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Hayes LH, Darras BT. Neuromuscular problems of the critically Ill neonate and child. Semin Pediatr Neurol 2024; 49:101123. [PMID: 38677802 DOI: 10.1016/j.spen.2024.101123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 04/08/2024] [Indexed: 04/29/2024]
Abstract
Acute neuromuscular disorders occasionally occur in the Pediatric Neurologic Intensive Care Unit. Many of these are primary disorders of the motor unit that may present acutely or exacerbate during an intercurrent illness. Additionally, acute neuromuscular disorders may develop during an acute systemic illness requiring intensive care management that predispose the child to another set of acute motor unit disorders. This chapter discusses acute neuromuscular crises in the infant, toddler, and adolescent, as well as neuromuscular disorders resulting from critical illness.
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Affiliation(s)
- Leslie H Hayes
- Department of Neurology, Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States.
| | - Basil T Darras
- Department of Neurology, Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
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2
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Pocratsky AM, Nascimento F, Özyurt MG, White IJ, Sullivan R, O’Callaghan BJ, Smith CC, Surana S, Beato M, Brownstone RM. Pathophysiology of Dyt1- Tor1a dystonia in mice is mediated by spinal neural circuit dysfunction. Sci Transl Med 2023; 15:eadg3904. [PMID: 37134150 PMCID: PMC7614689 DOI: 10.1126/scitranslmed.adg3904] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/14/2023] [Indexed: 05/05/2023]
Abstract
Dystonia, a neurological disorder defined by abnormal postures and disorganized movements, is considered to be a neural circuit disorder with dysfunction arising within and between multiple brain regions. Given that spinal neural circuits constitute the final pathway for motor control, we sought to determine their contribution to this movement disorder. Focusing on the most common inherited form of dystonia in humans, DYT1-TOR1A, we generated a conditional knockout of the torsin family 1 member A (Tor1a) gene in the mouse spinal cord and dorsal root ganglia (DRG). We found that these mice recapitulated the phenotype of the human condition, developing early-onset generalized torsional dystonia. Motor signs emerged early in the mouse hindlimbs before spreading caudo-rostrally to affect the pelvis, trunk, and forelimbs throughout postnatal maturation. Physiologically, these mice bore the hallmark features of dystonia, including spontaneous contractions at rest and excessive and disorganized contractions, including cocontractions of antagonist muscle groups, during voluntary movements. Spontaneous activity, disorganized motor output, and impaired monosynaptic reflexes, all signs of human dystonia, were recorded from isolated mouse spinal cords from these conditional knockout mice. All components of the monosynaptic reflex arc were affected, including motor neurons. Given that confining the Tor1a conditional knockout to DRG did not lead to early-onset dystonia, we conclude that the pathophysiological substrate of this mouse model of dystonia lies in spinal neural circuits. Together, these data provide new insights into our current understanding of dystonia pathophysiology.
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Affiliation(s)
- Amanda M. Pocratsky
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London; London, WC1N 3BG, UK
| | - Filipe Nascimento
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London; London, WC1N 3BG, UK
| | - M. Görkem Özyurt
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London; London, WC1N 3BG, UK
| | - Ian J. White
- Laboratory for Molecular Cell Biology, University College London; London, WC1E 6BT, UK
| | - Roisin Sullivan
- Department of Molecular Neuroscience, UCL Queen Square Institute of Neurology, University College London; London, WC1N 3BG, UK
| | - Benjamin J. O’Callaghan
- Department of Molecular Neuroscience, UCL Queen Square Institute of Neurology, University College London; London, WC1N 3BG, UK
| | - Calvin C. Smith
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London; London, WC1N 3BG, UK
| | - Sunaina Surana
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London; London, WC1N 3BG, UK
- UK Dementia Research Institute, University College London; London, WC1E 6BT, UK
| | - Marco Beato
- Department of Neuroscience, Physiology, and Pharmacology, University College London; London, WC1E 6BT, UK
| | - Robert M. Brownstone
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London; London, WC1N 3BG, UK
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Le Tanno P, Latypova X, Rendu J, Fauré J, Bourg V, Gauthier M, Billy-Lopez G, Jouk PS, Dieterich K. Diagnostic workup in children with arthrogryposis: description of practices from a single reference centre, comparison with literature and suggestion of recommendations. J Med Genet 2023; 60:13-24. [PMID: 34876503 DOI: 10.1136/jmedgenet-2021-107823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 11/18/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Arthrogryposis multiplex congenita (AMC) refers to a clinical presentation of congenital contractures involving two or more body areas. More than 400 distinct conditions may lead to AMC, making the aetiological diagnosis challenging. The objective of this work was to set up evidence-based recommendations for the diagnosis of AMC by taking advantage of both data from our nation-wide cohort of children with AMC and from the literature. MATERIAL AND METHODS We conducted a retrospective single-centre observational study. Patients had been evaluated at least once at a paediatric age in the AMC clinic of Grenoble University Hospital between 2007 and 2019. After gathering data about their diagnostic procedure, a literature review was performed for each paraclinical investigation to discuss their relevance. RESULTS One hundred and twenty-five patients were included, 43% had Amyoplasia, 27% had distal arthrogryposis and 30% had other forms. A definitive aetiological diagnosis was available for 66% of cases. We recommend a two-time diagnostic process: first, non-invasive investigations that aim at classifying patients into one of the three groups, and second, selected investigations targeting a subset of patients. CONCLUSION The aetiological management for patients with AMC remains arduous. This process will be facilitated by the increasing use of next-generation sequencing combined with detailed phenotyping. Invasive investigations should be avoided because of their limited yield.
