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Posa A, Kornhuber M. [EMG phenomena of myogenic hyperexcitability]. DER NERVENARZT 2024; 95:553-559. [PMID: 38193935 PMCID: PMC11178624 DOI: 10.1007/s00115-023-01597-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 01/10/2024]
Abstract
The type, distribution pattern and time course of spontaneous muscular activity are important for the diagnostics of neuromuscular diseases in the clinical practice. In neurogenic lesions with motor axonal involvement, pathologic spontaneous activity (PSA) is usually reliably detectable by needle electromyography (EMG) 2-4 weeks after occurrence of the lesion. The distribution pattern correlates with the lesion location. The focus of the present work is the description of the different forms of PSA in myogenic diseases.
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Affiliation(s)
- Andreas Posa
- Universitätsklinik für Neurologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.
| | - Malte Kornhuber
- Universitätsklinik für Neurologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
- Klinik für Neurologie, Helios Klinik Sangerhausen, Sangerhausen, Deutschland
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2
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Aburahma SK, Rousan LA, Shboul M, Biella F, Lucchiari S, Comi GP, Meola G, Pagliarani S. Case report: Dihydropyridine receptor ( CACNA1S) congenital myopathy, a novel phenotype with early onset periodic paralysis. Front Neurol 2024; 15:1359479. [PMID: 38426167 PMCID: PMC10902085 DOI: 10.3389/fneur.2024.1359479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction CACNA1S related congenital myopathy is an emerging recently described entity. In this report we describe 2 sisters with mutations in the CACNA1S gene and the novel phenotype of congenital myopathy and infantile onset episodic weakness. Clinical description Both sisters had neonatal onset hypotonia, muscle weakness, and delayed walking. Episodic weakness started in infancy and continued thereafter, provoked mostly by cold exposure. Muscle imaging revealed fat replacement of gluteus maximus muscles. Next generation sequencing found the missense p.Cys944Tyr variant and the novel splicing variant c.3526-2A>G in CACNA1S. Minigene assay revealed the splicing variant caused skipping of exon 28 from the transcript, potentially affecting protein folding and/or voltage dependent activation. Conclusion This novel phenotype supports the notion that there are age related differences in the clinical expression of CACNA1S gene mutations. This expands our understanding of mutations located in regions of the CACNA1S outside the highly conserved S4 segment, where most mutations thus far have been identified.
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Affiliation(s)
- Samah K. Aburahma
- Department of Pediatrics, Jordan University of Science and Technology, Irbid, Jordan
| | - Liqa A. Rousan
- Department of Radiology, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Shboul
- Department of Laboratory Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Fabio Biella
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sabrina Lucchiari
- Neuroscience Section, Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Milan, Italy
| | - Giacomo Pietro Comi
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Neuroscience Section, Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), University of Milan, Milan, Italy
| | - Giovanni Meola
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Serena Pagliarani
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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3
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Trivedi JR. Muscle Channelopathies. Continuum (Minneap Minn) 2022; 28:1778-1799. [PMID: 36537980 DOI: 10.1212/con.0000000000001183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW This article describes the clinical features, diagnosis, pathophysiology, and management of nondystrophic myotonia and periodic paralysis. RECENT FINDINGS An increasing awareness exists about the genotype-phenotype overlap in skeletal muscle channelopathies, and thus genetic testing is needed to make a definitive diagnosis. Electrodiagnostic testing in channelopathies is highly specialized with significant overlap in various mutation subtypes. Randomized clinical trials have now been conducted in these disorders with expanded treatment options for patients with muscle channelopathies. SUMMARY Skeletal muscle channelopathies are rare heterogeneous conditions characterized by lifelong symptoms that require a comprehensive management plan that includes pharmacologic and nonpharmacologic interventions. The significant variability in biophysical features of various mutations, coupled with the difficulties of performing clinical trials in rare diseases, makes it challenging to design and implement treatment trials for muscle channelopathies.
