST, ter Laak HJ, van Diggelen OP, DiMauro S, Vissing J. Is muscle glycogenolysis impaired in X-linked phosphorylase b kinase deficiency? Neurology 2008; 70:1876-82. [PMID: 18401027 DOI: 10.1212/01.wnl.0000289190.66955.67] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE It is unclear to what extent muscle phosphorylase b kinase (PHK) deficiency is associated with exercise-related symptoms and impaired muscle metabolism, because 1) only four patients have been characterized at the molecular level, 2) reported symptoms have been nonspecific, and 3) lactate responses to ischemic handgrip exercise have been normal. METHODS We studied a 50-year-old man with X-linked PHK deficiency using ischemic forearm and cycle ergometry exercise tests to define the derangement of muscle metabolism. We compared our findings with those in patients with McArdle disease and in healthy subjects. RESULTS Sequencing of PHKA1 showed a novel pathogenic mutation (c.831G>A) in exon 7. There was a normal increase of plasma lactate during forearm ischemic exercise, but lactate did not change during dynamic, submaximal exercise in contrast to the fourfold increase in healthy subjects. Constant workload elicited a second wind in all patients with McArdle disease, but not in the patient with PHK deficiency. IV glucose administration appeared to improve exercise tolerance in the patient with PHK deficiency, but not to the same extent as in the patients with McArdle disease. Lipolysis was higher in the patient with PHK deficiency than in controls. CONCLUSION These findings demonstrate that X-linked PHK deficiency causes a mild metabolic myopathy with blunted muscle glycogen breakdown and impaired lactate production during dynamic exercise, which impairs oxidative capacity only marginally. The different response of lactate to submaximal and maximal exercise is likely related to differential activation mechanisms for myophosphorylase.
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Meijer JWG, van Kuijk AA, Geurts ACH, Schelhaas HJ, Zwarts MJ. Acute Deterioration of Bulbar Function After Botulinum Toxin Treatment for Sialorrhoea in Amyotrophic Lateral Sclerosis. Am J Phys Med Rehabil 2008; 87:321-4. [DOI: 10.1097/phm.0b013e318164a931] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Arts IMP, van Rooij FG, Overeem S, Pillen S, Janssen HMHA, Schelhaas HJ, Zwarts MJ. Quantitative muscle ultrasonography in amyotrophic lateral sclerosis. ULTRASOUND IN MEDICINE & BIOLOGY 2008; 34:354-361. [PMID: 17964067 DOI: 10.1016/j.ultrasmedbio.2007.08.013] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Revised: 08/01/2007] [Accepted: 08/30/2007] [Indexed: 05/25/2023]
Abstract
In this study, we examined whether quantitative muscle ultrasonography can detect structural muscle changes in early-stage amyotrophic lateral sclerosis (ALS). Bilateral transverse scans were made of five muscles or muscle groups (sternocleidomastoid, biceps brachii/brachialis, forearm flexor group, quadriceps femoris and anterior tibialis muscles) in 48 patients with ALS. Twenty-five patients were also screened for fasciculations. Quantitative analysis revealed a significant increase in echo intensity in all muscles and a decrease in muscle thickness of the biceps brachii, forearm flexors and quadriceps femoris on both sides. Fasciculations were easy to detect in multiple muscles of all screened patients except one. We conclude that quantitative ultrasonography can be used to detect muscle changes caused by ALS in an early phase of the disease. (E-mail: m.zwarts@neuro.umcn.nl).
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Van Rooij F, Jurgen Schelhaas H, Lammers GJ, Verbeek M, Overeem S. CSF hypocretin-1 levels are normal in patients with amyotrophic lateral sclerosis. ACTA ACUST UNITED AC 2008. [DOI: 10.1080/17482960802315024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Blijham PJ, Schelhaas HJ, Ter Laak HJ, van Engelen BGM, Zwarts MJ. Early diagnosis of ALS: The search for signs of denervation in clinically normal muscles. J Neurol Sci 2007; 263:154-7. [PMID: 17655869 DOI: 10.1016/j.jns.2007.07.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2007] [Accepted: 07/05/2007] [Indexed: 10/23/2022]
Abstract
AIM AND METHODS We prospectively investigated whether early diagnosis of amyotrophic lateral sclerosis (ALS) could be facilitated by demonstrating signs of denervation in a muscle of a clinical and electromyographical unaffected region. Muscle fibre conduction velocity (MFCV) was determined in 18 patients in whom the diagnosis ALS was considered but not established beyond a level of clinically possible ALS according to the revised El Escorial criteria. A muscle biopsy was obtained from the same muscle, to demonstrate neurogenic changes. The study followed the guidelines from the STARD initiative. RESULTS AND CONCLUSION Results were analysed with respect to the final diagnosis. After a mean follow-up of 16 months, 9 patients developed probable or definite ALS. Sensitivity of abnormal MFCV for developing ALS was 89%. Muscle biopsy confirmed that denervation was the cause of abnormal MFCV. We concluded that MFCV can be used to detect denervation in muscles that show no clinical or electromyographical signs of lower motor neuron disease, and thus may contribute to early diagnosis of probable laboratory-supported ALS.
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