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Garmendia J, Labayru G, Souto Barreto PD, Vergara I, de Munain AL, Sistiaga A. Common Characteristics Between Frailty and Myotonic Dystrophy Type 1: A Narrative Review. Aging Dis 2024:AD.2024.0950. [PMID: 39325937 DOI: 10.14336/ad.2024.0950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Accepted: 08/29/2024] [Indexed: 09/28/2024] Open
Abstract
Myotonic dystrophy type 1 (DM1) is an inherited neuromuscular disorder often considered a model of accelerated aging due to the early appearance of certain age-related clinical manifestations and cellular and molecular aging markers. Frailty, a state of vulnerability related to aging, has been recently studied in neurological conditions but has received considerably less attention in neuromuscular disorders. This narrative review aims to describe 1) the common characteristics between Fried's frailty phenotype criteria (muscular weakness, slow gait speed, weight loss, exhaustion/fatigue, and low physical activity) and DM1, and 2) the psychological and social factors potentially contributing to frailty in DM1. This review gathered evidence suggesting that DM1 patients meet four of the five frailty phenotype criteria. Additionally, longitudinal studies report the deterioration of these criteria over time in DM1. Patients also exhibit psychological/cognitive and social factors that might contribute to frailty. Monitoring frailty criteria in the DM1 population could help to implement timely preventions and interventions to reduce the disease burden and severity of frailty symptoms.
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Affiliation(s)
- Joana Garmendia
- Department of Clinical and Health Psychology and Research Methodology, Psychology Faculty, University of the Basque Country (UPV/EHU), Donostia-San Sebastián, Gipuzkoa, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Madrid, Spain
| | - Garazi Labayru
- Department of Clinical and Health Psychology and Research Methodology, Psychology Faculty, University of the Basque Country (UPV/EHU), Donostia-San Sebastián, Gipuzkoa, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Madrid, Spain
- Neuroscience Area, Biogipuzkoa Health Research Institute, Donostia-San Sebastián, Gipuzkoa, Spain
| | - Philipe de Souto Barreto
- Institute on Aging, Toulouse University Hospital (CHU Toulouse), Toulouse, France
- Institut Hospitalo-Universitaire (IHU) HealthAge, Toulouse, France
- CERPOP UMR 1295, Inserm, Université Paul Sabatier, Toulouse, France
| | - Itziar Vergara
- Osakidetza Health Care Directorate, PC-IHO Research Unit of Gipuzkoa, Donostia-San Sebastián, Gipuzkoa, Spain
- Primary Care Group, Biogipuzkoa Health Research Institute, Donostia-San Sebastián, Gipuzkoa, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Spain
| | - Adolfo López de Munain
- Neurology Department, Donostia University Hospital, Donostia-San Sebastián, Gipuzkoa, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Madrid, Spain
- Neuroscience Area, Biogipuzkoa Health Research Institute, Donostia-San Sebastián, Gipuzkoa, Spain
| | - Andone Sistiaga
- Department of Clinical and Health Psychology and Research Methodology, Psychology Faculty, University of the Basque Country (UPV/EHU), Donostia-San Sebastián, Gipuzkoa, Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Madrid, Spain
- Neuroscience Area, Biogipuzkoa Health Research Institute, Donostia-San Sebastián, Gipuzkoa, Spain
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2
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Winblad S, Eliasdottir O, Nordström S, Lindberg C. Neurocognitive disorder in Myotonic dystrophy type 1. Heliyon 2024; 10:e30875. [PMID: 38778932 PMCID: PMC11109806 DOI: 10.1016/j.heliyon.2024.e30875] [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: 08/10/2023] [Revised: 03/08/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
Cognitive deficits and abnormal cognitive aging have been associated with Myotonic dystrophy type 1 (DM1), but the knowledge of the extent and progression of decline is limited. The aim of this study was to examine the prevalence of signs of neurocognitive disorder (mild cognitive impairment and dementia) in adult patients with DM1. A total of 128 patients with childhood, juvenile, adult, and late onset DM1 underwent a screening using the Montreal Cognitive Assessment (MoCA). Demographic and clinical information was collected. The results revealed that signs of neurocognitive disorder were relatively rare among the participants. However, 23.8 % of patients with late onset DM1 (aged over 60 years) scored below MoCA cut-off (=23), and this group also scored significantly worse compared to patients with adult onset. Age at examination were negatively correlated with MoCA scores, although it only explained a small portion of the variation in test results. Other demographic and clinical factors showed no association with MoCA scores. In conclusion, our findings indicate a low prevalence of signs of neurocognitive disorder in adult patients with DM1, suggesting that cognitive deficits rarely progress to severe disorders over time. However, the performance of patients with late onset DM1 suggests that this phenotype warrants further exploration in future studies, including longitudinal and larger sample analyses.
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Affiliation(s)
- Stefan Winblad
- Icon Lab, Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Olöf Eliasdottir
- Department of Neurology, Neuromuscular Center, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sara Nordström
- Department of Neurology, Neuromuscular Center, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christopher Lindberg
- Department of Neurology, Neuromuscular Center, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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3
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Wu Y, Wei Q, Lin J, Shang H, Ou R. Cognitive impairment, neuroimaging abnormalities, and their correlations in myotonic dystrophy: a comprehensive review. Front Cell Neurosci 2024; 18:1369332. [PMID: 38638300 PMCID: PMC11024338 DOI: 10.3389/fncel.2024.1369332] [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: 01/26/2024] [Accepted: 03/22/2024] [Indexed: 04/20/2024] Open
Abstract
Myotonic dystrophy (DM) encompasses a spectrum of neuromuscular diseases characterized by myotonia, muscle weakness, and wasting. Recent research has led to the recognition of DM as a neurological disorder. Cognitive impairment is a central nervous system condition that has been observed in various forms of DM. Neuroimaging studies have increasingly linked DM to alterations in white matter (WM) integrity and highlighted the relationship between cognitive impairment and abnormalities in WM structure. This review aims to summarize investigations into cognitive impairment and brain abnormalities in individuals with DM and to elucidate the correlation between these factors and the potential underlying mechanisms contributing to these abnormalities.