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Stunnenberg BC, LoRusso S, Arnold WD, Barohn RJ, Cannon SC, Fontaine B, Griggs RC, Hanna MG, Matthews E, Meola G, Sansone VA, Trivedi JR, van Engelen BG, Vicart S, Statland JM. Guidelines on clinical presentation and management of nondystrophic myotonias. Muscle Nerve 2020; 62:430-444. [PMID: 32270509 PMCID: PMC8117169 DOI: 10.1002/mus.26887] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/01/2020] [Accepted: 04/04/2020] [Indexed: 12/26/2022]
Abstract
The nondystrophic myotonias are rare muscle hyperexcitability disorders caused by gain-of-function mutations in the SCN4A gene or loss-of-function mutations in the CLCN1 gene. Clinically, they are characterized by myotonia, defined as delayed muscle relaxation after voluntary contraction, which leads to symptoms of muscle stiffness, pain, fatigue, and weakness. Diagnosis is based on history and examination findings, the presence of electrical myotonia on electromyography, and genetic confirmation. In the absence of genetic confirmation, the diagnosis is supported by detailed electrophysiological testing, exclusion of other related disorders, and analysis of a variant of uncertain significance if present. Symptomatic treatment with a sodium channel blocker, such as mexiletine, is usually the first step in management, as well as educating patients about potential anesthetic complications.
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Affiliation(s)
- Bas C. Stunnenberg
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Samantha LoRusso
- Department of Neurology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - W. David Arnold
- Department of Neurology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Richard J. Barohn
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
| | - Stephen C. Cannon
- Department of Physiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Bertrand Fontaine
- Assistance Publique-Hôpitaix de Paris, Sorbonne Université, INSERM, Service of Neuro-Myology and UMR 974, Institute of Myology, University Hospital Pitié-Salpêtrière, Paris, France
| | - Robert C. Griggs
- Department of Neurology, University of Rochester, Rochester, New York
| | - Michael G. Hanna
- MRC Centre for Neuromuscular Diseases, Department of Neuromuscular diseases, UCL Queen Square Institute of Neurology, United Kingdom
| | - Emma Matthews
- MRC Centre for Neuromuscular Diseases, Department of Neuromuscular diseases, UCL Queen Square Institute of Neurology, United Kingdom
| | - Giovanni Meola
- Department of Neurorehabilitation Sciences, Casa Cura Policlinico, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Valeria A. Sansone
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Neurorehabilitation Unit, University of Milan, NEuroMuscular Omnicentre (NEMO), Fondazione Serena Onlus, Milan, Italy
| | - Jaya R. Trivedi
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, Texas
| | | | - Savine Vicart
- Assistance Publique-Hôpitaix de Paris, Sorbonne Université, INSERM, Service of Neuro-Myology and UMR 974, Institute of Myology, University Hospital Pitié-Salpêtrière, Paris, France
| | - Jeffrey M. Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
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Bourque PR, Breiner A, Warman-Chardon J. Myofibrillar Myopathy Mimicking Polyneuropathy. Case Rep Neurol 2020; 12:97-102. [PMID: 32647524 PMCID: PMC7325212 DOI: 10.1159/000506193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 01/26/2020] [Indexed: 11/19/2022] Open
Abstract
A 76-year-old man with a 5-year history of gait difficulties was suspected to have length-dependent sensorimotor polyneuropathy. Electrodiagnostic results pointed to a foot drop of neurogenic etiology, except for the prominence of myotonic discharges on needle EMG. Tests for acquired and genetic causes of polyneuropathy were unrevealing. The patient's first-degree cousin, with a much different clinical phenotype had been diagnosed with myofibrillar myopathy. Our patient was eventually found to carry the same myotilin c.179C>T p.Ser60Phe mutation. Muscle MRI was helpful in delineating clinically unsuspected involvement of paraspinal and pelvi-femoral muscles, as well as showing marked myopathic fatty infiltration of distal leg muscles. The association of neuropathy and myopathy is a recognized feature of myofibrillar myopathy. In some patients with unexplained foot drop, whole-body muscle MRI and a dedicated genetic mutation testing strategy may help reveal a diagnosis of genetic myopathy.
