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Trucco F, Lizio A, Roma E, di Bari A, Salmin F, Albamonte E, Casiraghi J, Pozzi S, Becchiati S, Antonaci L, Salvalaggio A, Catteruccia M, Tosi M, Marinella G, Danti FR, Bruschi F, Veneruso M, Parravicini S, Fiorillo C, Berardinelli A, Pini A, Moroni I, Astrea G, Battini R, D’Amico A, Ricci F, Pane M, Mercuri EM, Johnson NE, Sansone VA. Association between Reported Sleep Disorders and Behavioral Issues in Children with Myotonic Dystrophy Type 1-Results from a Retrospective Analysis in Italy. J Clin Med 2024; 13:5459. [PMID: 39336946 PMCID: PMC11432637 DOI: 10.3390/jcm13185459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 08/19/2024] [Accepted: 08/20/2024] [Indexed: 09/30/2024] Open
Abstract
Background: Sleep disorders have been poorly described in congenital (CDM) and childhood (ChDM) myotonic dystrophy despite being highly burdensome. The aims of this study were to explore sleep disorders in a cohort of Italian CDM and ChDM and to assess their association with motor and respiratory function and disease-specific cognitive and behavioral assessments. Methods: This was an observational multicenter study. Reported sleep quality was assessed using the Pediatric Daytime Sleepiness Scale (PDSS) and Pediatric Sleep Questionnaire (PSQ). Sleep quality was correlated to motor function (6 min walk test, 6MWT and grip strength; pulmonary function (predicted Forced Vital Capacity%, FVC% pred.); executive function assessed by BRIEF-2; autism traits assessed by Autism Spectrum Screening Questionnaire (ASSQ) and Repetitive Behavior Scale-revised (RBS-R); Quality of life (PedsQL) and disease burden (Congenital Childhood Myotonic Dystrophy Health Index, CCMDHI). Results: Forty-six patients were included, 33 CDM and 13 ChDM, at a median age of 10.4 and 15.1 years. Daytime sleepiness and disrupted sleep were reported by 30% children, in both subgroups of CDM and ChDM. Daytime sleepiness correlated with autism traits in CDM (p < 0.05). Disrupted sleep correlated with poorer executive function (p = 0.04) and higher disease burden (p = 0.03). Conclusions: Sleep issues are a feature of both CDM and ChDM. They correlate with behavioral issues and impact on disease burden.
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Affiliation(s)
- Federica Trucco
- The NeMO Clinical Center in Milan, 20162 Milan, Italy; (F.T.); (A.L.); (E.R.); (A.d.B.); (F.S.); (E.A.); (J.C.); (S.P.); (S.B.)
- Department of Neurorehabilitation, University of Milan, 20122 Milan, Italy
- Paediatric Neurology and Muscular Diseases Unit, Istituto di Ricovero e Cura a Carattere Scientifico Istituto Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, 16132 Genoa, Italy
| | - Andrea Lizio
- The NeMO Clinical Center in Milan, 20162 Milan, Italy; (F.T.); (A.L.); (E.R.); (A.d.B.); (F.S.); (E.A.); (J.C.); (S.P.); (S.B.)
| | - Elisabetta Roma
- The NeMO Clinical Center in Milan, 20162 Milan, Italy; (F.T.); (A.L.); (E.R.); (A.d.B.); (F.S.); (E.A.); (J.C.); (S.P.); (S.B.)
| | - Alessandra di Bari
- The NeMO Clinical Center in Milan, 20162 Milan, Italy; (F.T.); (A.L.); (E.R.); (A.d.B.); (F.S.); (E.A.); (J.C.); (S.P.); (S.B.)
| | - Francesca Salmin
- The NeMO Clinical Center in Milan, 20162 Milan, Italy; (F.T.); (A.L.); (E.R.); (A.d.B.); (F.S.); (E.A.); (J.C.); (S.P.); (S.B.)
| | - Emilio Albamonte
- The NeMO Clinical Center in Milan, 20162 Milan, Italy; (F.T.); (A.L.); (E.R.); (A.d.B.); (F.S.); (E.A.); (J.C.); (S.P.); (S.B.)
| | - Jacopo Casiraghi
- The NeMO Clinical Center in Milan, 20162 Milan, Italy; (F.T.); (A.L.); (E.R.); (A.d.B.); (F.S.); (E.A.); (J.C.); (S.P.); (S.B.)
| | - Susanna Pozzi
- The NeMO Clinical Center in Milan, 20162 Milan, Italy; (F.T.); (A.L.); (E.R.); (A.d.B.); (F.S.); (E.A.); (J.C.); (S.P.); (S.B.)
| | - Stefano Becchiati
- The NeMO Clinical Center in Milan, 20162 Milan, Italy; (F.T.); (A.L.); (E.R.); (A.d.B.); (F.S.); (E.A.); (J.C.); (S.P.); (S.B.)
| | - Laura Antonaci
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS Università Cattolica del Sacro Cuore, 00136 Roma, Italy; (L.A.); (M.P.); (E.M.M.)
| | - Anna Salvalaggio
- Department of Sciences of Public Health and Pediatrics, University of Turin, 10124 Turin, Italy; (A.S.); (F.R.)
| | - Michela Catteruccia
- UOS Malattie Muscolari e Neurodegenerative—Ospedale Pediatrico Bambino Gesù, 00165 Roma, Italy; (M.C.); (M.T.); (A.D.)
| | - Michele Tosi
- UOS Malattie Muscolari e Neurodegenerative—Ospedale Pediatrico Bambino Gesù, 00165 Roma, Italy; (M.C.); (M.T.); (A.D.)
| | - Gemma Marinella
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, 56128 Calambrone Pisa, Italy; (G.M.); (G.A.); (R.B.)
| | - Federica R. Danti
- Department of Pediatric Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (F.R.D.); (I.M.)
| | - Fabio Bruschi
- Department of Pediatric Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (F.R.D.); (I.M.)
| | - Marco Veneruso
- Unit of Child Neuropsychiatry, IRCCS Istituto Giannina Gaslini and DINOGMI, University of Genova, 16132 Genova, Italy; (M.V.); (C.F.)
| | - Stefano Parravicini
- Child and Adolescent Neuromuscular Disorders Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (S.P.); (A.B.)
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Chiara Fiorillo
- Unit of Child Neuropsychiatry, IRCCS Istituto Giannina Gaslini and DINOGMI, University of Genova, 16132 Genova, Italy; (M.V.); (C.F.)
| | - Angela Berardinelli
- Child and Adolescent Neuromuscular Disorders Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy; (S.P.); (A.B.)
| | - Antonella Pini
- Pediatric Neuromuscular Unit, UOC Neuropsichiatria dell’età Pediatrica, IRCCS Istituto delle Scienze Neurologiche di Bologna, 40139 Bologna, Italy;
| | - Isabella Moroni
- Department of Pediatric Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (F.R.D.); (I.M.)
| | - Guja Astrea
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, 56128 Calambrone Pisa, Italy; (G.M.); (G.A.); (R.B.)
| | - Roberta Battini
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, 56128 Calambrone Pisa, Italy; (G.M.); (G.A.); (R.B.)
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Adele D’Amico
- UOS Malattie Muscolari e Neurodegenerative—Ospedale Pediatrico Bambino Gesù, 00165 Roma, Italy; (M.C.); (M.T.); (A.D.)
| | - Federica Ricci
- Department of Sciences of Public Health and Pediatrics, University of Turin, 10124 Turin, Italy; (A.S.); (F.R.)
| | - Marika Pane
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS Università Cattolica del Sacro Cuore, 00136 Roma, Italy; (L.A.); (M.P.); (E.M.M.)
| | - Eugenio M. Mercuri
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS Università Cattolica del Sacro Cuore, 00136 Roma, Italy; (L.A.); (M.P.); (E.M.M.)
| | - Nicholas E. Johnson
- Department of Neurology, Virginia Commonwealth University, Richmond, VA 23298, USA;
| | - Valeria A. Sansone
- The NeMO Clinical Center in Milan, 20162 Milan, Italy; (F.T.); (A.L.); (E.R.); (A.d.B.); (F.S.); (E.A.); (J.C.); (S.P.); (S.B.)
- Department of Neurorehabilitation, University of Milan, 20122 Milan, Italy
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Seabury J, Varma A, Weinstein J, Rosero SJ, Engebrecht C, Khosa S, Zizzi C, Wagner ES, Alexandrou D, Cohen BL, Dilek N, Heatwole JM, Lynch DR, Park CC, Wells M, Subramony SH, Heatwole CR. Friedreich Ataxia Caregiver-Reported Health Index: Development of a Novel, Disease-Specific Caregiver-Reported Outcome Measure. Neurol Clin Pract 2024; 14:e200303. [PMID: 38751829 PMCID: PMC11092940 DOI: 10.1212/cpj.0000000000200300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 02/05/2024] [Indexed: 05/18/2024]
Abstract
Background and Objectives The Friedreich ataxia (FRDA) scientific community needs access to patient-centered outcome measures that satisfy regulatory guidelines and are capable of tracking clinically meaningful changes in FRDA disease burden. The objective of this research was to develop a novel, disease-specific caregiver-reported outcome measure for use in FRDA research and clinical care. Methods In prior work, we conducted qualitative interviews and a cross-sectional study of FRDA caregivers and patients to determine the symptoms of greatest importance to individuals with FRDA. We designed the Friedreich Ataxia Caregiver-Reported Health Index (FACR-HI) to serially measure the symptoms of greatest importance to patients and utilized factor analysis, beta testing, reliability testing, and cross-sectional subgroup analysis to further evaluate and optimize this disease-specific outcome measure. Results The FACR-HI was designed to measure total disease burden and disease burden in 18 symptomatic domains. The FACR-HI total score demonstrated high internal consistency (Cronbach's α = 0.98) and test-retest reliability (intraclass correlation coefficient = 0.96). Beta interview participants found the FACR-HI to be highly relevant, comprehensive, and easy to use. FACR-HI total and subscale scores were associated with functional staging for ataxia scores and speech impairment. Discussion Initial evaluation of the FACR-HI supports its content validity, test-retest reliability, and construct validity as a caregiver-reported outcome measure for assessing how pediatric individuals with FRDA feel and function. The FACR-HI provides a potential mechanism to quantify changes in multifactorial FRDA disease burden during future clinical trials.
