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Vicino A, Veltsista D, van Alfen N. Muscle ultrasound in myopathies. Curr Opin Neurol 2024:00019052-990000000-00187. [PMID: 39051427 DOI: 10.1097/wco.0000000000001306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
PURPOSE OF REVIEW This review highlights recent developments in the field of muscle ultrasound (MUS) for the diagnosis and follow up of muscle disorders. RECENT FINDINGS The diagnostic screening capacity of quantitative grayscale analysis is still sufficient to assess children suspected of a neuromuscular disorder. A combination of visual and quantitative assessment is advised for optimal interpretation. MUS was more sensitive but less specific than MRI for detecting pathology in limb girdle dystrophies and inflammatory myopathies. New techniques such as shearwave elastography and artificial intelligence algorithms for automated image segmentation show promise but need further development for use in everyday practice.Muscle ultrasound has high correlations with clinical measures of function in skeletal and respiratory muscles and the orofacial region, in most of the myopathies and dystrophies studied. Over time, imaging changes precede changes in clinical status, making them attractive for biomarker use in trials. In Duchenne muscular dystrophy MUS was also responsive to the effects of steroid treatment. SUMMARY Muscle ultrasound is a sensitive technique to diagnose and follow up of skeletal, facial and respiratory muscles in neuromuscular disorders. Its role is both complementary to and partially overlapping with that of MRI.
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Affiliation(s)
- Alex Vicino
- Nerve-Muscle Unit, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Dimitra Veltsista
- Department of Neurology, University Hospital of Patras, Patras, Greece
| | - Nens van Alfen
- Department of Neurology& Clinical Neurophysiology, Clinical Neuromuscular Imaging Group, Donders Center for Neuroscience, Radboudumc, Nijmegen, The Netherlands
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Kroon RHMJM, Kalf JG, de Swart BJM, Heskamp L, de Rooy JWJ, van Engelen BGM, Horlings CGC. Muscle MRI in Patients With Oculopharyngeal Muscular Dystrophy: A Longitudinal Study. Neurology 2024; 102:e207833. [PMID: 38165364 PMCID: PMC10834117 DOI: 10.1212/wnl.0000000000207833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/03/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Oculopharyngeal muscular dystrophy (OPMD) is a rare progressive neuromuscular disease. MRI is one of the techniques that is used in neuromuscular disorders to evaluate muscle alterations. The aim of this study was to describe the pattern of fatty infiltration of orofacial and leg muscles using quantitative muscle MRI in a large national cohort and to determine whether MRI can be used as an imaging biomarker of disease progression in OPMD. METHODS Patients with OPMD (18 years or older) were invited from the national neuromuscular database or by their treating physicians and were examined twice with an interval of 20 months, with quantitative MRI of orofacial and leg muscles to assess fatty infiltration which were compared with clinical measures. RESULTS In 43 patients with genetically confirmed OPMD, the muscles that were affected most severely were the tongue (mean fat fraction: 37.0%, SD 16.6), adductor magnus (31.9%; 27.1), and soleus (27.9%; 21.5) muscles. The rectus femoris and tibialis anterior muscles were least severely affected (mean fat fractions: 6.8%; SD 4.7, 7.5%; 5.9). Eleven of 14 significant correlations were found between fat fraction and a clinical task in the corresponding muscles (r = -0.312 to -0.769, CI = -0.874 to -0.005). At follow-up, fat fractions had increased significantly in 17 of the 26 muscles: mean 1.7% in the upper leg muscles (CI = 0.8-2.4), 1.7% (1.0-2.3) in the lower leg muscles, and 1.9% (0.6-3.3) in the orofacial muscles (p < 0.05). The largest increase was seen for the soleus (3.8%, CI = 2.5-5.1). Correlations were found between disease duration and repeat length vs increased fat fraction in 7 leg muscles (r = 0.323 to -0.412, p < 0.05). DISCUSSION According to quantitative muscle MRI, the tongue, adductor magnus and soleus show the largest fat infiltration levels in patients with OPMD. Fat fractions increased in several orofacial and leg muscles over 20 months, with the largest fat fraction increase seen in the soleus. This study supports that this technique is sensitive enough to show worsening in fat fractions of orofacial and leg muscles and therefore a responsive biomarker for future clinical trials.