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Affiliation(s)
- Pierre R Bourque
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ari Breiner
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jodi Warman-Chardon
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Nicolau S, Liewluck T, Milone M. Myopathies with finger flexor weakness: Not only inclusion-body myositis. Muscle Nerve 2020; 62:445-454. [PMID: 32478919 DOI: 10.1002/mus.26914] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/29/2020] [Accepted: 05/03/2020] [Indexed: 12/11/2022]
Abstract
Muscle disorders are characterized by differential involvement of various muscle groups. Among these, weakness predominantly affecting finger flexors is an uncommon pattern, most frequently found in sporadic inclusion-body myositis. This finding is particularly significant when the full range of histopathological findings of inclusion-body myositis is not found on muscle biopsy. Prominent finger flexor weakness, however, is also observed in other myopathies. It occurs commonly in myotonic dystrophy types 1 and 2. In addition, individual reports and small case series have documented finger flexor weakness in sarcoid and amyloid myopathy, and in inherited myopathies caused by ACTA1, CRYAB, DMD, DYSF, FLNC, GAA, GNE, HNRNPDL, LAMA2, MYH7, and VCP mutations. Therefore, the finding of finger flexor weakness requires consideration of clinical, myopathological, genetic, electrodiagnostic, and sometimes muscle imaging findings to establish a diagnosis.
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Affiliation(s)
- Stefan Nicolau
- Department of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, Minnesota, 55905, USA
| | - Teerin Liewluck
- Department of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, Minnesota, 55905, USA
| | - Margherita Milone
- Department of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, Minnesota, 55905, USA
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8
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Milone M, Liewluck T. The unfolding spectrum of inherited distal myopathies. Muscle Nerve 2018; 59:283-294. [PMID: 30171629 DOI: 10.1002/mus.26332] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/26/2018] [Accepted: 08/28/2018] [Indexed: 12/30/2022]
Abstract
Distal myopathies are a group of rare muscle diseases characterized by distal weakness at onset. Although acquired myopathies can occasionally present with distal weakness, the majority of distal myopathies have a genetic etiology. Their age of onset varies from early-childhood to late-adulthood while the predominant muscle weakness can affect calf, ankle dorsiflexor, or distal upper limb muscles. A spectrum of muscle pathological changes, varying from nonspecific myopathic changes to rimmed vacuoles to myofibrillar pathology to nuclei centralization, have been noted. Likewise, the underlying molecular defect is heterogeneous. In addition, there is emerging evidence that distal myopathies can result from defective proteins encoded by genes causative of neurogenic disorders, be manifestation of multisystem proteinopathies or the result of the altered interplay between different genes. In this review, we provide an overview on the clinical, electrophysiological, pathological, and molecular aspects of distal myopathies, focusing on the most recent developments in the field. Muscle Nerve 59:283-294, 2019.
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Affiliation(s)
| | - Teerin Liewluck
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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9
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Abstract
Skeletal muscle channelopathies are rare heterogeneous diseases with marked genotypic and phenotypic variability. These disorders cause lifetime disability and impact quality of life. Despite advances in understanding of the molecular pathology of these disorders, the diverse phenotypic manifestations remain a challenge in diagnosis, therapeutic, genetic counseling, and research planning. Electrodiagnostic testing is useful in directing the diagnosis, but has several limitations: patient discomfort, time consuming, and significant overlap of findings in muscle channelopathies. Although genetic testing is the gold standard in making a definitive diagnosis, a mutation might not be identified in many patients with a well-supported clinical diagnosis of periodic paralysis. In the recent past, there have been landmark clinical trials in non-dystrophic myotonia and periodic paralysis which are encouraging as they demonstrate the ability of robust clinical research consortia to conduct well-controlled trials of rare diseases.