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Affiliation(s)
- Pauline Le Tanno
- Univ. Grenoble Alpes, Inserm, U1209, CHU Grenoble Alpes, Institut of Advanced Biosciences, 38000 Grenoble, France
| | - Xenia Latypova
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institute of Neurosciences, 38000 Grenoble, France
| | - John Rendu
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institute of Neurosciences, 38000 Grenoble, France
| | - Julien Fauré
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institute of Neurosciences, 38000 Grenoble, France
| | - Véronique Bourg
- Service de Médecine Physique et Réhabilitation pédiatrique, CHU Grenoble Alpes, 38000 Grenoble, France
| | - Marjolaine Gauthier
- Service de Génétique, Génomique et Procréation, CHU Grenoble Alpes, 38000 Grenoble, France
| | - Gipsy Billy-Lopez
- Service de Génétique, Génomique et Procréation, CHU Grenoble Alpes, 38000 Grenoble, France
| | - Pierre-Simon Jouk
- Service de Génétique, Génomique et Procréation, CHU Grenoble Alpes, 38000 Grenoble, France
| | - Klaus Dieterich
- Univ. Grenoble Alpes, Inserm, U1209, CHU Grenoble Alpes, Institut of Advanced Biosciences, 38000 Grenoble, France
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4
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Schwann cell functions in peripheral nerve development and repair. Neurobiol Dis 2023; 176:105952. [PMID: 36493976 DOI: 10.1016/j.nbd.2022.105952] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/23/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
The glial cell of the peripheral nervous system (PNS), the Schwann cell (SC), counts among the most multifaceted cells of the body. During development, SCs secure neuronal survival and participate in axonal path finding. Simultaneously, they orchestrate the architectural set up of the developing nerves, including the blood vessels and the endo-, peri- and epineurial layers. Perinatally, in rodents, SCs radially sort and subsequently myelinate individual axons larger than 1 μm in diameter, while small calibre axons become organised in non-myelinating Remak bundles. SCs have a vital role in maintaining axonal health throughout life and several specialized SC types perform essential functions at specific locations, such as terminal SC at the neuromuscular junction (NMJ) or SC within cutaneous sensory end organs. In addition, neural crest derived satellite glia maintain a tight communication with the soma of sensory, sympathetic, and parasympathetic neurons and neural crest derivatives are furthermore an indispensable part of the enteric nervous system. The remarkable plasticity of SCs becomes evident in the context of a nerve injury, where SC transdifferentiate into intriguing repair cells, which orchestrate a regenerative response that promotes nerve repair. Indeed, the multiple adaptations of SCs are captivating, but remain often ill-resolved on the molecular level. Here, we summarize and discuss the knowns and unknowns of the vast array of functions that this single cell type can cover in peripheral nervous system development, maintenance, and repair.
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Averdunk L, Donkervoort S, Horn D, Waldmüller S, Syeda S, Neuhaus SB, Chao KR, van Riesen A, Gauck D, Haack T, Japp AS, Lee U, Bönnemann CG, Mayatepek E, Distelmaier F. Recognizable Pattern of Arthrogryposis and Congenital Myopathy Caused by the Recurrent TTN Metatranscript-only c.39974-11T > G Splice Variant. Neuropediatrics 2022; 53:309-320. [PMID: 35605965 DOI: 10.1055/a-1859-0800] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Arthrogryposis is characterized by the presence of multiple contractures at birth and can be caused by pathogenic variants in TTN (Titin). Exons and variants that are not expressed in one of the three major isoforms of titin are referred to as "metatranscript-only" and have been considered to be only expressed during fetal development. Recently, the metatranscript-only variant (c.39974-11T > G) in TTN with a second truncating TTN variant has been linked to arthrogryposis multiplex congenita and myopathy. METHODS Via exome sequencing we identified the TTN c.39974-11T > G splice variant in trans with one of three truncating variants (p.Arg8922*, p.Lys32998Asnfs*63, p.Tyr10345*) in five individuals from three families. Clinical presentation and muscle ultrasound as well as MRI images were analyzed. RESULTS All five patients presented with generalized muscular hypotonia, reduced muscle bulk, and congenital contractures most prominently affecting the upper limbs and distal joints. Muscular hypotonia persisted and contractures improved over time. One individual, the recipient twin in the setting of twin-to-twin transfusion syndrome, died from severe cardiac hypertrophy 1 day after birth. Ultrasound and MRI imaging studies revealed a recognizable pattern of muscle involvement with striking fibrofatty involvement of the hamstrings and calves, and relative sparing of the femoral adductors and anterior segment of the thighs. CONCLUSION The recurrent TTN c.39974-11T > G variant consistently causes congenital arthrogryposis and persisting myopathy providing evidence that the metatranscript-only 213 to 217 exons impact muscle elasticity during early development and beyond. There is a recognizable pattern of muscle involvement, which is distinct from other myopathies and provides valuable clues for diagnostic work-up.
