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Luciano RDP, Puertas EB, Martins DE, Faloppa F, Del Curto D, Rodrigues LMR, Schmidt B, de Oliveira ASB, Wajchenberg M. Adolescent idiopathic scoliosis without limb weakness: a differential diagnosis of core myopathy? BMC Musculoskelet Disord 2015; 16:179. [PMID: 26242231 PMCID: PMC4524392 DOI: 10.1186/s12891-015-0629-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 07/13/2015] [Indexed: 11/10/2022] Open
Abstract
Background Core myopathies are a clinically and genetically heterogeneous group of congenital myopathies with the common defined histopathological feature of focally reduced oxidative activity on muscle biopsy. It has a low incidence, however, recent articles show broad clinical spectrum, suggesting that the real incidence should be considerably larger than previously described. Due to the important association between scoliosis and paravertebral muscle imbalance, numerous authors study, by biopsy of the spinal rotator muscles, potential changes that may elucidate the etiology of adolescent idiopathic scoliosis. Case presentation Two patients have been followed at Spine Group of Department of Orthopedics at Federal University of São Paulo, with an initial diagnosis of idiopathic scoliosis. Both patients had clinical and radiological findings compatible with it. The patients authorized, through the Term of Consent, intraoperative biopsy of muscle multifidus from the apex of the thoracic curve on concave and convex sides. After muscle biopsy was performed a histopathological analysis. As regard to the histopathological features: in both patients were identified, the presence of core structures in extensive areas with reduced oxidative activity running along the muscle fiber. Conclusions All patients with ‘idiopathic’ scoliosis deserve a careful neurological evaluation, even if they have minimal muscle symptoms in the extremities. The frequent occurrence of scoliosis in patients with CORE Myopathies, supports the thesis that the change in the paravertebral muscle fiber must be the underlying pathogenic factor in scoliosis and may help us understand the onset and progression of curves in patients previously diagnosed with idiopathic scoliosis.
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Affiliation(s)
- Rafael de Paiva Luciano
- Universidade Federal de Sao Paulo - Brazil - R. Borges Lagoa, 783, 5 andar, Vila Clementino, SP, Zip Code - 04038-031, Brazil.
| | - Eduardo Barros Puertas
- Universidade Federal de Sao Paulo - Brazil - R. Borges Lagoa, 783, 5 andar, Vila Clementino, SP, Zip Code - 04038-031, Brazil.
| | - Delio Eulalio Martins
- Universidade Federal de Sao Paulo - Brazil - R. Borges Lagoa, 783, 5 andar, Vila Clementino, SP, Zip Code - 04038-031, Brazil.
| | - Flavio Faloppa
- Universidade Federal de Sao Paulo - Brazil - R. Borges Lagoa, 783, 5 andar, Vila Clementino, SP, Zip Code - 04038-031, Brazil.
| | - David Del Curto
- Universidade Federal de Sao Paulo - Brazil - R. Borges Lagoa, 783, 5 andar, Vila Clementino, SP, Zip Code - 04038-031, Brazil.
| | - Luciano Miller Reis Rodrigues
- Universidade Federal de Sao Paulo - Brazil - R. Borges Lagoa, 783, 5 andar, Vila Clementino, SP, Zip Code - 04038-031, Brazil.
| | - Beny Schmidt
- Universidade Federal de Sao Paulo - Brazil - R. Borges Lagoa, 783, 5 andar, Vila Clementino, SP, Zip Code - 04038-031, Brazil.
| | - Acary Souza Bulle de Oliveira
- Universidade Federal de Sao Paulo - Brazil - R. Borges Lagoa, 783, 5 andar, Vila Clementino, SP, Zip Code - 04038-031, Brazil.
| | - Marcelo Wajchenberg
- Universidade Federal de Sao Paulo - Brazil - R. Borges Lagoa, 783, 5 andar, Vila Clementino, SP, Zip Code - 04038-031, Brazil.