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Affiliation(s)
| | | | | | | | - Ruwei Ou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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4
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Chawla T, Reddy N, Jankar R, Vengalil S, Polavarapu K, Arunachal G, Preethish-Kumar V, Nashi S, Bardhan M, Rajeshwaran J, Afsar M, Warrier M, Thomas PT, Thennarasu K, Nalini A. Myotonic Dystrophy Type 1 (DM1): Clinical Characteristics and Disease Progression in a Large Cohort. Neurol India 2024; 72:83-89. [PMID: 38443007 DOI: 10.4103/neuroindia.ni_1432_20] [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: 09/13/2020] [Accepted: 10/25/2021] [Indexed: 03/07/2024]
Abstract
BACKGROUND DM1 is a multisystem disorder caused by expansion of a CTG triplet repeat in the 3' non-coding region of DMPK. Neuropsychological consequences and sleep abnormalities are important associations in DM1. OBJECTIVE To describe the clinical phenotype, disease progression and characterize the sleep alterations and cognitive abnormalities in a sub-set of patients. MATERIALS AND METHODS A retrospective study on 120 genetically confirmed DM1 cases. Findings in neuropsychological assessment and multiple sleep questionnaires were compared with 14 age and sex matched healthy individuals. All 120 patients were contacted through letters/telephonic consultation/hospital visits to record their latest physical and functional disabilities. RESULTS The mean age at symptom onset was 23.1 ± 11.4 years, M: F = 3.8:1, mean duration of illness = 14.3 ± 9.5 years. Clinically 54.2% had adult onset form, juvenile = 27.5%, infantile = 10.8%, late adult onset = 7.5%. Paternal transmission occurred more frequently. The predominant initial symptoms were myotonia (37.5%), hand weakness (21.7%), lower limb weakness (23.3%) and bulbar (10%). Twenty patients completed sleep questionnaires (SQ). Abnormal scores were noted in Epworth sleepiness scale (55%); Pittsburgh sleep quality index (45%); Berlin SQ (30%); Rapid eye movement sleep Behaviour Disorder SQ (15%); Restless leg syndrome rating scale (10%). Neuropsychological assessment of 20 patients revealed frontal executive dysfunction, attention impairment and visuospatial dysfunction. Frontal lobe was most affected (72%) followed by parietal (16%) and temporal lobe (12%). CONCLUSIONS The current study provides a comprehensive account of the clinical characteristics in Indian patients with DM1. Hypersomnolence was most commonly seen. Excessive daytime sleepiness and Sleep disordered breathing were the most common sleep related abnormality. Cognitive impairment comprised predominantly of frontal lobe dysfunction.
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Affiliation(s)
- Tanushree Chawla
- Department of Neurology, Children's Hospital of Eastern Ontario Research Institute, The Ottawa Hospital, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Nishanth Reddy
- Department of Neurology, Children's Hospital of Eastern Ontario Research Institute, The Ottawa Hospital, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Rahul Jankar
- Department of Neurology, Children's Hospital of Eastern Ontario Research Institute, The Ottawa Hospital, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Seena Vengalil
- Department of Neurology, Children's Hospital of Eastern Ontario Research Institute, The Ottawa Hospital, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Kiran Polavarapu
- Department of Neurology, Children's Hospital of Eastern Ontario Research Institute, The Ottawa Hospital, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
- Department of Division of Neurology, Department of Medicine, Children's Hospital of Eastern Ontario Research Institute, The Ottawa Hospital, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Gautham Arunachal
- Department of Human Genetics, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Veeramani Preethish-Kumar
- Department of Neurology, Children's Hospital of Eastern Ontario Research Institute, The Ottawa Hospital, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Saraswati Nashi
- Department of Neurology, Children's Hospital of Eastern Ontario Research Institute, The Ottawa Hospital, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Mainak Bardhan
- Department of Neurology, Children's Hospital of Eastern Ontario Research Institute, The Ottawa Hospital, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
- Department of Division of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Jamuna Rajeshwaran
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Mohammad Afsar
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Manjusha Warrier
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Priya T Thomas
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Kandavel Thennarasu
- Department of Biostatistics, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Atchayaram Nalini
- Department of Neurology, Children's Hospital of Eastern Ontario Research Institute, The Ottawa Hospital, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
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Koscik TR, van der Plas E, Long JD, Cross S, Gutmann L, Cumming SA, Monckton DG, Shields RK, Magnotta V, Nopoulos PC. Longitudinal changes in white matter as measured with diffusion tensor imaging in adult-onset myotonic dystrophy type 1. Neuromuscul Disord 2023; 33:660-669. [PMID: 37419717 PMCID: PMC10529200 DOI: 10.1016/j.nmd.2023.05.010] [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: 11/19/2022] [Revised: 05/17/2023] [Accepted: 05/31/2023] [Indexed: 07/09/2023]
Abstract
Myotonic dystrophy type 1 is characterized by neuromuscular degeneration. Our objective was to compare change in white matter microstructure (fractional anisotropy, radial and axial diffusivity), and functional/clinical measures. Participants underwent yearly neuroimaging and neurocognitive assessments over three-years. Assessments encompassed full-scale intelligence, memory, language, visuospatial skills, attention, processing speed, and executive function, as well as clinical symptoms of muscle/motor function, apathy, and hypersomnolence. Mixed effects models were used to examine differences. 69 healthy adults (66.2% women) and 41 DM1 patients (70.7% women) provided 156 and 90 observations, respectively. There was a group by elapsed time interaction for cerebral white matter, where DM1 patients exhibited declines in white matter (all p<0.05). Likewise, DM1 patients either declined (motor), improved more slowly (intelligence), or remained stable (executive function) for functional outcomes. White matter was associated with functional performance; intelligence was predicted by axial (r = 0.832; p<0.01) and radial diffusivity (r = 0.291, p<0.05), and executive function was associated with anisotropy (r = 0.416, p<0.001), and diffusivity (axial: r = 0.237, p = 0.05 and radial: r = 0.300, p<0.05). Indices of white matter health are sensitive to progression in DM1. These results are important for clinical trial design, which utilize short intervals to establish treatment efficacy.
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Affiliation(s)
- Timothy R Koscik
- Arkansas Children's Research Institute, University of Arkansas for Medical Sciences, 13 Children's Way, Little Rock, AR 72202-3591, USA
| | - Ellen van der Plas
- Arkansas Children's Research Institute, University of Arkansas for Medical Sciences, 13 Children's Way, Little Rock, AR 72202-3591, USA
| | - Jeffrey D Long
- Department of Psychiatry, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA; Department of Biostatistics, College of Public Health, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Stephen Cross
- Arkansas Children's Research Institute, University of Arkansas for Medical Sciences, 13 Children's Way, Little Rock, AR 72202-3591, USA
| | - Laurie Gutmann
- Department of Neurology, School of Medicine, Indiana University, 362W 15th St, Indianapolis, IN 46202, USA
| | - Sarah A Cumming
- Institute of Molecular, Cell and Systems Biology, University of Glasgow, Glasgow G12 8QQ, UK
| | - Darren G Monckton
- Institute of Molecular, Cell and Systems Biology, University of Glasgow, Glasgow G12 8QQ, UK
| | - Richard K Shields
- Department of Radiology, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Vincent Magnotta
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, 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, School of Medicine, Indiana University, 362W 15th St, Indianapolis, IN 46202, USA; Department of Pediatrics, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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6
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Garmendia J, Labayru G, Zulaica M, Villanúa J, López de Munain A, Sistiaga A. Shedding light on motor premanifest myotonic dystrophy type 1: A molecular, muscular and central nervous system follow-up study. Eur J Neurol 2023; 30:215-223. [PMID: 36256504 PMCID: PMC10092190 DOI: 10.1111/ene.15604] [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: 02/21/2022] [Revised: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Myotonic dystrophy type 1 (DM1) is a hereditary and multisystemic disease that is characterized by heterogeneous manifestations. Although muscular impairment is central to DM1, a premanifest DM1 form has been proposed for those characterized by the absence of muscle signs in precursory phases. Nevertheless, subtle signs and/or symptoms related to other systems, such as the central nervous system (CNS), may emerge and progress gradually. This study aimed to validate the premanifest DM1 concept and to characterize and track affected individuals from a CNS centred perspective. METHODS Retrospective data of 120 participants (23 premanifest DM1, 25 manifest DM1 and 72 healthy controls) were analysed transversally and longitudinally (over 11.17 years). Compiled data included clinical, neuropsychological and neuroradiological (brain volume and white matter lesion, WML) measures taken at two time points. RESULTS Manifest DM1 showed significantly more molecular affectation, worse performance on neuropsychological domains, lower grey and white matter volumes and a different pattern of WMLs than premanifest DM1. The latter was slightly different from healthy controls regarding brain volume and WMLs. Additionally, daytime sleepiness and molecular expansion size explained 50% of the variance of the muscular deterioration at follow-up in premanifest individuals. CONCLUSIONS Premanifest DM1 individuals showed subtle neuroradiological alterations, which suggests CNS involvement early in the disease. Based on follow-up data, a debate emerges around the existence of a 'non-muscular DM1' subtype and/or a premanifest phase, as a precursory stage to other DM1 manifestations.