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Affiliation(s)
- Jamison Seabury
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - Anika Varma
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - Jennifer Weinstein
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - Spencer J Rosero
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - Charlotte Engebrecht
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - Shaweta Khosa
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - Christine Zizzi
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - Ellen S Wagner
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - Danae Alexandrou
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - Brittany L Cohen
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - Nuran Dilek
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - John M Heatwole
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - David R Lynch
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - Courtney C Park
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - McKenzie Wells
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - S H Subramony
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
| | - Chad R Heatwole
- Center for Health + Technology (JS, AV, JW, SJR, CE, SK, CZ, ESW, BLC, CRH); Department of Neurology (CZ, ND, CRH), University of Rochester, NY; Loyola University Chicago Stritch School of Medicine (DA), Maywood, IL; Cornell University (JMH), Ithaca, NY; Department of Neurology (DRL); Children's Hospital of Philadelphia (CHOP) (CCP, MW), PA; and Department of Neurology (SHS), University of Florida College of Medicine, Gainsville
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Seabury J, Rosero S, Varma A, Weinstein J, Engebrecht C, Dilek N, Heatwole J, Alexandrou D, Cohen B, Larkindale J, Lynch DR, Park C, Subramony SH, Wagner E, Walther S, Wells M, Zizzi C, Heatwole C. Friedreich's Ataxia-Health Index: Development and Validation of a Novel Disease-Specific Patient-Reported Outcome Measure. Neurol Clin Pract 2023; 13:e200180. [PMID: 37646046 PMCID: PMC10462051 DOI: 10.1212/cpj.0000000000200180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 06/02/2023] [Indexed: 09/01/2023]
Abstract
Background and Objectives To develop a valid, disease-specific, patient-reported outcome (PRO) measure for adolescents and adults with Friedreich ataxia (FA) for use in therapeutic trials. Methods We conducted semistructured qualitative interviews and a national cross-sectional study of individuals with FA to determine the most prevalent and burdensome symptoms and symptomatic themes to this population. These symptoms and symptomatic themes were included as questions in the first version of the Friedreich's Ataxia-Health Index (FA-HI). We subsequently used factor analysis, beta interviews with 17 individuals with FA, and test-retest reliability assessments with 20 individuals with FA to evaluate, refine, and optimize the FA-HI. Finally, we determined the capability of the FA-HI to differentiate between subgroups of FA participants with varying levels of disease severity. Results Participants with FA identified 18 symptomatic themes of importance to be included as subscales in the FA-HI. The FA-HI demonstrates high internal consistency and test-retest reliability, and it was identified by participants as highly relevant, comprehensive, and easy to complete. FA-HI total and subscale scores statistically differentiated between subgroups of participants with varying levels of disease burden. Discussion Initial evaluation of the FA-HI supports its validity and reliability as a PRO for assessing how individuals with FA feel and function.
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Affiliation(s)
- Jamison Seabury
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - Spencer Rosero
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - Anika Varma
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - Jennifer Weinstein
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - Charlotte Engebrecht
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - Nuran Dilek
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - John Heatwole
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - Danae Alexandrou
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - Brittany Cohen
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - Jane Larkindale
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - David R Lynch
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - Courtney Park
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - Sub H Subramony
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - Ellen Wagner
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - Susan Walther
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - McKenzie Wells
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - Christine Zizzi
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
| | - Chad Heatwole
- Center for Health + Technology (CHeT) (JS, SR, AV, JW, CE, BC, EW, CZ, CH); Department of Neurology and Biostatistics (ND), University of Rochester; Pittsford Sutherland High School (JH), NY; Loyola University Chicago Stritch School of Medicine (DA), IL; PepGen Inc. (JL), Boston, MA; Children's Hospital of Philadelphia (CHOP) (DRL, CP, MW), PA; University of Florida College of Medicine (SHS), Gainesville; Friedreich's Ataxia Research Alliance (FARA) (SW), Downingtown, PA; and Department of Neurology (CH), University of Rochester, NY
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4
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Varma A, Weinstein J, Seabury J, Rosero S, Engebrecht C, Wagner E, Zizzi C, Luebbe EA, Dilek N, McDermott MP, Kissel J, Sansone V, Heatwole C. The Facioscapulohumeral Muscular Dystrophy-Health Index: Development and evaluation of a disease-specific outcome measure. Muscle Nerve 2023; 68:422-431. [PMID: 37610084 DOI: 10.1002/mus.27951] [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: 01/25/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION/AIMS As promising therapeutic interventions are tested among patients with facioscapulohumeral muscular dystrophy (FSHD), there is a clear need for valid and reliable outcome tools to track disease progression and therapeutic gain in clinical trials and for clinical monitoring. Our aim was to develop and validate the Facioscapulohumeral Muscular Dystrophy-Health Index (FSHD-HI) as a multifaceted patient-reported outcome measure (PRO) designed to measure disease burden in adults with FSHD. METHODS Through initial interviews with 20 individuals and a national cross-sectional study with 328 individuals with FSHD, we identified the most prevalent and impactful symptoms in FSHD. The most relevant symptoms were included in the FSHD-HI. We used patient interviews, test-retest reliability evaluation, known groups validity testing, and factor analysis to evaluate and optimize the FSHD-HI. RESULTS The FSHD-HI contains 14 subscales that measure FSHD disease burden from the patient's perspective. Fourteen adults with FSHD participated in semistructured beta interviews and found the FSHD-HI to be clear, usable, and relevant to them. Thirty-two adults with FSHD participated in test-retest reliability assessments, which demonstrated the high reliability of the FSHD-HI total score (intraclass correlation coefficient = 0.924). The final FSHD-HI and its subscales also demonstrated a high internal consistency (Cronbach α = 0.988). DISCUSSION The FSHD-HI provides researchers and clinicians with a reliable and valid mechanism to measure multifaceted disease burden in patients with FSHD. The FSHD-HI may facilitate quantification of therapeutic effectiveness, as demonstrated by its use as a secondary and exploratory measure in several clinical trials.
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Affiliation(s)
- Anika Varma
- Center for Health + Technology, University of Rochester, Rochester, New York, USA
| | - Jennifer Weinstein
- Center for Health + Technology, University of Rochester, Rochester, New York, USA
| | - Jamison Seabury
- Center for Health + Technology, University of Rochester, Rochester, New York, USA
| | - Spencer Rosero
- Center for Health + Technology, University of Rochester, Rochester, New York, USA
| | - Charlotte Engebrecht
- Center for Health + Technology, University of Rochester, Rochester, New York, USA
| | - Ellen Wagner
- Center for Health + Technology, University of Rochester, Rochester, New York, USA
| | - Christine Zizzi
- Center for Health + Technology, University of Rochester, Rochester, New York, USA
| | - Elizabeth A Luebbe
- Department of Neurology, University of Rochester, Rochester, New York, USA
| | - Nuran Dilek
- Department of Neurology, University of Rochester, Rochester, New York, USA
| | - Michael P McDermott
- Center for Health + Technology, University of Rochester, Rochester, New York, USA
- Department of Neurology, University of Rochester, Rochester, New York, USA
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - John Kissel
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Valeria Sansone
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- The NEMO Clinical Center, Milan, Italy
| | - Chad Heatwole
- Center for Health + Technology, University of Rochester, Rochester, New York, USA
- Department of Neurology, University of Rochester, Rochester, New York, USA
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5
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Thornton CA, Moxley RT, Eichinger K, Heatwole C, Mignon L, Arnold WD, Ashizawa T, Day JW, Dent G, Tanner MK, Duong T, Greene EP, Herbelin L, Johnson NE, King W, Kissel JT, Leung DG, Lott DJ, Norris DA, Pucillo EM, Schell W, Statland JM, Stinson N, Subramony SH, Xia S, Bishop KM, Bennett CF. Antisense oligonucleotide targeting DMPK in patients with myotonic dystrophy type 1: a multicentre, randomised, dose-escalation, placebo-controlled, phase 1/2a trial. Lancet Neurol 2023; 22:218-228. [PMID: 36804094 DOI: 10.1016/s1474-4422(23)00001-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 02/17/2023]
Abstract
BACKGROUND Myotonic dystrophy type 1 results from an RNA gain-of-function mutation, in which DM1 protein kinase (DMPK) transcripts carrying expanded trinucleotide repeats exert deleterious effects. Antisense oligonucleotides (ASOs) provide a promising approach to treatment of myotonic dystrophy type 1 because they reduce toxic RNA levels. We aimed to investigate the safety of baliforsen (ISIS 598769), an ASO targeting DMPK mRNA. METHODS In this dose-escalation phase 1/2a trial, adults aged 20-55 years with myotonic dystrophy type 1 were enrolled at seven tertiary referral centres in the USA and randomly assigned via an interactive web or phone response system to subcutaneous injections of baliforsen 100 mg, 200 mg, or 300 mg, or placebo (6:2 randomisation at each dose level), or to baliforsen 400 mg or 600 mg, or placebo (10:2 randomisation at each dose level), on days 1, 3, 5, 8, 15, 22, 29, and 36. Sponsor personnel directly involved with the trial, participants, and all study personnel were masked to treatment assignments. The primary outcome measure was safety in all participants who received at least one dose of study drug up to day 134. This trial is registered with ClinicalTrials.gov (NCT02312011), and is complete. FINDINGS Between Dec 12, 2014, and Feb 22, 2016, 49 participants were enrolled and randomly assigned to baliforsen 100 mg (n=7, one patient not dosed), 200 mg (n=6), 300 mg (n=6), 400 mg (n=10), 600 mg (n=10), or placebo (n=10). The safety population comprised 48 participants who received at least one dose of study drug. Treatment-emergent adverse events were reported for 36 (95%) of 38 participants assigned to baliforsen and nine (90%) of ten participants assigned to placebo. Aside from injection-site reactions, common treatment-emergent adverse events were headache (baliforsen: ten [26%] of 38 participants; placebo: four [40%] of ten participants), contusion (baliforsen: seven [18%] of 38; placebo: one [10%] of ten), and nausea (baliforsen: six [16%] of 38; placebo: two [20%] of ten). Most adverse events (baliforsen: 425 [86%] of 494; placebo: 62 [85%] of 73) were mild in severity. One participant (baliforsen 600 mg) developed transient thrombocytopenia considered potentially treatment related. Baliforsen concentrations in skeletal muscle increased with dose. INTERPRETATION Baliforsen was generally well tolerated. However, skeletal muscle drug concentrations were below levels predicted to achieve substantial target reduction. These results support the further investigation of ASOs as a therapeutic approach for myotonic dystrophy type 1, but suggest improved drug delivery to muscle is needed. FUNDING Ionis Pharmaceuticals, Biogen.