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Affiliation(s)
- Luisa Averdunk
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, Heinrich-Heine-University, University Hospital, Düsseldorf, Germany
| | - Sandra Donkervoort
- Neuromuscular and Neurogenetic Disorders of Childhood Section, Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, United States
| | - Denise Horn
- Institute of Medical Genetics and Human Genetics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Stephan Waldmüller
- Institute of Medical Genetics and Applied Genomics, University of Tuebingen, Tuebingen, Germany
| | - Safoora Syeda
- Institute of Medical Genetics and Human Genetics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sarah B Neuhaus
- Neuromuscular and Neurogenetic Disorders of Childhood Section, Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, United States
| | - Katherine R Chao
- Center for Mendelian Genomics, Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States
| | - Anne van Riesen
- Center for Chronically Sick Children, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Pediatric Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Darja Gauck
- Institute of Medical Genetics and Applied Genomics, University of Tuebingen, Tuebingen, Germany
| | - Tobias Haack
- Institute of Medical Genetics and Applied Genomics, University of Tuebingen, Tuebingen, Germany
| | - Anna S Japp
- Institute of Pathology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Unaa Lee
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, Heinrich-Heine-University, University Hospital, Düsseldorf, Germany
| | - Carsten G Bönnemann
- Neuromuscular and Neurogenetic Disorders of Childhood Section, Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, United States
| | - Ertan Mayatepek
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, Heinrich-Heine-University, University Hospital, Düsseldorf, Germany
| | - Felix Distelmaier
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, Heinrich-Heine-University, University Hospital, Düsseldorf, Germany
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Chareyre J, Neuraz A, Badina A, Barnerias C, Hully M, Kermorvant-Duchemin E, Leroy-Terquem E, Carlier RY, Melki J, Desguerre I, Gitiaux C. Postnatal Diagnostic Workup in Children With Arthrogryposis: A Series of 82 Patients. J Child Neurol 2021; 36:1071-1077. [PMID: 34410827 DOI: 10.1177/08830738211022972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe a postnatal series of patients with arthrogryposis multiplex congenita by the causal mechanisms involved. METHODS In this single-center study, the local data warehouse was used to identify patients with arthrogryposis multiplex congenita. Patients were classified into different etiologic groups. RESULTS Of 82 patients included, the most frequent cause of arthrogryposis multiplex congenita was a neuromuscular disorder (39%), including skeletal muscle (n = 19), neuromuscular junction (n = 3), and peripheral nerve (n = 11) involvement. In other subgroups, 19 patients (23%) were classified by disorders in the central nervous system, 5 (6%) in connective tissue, 7 (8.5%) had mixed mechanisms, and 18 (22%) could not be classified. Contractures topography was not associated with a causal mechanism. Cerebral magnetic resonance imaging (MRI), electroneuromyography, and muscle biopsy were the most conclusive investigations. Metabolic investigations were normal in all the patients tested. Targeted or whole exome sequencing diagnostic rates were 51% and 71%, respectively. Thirty-three percent of patients died (early death occurred in patients with polyhydramnios, prematurity, and ventilatory dependency). DISCUSSION The benefits of a precise diagnosis in the neonatal period include more tailored management of arthrogryposis multiplex congenita and better genetic information.