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Affiliation(s)
- Joana Garmendia
- Department of Clinical and Health Psychology and Research Methodology, Psychology Faculty, University of the Basque Country (UPV/EHU), San Sebastián, Spain
| | - Garazi Labayru
- Department of Clinical and Health Psychology and Research Methodology, Psychology Faculty, University of the Basque Country (UPV/EHU), San Sebastián, Spain.,Neuroscience Area, Biodonostia Health Research Institute, Donostia-San Sebastián, Gipuzkoa, Spain.,CIBER, Centro de Investigación Biomédica en Red (CIBERNED), Institute Carlos III, Madrid, Spain
| | - Miren Zulaica
- Neuroscience Area, Biodonostia Health Research Institute, Donostia-San Sebastián, Gipuzkoa, Spain.,CIBER, Centro de Investigación Biomédica en Red (CIBERNED), Institute Carlos III, Madrid, Spain
| | - Jorge Villanúa
- Osatek, Donostia University Hospital, Donostia-San Sebastián, Spain
| | - Adolfo López de Munain
- Neuroscience Area, Biodonostia Health Research Institute, Donostia-San Sebastián, Gipuzkoa, Spain.,CIBER, Centro de Investigación Biomédica en Red (CIBERNED), Institute Carlos III, Madrid, Spain.,Neurology Department, Donostia University Hospital, Donostia-San Sebastián, Spain.,Neuroscience Department, University of the Basque Country (UPV/EHU), Donostia-San Sebastián, Spain
| | - Andone Sistiaga
- Department of Clinical and Health Psychology and Research Methodology, Psychology Faculty, University of the Basque Country (UPV/EHU), San Sebastián, Spain.,Neuroscience Area, Biodonostia Health Research Institute, Donostia-San Sebastián, Gipuzkoa, Spain.,CIBER, Centro de Investigación Biomédica en Red (CIBERNED), Institute Carlos III, Madrid, Spain
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7
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McGinnis SM, McCann RF, Patel V, Doughty CT, Miller MB, Gale SA, Silbersweig DA, Daffner KR. Case Study 5: A 74-Year-Old Man With Dysphagia, Weakness, and Memory Loss. J Neuropsychiatry Clin Neurosci 2023; 35:210-217. [PMID: 37448308 DOI: 10.1176/appi.neuropsych.20230030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Affiliation(s)
- Scott M McGinnis
- Departments of Neurology (McGinnis, Doughty, Gale, Daffner) and Psychiatry (McCann, Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Patel, Miller), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Ruth F McCann
- Departments of Neurology (McGinnis, Doughty, Gale, Daffner) and Psychiatry (McCann, Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Patel, Miller), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Viharkumar Patel
- Departments of Neurology (McGinnis, Doughty, Gale, Daffner) and Psychiatry (McCann, Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Patel, Miller), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Christopher T Doughty
- Departments of Neurology (McGinnis, Doughty, Gale, Daffner) and Psychiatry (McCann, Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Patel, Miller), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Michael B Miller
- Departments of Neurology (McGinnis, Doughty, Gale, Daffner) and Psychiatry (McCann, Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Patel, Miller), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Seth A Gale
- Departments of Neurology (McGinnis, Doughty, Gale, Daffner) and Psychiatry (McCann, Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Patel, Miller), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - David A Silbersweig
- Departments of Neurology (McGinnis, Doughty, Gale, Daffner) and Psychiatry (McCann, Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Patel, Miller), Brigham and Women's Hospital, Harvard Medical School, Boston
| | - Kirk R Daffner
- Departments of Neurology (McGinnis, Doughty, Gale, Daffner) and Psychiatry (McCann, Silbersweig), Center for Brain/Mind Medicine, and Department of Pathology (Patel, Miller), Brigham and Women's Hospital, Harvard Medical School, Boston
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8
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Fujino H, Suwazono S, Ueda Y, Kobayashi M, Nakayama T, Imura O, Matsumura T, Takahashi MP. Longitudinal Changes in Neuropsychological Functioning in Japanese Patients with Myotonic Dystrophy Type 1: A Five Year Follow-Up Study. J Neuromuscul Dis 2023; 10:1083-1092. [PMID: 37599536 PMCID: PMC10657671 DOI: 10.3233/jnd-230083] [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] [Accepted: 08/01/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Myotonic dystrophy type 1 (DM1) is a form of muscular dystrophy that causes various symptoms, including those of the central nervous system. Some studies have reported cognitive decline in patients with DM1, although the available evidence is limited. OBJECTIVE This study aimed to describe longitudinal differences in neuropsychological function in patients with DM1. METHODS A total of 66 Japanese adult patients with DM1 were investigated using a neuropsychological battery to assess several cognitive domains, including memory, processing speed, and executive function. The patients underwent neuropsychological evaluation approximately five years after baseline (Times 1 and 2). RESULTS Thirty-eight patients underwent a second neuropsychological evaluation. The participants in the Time 2 evaluation were younger than those who did not participate in Time 2. Patients showed a decline in the Mini-Mental State Examination, Trail Making Test (TMT), Block Design, and Symbol Digit Modalities Test at Time 2 (P < 0.05). Age at Time 1 was associated with a decline in TMT-A and TMT-B scores (rho = 0.57 and 0.45, respectively). CONCLUSION These results suggest a cognitive decline in patients with DM1 and warrant further investigation into the possible effects of age-related changes.