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Affiliation(s)
| | | | | | - Chad Heatwole
- Center for Health and Technology, University of Rochester, Rochester, NY, USA
| | - Laurence Mignon
- Translational Medicine, Ionis Pharmaceuticals, Carlsbad, CA, USA
| | - W David Arnold
- Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Tetsuo Ashizawa
- Neuroscience Research Program, Houston Methodist Research Institute, Houston, TX, USA
| | - John W Day
- Neuromuscular Medicine, Stanford University, Palo Alto, CA, USA
| | - Gersham Dent
- Neurodegeneration Development Unit, Biogen, Cambridge, MA, USA
| | | | - Tina Duong
- Neuromuscular Medicine, Stanford University, Palo Alto, CA, USA
| | - Ericka P Greene
- Neuromuscular Clinic, Houston Methodist Research Institute, Houston, TX, USA
| | - Laura Herbelin
- Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Wendy King
- Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John T Kissel
- Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Doris G Leung
- Center for Genetic Muscle Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Donovan J Lott
- Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Daniel A Norris
- Pharmacokinetics and Clinical Pharmacology, Ionis Pharmaceuticals, Carlsbad, CA, USA
| | | | - Wendy Schell
- Neuromuscular Clinic, Houston Methodist Research Institute, Houston, TX, USA
| | | | - Nikia Stinson
- Center for Genetic Muscle Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Sub H Subramony
- Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Shuting Xia
- Biometrics, Ionis Pharmaceuticals, Carlsbad, CA, USA
| | - Kathie M Bishop
- Clinical Development, Ionis Pharmaceuticals, Carlsbad, CA, USA
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6
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Oliwa A, Hocking C, Hamilton MJ, McLean J, Cumming S, Ballantyne B, Jampana R, Longman C, Monckton DG, Farrugia ME. Masseter muscle volume as a disease marker in adult-onset myotonic dystrophy type 1. Neuromuscul Disord 2022; 32:893-902. [PMID: 36207221 DOI: 10.1016/j.nmd.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/21/2022] [Accepted: 09/20/2022] [Indexed: 01/10/2023]
Abstract
The advent of clinical trials in myotonic dystrophy type 1 (DM1) necessitates the identification of reliable outcome measures to quantify different disease manifestations using minimal number of assessments. In this study, clinical correlations of mean masseter volume (mMV) were explored to evaluate its potential as a marker of muscle involvement in adult-onset DM1 patients. We utilised data from a preceding study, pertaining to 39 DM1 patients and 20 age-matched control participants. In this study participants had undergone MRI of the brain, completed various clinical outcome measures and had CTG repeats measured by small-pool PCR. Manual segmentation of masseter muscles was performed by a single rater to estimate mMV. The masseter muscle was atrophied in DM1 patients when compared to controls (p<0.001). Significant correlations were found between mMV and estimated progenitor allele length (p = 0.001), modal allele length (p = 0.003), disease duration (p = 0.009) and and the Muscle Impairment Rating Scale (p = 0.008). After correction for lean body mass, mMV was also inversely correlated with self-reported myotonia (p = 0.014). This study demonstrates that changes in mMV are sensitive in reflecting the underlying disease process. Quantitative MRI methods demonstrate that data concerning both central and peripheral disease could be acquired from MR brain imaging studies in DM1 patients.
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Affiliation(s)
- Agata Oliwa
- School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, United Kingdom.
| | - Clarissa Hocking
- School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, United Kingdom
| | - Mark J Hamilton
- West of Scotland Clinical Genetics Service, Queen Elizabeth University Hospital, Glasgow G51 4TF, United Kingdom
| | - John McLean
- Department of Neuroradiology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow G51 4TF, United Kingdom
| | - Sarah Cumming
- Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, United Kingdom; Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow G12 0XH, United Kingdom
| | - Bob Ballantyne
- West of Scotland Clinical Genetics Service, Queen Elizabeth University Hospital, Glasgow G51 4TF, United Kingdom
| | - Ravi Jampana
- Department of Neuroradiology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow G51 4TF, United Kingdom
| | - Cheryl Longman
- West of Scotland Clinical Genetics Service, Queen Elizabeth University Hospital, Glasgow G51 4TF, United Kingdom
| | - Darren G Monckton
- Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow G12 8QQ, United Kingdom; Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow G12 0XH, United Kingdom
| | - Maria Elena Farrugia
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow G51 4TF, United Kingdom
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7
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Kikuchi K, Satake M, Furukawa Y, Terui Y. Assessment of body composition, metabolism, and pulmonary function in patients with myotonic dystrophy type 1. Medicine (Baltimore) 2022; 101:e30412. [PMID: 36086756 PMCID: PMC10980380 DOI: 10.1097/md.0000000000030153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/05/2022] [Indexed: 11/25/2022] Open
Abstract
Abnormal body composition in myotonic dystrophy type 1 (DM1) are affected by energy intake above resting energy expenditure (REE). We aim to investigate the characteristics and relationship between body composition, REE, and pulmonary function in patients with DM1, and to examine their changes in 1 year. The study design was a single-center, cross-sectional, and longitudinal study of body composition, REE characteristics, and pulmonary function. Twenty-one male patients with DM1 and 16 healthy volunteers were registered in the study. Body composition was measured using dual-energy X-ray absorptiometry (DEXA). Fat mass (FM) index (kg/m2), fat-FM index (kg/m2), and skeletal mass index (kg/m2) were calculated. The measurements were taken breath by breath with a portable indirect calorimeter. The REE was calculated using the oxygen intake (VO2) and carbon dioxide output (VCO2) in the Weir equation. Basal energy expenditure (BEE) was calculated by substituting height, weight, and age into the Harris-Benedict equation. The study enrolled male patients with DM1 (n = 12) and healthy male volunteers (n = 16). Patients with DM1 (n = 7) and healthy volunteers (n = 14) could be followed in 1 year. The body composition of patients with DM1 was significantly higher in the FM index and significantly lower in the fat-FM index and skeletal mass index. The REE of patients with DM1 was significantly lower and was not associated with body composition. Patients with DM1 had poor metabolism that was not related to body composition. FM was high and lean body mass was low.
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Affiliation(s)
- Kazuto Kikuchi
- Department of Physical Therapy, Akita Rehabilitation College, Akita, Japan
| | - Masahiro Satake
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Yutaka Furukawa
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Yoshino Terui
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
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8
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Brumfield OS, Zizzi CE, Dilek N, Alexandrou DG, Glidden AM, Rosero S, Weinstein J, Seabury J, Kaat A, McDermott MP, Dorsey ER, Heatwole CR. The Huntington's Disease Health Index: Initial Evaluation of a Disease-Specific Patient Reported Outcome Measure. J Huntingtons Dis 2022; 11:217-226. [PMID: 35527560 DOI: 10.3233/jhd-210506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND When developed properly, disease-specific patient reported outcome measures have the potential to measure relevant changes in how a patient feels and functions in the context of a therapeutic trial. The Huntington's Disease Health Index (HD-HI) is a multifaceted disease-specific patient reported outcome measure (PROM) designed specifically to satisfy previously published FDA guidance for developing PROMs for product development and labeling claims. OBJECTIVE In preparation for clinical trials, we examine the validity, reliability, clinical relevance, and patient understanding of the Huntington's Disease Health Index (HD-HI). METHODS We partnered with 389 people with Huntington's disease (HD) and caregivers to identify the most relevant questions for the HD-HI. We subsequently utilized two rounds of factor analysis, cognitive interviews with fifteen individuals with HD, and test-retest reliability assessments with 25 individuals with HD to refine, evaluate, and optimize the HD-HI. Lastly, we determined the capability of the HD-HI to differentiate between groups of HD participants with high versus low total functional capacity score, prodromal versus manifest HD, and normal ambulation versus mobility impairment. RESULTS HD participants identified 13 relevant and unique symptomatic domains to be included as subscales in the HD-HI. All HD-HI subscales had a high level of internal consistency and reliability and were found by participants to have acceptable content, relevance, and usability. The total HD-HI score and each subscale score statistically differentiated between groups of HD participants with high versus low disease burden. CONCLUSION Initial evaluation of the HD-HI supports its validity and reliability as a PROM for assessing how individuals with HD feel and function.
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Affiliation(s)
- Olivia S Brumfield
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Christine E Zizzi
- Center for Health + Technology, University of Rochester, Rochester, NY, USA.,School of Public and International Affairs, Princeton University, Princeton, NJ, USA
| | - Nuran Dilek
- Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Danae G Alexandrou
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Alistair M Glidden
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Spencer Rosero
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Jennifer Weinstein
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Jamison Seabury
- Center for Health + Technology, University of Rochester, Rochester, NY, USA
| | - Aaron Kaat
- Department of Medical Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael P McDermott
- Department of Neurology, University of Rochester, Rochester, NY, USA.,Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - E Ray Dorsey
- Center for Health + Technology, University of Rochester, Rochester, NY, USA.,Department of Neurology, University of Rochester, Rochester, NY, USA
| | - Chad R Heatwole
- Center for Health + Technology, University of Rochester, Rochester, NY, USA.,Department of Neurology, University of Rochester, Rochester, NY, USA
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9
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Deutsch GK, Hagerman KA, Sampson J, Dent G, Dekdebrun J, Parker DM, Thornton CA, Heatwole CR, Subramony SH, Mankodi AK, Ashizawa T, Statland JM, Arnold WD, Moxley RT, Day JW. Brief assessment of cognitive function in myotonic dystrophy: multicenter longitudinal study using computer-assisted evaluation. Muscle Nerve 2022; 65:560-567. [PMID: 35179228 PMCID: PMC9102286 DOI: 10.1002/mus.27520] [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: 06/20/2021] [Revised: 02/09/2022] [Accepted: 02/12/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION/AIMS Myotonic dystrophy type 1 (DM1) is known to affect cognitive function, but the best methods to assess CNS involvement in multicenter studies have not been determined. This study's primary aim was to evaluate the potential of computerized cognitive tests to assess cognition in DM1. METHODS We conducted a prospective, longitudinal, observational study of 113 adults with DM1 at 6 sites. Psychomotor speed, attention, working memory, and executive functioning were assessed at baseline, 3-months and 12-months using computerized cognitive tests. Results were compared with assessments of muscle function and patient reported outcomes (PROs), including the Myotonic Dystrophy Health Index (MDHI) and EQ-5D-5L. RESULTS Based on intra-class correlation coefficients (ICCs), computerized cognitive tests had moderate to good reliability for psychomotor speed (0.76), attention (0.82), working memory speed (0.79), working memory accuracy (0.65), and executive functioning (0.87). Performance at baseline was lowest for working memory accuracy (p < 0.0001). Executive function performance improved from baseline to 3-months (p < 0.0001), without further changes over one year. There was a moderate correlation between poorer executive function and larger CTG repeat size (r = -0.433). There were some weak associations between PROs and cognitive performance. DISCUSSION Computerized tests of cognition are feasible in multicenter studies of DM1. Poor performance was exhibited in working memory, which may be a useful variable in clinical trials. Learning effects may have contributed to the improvement in executive functioning. The relationship between PROs and cognitive impairment in DM1 requires further study. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Gayle K Deutsch
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, United States
| | - Katharine A Hagerman
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, United States
| | - Jacinda Sampson
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, United States
| | | | - Jeanne Dekdebrun
- The University of Rochester Medical Center, Rochester, New York, United States
| | - Dana M Parker
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, United States
| | - Charles A Thornton
- The University of Rochester Medical Center, Rochester, New York, United States
| | - Chad R Heatwole
- The University of Rochester Medical Center, Rochester, New York, United States
| | - Sub H Subramony
- University of Florida McKnight Brain Institute, Gainesville, Florida, United States
| | - Ami K Mankodi
- National Institute of Neurological Disorders and Stroke, Rockville, Maryland, United States
| | | | | | - W David Arnold
- The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Richard T Moxley
- The University of Rochester Medical Center, Rochester, New York, United States
| | - John W Day
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, United States
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10
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Fujino H, Saito T, Takahashi MP, Takada H, Nakayama T, Imura O, Matsumura T. Quality of life and subjective symptom impact in Japanese patients with myotonic dystrophy type 1. BMC Neurol 2022; 22:55. [PMID: 35164706 PMCID: PMC8842550 DOI: 10.1186/s12883-022-02581-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 02/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although functional impairment in patients with myotonic dystrophy is an important determinant of the quality of life (QoL), patients' subjective evaluation of their symptoms may also affect their QoL. The aim of this study was to investigate the association between subjective symptom impact and the QoL of patients with myotonic dystrophy, after controlling for functional impairment. METHODS Eligible patients with myotonic dystrophy type 1 (DM1) were recruited from four hospitals in Japan. The subjective symptom impact of four symptoms (muscle weakness, fatigue, pain, and myotonia) and overall QoL were evaluated using the Individualized Neuromuscular Quality of Life (INQoL) questionnaire. Functional impairment was assessed using the modified Rankin Scale. RESULTS Seventy-seven patients with DM1 were included in this study. Overall QoL was significantly associated with subjective symptom impact of muscular weakness, fatigue, pain, myotonia, swallowing difficulty, and droopy eyelids. In the regression models, disease duration (beta = 0.11) and moderate to severe functional impairment (beta = 0.33) explained a significant part of the overall QoL. Furthermore, muscular weakness, fatigue, and myotonia significantly explained additional variance of the overall QoL (beta = 0.17-0.43). CONCLUSIONS Subjective symptom impact and functional impairment are independent features influencing the QoL of Japanese patients with DM1.