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Affiliation(s)
- Judith Chareyre
- Service de neurologie pédiatrique, Hôpital 37072Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris Centre, Université de Paris, Paris, France
| | - Antoine Neuraz
- Département d'informatique médicale, Hôpital Necker-Enfant Malades, Assistance Publique des Hôpitaux de Paris Centre, Paris, France ; INSERM, Centre de Recherche des Cordeliers, UMRS, Université de Paris, Paris, France
| | - Alina Badina
- Service d'orthopédie, 55531Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris Centre, Université de Paris, Paris, France
| | - Christine Barnerias
- Service de neurologie pédiatrique, Hôpital 37072Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris Centre, Université de Paris, Paris, France
| | - Marie Hully
- Service de neurologie pédiatrique, Hôpital 37072Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris Centre, Université de Paris, Paris, France
| | - Elsa Kermorvant-Duchemin
- Service de pédiatrie et réanimation néonatales, 246596Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris Centre, Université de Paris, Paris, France
| | - Elise Leroy-Terquem
- Service de pédiatrie et réanimation néonatales, 246596Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris Centre, Université de Paris, Paris, France
| | - Robert Y Carlier
- Service d'Imagerie Médicale, Hôpital Raymond Poincaré, Garches, DMU smart imaging, APHP Université Paris-Saclay, Université Versailles Saint Quentin en Yvelines -Paris Saclay UMR, France
| | - Judith Melki
- Institut National de la Santé et de la Recherche Médicale (Inserm) UMR, Université Paris Sud, Le Kremlin Bicêtre, France
| | - Isabelle Desguerre
- Service de neurologie pédiatrique, Hôpital 37072Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris Centre, Université de Paris, Paris, France.,Centre de référence des pathologies neuromusculaires "Paris Nord Est ", FILNEMUS, France
| | - Cyril Gitiaux
- Centre de référence des pathologies neuromusculaires "Paris Nord Est ", FILNEMUS, France.,Service de neurophysiologie clinique, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris Centre, Université de Paris, Paris, France
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Irumudomon OT, Ghosh PS. Electromyography in infants: experience from a pediatric neuromuscular center. Acta Neurol Belg 2021; 122:1195-1200. [PMID: 33891285 DOI: 10.1007/s13760-021-01681-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/13/2021] [Indexed: 11/28/2022]
Abstract
Electromyography plays a pivotal role in diagnosing neuromuscular disorders. The purpose of this study was to investigate the role of electromyography in infants. We performed a retrospective study of the infants who underwent electromyography from 2003 to 2017 and recorded demographic profile, indication, electrodiagnostic findings, and final diagnosis from the follow-up data. 179 studies were completed; electromyography was abnormal in 109 (60.9%) patients. The most common referral indication was hypotonia followed by birth trauma related injuries and rule out neuromuscular disorders. The most common electrodiagnostic diagnosis was localized to muscles followed by plexus and motor neurons. Among the patients with normal electromyography, the most common diagnosis was due to myopathies. Electromyography plays an important role in the workup of neuromuscular disorders in infants though with increased utilization of genetic testing we observed a declining trend in the number of electromyography performed in the latter half the study.
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Affiliation(s)
| | - Partha S Ghosh
- Department of Neurology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
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Langston S, Chu A. Arthrogryposis Multiplex Congenita. Pediatr Ann 2020; 49:e299-e304. [PMID: 32674167 DOI: 10.3928/19382359-20200624-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Arthrogryposis multiplex congenita (AMC) is a complex, etiologically diverse, clinical descriptor identified in a variety of diagnoses characterized by multiple congenital joint contractures. The root cause of AMC is decreased fetal movement in-utero, whether resulting from maternal or pregnancy influences, nervous system pathology, or an underlying genetic abnormality. Prenatal diagnosis via ultrasonography can be challenging and may require additional imaging techniques or studies. After birth, these infants may require assistance breathing and feeding depending on the underlying diagnosis. Physical therapy and surgical intervention of the contractures are the mainstays of therapy, and outcomes can be good when intervention is provided in a timely manner. Those infants with syndromic causes of arthrogryposis are more likely to have poor outcomes; therefore, determining the underlying etiology for AMC is important as this can influence counseling regarding individual prognosis as well as future pregnancies. [Pediatr Ann. 2020;49(7):e299-e304.].
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Heller SA, Shih R, Kalra R, Kang PB. Emery-Dreifuss muscular dystrophy. Muscle Nerve 2019; 61:436-448. [PMID: 31840275 PMCID: PMC7154529 DOI: 10.1002/mus.26782] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 12/04/2019] [Accepted: 12/07/2019] [Indexed: 12/19/2022]
Abstract
Emery-Dreifuss muscular dystrophy (EDMD) is a rare muscular dystrophy, but is particularly important to diagnose due to frequent life-threatening cardiac complications. EDMD classically presents with muscle weakness, early contractures, cardiac conduction abnormalities and cardiomyopathy, although the presence and severity of these manifestations vary by subtype and individual. Associated genes include EMD, LMNA, SYNE1, SYNE2, FHL1, TMEM43, SUN1, SUN2, and TTN, encoding emerin, lamin A/C, nesprin-1, nesprin-2, FHL1, LUMA, SUN1, SUN2, and titin, respectively. The Online Mendelian Inheritance in Man database recognizes subtypes 1 through 7, which captures most but not all of the associated genes. Genetic diagnosis is essential whenever available, but traditional diagnostic tools can help steer the evaluation toward EDMD and assist with interpretation of equivocal genetic test results. Management is primarily supportive, but it is important to monitor patients closely, especially for potential cardiac complications. There is a high potential for progress in the treatment of EDMD in the coming years.