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Affiliation(s)
- Lauren Phillips
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas, 75390, USA
| | - Jaya R Trivedi
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas, 75390, USA.
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Bugiardini E, Morrow JM, Shah S, Wood CL, Lynch DS, Pitmann AM, Reilly MM, Houlden H, Matthews E, Parton M, Hanna MG, Straub V, Yousry TA. The Diagnostic Value of MRI Pattern Recognition in Distal Myopathies. Front Neurol 2018; 9:456. [PMID: 29997562 PMCID: PMC6028608 DOI: 10.3389/fneur.2018.00456] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 05/29/2018] [Indexed: 12/14/2022] Open
Abstract
Objective: Distal myopathies are a diagnostically challenging group of diseases. We wanted to understand the value of MRI in the current clinical setting and explore the potential for optimizing its clinical application. Methods: We retrospectively audited the diagnostic workup in a distal myopathy patient cohort, reassessing the diagnosis, whilst documenting the usage of MRI. We established a literature based distal myopathies MRI pattern template and assessed its diagnostic utility in terms of sensitivity, specificity, and potential impact on the diagnostic workup. Results: Fifty-five patients were included; in 38 with a comprehensive set of data the diagnostic work-up was audited. The median time from symptoms onset to diagnosis was 12.1 years. The initial genetic diagnostic rate was 39%; 18% were misdiagnosed as neuropathies and 13% as inclusion body myositis (IBM). Based on 21 publications we established a MRI pattern template. Its overall sensitivity (50%) and specificity (32%) were low. However in some diseases (e.g., MYOT-related myopathy, TTN-HMERF) MRI correctly identified the causative gene. The number of genes suggested by MRI pattern analysis was smaller compared to clinical work up (median 1 vs. 9, p < 0.0001) but fewer genes were correctly predicted (5/10 vs. 7/10). MRI analysis ruled out IBM in all cases. Conclusion: In the diagnostic work-up of distal myopathies, MRI is useful in assisting genetic testing and avoiding misdiagnosis (IBM). The overall low sensitivity and specificity limits its generalized use when traditional single gene test methods are applied. However, in the context of next generation sequencing MRI may represent a valuable tool for interpreting complex genetic results.
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Affiliation(s)
- Enrico Bugiardini
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Jasper M. Morrow
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Sachit Shah
- Neuroradiological Academic Unit, UCL Institute of Neurology, London, United Kingdom
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Claire L. Wood
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle upon Tyne, United Kingdom
| | - David S. Lynch
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, United Kingdom
| | - Alan M. Pitmann
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, United Kingdom
| | - Mary M. Reilly
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, United Kingdom
| | - Henry Houlden
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, United Kingdom
| | - Emma Matthews
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Matt Parton
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Michael G. Hanna
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, United Kingdom
| | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle upon Tyne, United Kingdom
| | - Tarek A. Yousry
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom
- Neuroradiological Academic Unit, UCL Institute of Neurology, London, United Kingdom
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
- *Correspondence: Tarek A. Yousry
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Nojszewska M, Gawel M, Szmidt-Salkowska E, Kostera-Pruszczyk A, Potulska-Chromik A, Lusakowska A, Kierdaszuk B, Lipowska M, Macias A, Gawel D, Seroka A, Kaminska AM. Abnormal spontaneous activity in primary myopathic disorders. Muscle Nerve 2016; 56:427-432. [PMID: 28000226 DOI: 10.1002/mus.25521] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 12/08/2016] [Accepted: 12/14/2016] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Reproducible non-insertional spontaneous activity (SA), with the exception of endplate activity, is an unequivocal sign of abnormality and is one of the most useful findings obtained on electromyography. METHODS In this retrospective study we analyzed occurrence and distribution of abnormal SA in 151 patients with genetically confirmed myopathies. RESULTS Complex repetitive discharges (CRDs) occurred more frequently than fibrillation potentials (fibs) and positive sharp waves (PSWs) in centronuclear myopathy (CNM) and limb-girdle muscular dystrophy type 2A (LGMD-2A), whereas fibs/PSWs were observed more often in desminopathy and facioscapulohumeral dystrophy (FSHD). Abnormal SA was commonly found in CNM (66.7%) and desminopathy (61.5%), occasionally in Duchenne (DMD) and Becker muscular dystrophy (BMD) (45.2% and 27.6%, respectively), but rarely in FSHD (14.9%) and LGMD-2A (12.0%). CONCLUSIONS Abnormal SA probably occurs more frequently in disorders associated with structural changes in muscle fibers. Screening for SA may be a valuable tool for diagnosis of non-myotonic myopathies. Muscle Nerve 56: 427-432, 2017.