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Affiliation(s)
- Haruo Fujino
- Department of Child Development, United Graduate School of Child Development, Osaka University, 2-2 Yamadaoka, Suita, 5650871, Japan. .,Department of Special Needs Education, Oita University, 700 Dannoharu, Oita, Japan. .,Graduate School of Human Sciences, Osaka University, 1-2 Yamadaoka, Suita, Japan.
| | - Toshio Saito
- Division of Child Neurology, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Japan.,Department of Neurology, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Japan
| | - Masanori P Takahashi
- Department of Clinical Laboratory and Biomedical Sciences, Osaka University Graduate School of Medicine, 1-7 Yamadaoka, Suita, Japan.,Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Japan
| | - Hiroto Takada
- Department of Neurology, National Hospital Organization Aomori National Hospital, 155-1 Megasawa-Hirano, Aomori, Japan
| | - Takahiro Nakayama
- Department of Neurology, Yokohama Rosai Hospital, 3211 Kozukue, Yokohama, Japan
| | - Osamu Imura
- Graduate School of Human Sciences, Osaka University, 1-2 Yamadaoka, Suita, Japan.,Faculty of Social Sciences, Nara University, 1500 Misasagi, Nara, Japan
| | - Tsuyoshi Matsumura
- Department of Neurology, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1 Toneyama, Toyonaka, Japan
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11
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Liu J, Guo ZN, Yan XL, Yang Y, Huang S. Brain Pathogenesis and Potential Therapeutic Strategies in Myotonic Dystrophy Type 1. Front Aging Neurosci 2021; 13:755392. [PMID: 34867280 PMCID: PMC8634727 DOI: 10.3389/fnagi.2021.755392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 10/20/2021] [Indexed: 12/17/2022] Open
Abstract
Myotonic dystrophy type 1 (DM1) is the most common muscular dystrophy that affects multiple systems including the muscle and heart. The mutant CTG expansion at the 3'-UTR of the DMPK gene causes the expression of toxic RNA that aggregate as nuclear foci. The foci then interfere with RNA-binding proteins, affecting hundreds of mis-spliced effector genes, leading to aberrant alternative splicing and loss of effector gene product functions, ultimately resulting in systemic disorders. In recent years, increasing clinical, imaging, and pathological evidence have indicated that DM1, though to a lesser extent, could also be recognized as true brain diseases, with more and more researchers dedicating to develop novel therapeutic tools dealing with it. In this review, we summarize the current advances in the pathogenesis and pathology of central nervous system (CNS) deficits in DM1, intervention measures currently being investigated are also highlighted, aiming to promote novel and cutting-edge therapeutic investigations.
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Affiliation(s)
- Jie Liu
- Department of Neurology, Stroke Center & Clinical Trial and Research Center for Stroke, The First Hospital of Jilin University, Changchun, China
- China National Comprehensive Stroke Center, Changchun, China
- Jilin Provincial Key Laboratory of Cerebrovascular Disease, Changchun, China
| | - Zhen-Ni Guo
- Department of Neurology, Stroke Center & Clinical Trial and Research Center for Stroke, The First Hospital of Jilin University, Changchun, China
- China National Comprehensive Stroke Center, Changchun, China
- Jilin Provincial Key Laboratory of Cerebrovascular Disease, Changchun, China
| | - Xiu-Li Yan
- Department of Neurology, Stroke Center & Clinical Trial and Research Center for Stroke, The First Hospital of Jilin University, Changchun, China
| | - Yi Yang
- Department of Neurology, Stroke Center & Clinical Trial and Research Center for Stroke, The First Hospital of Jilin University, Changchun, China
- China National Comprehensive Stroke Center, Changchun, China
- Jilin Provincial Key Laboratory of Cerebrovascular Disease, Changchun, China
| | - Shuo Huang
- Department of Neurology, Stroke Center & Clinical Trial and Research Center for Stroke, The First Hospital of Jilin University, Changchun, China
- China National Comprehensive Stroke Center, Changchun, China
- Jilin Provincial Key Laboratory of Cerebrovascular Disease, Changchun, China
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12
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van As D, Okkersen K, Bassez G, Schoser B, Lochmüller H, Glennon JC, Knoop H, van Engelen BGM, 't Hoen PAC. Clinical Outcome Evaluations and CBT Response Prediction in Myotonic Dystrophy. J Neuromuscul Dis 2021; 8:1031-1046. [PMID: 34250945 PMCID: PMC8673496 DOI: 10.3233/jnd-210634] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND The European OPTIMISTIC clinical trial has demonstrated a significant, yet heterogenous effect of Cognitive Behavioural Therapy (CBT) for Myotonic Dystrophy type 1 (DM1) patients. One of its remaining aims was the assessment of efficacy and adequacy of clinical outcome measures, including the relatively novel primary trial outcome, the DM1-Activ-c questionnaire. OBJECTIVES Assessment of the relationship between the Rasch-built DM1-Activ-c questionnaire and 26 commonly used clinical outcome measurements. Identification of variables associated with CBT response in DM1 patients. METHODS Retrospective analysis of the to date largest clinical trial in DM1 (OPTIMISTIC), comprising of 255 genetically confirmed DM1 patients randomized to either standard care or CBT with optionally graded exercise therapy. Correlations of 27 different outcome measures were calculated at baseline (cross-sectional) and of their respective intervention induced changes (longitudinal). Bootstrap enhanced Elastic-Net (BeEN) regression was validated and implemented to select variables associated with CBT response. RESULTS In cross-sectional data, DM1-Activ-c correlated significantly with the majority of other outcome measures, including Six Minute Walk Test and Myotonic Dystrophy Health Index. Fewer and weaker significant longitudinal correlations were observed. Nine variables potentially associated with CBT response were identified, including measures of disease severity, executive cognitive functioning and perceived social support. CONCLUSIONS The DM1-Activ-c questionnaire appears to be a well suited cross-sectional instrument to assess a variety of clinically relevant dimensions in DM1. Yet, apathy and experienced social support measures were less well captured. CBT response was heterogenous, requiring careful selection of outcome measures for different disease aspects.
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Affiliation(s)
- Daniël van As
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Center for Molecular and Biomolecular Informatics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kees Okkersen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Guillaume Bassez
- Neuromuscular Reference Centre, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Benedikt Schoser
- Friedrich-Baur-Institute, Department of Neurology, Klinikum der Universität München, Ludwig Maximilians-Universität München, Munich, Germany
| | - Hanns Lochmüller
- Children's Hospital of Eastern Ontario Research Institute; Division of Neurology, Department of Medicine, The Ottawa Hospital; and Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada
| | - Jeffrey C Glennon
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.,Conway Institute of Biomolecular and Biomedical Sciences, School of Medicine, University College Dublin, Ireland
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Baziel G M van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter A C 't Hoen
- Center for Molecular and Biomolecular Informatics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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13
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Koscik TR, van der Plas E, Gutmann L, Cumming SA, Monckton DG, Magnotta V, Shields RK, Nopoulos PC. White matter microstructure relates to motor outcomes in myotonic dystrophy type 1 independently of disease duration and genetic burden. Sci Rep 2021; 11:4886. [PMID: 33649422 PMCID: PMC7921687 DOI: 10.1038/s41598-021-84520-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 02/15/2021] [Indexed: 11/09/2022] Open
Abstract
Deficits in white matter (WM) integrity and motor symptoms are among the most robust and reproducible features of myotonic dystrophy type 1 (DM1). In the present study, we investigate whether WM integrity, obtained from diffusion-weighted MRI, corresponds to quantifiable motor outcomes (e.g., fine motor skills and grip strength) and patient-reported, subjective motor deficits. Critically, we explore these relationships in the context of other potentially causative variables, including: disease duration, elapsed time since motor symptom onset; and genetic burden, the number of excessive CTG repeats causing DM1. We found that fractional anisotropy (a measure of WM integrity) throughout the cerebrum was the strongest predictor of grip strength independently of disease duration and genetic burden, while radial diffusivity predicted fine motor skill (peg board performance). Axial diffusivity did not predict motor outcomes. Our results are consistent with the notion that systemic degradation of WM in DM1 mediates the relationship between DM1 progression and genetic burden with motor outcomes of the disease. Our results suggest that tracking changes in WM integrity over time may be a valuable biomarker for tracking therapeutic interventions, such as future gene therapies, for DM1.