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Affiliation(s)
- Scott A Heller
- Department of Neurology, University of Florida College of Medicine, Gainesville, Florida
| | - Renata Shih
- Congenital Heart Center, University of Florida College of Medicine, Gainesville, Florida
| | - Raghav Kalra
- Division of Pediatric Neurology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida
| | - Peter B Kang
- Department of Neurology, University of Florida College of Medicine, Gainesville, Florida.,Division of Pediatric Neurology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida.,Genetics Institute and Myology Institute, University of Florida, Gainesville, Florida
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10
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Dieterich K, Le Tanno P, Kimber E, Jouk PS, Hall J, Giampietro P. The diagnostic workup in a patient with AMC: Overview of the clinical evaluation and paraclinical analyses with review of the literature. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2019; 181:337-344. [PMID: 31368648 DOI: 10.1002/ajmg.c.31730] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 11/10/2022]
Abstract
Arthrogryposis multiplex congenita, or AMC, is a clinical sign defined as congenital contractures of at least two joint levels. These joint contractures are always secondary to diminished fetal movement which can have numerous causes that affect any part of the anatomical structures implicated in movement: the central nervous system, the anterior horn cell, the nerve, the neuromuscular junction, the muscle, or the joint itself. Make a precise diagnosis of the cause in a patient with multiple joint contractures is therefore challenging. The aim of this article is to summarize the use and diagnostic value of common examinations and analyses performed postnatally in patients affected by AMC from a literature review. We also compare this data with results from our clinical practice. Even though it is difficult to give precise guidelines today, it appears that genetic studies, such as whole exome or genome analysis in all patients and chromosomal microarray analysis in patients with intellectual disability and AMC should be preferred as first tier investigations over EMG and muscle biopsy.
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Affiliation(s)
- Klaus Dieterich
- University of Grenoble Alpes, Inserm, U1216, GIN, Grenoble, France.,Department of Medical Genetics, CHU Grenoble Alpes, Génétique Médicale, Grenoble, France
| | - Pauline Le Tanno
- Department of Medical Genetics, CHU Grenoble Alpes, Génétique Médicale, Grenoble, France
| | - Eva Kimber
- Department of Pediatrics, Sahlgrenska Academy, Goteborg, Sweden
| | - Pierre-Simon Jouk
- Department of Medical Genetics, CHU Grenoble Alpes, Génétique Médicale, Grenoble, France
| | - Judith Hall
- Children's & Women's Health Centre of BC, Medical Genetics, UBC, Vancouver, British Columbia, Canada
| | - Philip Giampietro
- Robert Wood Johnson School of Medicine, Rutgers University, New Brunswick, New Jersey, USA
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11
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Hafner P, Phadke R, Manzur A, Smith R, Jaiser S, Schutz P, Sewry C, Muntoni F, Pitt M. Electromyography and muscle biopsy in paediatric neuromuscular disorders – Evaluation of current practice and literature review. Neuromuscul Disord 2019; 29:14-20. [DOI: 10.1016/j.nmd.2018.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 12/14/2022]
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12
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Ghosh PS, Sorenson EJ. Diagnostic yield of electromyography in children with myopathic disorders. Pediatr Neurol 2014; 51:215-9. [PMID: 24950662 DOI: 10.1016/j.pediatrneurol.2014.04.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 04/08/2014] [Accepted: 04/12/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Interpretation of pediatric electromyography interpretation in myopathic disorders is technically challenging. We assessed our electromyographic experience with respect to sensitivity and specificity in pediatric myopathy. METHODS We did a retrospective chart review of patients ≤18 years between 2009 and 2013. Two hundred twenty-four electromyographic studies were reviewed with the following referral diagnoses: myopathy, muscle weakness, neuromuscular disorders, myositis, myalgia, myoglobinuria, myasthenia, myotonia, cramps, periodic paralysis, hypotonia, and developmental delay. Only children who had an electromyography and muscle biopsy were included for analysis. Patients with neurogenic electromyography and neuromuscular junction disorders were excluded. Myopathic electromyography was defined as short duration, low amplitude, polyphasic motor unit potentials with rapid recruitment. RESULTS Seventy-two patients were included (age range, 6 months-18 years). The following observations were made: group A: myopathic electromyography or pathognomonic of muscle disease and biopsy or genetically confirmed myopathy (32 cases); group B: myopathic electromyography but biopsy normal or nondiagnostic (12 cases); group C: normal electromyography but biopsy or genetically confirmed myopathy (three cases, all with metabolic myopathy); and group D: electromyography normal and biopsy normal or nondiagnostic (25 cases). The most common diagnoses were congenital myopathy (seven cases), metabolic myopathy (six cases), muscular dystrophy (six cases), genetically confirmed myopathy (five cases), myopathy, undefined (five cases), and inflammatory myopathy (four cases). CONCLUSIONS Pediatric electromyography was 91% sensitive and 67% specific in myopathic disorders. The metabolic myopathies were commonly missed by electromyography.