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Affiliation(s)
- Monika Nojszewska
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Malgorzata Gawel
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | | | | | | | - Anna Lusakowska
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Biruta Kierdaszuk
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Marta Lipowska
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Anna Macias
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Damian Gawel
- Department of Biochemistry and Molecular Biology, Centre of Postgraduate Medical Education, Marymoncka Strasse 99/103, 01-813, Warsaw, Poland
| | - Andrzej Seroka
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Anna M Kaminska
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
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Zheng J, Chen S, Chen Y, Zhu M, Hong D. A novel mutation in the PDZ-like motif of ZASP causes distal ZASP-related myofibrillar myopathy. Neuropathology 2016; 37:45-51. [PMID: 27546599 DOI: 10.1111/neup.12328] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/03/2016] [Accepted: 07/05/2016] [Indexed: 12/11/2022]
Abstract
Mutations in the LDB3 gene have been identified in patients with Z-disc-associated, alternatively spliced, PDZ motif-containing protein (ZASP)-related myofibrillar myopathy (ZASP-MFM) characterized by late-onset distal myopathy with signs of cardiomyopathy and neuropathy. We describe an autosomal dominant inherited pedigree with ZASP-MFM that is in line with the typical phenotype of distal myopathy without cardiomyopathy and neuropathy, while mild asymmetrical muscle atrophy can be observed in some affected members. Muscle MRI revealed considerable fatty degeneration involved in the posterior compartment of thigh and lower leg, but relatively preserved in rectus femoris, sartorius, gracilis, adductor longus and biceps femoris breve muscles in the later stage. In addition, fatty infiltration of medial gastrocnemius muscle can be initiated as early as in the third decade in asymptomatic individuals. Myopathological features showed sarcoplasmic accumulation of multiple protein deposits and electron dense filamentous bundle aggregates. A novel heterozygous missense mutation (p.N155H) in a highly conserved PDZ-like motif of ZASP was identified. The results indicate that typical ZASP-MFM presenting with late-onset distal myopathy is commonly associated with mutations in PDZ-like motif of ZASP. The development of fatty degeneration is consistent with the typical pattern of ZASP-MFM, and the initial fatty infiltration might be started from medial gastrocnemius muscle. Our study expands the clinical and mutational spectrum of ZASP-MFM.