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Affiliation(s)
- Timothy R Koscik
- Department of Psychiatry, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| | - Ellen van der Plas
- Department of Psychiatry, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Laurie Gutmann
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Sarah A Cumming
- Institute of Molecular, Cell and Systems Biology, University of Glasgow, Glasgow, Scotland
| | - Darren G Monckton
- Institute of Molecular, Cell and Systems Biology, University of Glasgow, Glasgow, Scotland
| | - Vincent Magnotta
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Richard K Shields
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Peggy C Nopoulos
- Department of Psychiatry, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.,Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, USA.,Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, USA
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14
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Johnson C, Langbehn KE, Long JD, Moser D, Cross S, Gutmann L, Nopoulos PC, van der Plas E. Encoding of facial expressions in individuals with adult-onset myotonic dystrophy type 1. J Clin Exp Neuropsychol 2020; 42:932-940. [PMID: 33028165 PMCID: PMC7676461 DOI: 10.1080/13803395.2020.1826410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/13/2020] [Indexed: 10/23/2022]
Abstract
Introduction: Emotional issues are often reported among individuals with myotonic dystrophy type 1 (DM1) and some studies have suggested that deficits in ability to quickly encode emotions may contribute to these problems. However, poor performance on emotion encoding tasks could also be explained by a more general cognitive deficit (Full Scale IQ [FSIQ]), rather than a specific deficit in emotional processing. Since individuals with DM1 are known to exhibit difficulties in general cognitive abilities, it is important to account for FSIQ when evaluating emotion encoding. The aim of this study was to compare emotion encoding abilities between individuals with and without DM1, while adjusting for the impact of general cognitive abilities (FSIQ). Methods: The sample included 35 individuals with adult-onset DM1 and 54 unaffected adults who completed assessments of emotion encoding abilities (Ekman faces test) and general cognitive abilities (Wechsler Adult Intelligence Scale-IV). Performance on the emotion encoding task was operationalized as proportion correct and response time. Group differences in proportion correct were evaluated with generalized linear regression, while linear regression models were used to determine the effect of group on response time. Models were adjusted for age, sex, and FSIQ. The false discovery rate (FDR) was applied to control false positives due to multiple comparisons (pfdr ). Results: No significant group differences were observed for emotion encoding abilities (all pfdr > 0.13). FSIQ was significantly associated with proportion correct and with response time (all pfdr < 0.05). Conclusions: Emotion encoding appears intact in individuals with DM1 and variation in the ability to encode facial expressions was associated with FSIQ. Further research is required to address the relationship between general cognitive abilities and emotion encoding abilities among DM1 patients.
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Affiliation(s)
- Claire Johnson
- Department of Psychiatry, University of Iowa Hospitals & Clinics, Iowa City IA, USA
| | - Kathleen E. Langbehn
- Department of Psychiatry, University of Iowa Hospitals & Clinics, Iowa City IA, USA
| | - Jeff D. Long
- Department of Psychiatry, University of Iowa Hospitals & Clinics, Iowa City IA, USA
| | - David Moser
- Department of Psychiatry, University of Iowa Hospitals & Clinics, Iowa City IA, USA
| | - Stephen Cross
- Department of Psychiatry, University of Iowa Hospitals & Clinics, Iowa City IA, USA
| | - Laurie Gutmann
- Department of Neurology, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Peggy C. Nopoulos
- Department of Psychiatry, University of Iowa Hospitals & Clinics, Iowa City IA, USA
| | - Ellen van der Plas
- Department of Psychiatry, University of Iowa Hospitals & Clinics, Iowa City IA, USA
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15
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Jimenez-Moreno AC, Nikolenko N, Kierkegaard M, Blain AP, Newman J, Massey C, Moat D, Sodhi J, Atalaia A, Gorman GS, Turner C, Lochmüller H. Analysis of the functional capacity outcome measures for myotonic dystrophy. Ann Clin Transl Neurol 2019; 6:1487-1497. [PMID: 31402614 PMCID: PMC6689676 DOI: 10.1002/acn3.50845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/11/2019] [Accepted: 06/26/2019] [Indexed: 11/30/2022] Open
Abstract
Objectives Defining clinically relevant outcome measures for myotonic dystrophy type 1 (DM1) that can be valid and feasible for different phenotypes has proven problematic. The Outcome Measures for Myotonic Dystrophy (OMMYD) group proposed a battery of functional outcomes: 6‐minute walk test, 30 seconds sit and stand test, timed 10 m walk test, timed 10 m walk/run test, and nine‐hole peg test. This, however, required a large‐scale investigation, Methods A cohort of 213 patients enrolled in the natural history study, PhenoDM1, was analyzed in cross‐sectional analysis and subsequently 98 patients were followed for longitudinal analysis. We aimed to assess: (1) feasibility and best practice; (2) intra‐session reliability; (3) validity; and (4) behavior over time, of these tests. Results OMMYD outcomes proved feasible as 96% of the participants completed at least one trial for all tests and more than half (n = 113) performed all three trials of each test. Body mass index and disease severity associate with functional capacity. There was a significant difference between the first and second trials of each test. There was a moderate to strong correlation between these functional outcomes and muscle strength, disease severity and patient‐reported outcomes. All outcomes after 1 year detected a change in functional capacity except the nine‐hole peg test. Conclusions These tests can be used as a battery of outcomes or independently based on the shown overlapping psychometric features and strong cross‐correlations. Due to the large and heterogeneous sample of this study, these results can serve as reference values for future studies.
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Affiliation(s)
- Aura Cecilia Jimenez-Moreno
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK.,Welcome Trust Mitochondrial Research Centre, Institute of Neurosciences, Newcastle University, Newcastle upon Tyne, UK
| | - Nikoletta Nikolenko
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK.,National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Marie Kierkegaard
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden
| | - Alasdair P Blain
- Welcome Trust Mitochondrial Research Centre, Institute of Neurosciences, Newcastle University, Newcastle upon Tyne, UK
| | - Jane Newman
- Welcome Trust Mitochondrial Research Centre, Institute of Neurosciences, Newcastle University, Newcastle upon Tyne, UK
| | - Charlotte Massey
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Dionne Moat
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK.,The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jas Sodhi
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK.,The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Antonio Atalaia
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK.,Center of Research in Myology, Sorbonne Université, Paris, France
| | - Grainne S Gorman
- Welcome Trust Mitochondrial Research Centre, Institute of Neurosciences, Newcastle University, Newcastle upon Tyne, UK
| | - Chris Turner
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Hanns Lochmüller
- Department of Neuropediatrics and Muscle Disorders, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Centro Nacional de Análisis Genómico (CNAG-CRG), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Barcelona, Spain.,Research Institute, The Children's Hospital of Eastern Ontario, Ottawa, Canada.,Division of Neurology, Department of Medicine, Ottawa University, Ottawa, Canada
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16
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Body composition analysis in patients with myotonic dystrophy types 1 and 2. Neurol Sci 2019; 40:1035-1040. [PMID: 30790082 DOI: 10.1007/s10072-019-03763-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION To date, there are only several reports on body composition in myotonic dystrophy type 1 (DM1) and there are no data for myotonic dystrophy type 2 (DM2). The aim was to analyze body composition of patients with DM1 and DM2, and its association with socio-demographic and clinical features of the diseases. METHODS There were no statistical differences in sociodemographic features between 20 DM1 patients and 12 DM2 patients. Body composition was assessed by DEXA (dual-energy x-ray absorptiometry). A three-compartment model was used: bone mineral content (BMC), fat mass (FM), and lean tissue mass (LTM). RESULTS Patients with DM1 and DM2 had similar total body mass (TBM), BMC, FM, and LTM. Patients with DM1 had higher trunk-limb fat index (TLFI) in comparison to DM2 patients which indicates visceral fat deposition in DM1 (1.16 ± 0.32 for DM1 vs. 0.87 ± 0.23 for DM2, p < 0.05). Right ribs bone mineral density was lower in DM2 group (0.68 ± 0.07 g/cm2 vs. 0.61 ± 0.09 g/cm2, p < 0.05). Higher percentage of FM in legs showed correlation with lower strength of the upper leg muscles in DM1 (ρ = - 0.47, p < 0.05). Higher muscle strength in DM2 patients was in correlation with higher bone mineral density (ρ = + 0.62, p < 0.05 for upper arm muscles, ρ = + 0.87, p < 0.01 for lower arm muscles, ρ = + 0.72, p < 0.05 for lower leg muscles). CONCLUSION DM1 patients had visceral obesity, and percentage of FM correlated with a degree of muscle weakness in upper legs. In DM2 patients, degree of muscle weakness was in correlation with higher FM index and lower bone mineral density.