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Affiliation(s)
- Rosemarie H M J M Kroon
- From the Departments of Rehabilitation (R.H.M.J.M.K., J.G.K., B.J.M.d.S.) and Neurology (B.G.M.v.E., C.G.C.H.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen; Department of Radiology (L.H.), University Medical Centre Utrecht; Department of Imaging (J.W.J.d.R.), Radboud University Medical Center, Nijmegen; and Department of Neurology (C.G.C.H.), Medical University of Innsbruck, Austria
| | - Johanna G Kalf
- From the Departments of Rehabilitation (R.H.M.J.M.K., J.G.K., B.J.M.d.S.) and Neurology (B.G.M.v.E., C.G.C.H.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen; Department of Radiology (L.H.), University Medical Centre Utrecht; Department of Imaging (J.W.J.d.R.), Radboud University Medical Center, Nijmegen; and Department of Neurology (C.G.C.H.), Medical University of Innsbruck, Austria
| | - Bert J M de Swart
- From the Departments of Rehabilitation (R.H.M.J.M.K., J.G.K., B.J.M.d.S.) and Neurology (B.G.M.v.E., C.G.C.H.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen; Department of Radiology (L.H.), University Medical Centre Utrecht; Department of Imaging (J.W.J.d.R.), Radboud University Medical Center, Nijmegen; and Department of Neurology (C.G.C.H.), Medical University of Innsbruck, Austria
| | - Linda Heskamp
- From the Departments of Rehabilitation (R.H.M.J.M.K., J.G.K., B.J.M.d.S.) and Neurology (B.G.M.v.E., C.G.C.H.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen; Department of Radiology (L.H.), University Medical Centre Utrecht; Department of Imaging (J.W.J.d.R.), Radboud University Medical Center, Nijmegen; and Department of Neurology (C.G.C.H.), Medical University of Innsbruck, Austria
| | - Jacky W J de Rooy
- From the Departments of Rehabilitation (R.H.M.J.M.K., J.G.K., B.J.M.d.S.) and Neurology (B.G.M.v.E., C.G.C.H.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen; Department of Radiology (L.H.), University Medical Centre Utrecht; Department of Imaging (J.W.J.d.R.), Radboud University Medical Center, Nijmegen; and Department of Neurology (C.G.C.H.), Medical University of Innsbruck, Austria
| | - Baziel G M van Engelen
- From the Departments of Rehabilitation (R.H.M.J.M.K., J.G.K., B.J.M.d.S.) and Neurology (B.G.M.v.E., C.G.C.H.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen; Department of Radiology (L.H.), University Medical Centre Utrecht; Department of Imaging (J.W.J.d.R.), Radboud University Medical Center, Nijmegen; and Department of Neurology (C.G.C.H.), Medical University of Innsbruck, Austria
| | - Corinne G C Horlings
- From the Departments of Rehabilitation (R.H.M.J.M.K., J.G.K., B.J.M.d.S.) and Neurology (B.G.M.v.E., C.G.C.H.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen; Department of Radiology (L.H.), University Medical Centre Utrecht; Department of Imaging (J.W.J.d.R.), Radboud University Medical Center, Nijmegen; and Department of Neurology (C.G.C.H.), Medical University of Innsbruck, Austria
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Infante JM, Nepomuceno BL. Choked: A Case Report of Oculopharyngeal Muscular Dystrophy Mimicking Hypothyroidism From the Philippines. Cureus 2023; 15:e41025. [PMID: 37519616 PMCID: PMC10373107 DOI: 10.7759/cureus.41025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Oculopharyngeal muscular dystrophy (OPMD) is a late-onset myopathic genetic disorder characterized by chronic progressive dysphagia and ptosis with or without proximal limb weakness. It is most often caused by an abnormal alanine-encoding (GCN) trinucleotide repeat expansion in the first exon of the poly(A)-binding protein nuclear 1 (PABPN1) gene. Patients with hypothyroidism may similarly report bilateral ptosis, dysphagia, and limb weakness. Here, we report the case of a 65-year-old Austrian female with hypothyroidism living in the Philippines who presented with gradually progressive ptosis, dysphagia, and intermittent choking episodes. No known relatives had similar symptoms. Physical examination showed bilateral symmetric ptosis, good cough reflex, and good limb muscle strength. Electromyographic studies of facial and laryngeal muscles were found to be normal. Thyroid evaluation showed biochemically hyperthyroid status while taking Levothyroxine. With a clinical suspicion for genetic progressive myopathy, we considered OPMD. Genetic testing revealed abnormal expansion of GCN trinucleotide repeats in the PABPN1 gene. We describe the first reported case of OPMD with detected PABPN1 gene expansion in the Philippines simulating hypothyroidism symptoms, suggesting possible points for misidentification and underdiagnosis of OPMD in developing countries.
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Affiliation(s)
- Jerome M Infante
- Institute for Neurosciences, Section of Neurology, St. Luke's Medical Center, Quezon City, PHL
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Stoffels AAF, van Voorthuizen EL, van Hees HWH, Peters JB, van Helvoort HAC, Voermans NC, Doorduin J, van den Borst B. Longitudinal Analysis of Quadriceps Muscle Strength in Patients with Previous COVID-19 Hospitalization and in Patients with Post-Acute Sequelae following Mild COVID-19. Nutrients 2022; 14:nu14204319. [PMID: 36297002 PMCID: PMC9608500 DOI: 10.3390/nu14204319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022] Open
Abstract
Muscle weakness is a prominent symptom in post-acute sequelae of COVID-19 (PASC). However, few studies have objectively and longitudinally assessed muscle strength after varying COVID-19 severity grades. This observational study aimed to explore the prevalence, determinants, and 1.5 years change of quadriceps muscle weakness in 98 patients discharged from COVID-19 hospitalization and in 50 patients with PASC following mild COVID-19. Isometric quadriceps maximal voluntary contraction (MVC) was assessed on a computerized dynamometer at three visits. Also, in a subgroup of 14 post-COVID-19 patients with quadriceps muscle weakness, muscle thickness and echo intensity were determined by muscle ultrasound of nine upper and lower extremity muscles. Muscle weakness was found in 59% of post-hospitalized patients and in 65% of those with PASC following mild COVID-19 at ~14 weeks after acute COVID-19. Whereas during ~1.5 years follow-up MVC modestly improved, muscle weakness prevalence remained unchanged. Hospital length of stay and diabetes mellitus were identified as possible predictors of muscle weakness following COVID-19 hospitalization. No predictors could be identified in those with PASC following mild COVID-19. Ultrasound outcomes revealed no large structural abnormalities. In conclusion, clinically relevant muscle weakness is common after COVID-19 and its long-term improvement is poor. Future studies with relevant control groups are warranted to confirm our data.
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Affiliation(s)
- Anouk A. F. Stoffels
- Department of Pulmonary Diseases, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
- Correspondence:
| | - Esther L. van Voorthuizen
- Department of Pulmonary Diseases, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Hieronymus W. H. van Hees
- Department of Pulmonary Diseases, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Jeannette B. Peters
- Department of Pulmonary Diseases, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | | | - Nicol C. Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Jonne Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Bram van den Borst
- Department of Pulmonary Diseases, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
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