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Affiliation(s)
- Junjun Zheng
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shuyun Chen
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yunqing Chen
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Min Zhu
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Daojun Hong
- Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, China
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13
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Béhin A, Salort-Campana E, Wahbi K, Richard P, Carlier RY, Carlier P, Laforêt P, Stojkovic T, Maisonobe T, Verschueren A, Franques J, Attarian S, Maues de Paula A, Figarella-Branger D, Bécane HM, Nelson I, Duboc D, Bonne G, Vicart P, Udd B, Romero N, Pouget J, Eymard B. Myofibrillar myopathies: State of the art, present and future challenges. Rev Neurol (Paris) 2015; 171:715-29. [DOI: 10.1016/j.neurol.2015.06.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 05/11/2015] [Accepted: 06/02/2015] [Indexed: 12/18/2022]
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14
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Primary Hyperparathyroidism and Hyperthyroidism in a Patient with Myotonic Dystrophy: A Case Report and Review of the Literature. Case Rep Endocrinol 2015; 2015:735868. [PMID: 26175917 PMCID: PMC4484841 DOI: 10.1155/2015/735868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 05/19/2015] [Indexed: 11/17/2022] Open
Abstract
Various endocrine manifestations are commonly described in myotonic dystrophy (MD), including primary hypogonadism, diabetes mellitus, and thyroid and parathyroid dysfunction. We describe a 46-year-old woman with a family history of MD with her son. She was diagnosed with cardiac arrhythmia and required the implantation of a pacemaker. She was noted to have a bilateral cataract. She complained of muscle weakness, diffuse myalgia, and palpitation. The electromyography (EMG) showed myotonic discharges. Laboratory tests showed high serum calcium 2.83 mmol/L, serum phosphate 1.2 mmol/L, parathormone 362.5 pg/mL, thyroid stimulating hormone TSH 0.02 mIU/L (normal range: 0.34–5.6 mIU/L), FT4 21.17 ng/mL, and negative anti-thyroperoxidase antibodies. Cervical ultrasound revealed a multinodular goiter. The 99mTc-MIBI scintigraphy localized a lower right parathyroid adenoma. The clinical data, the family history of MD, EMG data, and endocrine disturbances were strongly suggestive of MD associated with hyperthyroidism and primary hyperparathyroidism.
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Müller TJ, Kraya T, Stoltenburg-Didinger G, Hanisch F, Kornhuber M, Stoevesandt D, Senderek J, Weis J, Baum P, Deschauer M, Zierz S. Phenotype of matrin-3-related distal myopathy in 16 German patients. Ann Neurol 2014; 76:669-80. [DOI: 10.1002/ana.24255] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 08/21/2014] [Accepted: 08/21/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Tobias J. Müller
- Department of Neurology; Martin Luther University of Halle-Wittenberg; Halle Germany
| | - Torsten Kraya
- Department of Neurology; Martin Luther University of Halle-Wittenberg; Halle Germany
| | - Gisela Stoltenburg-Didinger
- Department of Neurology; Martin Luther University of Halle-Wittenberg; Halle Germany
- Institute of Cell and Neurobiology; Charité University Medicine Berlin; Berlin Germany
| | - Frank Hanisch
- Department of Neurology; Martin Luther University of Halle-Wittenberg; Halle Germany
| | - Malte Kornhuber
- Department of Neurology; Martin Luther University of Halle-Wittenberg; Halle Germany
| | - Dietrich Stoevesandt
- Department of Diagnostic Radiology; Martin Luther University of Halle-Wittenberg; Halle Germany
| | - Jan Senderek
- Friedrich Bauer Institute; Ludwig Maximilian University of Munich; Munich Germany
| | - Joachim Weis
- Institute of Neuropathology; RWTH Aachen University Hospital; Aachen Germany
| | - Petra Baum
- Clinic and Polyclinic for Neurology; University of Leipzig; Leipzig Germany
| | - Marcus Deschauer
- Department of Neurology; Martin Luther University of Halle-Wittenberg; Halle Germany
| | - Stephan Zierz
- Department of Neurology; Martin Luther University of Halle-Wittenberg; Halle Germany