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Affiliation(s)
- Haruo Fujino
- Department of Child Development, United Graduate School of Child Development, Osaka University, Suita, Japan
- Graduate School of Human Sciences, Osaka University, Suita, Japan
| | - Shugo Suwazono
- Center for Clinical Neuroscience, National Hospital Organization Okinawa National Hospital, Ginowan, Japan
| | | | - Michio Kobayashi
- Department of Neurology, National Hospital Organization Akita National Hospital, Yurihonjo, Japan
| | | | - Osamu Imura
- Faculty of Social Sciences, Nara University, Nara, Japan
| | - Tsuyoshi Matsumura
- Department of Neurology, National Hospital Organization Osaka Toneyama Medical Center, Toyonaka, Japan
| | - Masanori P. Takahashi
- Department of Clinical Laboratory and Biomedical Sciences, Division of Health Sciences, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Neurology, Osaka University Graduate School of Medicine, Suita, Japan
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9
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Peric S, Gunjic I, Delic N, Stojiljkovic Tamas O, Salak-Djokic B, Pesovic J, Petrovic Djordjevic I, Ivanovic V, Savic-Pavicevic D, Meola G, Rakocevic-Stojanovic V. Cognitive assessment in patients with myotonic dystrophy type 2. Neuromuscul Disord 2022; 32:743-748. [PMID: 35879188 DOI: 10.1016/j.nmd.2022.06.011] [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: 04/30/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 10/17/2022]
Abstract
Myotonic dystrophy type 2 (DM2) is an autosomal dominant multisystemic disorder. Previous studies conducted on small cohorts of DM2 patients indicated presence of a cognitive dysfunction. We aimed to assess cognitive functions in a larger cohort of Serbian DM2 patients using an extensive battery of neuropsychological tests. The study included 76 patients with a genetically confirmed DM2, 68 of whom had all tests for different cognitive domains performed. Patients underwent clinical and neuropsychological testing, including cognitive screening and assessment of general intellectual level, attention, executive and visuospatial abilities, memory, and language functions. Only 6% of patients achieved a below-average score on the general intellectual level test. Cognitive screening tests indicated presence of cognitive deficits in 5.5% of patients according to the Mini Mental State Examination test and 25.8% according to the Addenbrooke's Cognitive Examination Revised test. Twenty-four (35.3%) patients had a cognitive impairment (being two standard deviations out of norm in at least two cognitive domains). Around one quarter of DM2 patients had a significant cognitive impairment that interfered with their everyday functioning. Patients with significant cognitive impairment were older at testing and at disease onset, less educated, and had more severe muscle weakness.
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Affiliation(s)
- Stojan Peric
- University Clinical Center of Serbia, Neurology Clinic, Dr Subotic Street 6, 11000 Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Dr Subotic Street 8, 11000 Belgrade, Serbia.
| | - Ilija Gunjic
- University of Belgrade, Faculty of Medicine, Dr Subotic Street 8, 11000 Belgrade, Serbia
| | - Neda Delic
- University of Belgrade, Faculty of Medicine, Dr Subotic Street 8, 11000 Belgrade, Serbia
| | - Olivera Stojiljkovic Tamas
- University Clinical Center of Serbia, Neurology Clinic, Dr Subotic Street 6, 11000 Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Dr Subotic Street 8, 11000 Belgrade, Serbia
| | - Biljana Salak-Djokic
- University Clinical Center of Serbia, Neurology Clinic, Dr Subotic Street 6, 11000 Belgrade, Serbia
| | - Jovan Pesovic
- University of Belgrade, Faculty of Biology, Studentski trg 16, Belgrade, Serbia
| | - Ivana Petrovic Djordjevic
- University of Belgrade, Faculty of Medicine, Dr Subotic Street 8, 11000 Belgrade, Serbia; University Clinical Center of Serbia, Cardiology Clinic, Pasterova 2, 11000 Belgrade, Serbia
| | - Vukan Ivanovic
- University Clinical Center of Serbia, Neurology Clinic, Dr Subotic Street 6, 11000 Belgrade, Serbia
| | | | - Giovanni Meola
- Department of Neurorehabilitation Sciences, Casa Di Cura del Policlinico, Department of Biomedical Sciences for Health, University of Milan, Via Dezza 48, 20144 Milan, Italy
| | - Vidosava Rakocevic-Stojanovic
- University Clinical Center of Serbia, Neurology Clinic, Dr Subotic Street 6, 11000 Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Dr Subotic Street 8, 11000 Belgrade, Serbia
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10
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Labayru G, Camino B, Jimenez-Marin A, Garmendia J, Villanua J, Zulaica M, Cortes JM, López de Munain A, Sistiaga A. White matter integrity changes and neurocognitive functioning in adult-late onset DM1: a follow-up DTI study. Sci Rep 2022; 12:3988. [PMID: 35256728 PMCID: PMC8901711 DOI: 10.1038/s41598-022-07820-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 02/21/2022] [Indexed: 12/04/2022] Open
Abstract
Myotonic Dystrophy Type 1 (DM1) is a multisystemic disease that affects gray and white matter (WM) tissues. WM changes in DM1 include increased hyperintensities and altered tract integrity distributed in a widespread manner. However, the precise temporal and spatial progression of the changes are yet undetermined. MRI data were acquired from 8 adult- and late-onset DM1 patients and 10 healthy controls (HC) at two different timepoints over 9.06 years. Fractional anisotropy (FA) and mean diffusivity (MD) variations were assessed with Tract-Based Spatial Statistics. Transversal and longitudinal intra- and intergroup analyses were conducted, along with correlation analyses with clinical and neuropsychological data. At baseline, reduced FA and increased MD values were found in patients in the uncinate, anterior-thalamic, fronto-occipital, and longitudinal tracts. At follow-up, the WM disconnection was shown to have spread from the frontal part to the rest of the tracts in the brain. Furthermore, WM lesion burden was negatively correlated with FA values, while visuo-construction and intellectual functioning were positively correlated with global and regional FA values at follow-up. DM1 patients showed a pronounced WM integrity loss over time compared to HC, with a neurodegeneration pattern that suggests a progressive anterior-posterior disconnection. The visuo-construction domain stands out as the most sensitive neuropsychological measure for WM microstructural impairment.
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Affiliation(s)
- Garazi Labayru
- Department of Clinical and Health Psychology and Research Methodology, Psychology Faculty, University of the Basque Country (UPV/EHU), Avda. Tolosa, 70. 20018, Donostia-San Sebastián, Gipuzkoa, Spain.
- Neuroscience Area, Biodonostia Health Research Institute, Donostia-San Sebastián, Gipuzkoa, Spain.
- Center for Biomedical Research Network (CIBER), Institute of Health Carlos III, Madrid, Spain.
| | - Borja Camino
- Biocruces-Bizkaia Health Research Institute, Barakaldo, Spain
- Biomedical Research Doctorate Program, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Antonio Jimenez-Marin
- Biocruces-Bizkaia Health Research Institute, Barakaldo, Spain
- Biomedical Research Doctorate Program, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Joana Garmendia
- Department of Clinical and Health Psychology and Research Methodology, Psychology Faculty, University of the Basque Country (UPV/EHU), Avda. Tolosa, 70. 20018, Donostia-San Sebastián, Gipuzkoa, Spain
| | - Jorge Villanua
- Osatek, Donostia University Hospital, Donostia-San Sebastián, Gipuzkoa, Spain
| | - Miren Zulaica
- Neuroscience Area, Biodonostia Health Research Institute, Donostia-San Sebastián, Gipuzkoa, Spain
- Center for Biomedical Research Network (CIBER), Institute of Health Carlos III, Madrid, Spain
| | - Jesus M Cortes
- Biocruces-Bizkaia Health Research Institute, Barakaldo, Spain
- Department of Cell Biology and Histology, University of the Basque Country (UPV/EHU), Leioa, Spain
- IKERBASQUE, The Basque Foundation for Science, Bilbao, Spain
| | - Adolfo López de Munain
- Neuroscience Area, Biodonostia Health Research Institute, Donostia-San Sebastián, Gipuzkoa, Spain
- Center for Biomedical Research Network (CIBER), Institute of Health Carlos III, Madrid, Spain
- Neurology Department, Donostia University Hospital, Donostia-San Sebastián, Gipuzkoa, Spain
- Neuroscience Department, University of the Basque Country (UPV/EHU), Donostia-San Sebastián, Gipuzkoa, Spain
| | - Andone Sistiaga
- Department of Clinical and Health Psychology and Research Methodology, Psychology Faculty, University of the Basque Country (UPV/EHU), Avda. Tolosa, 70. 20018, Donostia-San Sebastián, Gipuzkoa, Spain.