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Affiliation(s)
- Partha S Ghosh
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
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Karakis I, Liew W, Darras BT, Jones HR, Kang PB. Referral and diagnostic trends in pediatric electromyography in the molecular era. Muscle Nerve 2014; 50:244-9. [DOI: 10.1002/mus.24152] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 12/11/2013] [Accepted: 12/18/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Ioannis Karakis
- Department of Neurology; Boston Children's Hospital, Harvard Medical School; 300 Longwood Avenue Boston Massachusetts 02115 USA
- Department of Neurology; Lahey Clinic Burlington Massachusetts USA
- Department of Neurology; Emory University School of Medicine; Atlanta Georgia USA
| | - Wendy Liew
- Department of Neurology; Boston Children's Hospital, Harvard Medical School; 300 Longwood Avenue Boston Massachusetts 02115 USA
| | - Basil T. Darras
- Department of Neurology; Boston Children's Hospital, Harvard Medical School; 300 Longwood Avenue Boston Massachusetts 02115 USA
| | - H. Royden Jones
- Department of Neurology; Boston Children's Hospital, Harvard Medical School; 300 Longwood Avenue Boston Massachusetts 02115 USA
- Department of Neurology; Lahey Clinic Burlington Massachusetts USA
| | - Peter B. Kang
- Department of Neurology; Boston Children's Hospital, Harvard Medical School; 300 Longwood Avenue Boston Massachusetts 02115 USA
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14
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Haliloglu G, Topaloglu H. Arthrogryposis and fetal hypomobility syndrome. HANDBOOK OF CLINICAL NEUROLOGY 2013; 113:1311-9. [PMID: 23622356 DOI: 10.1016/b978-0-444-59565-2.00003-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Arthrogryposis is a heterogeneous condition, evident from birth, which can be defined as multiple contractures of the joints. The etiology is multifold: genetic disorders of the central or peripheral nervous system, or of the connective tissue leading to decreased fetal movements, and vascular and environmental causes. The problem begins in utero. There may be overlapping conditions between sporadic, syndromic, neurogenic, myopathic and metabolic types. The workup should include a family tree. Systemic involvement, for example of the renal and pulmonary systems, may be encountered in associated syndromes. Motor neuron disorders leading to the condition are the most commonly seen type. Fetal or neonatal akinesia/hypokinesia is at the severe end of the spectrum, in which there is literally intrauterine limitation of movement. Children with amyplasia are born with little or diminished muscle bulk of the extremities. Distal arthrogryposis is almost always a dominantly inherited condition. A multidisciplinary care approach is required in order to provide optimum healthcare. The management team should include a nutritionist and a physiotherapist. Genetic counseling is possible in most instances. A truly genetic cause can be identified in more than 50% of cases. Survivors, though handicapped, can lead near normal lives.
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Affiliation(s)
- Goknur Haliloglu
- Department of Pediatric Neurology, Hacettepe University Children's Hospital, Ankara, Turkey
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15
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Gaitanis JN, McMillan HJ, Wu A, Darras BT. Electrophysiologic evidence for anterior horn cell disease in amyoplasia. Pediatr Neurol 2010; 43:142-7. [PMID: 20610128 DOI: 10.1016/j.pediatrneurol.2010.03.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Revised: 02/01/2010] [Accepted: 03/29/2010] [Indexed: 10/19/2022]
Abstract
Amyoplasia is the most common subtype of arthrogryposis multiplex congenita. Children exhibit congenital muscle aplasia or hypoplasia, resulting in symmetric limb contractures that occur in a characteristic pattern. A high incidence of midforehead capillary hemangiomas, micrognathia, and minor genital anomalies also occurs with this disorder. The etiology and specific site of injury in amyoplasia remain unclear. Previous muscle biopsy and electrophysiologic studies could not differentiate between neurogenic or myogenic causes. We describe five children with amyoplasia. Four children demonstrated electrophysiologic features consistent with motor neuronopathy. A careful segmental needle electromyography study revealed variable involvement at different myotomes. We hypothesize that the anterior horn cell may represent the site of disease in a subset of children with amyoplasia.