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17
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Hagerman KA, Howe SJ, Heatwole CR. The myotonic dystrophy experience: a North American cross-sectional study. Muscle Nerve 2019; 59:457-464. [PMID: 30677147 PMCID: PMC6590656 DOI: 10.1002/mus.26420] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 01/07/2019] [Accepted: 01/20/2019] [Indexed: 11/07/2022]
Abstract
Introduction: Myotonic dystrophy (DM) is a chronic, multisystemic, neurological condition. Patients and caregivers are uniquely suited to identify what symptoms are most important and highlight the unmet needs that are most relevant to DM. Methods: We conducted a North American, cross‐sectional study of people with DM type‐1, congenital DM, and DM type‐2 and their family members. We sent patients and caregivers separate surveys to identify and quantitate the issues of greatest importance, examine the differences between groups, and identify the most important challenges experienced by this population. Results: 1,180 people with DM and 402 family members/caregivers responded to the surveys. They reported considerable physical and cognitive symptoms, extensive diagnostic delays, and varying clinical phenotypes on the basis of DM type. Discussion: Marked disease burden and numerous unmet needs exist in DM. These needs vary based on DM type and highlight the complex clinical phenotypes of these neurological disorders. Muscle Nerve 59:457–464, 2019
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Affiliation(s)
- Katharine A Hagerman
- Department of Neurology, Stanford University, 1201 Welch Road, MSLS Room P220, Stanford, California, 94305, USA
| | | | - Chad R Heatwole
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
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18
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Gagnon C, Heatwole C, Hébert LJ, Hogrel JY, Laberge L, Leone M, Meola G, Richer L, Sansone V, Kierkegaard M. Report of the third outcome measures in myotonic dystrophy type 1 (OMMYD-3) international workshop Paris, France, June 8, 2015. J Neuromuscul Dis 2019; 5:523-537. [PMID: 30248061 DOI: 10.3233/jnd-180329] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Cynthia Gagnon
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Québec, Canada.,Centre de recherche Charles-Le-Moyne Saguenay - Lac-St-Jean sur les innovations en santé, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Québec, Canada
| | - Chad Heatwole
- Department of Neurology, University of Rochester Medical Center, New York, USA
| | - Luc J Hébert
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), and Faculty of Medicine, Université Laval, Québec, Canada
| | | | - Luc Laberge
- ÉCOBES, Cégep de Jonquière, Québec, Canada.,Department of Health Sciences, Université du Québec á Chicoutimi, Québec, Canada
| | - Mario Leone
- Department of Health Sciences, Université du Québec á Chicoutimi, Québec, Canada
| | - Giovanni Meola
- Department of Biomedical sciences for health, University of Milan, IRCCS Policlinico San Donato, Italy
| | - Louis Richer
- Department of Health Sciences, Université du Québec á Chicoutimi, Québec, Canada
| | - Valeria Sansone
- Centro Clinico NEMO, Neurorehabilitation Unit, University of Milan, Italy
| | - Marie Kierkegaard
- Functional Area Occupational Therapy & Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
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19
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Mori I, Fujino H, Matsumura T, Takada H, Ogata K, Nakamori M, Innami K, Shingaki H, Imura O, Takahashi MP, Heatwole C. The myotonic dystrophy health index: Japanese adaption and validity testing. Muscle Nerve 2019; 59:577-582. [PMID: 30681157 DOI: 10.1002/mus.26422] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 01/17/2019] [Accepted: 01/19/2019] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The Myotonic Dystrophy Health Index (MDHI) is a disease-specific, patient-reported outcome measure. The objective of this study was to translate, evaluate, and validate a Japanese version of the MDHI (MDHI-J). METHODS We utilized forward and backward translations and qualitative interviews with 11 myotonic dystrophy type 1 (DM1) participants. We subsequently tested the internal consistency, test-retest reliability, concurrent validity against muscle strength, and 3 quality-of-life measures, and the known-groups validity of the MDHI-J with 60 adult patients. RESULTS The MDHI-J was found to be culturally appropriate, comprehensive, and clinically relevant. The MDHI-J and its subscales had high internal consistency (mean Cronbach's α = 0.91), test-retest reliability (intraclass coefficient 0.678-0.915), and concurrent validity (Spearman's ρ - 0.869 to 0.904). MDHI-J scores were strongly associated with employment, duration of symptoms, and modified Rankin Scale. DISCUSSION The MDHI-J is suitable and valid to measure patient-reported disease burden in adult Japanese patients with DM1. Muscle Nerve 59:577-577, 2019.
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Affiliation(s)
- Itsuki Mori
- Department of Functional Diagnostic Science, Osaka University Graduate School of Medicine, 1-7 Yamadaoka Suita, Osaka 565-0871, Japan
| | - Haruo Fujino
- Department of Special Needs Education, Oita University, Oita, Japan.,Graduate School of Human Sciences, Osaka University, Suita, Japan
| | - Tsuyoshi Matsumura
- Department of Neurology, National Hospital Organization Toneyama National Hospital, Toyonaka, Japan
| | - Hiroto Takada
- Department of Neurology, National Hospital Organization Aomori National Hospital, Aomori, Japan
| | - Katsuhisa Ogata
- Department of Neurology, National Hospital Organization Higashisaitama National Hospital, Hasuda, Japan
| | - Masayuki Nakamori
- Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Keisuke Innami
- International and Translational Medicine Program, Osaka University Graduate School of Medicine Suita, Japan.,Knowledge Capital Association, Osaka, Japan
| | - Honoka Shingaki
- Graduate School of Human Sciences, Osaka University, Suita, Japan
| | - Osamu Imura
- Graduate School of Human Sciences, Osaka University, Suita, Japan
| | - Masanori P Takahashi
- Department of Functional Diagnostic Science, Osaka University Graduate School of Medicine, 1-7 Yamadaoka Suita, Osaka 565-0871, Japan.,Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Chad Heatwole
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
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20
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Hamilton MJ, McLean J, Cumming S, Ballantyne B, McGhie J, Jampana R, Longman C, Evans JJ, Monckton DG, Farrugia ME. Outcome Measures for Central Nervous System Evaluation in Myotonic Dystrophy Type 1 May Be Confounded by Deficits in Motor Function or Insight. Front Neurol 2018; 9:780. [PMID: 30333784 PMCID: PMC6176265 DOI: 10.3389/fneur.2018.00780] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/30/2018] [Indexed: 01/18/2023] Open
Abstract
Background: Central nervous system involvement in myotonic dystrophy type 1 (DM1) is associated with cognitive deficits, impaired social performance and excessive somnolence, which greatly impact quality of life. With the advent of clinical trials in DM1, there is a pressing need to identify outcome measures for quantification of central symptoms that are feasible and valid. In this context, we sought to evaluate neuropsychological and self-reported measures currently recommended by expert consensus, with particular reference to their specificity for central nervous system involvement in a moderate-sized DM1 cohort. Methods: Forty-five adults with DM1 and 20 controls completed neuropsychology assessments and symptom questionnaires. Those without contraindication also underwent MRI brain, from which global gray matter volume and white matter lesion volume were quantified. CTG repeat was measured by small pool PCR, and was screened for the presence of variant repeat sequences. Results: The neuropsychology test battery was well tolerated and detected impairment across various domains in the DM1 group vs. controls. Large effect sizes in the Stroop and Trail Making Tests were however attenuated by correction for basic speed, which could be influenced by dysarthria and upper limb weakness, respectively. Low mood was strongly associated with increased self-reporting of central symptoms, including cognitive impairment. Conversely, self-reported cognitive impairment did not generally predict poorer performance in neuropsychology assessments, and there was a trend toward greater self-reporting of low mood and cognitive problems in those with milder white matter change on MRI. Global gray matter volume correlated with performance in several neuropsychology assessments in a multivariate model with age and sex, while white matter lesion volume was associated with executive dysfunction reported by a proxy. Screening for variant repeats was positive in three individuals, who reported mild muscle symptoms. Conclusions: Identification of outcome measures with good specificity for brain involvement in DM1 is challenging, since complex cognitive assessments may be compromised by peripheral muscle weakness and self-reported questionnaires may be influenced by mood and insight. This highlights the need for further large, longitudinal studies to identify and validate objective measures, which may include imaging biomarkers and cognitive measures not influenced by motor speed.
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Affiliation(s)
- Mark J Hamilton
- West of Scotland Clinical Genetics Service, Queen Elizabeth University Hospital, Glasgow, United Kingdom.,Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - John McLean
- Department of Neuroradiology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Sarah Cumming
- Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Bob Ballantyne
- West of Scotland Clinical Genetics Service, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Josephine McGhie
- Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Ravi Jampana
- Department of Neuroradiology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Cheryl Longman
- West of Scotland Clinical Genetics Service, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Jonathan J Evans
- Institute of Health and Wellbeing, Gartnavel Royal Hospital, University of Glasgow, Glasgow, United Kingdom
| | - Darren G Monckton
- Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Maria Elena Farrugia
- Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, United Kingdom
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Towards clinical outcome measures in myotonic dystrophy type 2: a systematic review. Curr Opin Neurol 2018; 31:599-609. [DOI: 10.1097/wco.0000000000000591] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Pucillo EM, Mcintyre MM, Pautler M, Hung M, Bounsanga J, Voss MW, Hayes H, Dibella DL, Trujillo C, Dixon M, Butterfield RJ, Johnson NE. Modified dynamic gait index and limits of stability in myotonic dystrophy type 1. Muscle Nerve 2018; 58:694-699. [PMID: 30160307 DOI: 10.1002/mus.26331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 08/22/2018] [Accepted: 08/25/2018] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The purpose of this study was to describe and compare the performance of balance and walking tests in relation to self-reported fall history in adults with myotonic dystrophy type 1 (DM1). METHODS Twenty-two (13 male) participants with DM1 completed, a 6-month fall history questionnaire, the modified Dynamic Gait Index (mDGI), limits of stability (LoS) testing, and 10-m walking tests. RESULTS Mean (SD) falls in 6 months was 3.7 (3.1), and 19 (86%) participants reported at least 1 fall. Significant differences in mDGI scores (P = 0.006) and 10-m fast walking gait velocity (P = 0.02) were found between those who had been classified as "fallers" and those who had been classified as "nonfallers." Significant correlations were found between mDGI scores and 10-m walking time. DISCUSSION Falls are common in DM1, and the mDGI may have potential to distinguish fallers from nonfallers, whereas the LoS failed to detect such impairment. Future studies should further explore use of the mDGI in DM1. Muscle Nerve 58: 694-699, 2018.
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Affiliation(s)
- Evan M Pucillo
- Department of Physical Therapy, University of Saint Augustine Health Sciences, 1 University Boulevard, Room D129, Saint Augustine, Florida, 32086, USA
| | | | - Mary Pautler
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Man Hung
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA.,Division of Public Health, University of Utah, Salt Lake City, Utah, USA
| | - Jerry Bounsanga
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Maren W Voss
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Heather Hayes
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, Utah, USA
| | - Deanna L Dibella
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Caren Trujillo
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
| | - Melissa Dixon
- Department of Neurology, University of Utah, Salt Lake City, Utah, USA
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Thomas JD, Oliveira R, Sznajder ŁJ, Swanson MS. Myotonic Dystrophy and Developmental Regulation of RNA Processing. Compr Physiol 2018; 8:509-553. [PMID: 29687899 PMCID: PMC11323716 DOI: 10.1002/cphy.c170002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Myotonic dystrophy (DM) is a multisystemic disorder caused by microsatellite expansion mutations in two unrelated genes leading to similar, yet distinct, diseases. DM disease presentation is highly variable and distinguished by differences in age-of-onset and symptom severity. In the most severe form, DM presents with congenital onset and profound developmental defects. At the molecular level, DM pathogenesis is characterized by a toxic RNA gain-of-function mechanism that involves the transcription of noncoding microsatellite expansions. These mutant RNAs disrupt key cellular pathways, including RNA processing, localization, and translation. In DM, these toxic RNA effects are predominantly mediated through the modulation of the muscleblind-like and CUGBP and ETR-3-like factor families of RNA binding proteins (RBPs). Dysfunction of these RBPs results in widespread RNA processing defects culminating in the expression of developmentally inappropriate protein isoforms in adult tissues. The tissue that is the focus of this review, skeletal muscle, is particularly sensitive to mutant RNA-responsive perturbations, as patients display a variety of developmental, structural, and functional defects in muscle. Here, we provide a comprehensive overview of DM1 and DM2 clinical presentation and pathology as well as the underlying cellular and molecular defects associated with DM disease onset and progression. Additionally, fundamental aspects of skeletal muscle development altered in DM are highlighted together with ongoing and potential therapeutic avenues to treat this muscular dystrophy. © 2018 American Physiological Society. Compr Physiol 8:509-553, 2018.