- Neuroscience Area, Biodonostia Health Research Institute, Donostia-San Sebastián, Gipuzkoa, Spain.
- Center for Biomedical Research Network (CIBER), Institute of Health Carlos III, Madrid, Spain.
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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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Mateus T, Costa A, Viegas D, Marques A, Herdeiro MT, Rebelo S. Outcome measures frequently used to assess muscle strength in patients with myotonic dystrophy type 1: a systematic review. Neuromuscul Disord 2021; 32:99-115. [PMID: 35031191 DOI: 10.1016/j.nmd.2021.09.014] [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: 01/30/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 10/20/2022]
Abstract
Measurement of muscle strength is fundamental for the management of patients with myotonic dystrophy type 1 (DM1). Nevertheless, guidance on this topic is somewhat limited due to heterogeneous outcome measures used. This systematic literature review aimed to summarize the most frequent outcome measures to assess muscle strength in patients with DM1. We searched on Pubmed, Web of Science and Embase databases. Observational studies using measures of muscle strength assessment in adult patients with DM1 were included. From a total of 80 included studies, 24 measured cardiac, 45 skeletal and 23 respiratory muscle strength. The most common method and outcome measures used to assess cardiac muscle strength were echocardiography and ejection fraction, for skeletal muscle strength were quantitative muscle test, manual muscle test and maximum isometric torque and medical research council and for respiratory muscle strength were manometry and maximal inspiratory and expiratory pressure. We successfully gathered the more consensual methods and measures to evaluate muscle strength in future clinical studies, particularly to test muscle strength response to treatments in patients with DM1. Future consensus on a set of measures to evaluate muscle strength (core outcome set), is important for these patients.
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Affiliation(s)
- Tiago Mateus
- Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro 3810-193, Portugal
| | - Adriana Costa
- Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro 3810-193, Portugal
| | - Diana Viegas
- Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro 3810-193, Portugal
| | - Alda Marques
- Respiratory Research and Rehabilitation Laboratory - Lab3R, Institute of Biomedicine (iBiMED), School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal
| | - Maria Teresa Herdeiro
- Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro 3810-193, Portugal
| | - Sandra Rebelo
- Department of Medical Sciences, Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro 3810-193, Portugal.
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13
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Peric S, Rakocevic-Stojanovic V, Meola G. Cerebral involvement and related aspects in myotonic dystrophy type 2. Neuromuscul Disord 2021; 31:681-694. [PMID: 34244019 DOI: 10.1016/j.nmd.2021.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 01/18/2023]
Abstract
Myotonic dystrophy type 2 (DM2) is an autosomal dominant multisystemic disorder caused by CCTG repeats expansion in the first intron of the CNBP gene. In this review we focus on the brain involvement in DM2, including its pathogenic mechanisms, microstructural, macrostructural and functional brain changes, as well as the effects of all these impairments on patients' everyday life. We also try to understand how brain abnormalities in DM2 should be adequately measured and potentially treated. The most important pathogenetic mechanisms in DM2 are RNA gain-of-function and repeat-associated non-ATG (RAN) translation. One of the main neuroimaging findings in DM2 is the presence of diffuse periventricular white matter hyperintensity lesions (WMHLs). Brain atrophy has been described in DM2 patients, but it is not clear if it is mostly caused by a decrease of the white or gray matter volume. The most commonly reported specific cognitive symptoms in DM2 are dysexecutive syndrome, visuospatial and memory impairments. Fatigue, sleep-related disorders and pain are also frequent in DM2. The majority of key symptoms and signs in DM2 has a great influence on patients' daily lives, their psychological status, economic situation and quality of life.
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Affiliation(s)
- Stojan Peric
- Neurology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Giovanni Meola
- Department of Neurorehabilitation Sciences, Casa Di Cura del Policlinico, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Theodosiou T, Christidi F, Xirou S, Bede P, Karavasilis E, Papadopoulos C, Kourtesis P, Pantoleon V, Kararizou E, Papadimas G, Zalonis I. Neuropsychological Assessment Should Always be Considered in Myotonic Dystrophy Type 2. Cogn Behav Neurol 2021; 34:1-10. [PMID: 33652465 DOI: 10.1097/wnn.0000000000000263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 07/21/2020] [Indexed: 11/26/2022]
Abstract
Myotonic dystrophies (DMs) are hereditary, multisystem, slowly progressive myopathies. One of the systems they affect is the CNS. In contrast to the well-established cognitive profile of myotonic dystrophy type 1 (DM1), only a few studies have investigated cognitive dysfunction in individuals with myotonic dystrophy type 2 (DM2), and their findings have been inconsistent. To identify the most commonly affected cognitive domains in individuals with DM2, we performed a formal comprehensive review of published DM2 studies. Using the terms "myotonic dystrophy type 2" AND "cognitive deficits," "cognitive," "cognition," "neuropsychological," "neurocognitive," and "neurobehavioral" in all fields, we conducted an advanced search on PubMed. We read and evaluated all of the available original research articles (13) and one case study, 14 in total, and included them in our review. Most of the research studies of DM2 reported primary cognitive deficits in executive functions (dysexecutive syndrome), memory (short-term nonverbal, verbal episodic memory), visuospatial/constructive-motor functions, and attention and processing speed; language was rarely reported to be affected. Based on the few neuroimaging and/or multimodal DM2 studies we could find, the cognitive profile of DM2 is associated with brain abnormalities in several secondary and high-order cortical and subcortical regions and associative white matter tracts. The limited sample size of individuals with DM2 was the most prominent limitation of these studies. The multifaceted profile of cognitive deficits found in individuals with DM2 highlights the need for routine neuropsychological assessment at both baseline and follow-up, which could unveil these individuals' cognitive strengths and deficits.
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Affiliation(s)
- Thomas Theodosiou
- First Department of Neurology, Medical School, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Foteini Christidi
- First Department of Neurology, Medical School, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sofia Xirou
- First Department of Neurology, Medical School, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Peter Bede
- Biomedical Imaging Laboratory, Sorbonne University, National Center for Scientific Research, National Institute of Health and Medical Research, Paris, France
- Computational Neuroimaging Group, Trinity College, Dublin, Ireland
| | - Efstratios Karavasilis
- Radiology and Medical Imaging Research Unit, Second Department of Radiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantinos Papadopoulos
- First Department of Neurology, Medical School, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Kourtesis
- Human Cognitive Neuroscience, Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | - Varvara Pantoleon
- Radiology and Medical Imaging Research Unit, Second Department of Radiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Kararizou
- First Department of Neurology, Medical School, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Papadimas
- First Department of Neurology, Medical School, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Zalonis
- First Department of Neurology, Medical School, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
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15
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Longitudinal study in patients with myotonic dystrophy type 1: correlation of brain MRI abnormalities with cognitive performances. Neuroradiology 2020; 63:1019-1029. [PMID: 33237431 DOI: 10.1007/s00234-020-02611-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 11/16/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Myotonic dystrophy type 1 (DM1) is a muscular dystrophy with neurological, cognitive, and radiological abnormalities. The developmental or degenerative nature of these abnormalities, and their progression over time, remains unclear. The aim of this study is to perform a longitudinal assessment of imaging and cognitive performances in a group of patients with DM1. METHODS A longitudinal observational study was conducted in a group of 33 DM1 patients. All patients underwent cognitive and MRI evaluation, including the use of structural and diffusion tensor imaging techniques, at baseline and follow-up evaluation (4 years). Longitudinal changes in white matter lesion (WML), volumetric analysis, and diffusivity values were assessed and correlated with neuropsychological test findings. RESULTS An increase in WML was observed in 16 patients (48.5%). An increase in ventricular system volume and a decrease in volume of the left thalamus, caudates, putamen, and hippocampus were observed (p < 0.001). Global cortical volume showed a significant decrease (p < 0.001), although no changes were observed in white matter volume. A significant increase in mean diffusivity and decrease in fractional anisotropy for the white matter were found (p < 0.001). Neuropsychological evaluation showed a significant deterioration in test performance that measures working memory (Letter-Number Sequencing, p = 0.049) and visuospatial skills (Benton Visual Retention Test, p = 0.001). These findings were significantly associated with WML load (working memory p = 0.002 and visuospatial skills p = 0.021) and mean diffusivity increase (visuospatial skills p = 0.003 in the corpus callosum and working memory p = 0.043 in the right cerebral white matter). CONCLUSION White matter and grey matter involvement in DM1 patients is progressive. Patients experience a worsening in cognitive impairment that correlates with white matter involvement. These findings support the neurodegenerative nature of this disease.