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Affiliation(s)
- John N Gaitanis
- Department of Neurology, Hasbro Children's Hospital, Brown Medical School, Providence, Rhode Island, USA
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16
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Yis U, Kurul SH, Oztura I, Ozden O, Akinci G, Dirik E. Temporary diazepam responsive apneic attacks and congenital myasthenic syndrome. J Child Neurol 2009; 24:895-8. [PMID: 19289695 DOI: 10.1177/0883073808331083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Congenital myasthenic syndromes are a genetically and phenotypically heterogeneous group of hereditary disorders affecting neuromuscular junction. Mutations in the gene encoding choline acetyltransferase cause presynaptic defects. The missense mutation I336T has been identified in Turkish population, and most of the cases carrying this mutation present with exercise-induced fatigability and ptosis. Although apneic attacks occur in these cases during febrile illness in childhood, the number of reported respiratory distress episodes during infancy is scarce. Another important feature of these cases is that response to esterase inhibitors is satisfactory. We present a case of congenital myasthenic syndrome with I336T choline acetyltransferase mutation who presented with numerous attacks of respiratory distress in the infancy period. Interestingly, the patient had myopathic findings on electromyography and diazepam decreased severity of apneic attacks. There was also no improvement with esterase inhibitors.
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Affiliation(s)
- Uluç Yis
- Division of Child Neurology, Gaziantep Children's Hospital, Gaziantep, Turkey.
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17
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Laugel V, Cossée M, Matis J, de Saint-Martin A, Echaniz-Laguna A, Mandel JL, Astruc D, Fischbach M, Messer J. Diagnostic approach to neonatal hypotonia: retrospective study on 144 neonates. Eur J Pediatr 2008; 167:517-23. [PMID: 17641914 DOI: 10.1007/s00431-007-0539-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Revised: 05/22/2007] [Accepted: 05/29/2007] [Indexed: 10/23/2022]
Abstract
The objectives of our study were to determine the actual frequency of the different disorders causing neonatal hypotonia and to assess the reliability of the first physical examination as well as the contribution of the main standard diagnostic tests. One hundred and forty-four infants diagnosed with neonatal hypotonia between January 1st 1999 and June 30th 2005 in our tertiary care facility were retrospectively included in the study. Perinatal history, clinical type of hypotonia, results of standard diagnostic tests, final diagnosis and outcome were abstracted from the original charts. A final diagnosis was reached in 120 cases. Central (cerebral) causes represented 82% of the elucidated cases, mostly hypoxic and hemorrhagic lesions of the brain (34%), chromosomal aberrations and syndromic disorders (26%) and brain malformations (12%). Peripheral (neuromuscular) causes were mainly represented by spinal muscular atrophy (6%) and myotonic dystrophy (4%). Positive predictive value of the initial clinical examination was higher in central type hypotonia. Neuroimaging, karyotype analysis and DNA-based tests were the most helpful diagnostic tools. These recent clinical data can be used to improve our strategy in investigating neonatal hypotonia and a diagnostic algorithm is proposed based on our findings.
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Affiliation(s)
- Vincent Laugel
- Department of Pediatrics, Strasbourg University Hospital, Strasbourg Cedex, France.
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18
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Abstract
Reports show wide variability of electromyography (EMG) in detecting pediatric neuromuscular disorders. The study's aim was to determine EMG/nerve conduction study accuracy compared to muscle biopsy and final clinical diagnosis, and sensitivity for myopathic motor unit potential detection in childhood. Of 550 EMG/nerve conduction studies performed by the same examiner from a pediatric neuromuscular service, 27 children (ages 6 days to 16 years [10 boys; M:F, 1:1.7]) with muscle biopsies and final clinical diagnoses were compared retrospectively. Final clinical diagnoses were congenital myopathies (5 of 27,18%), nonspecific myopathies (biopsy myopathic, final diagnosis uncertain; 6 of 27, 22%), congenital myasthenic syndrome (3 of 27, 11%), juvenile myasthenia gravis (1 of 27, 4%), arthrogryposis multiplex congenita (2 of 27, 7%), hereditary motor and sensory neuropathy (1 of 27, 4%), bilateral peroneal neuropathies (1 of 27, 4%), and normal (8 of 27, 30%). There were no muscular dystrophy or spinal muscular atrophy patients. EMG/nerve conduction studies had a 74% agreement with final clinical diagnoses and 100% agreement in neurogenic, neuromuscular junction, and normal categories. Muscle biopsies concurred with final diagnoses in 87%, and 100% in myopathic and normal categories. In congenital myasthenic syndrome, muscle biopsies showed mild variation in fiber size in 2 of 3 children and were normal in 1 of 3. EMG sensitivity for detecting myopathic motor unit potentials in myopathies was 4 of 11 (36%), greater over 2 years of age (3 of 4, 75%), compared to infants less than 2 years (1 of 7, 14%), not statistically significant (P = .0879). EMGs false-negative for myopathy in infants < 2 years of age were frequently neurogenic (3 of 6, 50%). In congenital myopathies EMG detected myopathic motor unit potentials in 40%, with false-negative results neurogenic (20%) or normal (40%). Because our study has no additional tests for active myopathies, for example Duchenne muscular dystrophy genetic testing, our sensitivity for myopathies is lower than if we used a more global view. In conclusion, EMG detection rate of myopathic motor unit potentials at a young age was low, improving in children over 2 years of age. In neurogenic and neuromuscular junction disorders, the EMG has a very high detection rate. In children with mild to moderate neurogenic EMG findings and normal nerve conduction, a myopathy should always be considered.