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Affiliation(s)
- James D. Thomas
- Department of Molecular Genetics and Microbiology, Center for NeuroGenetics and the Genetics Institute, University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Ruan Oliveira
- Department of Molecular Genetics and Microbiology, Center for NeuroGenetics and the Genetics Institute, University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Łukasz J. Sznajder
- Department of Molecular Genetics and Microbiology, Center for NeuroGenetics and the Genetics Institute, University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Maurice S. Swanson
- Department of Molecular Genetics and Microbiology, Center for NeuroGenetics and the Genetics Institute, University of Florida, College of Medicine, Gainesville, Florida, USA
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24
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222nd ENMC International Workshop:: Myotonic dystrophy, developing a European consortium for care and therapy, Naarden, The Netherlands, 1-2 July 2016. Neuromuscul Disord 2018; 28:463-469. [PMID: 29550152 DOI: 10.1016/j.nmd.2018.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 02/05/2018] [Indexed: 01/08/2023]
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25
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Heatwole C, Johnson N, Dekdebrun J, Dilek N, Eichinger K, Hilbert J, Luebbe E, Martens W, Mcdermott MP, Thornton C, Moxley R. Myotonic dystrophy patient preferences in patient-reported outcome measures. Muscle Nerve 2018; 58:49-55. [PMID: 29328504 DOI: 10.1002/mus.26066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 01/05/2018] [Accepted: 01/07/2018] [Indexed: 01/06/2023]
Abstract
INTRODUCTION When preparing for clinical trials in myotonic dystrophy type-1 (DM1), it is important that researchers develop and identify patient-reported outcome measures with good measurement properties. METHODS Fifty-two DM1 patients enrolled in 2 clinical studies completed the Myotonic Dystrophy Health Index (MDHI), 36-Item Short Form Health Survey (version 2; SF-36v2), Individualized Neuromuscular Quality of Life questionnaire (INQoL), and a questionnaire comparing the relevance, usability, overall preference, and perceived responsiveness of each measure. The associations between instrument scores and physical function, genetic test results, and employment status were examined. RESULTS The MDHI was preferred over the INQoL in 13 of 13 areas and was preferred over the SF-36v2 in 9 of 13 areas. The MDHI was the only score that was associated with participant employment status, CTG repeat length, and the 3 measurements of clinical function. DISCUSSION The MDHI correlates well with physical function and is viewed favorably by participants in DM1 clinical studies. Muscle Nerve, 2018.
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Affiliation(s)
- Chad Heatwole
- Department of Neurology, University of Rochester Medical Center, Box 673, 601 Elmwood Avenue Rochester, New York, 14642, USA
| | - Nicholas Johnson
- Department of Neurology, University of Utah Medical Center, Salt Lake City, Utah, USA
| | - Jeanne Dekdebrun
- Department of Neurology, University of Rochester Medical Center, Box 673, 601 Elmwood Avenue Rochester, New York, 14642, USA
| | - Nuran Dilek
- Department of Neurology, University of Rochester Medical Center, Box 673, 601 Elmwood Avenue Rochester, New York, 14642, USA
| | - Kate Eichinger
- Department of Neurology, University of Rochester Medical Center, Box 673, 601 Elmwood Avenue Rochester, New York, 14642, USA
| | - James Hilbert
- Department of Neurology, University of Rochester Medical Center, Box 673, 601 Elmwood Avenue Rochester, New York, 14642, USA
| | - Elizabeth Luebbe
- Department of Neurology, University of Rochester Medical Center, Box 673, 601 Elmwood Avenue Rochester, New York, 14642, USA
| | - William Martens
- Department of Neurology, University of Rochester Medical Center, Box 673, 601 Elmwood Avenue Rochester, New York, 14642, USA
| | - Michael P Mcdermott
- Department of Neurology, University of Rochester Medical Center, Box 673, 601 Elmwood Avenue Rochester, New York, 14642, USA
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York, USA
| | - Charles Thornton
- Department of Neurology, University of Rochester Medical Center, Box 673, 601 Elmwood Avenue Rochester, New York, 14642, USA
| | - Richard Moxley
- Department of Neurology, University of Rochester Medical Center, Box 673, 601 Elmwood Avenue Rochester, New York, 14642, USA
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Fujino H, Shingaki H, Suwazono S, Ueda Y, Wada C, Nakayama T, Takahashi MP, Imura O, Matsumura T. Cognitive impairment and quality of life in patients with myotonic dystrophy type 1. Muscle Nerve 2017; 57:742-748. [PMID: 29193182 DOI: 10.1002/mus.26022] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 11/25/2017] [Accepted: 11/27/2017] [Indexed: 01/25/2023]
Abstract
INTRODUCTION This study sought to clarify whether specific cognitive abilities are impaired in patients with myotonic dystrophy type 1 (DM1) as well as to investigate the relationships among quality of life (QoL), cognitive function, and psychological factors. METHODS Sixty patients with DM1 were evaluated on cognitive functioning (abstract reasoning, attention/working memory, executive function, processing speed, and visuoconstructive ability), apathy, depression, excessive daytime sleepiness, fatigue, and QoL. QoL was assessed by 2 domains of the Muscular Dystrophy Quality of Life Scale (Psychosocial Relationships and Physical Functioning and Health). RESULTS More than half of the patients exhibited cognitive impairment in attention/working memory, executive function, processing speed, and visuoconstructive ability. The Psychosocial Relationships factor was associated with processing speed, attention/working memory, and apathy, whereas depression and fatigue were associated with 2 QoL domains. DISCUSSION Our study identified specific cognitive impairments in DM1. Specific cognitive functions and psychological factors may be potential contributors to QoL. Muscle Nerve 57: 742-748, 2018.
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Affiliation(s)
- Haruo Fujino
- Department of Special Needs Education, Oita University, 700 Dannoharu, Oita, Japan, 870-1192.,Graduate School of Human Sciences, Osaka University, Osaka, Japan
| | - Honoka Shingaki
- Graduate School of Human Sciences, Osaka University, Osaka, Japan
| | - Shugo Suwazono
- Department of Neurology, National Hospital Organization Okinawa Hospital, Okinawa, Japan
| | | | - Chizu Wada
- Department of Neurology, National Hospital Organization Akita National Hospital, Yurihonjo, Japan
| | | | - Masanori P Takahashi
- Department of Functional Diagnostic Science, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Osamu Imura
- Graduate School of Human Sciences, Osaka University, Osaka, Japan
| | - Tsuyoshi Matsumura
- Department of Neurology, National Hospital Organization Toneyama National Hospital, Osaka, Japan
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Gagnon C, Tremblay M, CôTé I, Heatwole C. French translation and cross-cultural adaptation of The Myotonic Dystrophy Health Index. Muscle Nerve 2017; 57:686-689. [PMID: 29053894 DOI: 10.1002/mus.25994] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2017] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Validation studies of disease-specific instruments for myotonic dystrophy type-1 (DM1) are required prior to their global use in clinical trials involving different cultures and countries. Here we translate and culturally adapt the Myotonic Dystrophy Health Index (MDHI), a disease-specific patient-reported outcome (PRO) measure, for a French DM1 population. METHODS Using the International Society for Pharmacoeconomics and Outcomes Research Task Force method for translation and adaptation of PRO questionnaires, we created a French translation of the MDHI. We subsequently tested this instrument in a cohort of French-speaking patients with DM1. RESULTS The MDHI was forward and back translated and modified by consensus to create the most compatible translation. Cognitive interviews were conducted with 5 patients with DM1 to ensure the usability and understanding of the translation. DISCUSSION The French version of the MDHI is an optimal translation of the original instrument that is acceptable to native patients and ready for clinical trial use. Muscle Nerve 57: 686-689, 2018.
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Affiliation(s)
- Cynthia Gagnon
- Centre de recherche Charles-Le-Moyne, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Marjolaine Tremblay
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Hôpital de Jonquière, Saguenay, Québec, Canada
| | - Isabelle CôTé
- Groupe de recherche interdisciplinaire sur les maladies neuromusculaires (GRIMN), Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Hôpital de Jonquière, Saguenay, Québec, Canada
| | - Chad Heatwole
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
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Guber RD, Kokkinis AD, Schindler AB, Bendixen RM, Heatwole CR, Fischbeck KH, Grunseich C. Patient-identified impact of symptoms in spinal and bulbar muscular atrophy. Muscle Nerve 2017; 57:40-44. [PMID: 28877556 PMCID: PMC5763365 DOI: 10.1002/mus.25957] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2017] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The effects of spinal bulbar muscular atrophy (SBMA) on quality of life (QoL) are not well understood. This study describes symptoms from the patient's perspective and the impact these symptoms have on QoL. METHODS We conducted open-ended interviews with 21 adult men with genetically confirmed SBMA. Using a qualitative framework technique, we coded and analyzed interviews to identify symptoms and resulting themes. RESULTS From these interviews, 729 quotations were extracted. We identified 200 SBMA-specific symptoms and 20 symptomatic themes. Weakness was mentioned by all interviewees. Symptoms within the domain of mental health and the specific themes of emotional issues and psychological impact were also frequently mentioned. DISCUSSION Numerous symptoms affect QoL for patients with SBMA. We identified previously unrecognized symptoms that are important to address in enhancing clinical care for patients with SBMA and in developing tools to evaluate efficacy in future clinical trials. Muscle Nerve 57: 40-44, 2018.
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Affiliation(s)
- Robert D Guber
- Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 35 Convent Drive Bethesda, Maryland, 20892, USA
| | - Angela D Kokkinis
- Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 35 Convent Drive Bethesda, Maryland, 20892, USA
| | - Alice B Schindler
- Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 35 Convent Drive Bethesda, Maryland, 20892, USA
| | - Roxanna M Bendixen
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Chad R Heatwole
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Kenneth H Fischbeck
- Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 35 Convent Drive Bethesda, Maryland, 20892, USA
| | - Christopher Grunseich
- Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 35 Convent Drive Bethesda, Maryland, 20892, USA
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Sansone VA, Lizio A, Greco L, Gragnano G, Zanolini A, Gualandris M, Iatomasi M, Heatwole C. The Myotonic Dystrophy Health Index: Italian validation of a disease-specific outcome measure. Neuromuscul Disord 2017; 27:1047-1053. [PMID: 28890289 DOI: 10.1016/j.nmd.2017.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/09/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
Abstract
The Myotonic Dystrophy Health Index (MDHI) is a disease-specific, self-reported outcome measure that assesses total disease burden and 17 areas of Myotonic Dystrophy type 1 (DM1) specific health. This study translated the MDHI into Italian and validated the instrument using a cohort of Italian DM1 patients. Italian DM1 patients were interviewed regarding the form and content of the instrument. Thirty-eight DM1 patients were subsequently recruited to test the reliability and concurrent validity of the instrument by serially completing the MDHI and a battery of clinical tests. Lastly, we determined the internal consistency of the Italian MDHI and each of its subscales. The internal consistency was excellent in the total Italian MDHI score and acceptable in all of its subscales; the test-retest reliability was high (intraclass correlation coefficient = 0.95); Italian MDHI total scores and subscales were associated with neuromuscular function, cognitive and social health, respiratory function, and quality of life. Overall, the Italian MDHI is valid and well suited to measure the multi-dimensional aspects of disease burden in Myotonic Dystrophy clinical trials.