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16
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Labayru G, Jimenez‐Marin A, Fernández E, Villanua J, Zulaica M, Cortes JM, Díez I, Sepulcre J, López de Munain A, Sistiaga A. Neurodegeneration trajectory in pediatric and adult/late DM1: A follow-up MRI study across a decade. Ann Clin Transl Neurol 2020; 7:1802-1815. [PMID: 32881379 PMCID: PMC7545612 DOI: 10.1002/acn3.51163] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/24/2020] [Accepted: 07/25/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To characterize the progression of brain structural abnormalities in adults with pediatric and adult/late onset DM1, as well as to examine the potential predictive markers of such progression. METHODS 21 DM1 patients (pediatric onset: N = 9; adult/late onset: N = 12) and 18 healthy controls (HC) were assessed longitudinally over 9.17 years through brain MRI. Additionally, patients underwent neuropsychological, genetic, and muscular impairment assessment. Inter-group comparisons of total and voxel-level regional brain volume were conducted through Voxel Based Morphometry (VBM); cross-sectionally and longitudinally, analyzing the associations between brain changes and demographic, clinical, and cognitive outcomes. RESULTS The percentage of GM loss did not significantly differ in any of the groups compared with HC and when assessed independently, adult/late DM1 patients and their HC group suffered a significant loss in WM volume. Regional VBM analyses revealed subcortical GM damage in both DM1 groups, evolving to frontal regions in the pediatric onset patients. Muscular impairment and the outcomes of certain neuropsychological tests were significantly associated with follow-up GM damage, while visuoconstruction, attention, and executive function tests showed sensitivity to WM degeneration over time. INTERPRETATION Distinct patterns of brain atrophy and its progression over time in pediatric and adult/late onset DM1 patients are suggested. Results indicate a possible neurodevelopmental origin of the brain abnormalities in DM1, along with the possible existence of an additional neurodegenerative process. Fronto-subcortical networks appear to be involved in the disease progression at young adulthood in pediatric onset DM1 patients. The involvement of a multimodal integration network in DM1 is discussed.
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Affiliation(s)
- Garazi Labayru
- Personality, Assessment and psychological treatment department; Psychology FacultyUniversity of the Basque Country (UPV/EHU)San SebastiánGipuzkoaSpain
- Neuroscience AreaBiodonostia Research Institute, OsakidetzaDonostia‐San SebastiánGipuzkoaSpain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED)Institute Carlos IIIMadridSpain
| | - Antonio Jimenez‐Marin
- Biocruces‐Bizkaia Health Research InstituteBarakaldoBizkaiaSpain
- Biomedical Research Doctorate ProgramUniversity of the Basque Country (UPV/EHU)LeioaSpain
| | - Esther Fernández
- OsatekDonostia University HospitalDonostia‐ San SebastiánGipuzkoaSpain
| | - Jorge Villanua
- OsatekDonostia University HospitalDonostia‐ San SebastiánGipuzkoaSpain
| | - Miren Zulaica
- Neuroscience AreaBiodonostia Research Institute, OsakidetzaDonostia‐San SebastiánGipuzkoaSpain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED)Institute Carlos IIIMadridSpain
| | - Jesus M. Cortes
- Biocruces‐Bizkaia Health Research InstituteBarakaldoBizkaiaSpain
- Cell Biology and Histology DepartmentUniversity of the Basque Country (UPV/EHU)LeioaSpain
- IKERBASQUEThe Basque Foundation for ScienceBilbaoSpain
| | - Ibai Díez
- Gordon Center for Medical ImagingDepartment of RadiologyMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
- Athinoula A. Martinos Center for Biomedical ImagingMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Neurotechnology LaboratoryTecnalia Health DepartmentDerioSpain
| | - Jorge Sepulcre
- Gordon Center for Medical ImagingDepartment of RadiologyMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusettsUSA
- Athinoula A. Martinos Center for Biomedical ImagingMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Adolfo López de Munain
- Neuroscience AreaBiodonostia Research Institute, OsakidetzaDonostia‐San SebastiánGipuzkoaSpain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED)Institute Carlos IIIMadridSpain
- Neurology DepartmentDonostia University HospitalDonostia‐ San SebastiánGipuzkoaSpain
- Neuroscience DepartmentUniversity of the Basque Country (UPV/EHU)Donostia‐San SebastiánGipuzkoaSpain
| | - Andone Sistiaga
- Personality, Assessment and psychological treatment department; Psychology FacultyUniversity of the Basque Country (UPV/EHU)San SebastiánGipuzkoaSpain
- Neuroscience AreaBiodonostia Research Institute, OsakidetzaDonostia‐San SebastiánGipuzkoaSpain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED)Institute Carlos IIIMadridSpain
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Ramon-Duaso C, Rodríguez-Morató J, Selma-Soriano E, Fernández-Avilés C, Artero R, de la Torre R, Pozo ÓJ, Robledo P. Protective effects of mirtazapine in mice lacking the Mbnl2 gene in forebrain glutamatergic neurons: Relevance for myotonic dystrophy 1. Neuropharmacology 2020; 170:108030. [PMID: 32171677 DOI: 10.1016/j.neuropharm.2020.108030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 01/17/2023]
Abstract
Myotonic dystrophy type 1 (DM1) is a multisystemic disorder characterized by muscle weakness and wasting and by important central nervous system-related symptoms including impairments in executive functions, spatial abilities and increased anxiety and depression. The Mbnl2 gene has been implicated in several phenotypes consistent with DM1 neuropathology. In this study, we developed a tissue-specific knockout mouse model lacking the Mbnl2 gene in forebrain glutamatergic neurons to examine its specific contribution to the neurobiological perturbations related to DM1. We found that these mice exhibit long-term cognitive deficits and a depressive-like state associated with neuronal loss, increased microglia and decreased neurogenesis, specifically in the dentate gyrus (DG). Chronic treatment with the atypical antidepressant mirtazapine (3 and 10 mg/kg) for 21 days rescued these behavioral alterations, reduced inflammatory microglial overexpression, and reversed neuronal loss in the DG. We also show that mirtazapine re-established 5-HT1A and histaminergic H1 receptor gene expression in the hippocampus. Finally, metabolomics studies indicated that mirtazapine increased serotonin, noradrenaline, gamma-aminobutyric acid and adenosine production. These data suggest that loss of Mbnl2 gene in the glutamatergic neurons of hippocampus and cortex may underlie the most relevant DM1 neurobiological and behavioral features, and provide evidence that mirtazapine could be a novel potential candidate to alleviate these debilitating symptoms in DM1 patients.