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Semmler AL, Sacconi S, Bach JE, Liebe C, Bürmann J, Kley RA, Ferbert A, Anderheiden R, Van den Bergh P, Martin JJ, De Jonghe P, Neuen-Jacob E, Müller O, Deschauer M, Bergmann M, Schröder JM, Vorgerd M, Schulz JB, Weis J, Kress W, Claeys KG. Unusual multisystemic involvement and a novel BAG3 mutation revealed by NGS screening in a large cohort of myofibrillar myopathies. Orphanet J Rare Dis 2014; 9:121. [PMID: 25208129 PMCID: PMC4347565 DOI: 10.1186/s13023-014-0121-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 07/21/2014] [Indexed: 12/14/2022] Open
Abstract
Background Myofibrillar myopathies (MFM) are a group of phenotypically and genetically heterogeneous neuromuscular disorders, which are characterized by protein aggregations in muscle fibres and can be associated with multisystemic involvement. Methods We screened a large cohort of 38 index patients with MFM for mutations in the nine thus far known causative genes using Sanger and next generation sequencing (NGS). We studied the clinical and histopathological characteristics in 38 index patients and five additional relatives (n = 43) and particularly focused on the associated multisystemic symptoms. Results We identified 14 heterozygous mutations (diagnostic yield of 37%), among them the novel p.Pro209Gln mutation in the BAG3 gene, which was associated with onset in adulthood, a mild phenotype and an axonal sensorimotor polyneuropathy, in the absence of giant axons at the nerve biopsy. We revealed several novel clinical phenotypes and unusual multisystemic presentations with previously described mutations: hearing impairment with a FLNC mutation, dysphonia with a mutation in DES and the first patient with a FLNC mutation presenting respiratory insufficiency as the initial symptom. Moreover, we described for the first time respiratory insufficiency occurring in a patient with the p.Gly154Ser mutation in CRYAB. Interestingly, we detected a polyneuropathy in 28% of the MFM patients, including a BAG3 and a MYOT case, and hearing impairment in 13%, including one patient with a FLNC mutation and two with mutations in the DES gene. In four index patients with a mutation in one of the MFM genes, typical histological findings were only identified at the ultrastructural level (29%). Conclusions We conclude that extraskeletal symptoms frequently occur in MFM, particularly cardiac and respiratory involvement, polyneuropathy and/or deafness. BAG3 mutations should be considered even in cases with a mild phenotype or an adult onset. We identified a genetic defect in one of the known genes in less than half of the MFM patients, indicating that more causative genes are still to be found. Next generation sequencing techniques should be helpful in achieving this aim.
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Affiliation(s)
- Anna-Lena Semmler
- Department of Neurology, RWTH Aachen University, Aachen, Germany. .,Institute of Neuropathology, RWTH Aachen University, Aachen, Germany.
| | - Sabrina Sacconi
- Centre de Référence des Maladies Neuromusculaires, Nice Hospital and UMR CNRS6543, Nice University, Nice, France.
| | - J Elisa Bach
- Department of Human Genetics, University of Würzburg, Würzburg, Germany.
| | - Claus Liebe
- Department of Neurology, RWTH Aachen University, Aachen, Germany. .,Institute of Neuropathology, RWTH Aachen University, Aachen, Germany.
| | - Jan Bürmann
- Department of Neurology, Saarland University, Homburg/Saar, Germany.
| | - Rudolf A Kley
- Department of Neurology, Neuromuscular Center Ruhrgebiet, University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.
| | | | | | - Peter Van den Bergh
- Department of Neurology, Neuromuscular Reference Center, University Hospital Saint-Luc, Brussel, Belgium.
| | | | - Peter De Jonghe
- Institute Born-Bunge, University of Antwerpen, Antwerpen, Belgium. .,Neurogenetics Group, VIB-Department of Molecular Genetics, University of Antwerpen, Antwerpen, Belgium. .,Department of Neurology, University Hospital of Antwerpen, Antwerpen, Belgium.
| | - Eva Neuen-Jacob
- Institute of Neuropathology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
| | - Oliver Müller
- Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, Germany. .,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg, Heidelberg, Germany.
| | - Marcus Deschauer
- Department of Neurology, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
| | - Markus Bergmann
- Institute of Neuropathology, Klinikum Bremen-Mitte, Bremen, Germany.
| | | | - Matthias Vorgerd
- Department of Neurology, Neuromuscular Center Ruhrgebiet, University Hospital Bergmannsheil, Ruhr-University Bochum, Bochum, Germany.