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Affiliation(s)
- Valeria A Sansone
- Neurorehabilitation Unit, University of Milan, The NEMO Clinical Center (NEuroMuscular Omnicenter - Fondazione Serena Onlus), Piazza Ospedale Maggiore 3, 20162 Milan, Italy; Dept. Biomedical Sciences for Health, University of Milan, Italy.
| | - Andrea Lizio
- Neurorehabilitation Unit, University of Milan, The NEMO Clinical Center (NEuroMuscular Omnicenter - Fondazione Serena Onlus), Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Lucia Greco
- Neurorehabilitation Unit, University of Milan, The NEMO Clinical Center (NEuroMuscular Omnicenter - Fondazione Serena Onlus), Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Gaia Gragnano
- Neurorehabilitation Unit, University of Milan, The NEMO Clinical Center (NEuroMuscular Omnicenter - Fondazione Serena Onlus), Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Alice Zanolini
- Neurorehabilitation Unit, University of Milan, The NEMO Clinical Center (NEuroMuscular Omnicenter - Fondazione Serena Onlus), Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Marco Gualandris
- Neurorehabilitation Unit, University of Milan, The NEMO Clinical Center (NEuroMuscular Omnicenter - Fondazione Serena Onlus), Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Marino Iatomasi
- Neurorehabilitation Unit, University of Milan, The NEMO Clinical Center (NEuroMuscular Omnicenter - Fondazione Serena Onlus), Piazza Ospedale Maggiore 3, 20162 Milan, Italy
| | - Chad Heatwole
- The University of Rochester Medical Center, Department of Neurology, 601 Elmwood Avenue, Rochester, New York, USA
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Schwarzer S, Rapis K. [Upper abdominal pain, nausea, and vomiting in a 63-year-old woman]. Internist (Berl) 2017; 58:1324-1331. [PMID: 28597104 DOI: 10.1007/s00108-017-0271-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We present a case of myotonic dystrophy type I and its complications including cholangitis and cardiac arrhythmias. The therapy options focus on the consequences of the disease and result in an endoscopic retrograde cholangiography (ERC) and implantation of an implantable cardioverter-defibrillator (ICD). Myotonic dystrophy is a disease which results in a loss of smooth and skeletal muscle cells leading to multiple consequences such as gastrointestinal symptoms and cardiac manifestations.
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Affiliation(s)
- S Schwarzer
- Medizinische Klinik II, Klinik für Gastroenterologie, Hepatologie, Neurogastroenterologie, Infektiologie, Hämatologie, Onkologie und Palliativmedizin, HELIOS Klinikum Krefeld, Lutherplatz 40, 47805, Krefeld, Deutschland.
| | - K Rapis
- Medizinische Klinik I, Klinik für Kardiologie und konservative Intensivmedizin, HELIOS Klinikum Krefeld, Krefeld, Deutschland
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Pucillo EM, Dibella DL, Hung M, Bounsanga J, Crockett B, Dixon M, Butterfield RJ, Campbell C, Johnson NE. Physical function and mobility in children with congenital myotonic dystrophy. Muscle Nerve 2017; 56:224-229. [PMID: 27859360 PMCID: PMC5436951 DOI: 10.1002/mus.25482] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 11/11/2016] [Accepted: 11/16/2016] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Congenital myotonic dystrophy (CDM) occurs when symptoms of myotonic dystrophy present at birth. In this study we evaluated the relationship between physical function, muscle mass, and age to provide an assessment of the disease and help prepare for therapeutic trials. METHODS CDM participants performed timed functional tests (TFTs), the first 2 minutes of 6-minute walk tests (2/6MWTs), and myometry tests, and also performed dual-energy X-ray absorption (DEXA) scans. Healthy controls (HCs) performed TFTs, 6MWTs, and myometry. RESULTS Thirty-seven children with CDM and 27 HCs (age range 3-13 years) participated in the study. There were significant differences in the 10-meter walk (11.3 seconds in CDM vs. 6.8 seconds in HC) and 2MWT (91 meters in CDM vs. 193 meters in HCs). DEXA lean mass of the right arm correlated with grip strength (r = 0.91), and lean mass of the right leg correlated with 6MWT (r = 0.62). CONCLUSION Children with CDM have significant limitations in strength and mobility. The tests performed were reliable, and lean muscle mass may serve as a useful biomarker. Muscle Nerve 56: 224-229, 2017.
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Affiliation(s)
- Evan M Pucillo
- Eccles Institute of Human Genetics, Department of Neurology, University of Utah School of Medicine, 15N 2030 East, Salt Lake City, Utah, 84112, USA
| | - Deanna L Dibella
- Eccles Institute of Human Genetics, Department of Neurology, University of Utah School of Medicine, 15N 2030 East, Salt Lake City, Utah, 84112, USA
| | - Man Hung
- Department of Orthopedics, University of Utah, Salt Lake City, Utah, USA.,Division of Public Health, University of Utah, Salt Lake City, Utah, USA
| | - Jerry Bounsanga
- Department of Orthopedics, University of Utah, Salt Lake City, Utah, USA
| | - Becky Crockett
- Eccles Institute of Human Genetics, Department of Neurology, University of Utah School of Medicine, 15N 2030 East, Salt Lake City, Utah, 84112, USA
| | - Melissa Dixon
- Eccles Institute of Human Genetics, Department of Neurology, University of Utah School of Medicine, 15N 2030 East, Salt Lake City, Utah, 84112, USA
| | | | - Craig Campbell
- Department of Pediatrics, Clinical Neurological Sciences and Epidemiology, Western University, London, Ontario, Canada
| | - Nicholas E Johnson
- Eccles Institute of Human Genetics, Department of Neurology, University of Utah School of Medicine, 15N 2030 East, Salt Lake City, Utah, 84112, USA
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Hesterlee S, Amur S, Bain LJ, Carulli J, Clarke S, Day JW, Gagnon C, Hagerman K, Heatwole C, Johnson NE, Moxley R, Patel N, Thornton C, Kessel W, White M. Patient-Centered Therapy Development for Myotonic Dystrophy: Report of the Myotonic Dystrophy Foundation-Sponsored Workshop. Ther Innov Regul Sci 2017; 51:516-522. [PMID: 30227044 DOI: 10.1177/2168479016683988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Myotonic dystrophy (DM) is an autosomal dominant, repeat expansion, progressive disorder with no drug therapies. Consequently, to better define a regulatory pathway in anticipation of new treatment strategies under investigation, the Myotonic Dystrophy Foundation convened a workshop entitled "Patient-Centered Therapy Development for Myotonic Dystrophy" in September 2015. Participants included representatives from academia, industry, the patient community, the National Institutes of Health (NIH) and the Food and Drug Administration (FDA). Presenters described the symptom burden of the disease, and existing data on DM biomarkers, endpoints, natural history, and benefit-risk considerations. FDA participants helped clarify the regulatory requirements for new drug treatment approvals and DM-specific issues such as variability, slow progression, and low prevalence. Workshop attendees gained a better understanding of DM and the current status of existing data and tools to support therapeutic drug research and development.
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Affiliation(s)
| | - Shashi Amur
- 2 Office of Translational Sciences, CDER, FDA, Silver Spring, MD, USA
| | | | - John Carulli
- 4 Precision Medicine, Biogen, Cambridge, MA, USA
| | | | - John W Day
- 6 Department of Neurology, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Cynthia Gagnon
- 7 School of Rehabilitation, Université de Sherbrooke, Quebec, Canada
| | - Katharine Hagerman
- 6 Department of Neurology, School of Medicine, Stanford University, Palo Alto, CA, USA
| | - Chad Heatwole
- 8 Department of Neurology, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Nicholas E Johnson
- 9 Department of Neurology, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Richard Moxley
- 8 Department of Neurology, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Nikunj Patel
- 10 Office of New Drugs, CDER, FDA, Silver Spring, MD, USA
| | - Charles Thornton
- 8 Department of Neurology, School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA
| | - Woodie Kessel
- 1 Myotonic Dystrophy Foundation, San Francisco, CA, USA
| | - Molly White
- 1 Myotonic Dystrophy Foundation, San Francisco, CA, USA
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De Antonio M, Dogan C, Hamroun D, Mati M, Zerrouki S, Eymard B, Katsahian S, Bassez G. Unravelling the myotonic dystrophy type 1 clinical spectrum: A systematic registry-based study with implications for disease classification. Rev Neurol (Paris) 2016; 172:572-580. [DOI: 10.1016/j.neurol.2016.08.003] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 07/15/2016] [Accepted: 08/22/2016] [Indexed: 10/21/2022]
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Drug Development and Challenges for Neuromuscular Clinical Trials. J Mol Neurosci 2015; 58:374-8. [PMID: 26691331 DOI: 10.1007/s12031-015-0700-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 12/10/2015] [Indexed: 10/22/2022]
Abstract
Drug development process faces many challenges, including those encountered in clinical trials for neuromuscular diseases. Drug development is a lengthy and highly costly process. Out of 10 compounds entering first study in man (phase 1), only one compound reaches the market after an average of 14 years with a cost of $2.7 billion. Nevertheless, according to the Centers for Medicare and Medicaid services, prescription drugs constituted only 9 % of each health care dollar spent in USA in 2013. Examples of challenges encountered in neuromuscular clinical trials include lack of validated patient-reported outcome tools, blinding issues, and the use of placebo in addition to lack of health authority guidance for orphan diseases. Patient enrollment challenge is the leading cause of missed clinical trial deadlines observed in about 80 % of clinical trials, resulting in delayed availability of potentially life-saving therapies. Another specific challenge introduced by recent technology is the use of social media and risk of bias. Sharing personal experiences while in the study could easily introduce bias among patients that would interfere with accurate interpretation of collected data. To minimize this risk, recent neuromuscular studies incorporate as an inclusion criterion the patient's agreement not to share any of study experiences through social media with other patients during the study conduct. Consideration of these challenges will allow timely response to the high unmet medical needs for many neuromuscular diseases.
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