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Affiliation(s)
- Carla Ramon-Duaso
- Integrative Pharmacology and Systems Neuroscience, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Department of Experimental and Health Sciences, Pompeu Fabra University (CEXS-UPF), Barcelona, Spain
| | - Jose Rodríguez-Morató
- Integrative Pharmacology and Systems Neuroscience, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Department of Experimental and Health Sciences, Pompeu Fabra University (CEXS-UPF), Barcelona, Spain; CIBER de la Fisiopatología de la Obesidad y la Nutrición (CIBERON), Instituto de Salud Carlos III, Madrid, Spain
| | - Estela Selma-Soriano
- Translational Genomics Group, Incliva Health Research Institute, Valencia, Spain; Interdisciplinary Research Structure for Biotechnology and Biomedicine (ERI BIOTECMED), University of Valencia, Valencia, Spain; CIPF-INCLIVA Joint Unit, Spain
| | - Cristina Fernández-Avilés
- Integrative Pharmacology and Systems Neuroscience, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Rubén Artero
- Translational Genomics Group, Incliva Health Research Institute, Valencia, Spain; Interdisciplinary Research Structure for Biotechnology and Biomedicine (ERI BIOTECMED), University of Valencia, Valencia, Spain; CIPF-INCLIVA Joint Unit, Spain
| | - Rafael de la Torre
- Integrative Pharmacology and Systems Neuroscience, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Department of Experimental and Health Sciences, Pompeu Fabra University (CEXS-UPF), Barcelona, Spain; CIBER de la Fisiopatología de la Obesidad y la Nutrición (CIBERON), Instituto de Salud Carlos III, Madrid, Spain
| | - Óscar J Pozo
- Integrative Pharmacology and Systems Neuroscience, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Patricia Robledo
- Integrative Pharmacology and Systems Neuroscience, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Department of Experimental and Health Sciences, Pompeu Fabra University (CEXS-UPF), Barcelona, Spain.
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18
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La Rosa P, Petrillo S, Bertini ES, Piemonte F. Oxidative Stress in DNA Repeat Expansion Disorders: A Focus on NRF2 Signaling Involvement. Biomolecules 2020; 10:biom10050702. [PMID: 32369911 PMCID: PMC7277112 DOI: 10.3390/biom10050702] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 12/13/2022] Open
Abstract
DNA repeat expansion disorders are a group of neuromuscular and neurodegenerative diseases that arise from the inheritance of long tracts of nucleotide repetitions, located in the regulatory region, introns, or inside the coding sequence of a gene. Although loss of protein expression and/or the gain of function of its transcribed mRNA or translated product represent the major pathogenic effect of these pathologies, mitochondrial dysfunction and imbalance in redox homeostasis are reported as common features in these disorders, deeply affecting their severity and progression. In this review, we examine the role that the redox imbalance plays in the pathological mechanisms of DNA expansion disorders and the recent advances on antioxidant treatments, particularly focusing on the expression and the activity of the transcription factor NRF2, the main cellular regulator of the antioxidant response.
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Lenzoni S, Bozzoni V, Burgio F, de Gelder B, Wennberg A, Botta A, Pegoraro E, Semenza C. Recognition of emotions conveyed by facial expression and body postures in myotonic dystrophy (DM). Cortex 2020; 127:58-66. [PMID: 32169676 DOI: 10.1016/j.cortex.2020.02.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 10/04/2019] [Accepted: 02/07/2020] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Neuromuscular diseases may be of neuropsychological interest insofar as they may affect representations based on embodied cognition theories. Previous studies have shown impaired ability to recognize facial emotions and an association between facial emotion recognition and visuospatial abilities in myotonic dystrophy type 1 (DM1) patients. Here we examined the ability of both DM1 and DM2 patients to recognize emotions expressed by body postures and its relation, and their association with cognitive performance. METHODS Participants included 34 DM1 patients, 8 DM2 patients, and 24 healthy control subjects. Emotional recognition ability was assessed through two computerized matching tasks (face and bodies). A neuropsychological battery was used to measure cognition in three domains and global cognition. We used univariate and adjusted linear regression models to investigate the association between cognition and emotion recognition performance. RESULTS DM patients (combined DM1 and DM2) performed worse on emotional facial expression (p = .006) and body posture (p = .004) accuracy measures than healthy controls. In linear regression models, DM patients' facial expression accuracy was associated with executive function (p = .013) and visuospatial (p < .001) z-scores. Body posture accuracy was associated with visuospatial (p = .001) and memory (p = .012) z-scores. There were no associations among controls or between cognition and reaction time. DISCUSSION These findings suggest that impaired emotional recognition among DM patients is also extended to emotions conveyed by body postures. Consistent with embodied cognition theories, people affected in their body and its movement may have impaired sensorimotor representation in ways that have yet to be fully understood.
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Affiliation(s)
- Sabrina Lenzoni
- Department of Neurosciences (Padova Neuroscience Center), Università degli Studi di Padova, Italy.
| | - Virginia Bozzoni
- Department of Neurosciences (Padova Neuroscience Center), Università degli Studi di Padova, Italy.
| | | | | | - Alexandra Wennberg
- Department of Neurosciences (Padova Neuroscience Center), Università degli Studi di Padova, Italy.
| | - Annalisa Botta
- Department of Biomedicine and Prevention, Medical Genetics Section, University of Rome Tor Vergata, Rome, Italy.
| | - Elena Pegoraro
- Department of Neurosciences (Padova Neuroscience Center), Università degli Studi di Padova, Italy.
| | - Carlo Semenza
- Department of Neurosciences (Padova Neuroscience Center), Università degli Studi di Padova, Italy; IRCCS San Camillo Hospital, Venice, Italy.
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Wang J, Liu M, Shang W, Chen Z, Peng G. Myotonic dystrophy type 1 accompanied with normal pressure hydrocephalus: a case report and literature review. BMC Neurol 2020; 20:53. [PMID: 32050933 PMCID: PMC7017494 DOI: 10.1186/s12883-020-01636-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/05/2020] [Indexed: 01/13/2023] Open
Abstract
Background Myotonic dystrophy type 1 (DM1) is the most common disease that can cause muscle weakness and atrophy among adults. Normal pressure hydrocephalus (NPH) is characterized by the triad of gait disturbance, cognitive impairment and urinary incontinence. The association between DM1 and NPH is extremely rare. We report a Chinese female patient with DM1 in association with NPH. Case presentation The patient presented with a history of 3-year of walking instability and cognitive impairment. Her brain MRI showed ventriculomegaly with normal cerebrospinal fluid (CSF) pressure and the CSF tap-test was positive, which indicated the diagnosis of probable NPH. DM1 was confirmed by genetic testing. Conclusions Four patients with DM1-NPH association were found before. The association between NPH and DM1 may not be just a coincidence, NPH may occur in DM1 later in life and it is vital to recognize the association as a shunt surgery may improve patients’ quality of life.