| | - Jörg B Schulz
- Department of Neurology, RWTH Aachen University, Aachen, Germany. .,JARA - Translational Brain Medicine, Jülich and Aachen, Germany.
| | - Joachim Weis
- Institute of Neuropathology, RWTH Aachen University, Aachen, Germany. .,JARA - Translational Brain Medicine, Jülich and Aachen, Germany.
| | - Wolfram Kress
- Department of Human Genetics, University of Würzburg, Würzburg, Germany.
| | - Kristl G Claeys
- Department of Neurology, RWTH Aachen University, Aachen, Germany. .,Institute of Neuropathology, RWTH Aachen University, Aachen, Germany. .,JARA - Translational Brain Medicine, Jülich and Aachen, Germany.
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Liewluck T, Milone M, Mauermann ML, Castro-Couch M, Cerhan JH, Murthy NS. A novel VCP
mutation underlies scapuloperoneal muscular dystrophy and dropped head syndrome featuring lobulated fibers. Muscle Nerve 2014; 50:295-9. [DOI: 10.1002/mus.24290] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2014] [Indexed: 12/23/2022]
Affiliation(s)
- Teerin Liewluck
- Department of Neurology; University of Colorado School of Medicine, Anschutz Medical Campus; 12631 East 17th Avenue Aurora Colorado USA
| | - Margherita Milone
- Department of Neurology; Mayo Clinic College of Medicine; Rochester Minnesota USA
| | | | - Melissa Castro-Couch
- Department of Psychiatry and Psychology; Mayo Clinic College of Medicine; Rochester Minnesota USA
| | - Jane H. Cerhan
- Department of Psychiatry and Psychology; Mayo Clinic College of Medicine; Rochester Minnesota USA
| | - Naveen S. Murthy
- Division of Musculoskeletal Radiology; Department of Radiology; Mayo Clinic College of Medicine; Rochester Minnesota USA
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Hanisch F, Kronenberger C, Zierz S, Kornhuber M. The significance of pathological spontaneous activity in various myopathies. Clin Neurophysiol 2014; 125:1485-90. [DOI: 10.1016/j.clinph.2013.11.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 11/23/2013] [Accepted: 11/25/2013] [Indexed: 10/26/2022]
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Dabby R, Sadeh M, Gilad R, Jurkat-Rott K, Lehmann-Horn F, Leshinsky-Silver E. Myotonia in DNM2-related centronuclear myopathy. J Neural Transm (Vienna) 2013; 121:549-53. [PMID: 24366529 DOI: 10.1007/s00702-013-1140-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 12/12/2013] [Indexed: 12/16/2022]
Abstract
Centronuclear myopathy (CNM) is a rare hereditary myopathy characterized by centrally located muscle fiber nuclei. Mutations in the dynamin 2 (DNM2) gene are estimated to account for about 50 % of CNM cases. Electromyographic recordings in CNM may show myopathic motor unit potentials without spontaneous activity at rest. Myotonic discharges, a distinctive electrical activity caused by membrane hyperexcitability, are characteristic of certain neuromuscular disorders. Such activity has been reported in only one CNM case without a known genetic cause. We sequenced the DNM2 gene and the genes associated with myotonia (CLCN1, SCN4A, DMPK and ZNF9) in a sporadic adult patient with CNM and myotonic discharges. Sequencing the entire coding region and exon-intron boundaries revealed a heterozygous c.1106g-a substitution in exon 8, resulting in a R369Q change in the DNM2. Sequencing the CLCN1, SCN4A, DMPK and ZNF9 genes ruled out mutations in these genes. This is the first report of DNM2-related CNM presenting with myotonia. The diagnosis of CNM should be considered in patients with myotonic discharges of an unknown cause.
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Affiliation(s)
- Ron Dabby
- Departments of Neurology, Edith Wolfson Medical Center, 58100, Holon, Israel,
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