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Affiliation(s)
- Malcolm Rabie
- Neuropediatric Unit, Hadassah Hebrew University Medical Center, Mount Scopus, Jerusalem 91240, Israel
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19
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Yamada N, Nagai T, Shikura K, Nonaka I. Benign infantile neurogenic muscle atrophy predominantly involving the upper extremities. Brain Dev 2006; 28:339-41. [PMID: 16376048 DOI: 10.1016/j.braindev.2005.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2005] [Revised: 09/28/2005] [Accepted: 10/14/2005] [Indexed: 11/21/2022]
Abstract
An eight year-old girl was first noted to be hypotonic at 4 months of age. She had a delay in achieving developmental milestones and showed apparent weakness predominantly affecting muscles of the upper extremities. In the left biceps brachii muscle biopsy at the age of 5 months, there were groups of atrophic fibers and marked fiber type grouping, but intramuscular nerves were well myelinated and there were few type 2C fibers. She improved with age and learned to walk at 1 year and 4 months and had minimal weakness of the forearm muscles and mild atrophy of the muscles of the right upper extremity. She recently developed a mild scoliosis. Since the EMG was not neurogenic and no mutations were found in the survival motor neuron (SMN) gene, we believe that she does not have a degenerative neurogenic disorder but rather has an abnormal innervation of the skeletal muscles due either to anterior horn cell dysgenesis or anomalous peripheral nerve branching.
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Affiliation(s)
- Naoto Yamada
- Department of Pediatrics, Ryokuseikai-Seiikuen Hospital for Severe Motor and Intellectual Disabilities, 2-35-1 Ogawanishi-machi, Kodaira, Tokyo 187-8585, Japan.
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20
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Kim ES, Jung KE, Kim SD, Kim EK, Chae JH, Kim HS, Park JD, Kim KJ, Kim BI, Hwang YS, Choi JH. Diagnostic classification and clinical aspects of floppy infants in the neonatal and pediatric intensive care units. KOREAN JOURNAL OF PEDIATRICS 2006. [DOI: 10.3345/kjp.2006.49.11.1158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Eun Sun Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Eun Jung
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Duk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Eo Kyung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Hee Chae
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Han Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - June Dong Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ki Joong Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Beyong Il Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Seung Hwang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Hwan Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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21
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Henningsen CG, Smith SL. Arthrogryposis Multiplex Congenita. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2005. [DOI: 10.1177/8756479305282917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Arthrogryposis multiplex congenita (AMC) is a disorder that encompasses a range of severity of congenital joint contractures from mild to severe. The etiologies of this condition are numerous but can generally be classified into endogenous and exogenous factors. Endogenous factors are related to those conditions that originate within the fetus and can further be classified into central nervous system disorders, musculoskeletal abnormalities, and abnormalities of the joints and connective tissues. The sonographic presentation of AMC includes decreased or absent fetal movement with contractures of multiple extremities. Treatment and medical management of AMC depends on the severity of the contractures and the absence or presence of associated syndromes. Accurate diagnosis of AMC allows for accurate prenatal counseling regarding future morbidity and mortality of the fetus and includes options regarding treatment, medical management, and pregnancy termination depending on the severity of the condition.
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Affiliation(s)
| | - Sarah L. Smith
- Florida Hospital College of Health Sciences, Orlando, FL
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22
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Dipti S, Childs AM, Livingston JH, Aggarwal AK, Miller M, Williams C, Crow YJ. Brown-Vialetto-Van Laere syndrome; variability in age at onset and disease progression highlighting the phenotypic overlap with Fazio-Londe disease. Brain Dev 2005; 27:443-6. [PMID: 16122634 DOI: 10.1016/j.braindev.2004.10.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2004] [Revised: 10/01/2004] [Accepted: 10/14/2004] [Indexed: 10/26/2022]
Abstract
We report four siblings showing features of a pontobulbar palsy, a mixed spinal and upper motor neuropathy and variable deafness. The observation of affected males and females born to consanguineous first cousin parents suggests autosomal recessive inheritance. Two children presented in the first 16 months of life with stridor and died of respiratory failure by the age of 2 years. Hearing loss was not apparent in these infants. In contrast, 2 further siblings developed a bulbar palsy in their sixth year followed by the onset of deafness and features of an anterior horn neuropathy with corticospinal tract involvement. They exhibited a relatively slow but relentless decline over a period of several years. These cases highlight the phenotypic overlap of Brown-Vialetto-Van Laere syndrome with Fazio-Londe disease. Rather than representing two separate disorders, our findings suggest the possibility of a single disease entity which may usefully be considered a form of juvenile amyotrophic lateral sclerosis.
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