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Imagama S, Kawakami N, Tsuji T, Ohara T, Ishiguro N. Kyphoscoliosis associated with congenital neuromuscular disease with uniform type 1 fibers. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 21 Suppl 4:S499-504. [PMID: 22193842 DOI: 10.1007/s00586-011-2128-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 12/07/2011] [Accepted: 12/14/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To report the first case of surgical treatment for severe kyphoscoliosis associated with respiratory disorder in a patient with congenital neuromuscular disease with uniform type 1 fibers (CNMDU1), including management of the possible onset of malignant hyperthermia (MH) in general anesthesia. CNMDU1 is rare among congenital neuromuscular diseases, and surgery for spinal deformity in CNMDU1 has not been described. Onset of MH in general anesthesia is a concern in this disease. METHODS A 13-year-old female with motor retardation, suspected myopathy, and severe spinal deformity was followed at another pediatric hospital before referral to Meijo Hospital. Symptoms at the initial consultation were mild general muscular weakness and muscular atrophy. The rib hump was 60° and trunk balance was poor. The tendon reflex showed hyporeflexia, and blood tests were normal. Vital capacity was 0.69 L and forced expiratory volume percentage in 1 s was 75.5%, showing a restrictive and obstructive ventilatory defect. A plain radiograph showed severe kyphoscoliosis with thoracic scoliosis of 130° (T5-L1) and thoracic kyphosis of 110° (T2-T12) with almost no flexibility in bending or traction film. RESULTS After preoperative halo traction for 2 months, one-stage anterior and posterior correction and fusion from T2 to L3 was conducted. MH did not occur, but recovery of respiratory function required 8 days by intubation after surgery. Postoperatively, thoracic kyphosis improved to 25° and thoracic scoliosis was 66° (correction rate: 49%). Pathological results of an intraoperative muscle biopsy from the paraspinal muscles confirmed the diagnosis of CNMDU1. At 6 years after surgery, the patient has no problems in daily life and no respiratory difficulty. CONCLUSION Spinal deformity in CNMDU1 has a risk of severe progression, which makes early diagnosis by biopsy important. The surgery may be recommended before severe progression of spinal deformity and respiratory disorder. Perioperative MH is a concern, but can be managed by appropriate procedures.
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Affiliation(s)
- Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65, Tsurumai, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
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Duarte ST, Oliveira J, Santos R, Pereira P, Barroso C, Conceição I, Evangelista T. Dominant and recessive RYR1 mutations in adults with core lesions and mild muscle symptoms. Muscle Nerve 2011; 44:102-8. [PMID: 21674524 DOI: 10.1002/mus.22009] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Ryanodine receptor gene (RYR1) mutations have been associated with central core disease (CCD), multiminicore/minicore/multicore disease (MmD), and susceptibility to malignant hyperthermia (MH). METHODS Patients with muscle symptoms in adulthood, who had features compatible with CCD/MmD, underwent clinical, histological, and genetic (RYR1 and SEPN1 genes) evaluations. Published cases of CCD and MmD with adult onset were also reviewed. RESULTS Eight patients fulfilled the criteria for further analysis. Five RYR1 mutations, 4 of them unreported, were detected in 3 patients. Compound heterozygosity was proven in 1 case. CONCLUSIONS To our knowledge, this is the only report of adult onset associated with recessive RYR1 mutations and central core/multiminicores on muscle biopsy. Although adult patients with CCD, MmD, and minimally symptomatic MH with abnormal muscle biopsy findings usually have a mild clinical course, differential diagnosis and carrier screening is crucial for prevention of potentially life-threatening reactions to general anesthesia.
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Affiliation(s)
- Sofia T Duarte
- Neuropaediatrics Department, Hospital de D. Estefânia, Centro Hospitalar de Lisboa Central, E.P.E., Rua Jacinta Marto, 1169-045 Lisboa, Portugal.
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Jeong SK, Kim DC, Cho YG, Sunwoo IN, Kim DS. A double mutation of the ryanodine receptor type 1 gene in a malignant hyperthermia family with multiminicore myopathy. J Clin Neurol 2008; 4:123-30. [PMID: 19513315 PMCID: PMC2686874 DOI: 10.3988/jcn.2008.4.3.123] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 07/08/2008] [Accepted: 07/08/2008] [Indexed: 11/17/2022] Open
Abstract
Background and purpose At least 100 Ryanodine receptor type 1 (RYR1) mutations associated with malignant hyperthermia (MH) and central core disease (CCD) have been identified, but 2 RYR1 mutations accompanying multiminicore myopathy in an MH and/or CCD family have been reported only rarely. Methods Fifty-three members of a large MH family were investigated with clinical, histopathologic, RYR1 mutation, and haplotyping studies. Blood creatine kinase (CK) and myoglobin levels were also measured where possible. Results Sequencing of the entire RYR1 coding region identified a double RYR1 mutation (R2435H and A4295V) in MH/CCD regions 2 and 3. Haplotyping analysis revealed that the two missense heterozygous mutations (c.7304G>A and c.12891C>T) were always present on a common haplotype allele, and were closely cosegregated with histological multiminicores and elevated serum CK. All the subjects with the double mutation showed elevated serum CK and myoglobin, and the obtained muscle biopsy samples showed multiminicore lesions, but only two family members presented a late-onset, slowly progressive myopathy. Conclusions We found multiminicore myopathy with clinical and histological variability in a large MH family with an unusual double RYR1 mutation, including a typical CCD-causing known mutant. These results suggest that multiminicore lesions are associated with the presence of more than two mutations in the RYR1 gene.
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Affiliation(s)
- Seul-Ki Jeong
- Department of Neurology, Chonbuk National University Medical School, Jeonju, Korea
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