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Affiliation(s)
- Junyang Wang
- Department of Neurology, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
| | - Ming Liu
- Department of Neurology, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
| | - Wenjie Shang
- Department of Neurology, Shengzhou People's Hospital, 666 Dangui Road, Shengzhou, 312403, China
| | - Zhongqin Chen
- Department of Neurology, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China
| | - Guoping Peng
- Department of Neurology, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, China.
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Abstract
There is increasing evidence of central nervous system involvement in numerous neuromuscular disorders primarily considered diseases of skeletal muscle. Our knowledge on cerebral affection in myopathies is expanding continuously due to a better understanding of the genetic background and underlying pathophysiological mechanisms. Intriguingly, there is a remarkable overlap of brain pathology in muscular diseases with pathomechanisms involved in neurodegenerative or neurodevelopmental disorders. A rapid progress in advanced neuroimaging techniques results in further detailed insight into structural and functional cerebral abnormalities. The spectrum of clinical manifestations is broad and includes movement disorders, neurovascular complications, paroxysmal neurological symptoms like migraine and epileptic seizures, but also behavioural abnormalities and cognitive dysfunction. Cerebral involvement implies a high socio-economic and personal burden in adult patients sometimes exceeding the everyday challenges associated with muscle weakness. It is especially important to clarify the nature and natural history of brain affection against the background of upcoming specific treatment regimen in hereditary myopathies that should address the brain as a secondary target. This review aims to highlight the character and extent of central nervous system involvement in patients with hereditary myopathies manifesting in adulthood, however also includes some childhood-onset diseases with brain abnormalities that transfer into adult neurological care.
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Affiliation(s)
- Jens Reimann
- Department of Neurology, Section of Neuromuscular Diseases, University Hospital Bonn, Germany
- Center for Rare Diseases, University Hospital Bonn, Germany
| | - Cornelia Kornblum
- Department of Neurology, Section of Neuromuscular Diseases, University Hospital Bonn, Germany
- Center for Rare Diseases, University Hospital Bonn, Germany
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22
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Look at the cognitive deficits in patients with myotonic dystrophy type 1: an exploratory research on the effects of virtual reality. Int J Rehabil Res 2019; 43:90-94. [PMID: 31851022 DOI: 10.1097/mrr.0000000000000384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Myotonic dystrophy type 1 is a neuromuscular disease, characterized by a progressive loss of strength, muscle stiffness, and difficulty in relaxation. Myotonic dystrophy type 1 patients can present several neuropsychological deficits, as well as anxiety and mood disorders. Aim of this study is to evaluate the feasibility and the effect of virtual reality in the cognitive and behavioral recovery of myotonic dystrophy type 1 patients. Eleven patients (8 female and 3 male) underwent a specific cognitive rehabilitation program including a conventional neuropsychological treatment followed by a virtual reality neurorehabilitation training using the Virtual Reality Rehabilitation System (Khymeia, Italy). Virtual reality improved many cognitive domains, including executive function, attention, verbal and visuo-spatial abilities, as well as mood and coping strategies. Due to the high prevalence of neuropsychological symptoms in patients with myotonic dystrophy type 1, cognitive rehabilitation should enter into the framework of these patients to potentially boost cognitive and behavioral function and improve quality of life.
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Labayru G, Diez I, Sepulcre J, Fernández E, Zulaica M, Cortés JM, López de Munain A, Sistiaga A. Regional brain atrophy in gray and white matter is associated with cognitive impairment in Myotonic Dystrophy type 1. NEUROIMAGE-CLINICAL 2019; 24:102078. [PMID: 31795042 PMCID: PMC6861566 DOI: 10.1016/j.nicl.2019.102078] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/28/2019] [Accepted: 11/04/2019] [Indexed: 11/28/2022]
Abstract
Predominance of white matter impairment in DM1 is questioned. Age poses vulnerability to grey matter loss in specific areas in DM1. White matter alterations in DM1 may be developmental. Muscular and genetic features are associated with brain abnormalities in DM1. Neuropsychology is an unspecific but strong predictor of gray matter damage in DM1.
Background Myotonic Dystrophy type 1 (DM1) is a slowly progressive myopathy characterized by varying multisystemic involvement. Several cerebral features such as brain atrophy, ventricular enlargement, and white matter lesions (WMLs) have frequently been described. The aim of this study is to investigate the structural organization of the brain that defines the disease through multimodal imaging analysis, and to analyze the relation between structural cerebral changes and DM1 clinical and neuropsychological profiles. Method 31 DM1 patients and 57 healthy controls underwent an MRI scan protocol, including T1, T2 and DTI. Global gray matter (GM), global white matter (WM), and voxel-level Voxel Based Morphometry (VBM) and voxel-level microstructural WM abnormalities through Diffusion Tensor Imaging (DTI) were assessed through group comparisons and linear regression analysis with age, degree of muscular impairment (MIRS score), CTG expansion size and neuropsychological outcomes from a comprehensive assessment. Results Compared with healthy controls, DM1 patients showed a reduction in both global GM and WM volume; and further regional GM decrease in specific primary sensory, multi-sensory and association cortical regions. Fractional anisotropy (FA) was reduced in both total brain and regional analysis, being most marked in frontal, paralimbic, temporal cortex, and subcortical regions. Higher ratings on muscular impairment and longer CTG expansion sizes predicted a greater volume decrease in GM and lower FA values. Age predicted global GM reduction, specifically in parietal regions. At the cognitive level, the DM1 group showed significant negative correlations between IQ estimate, visuoconstructive and executive neuropsychological scores and both global and regional volume decrease, mainly distributed in the frontal, parietal and subcortical regions. Conclusions In this study, we describe the structural brain signatures that delineate the involvement of the CNS in DM1. We show that specific sensory and multi-sensory — as well as frontal cortical areas — display potential vulnerability associated with the hypothesized neurodegenerative nature of DM1 brain abnormalities.
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Affiliation(s)
- Garazi Labayru
- Neuroscience Area, Biodonostia Research Institute, San Sebastián, Gipuzkoa, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Madrid, Spain; Personality, Assessment and psychological treatment department; Psychology Faculty, University of the Basque Country (UPV/EHU), San Sebastian, Gipuzkoa, Spain.
| | - Ibai Diez
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Neurotechnology Laboratory, Tecnalia Health Department, Derio, Spain
| | - Jorge Sepulcre
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Esther Fernández
- Neuroscience Area, Biodonostia Research Institute, San Sebastián, Gipuzkoa, Spain; Osatek, Donostia University Hospital, Donostia-San Sebastian, Gipuzkoa, Spain; Radiolody Department, University of the Basque Country (UPV/EHU), Donostia-San Sebastian, Gipuzkoa, Spain
| | - Miren Zulaica
- Neuroscience Area, Biodonostia Research Institute, San Sebastián, Gipuzkoa, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Madrid, Spain
| | - Jesús M Cortés
- Biocruces Health Research Institute. Hospital Universitario de Cruces, Barakaldo, Spain; Cell Biology and Histology Department, University of the Basque Country (UPV/EHU), Leioa, Spain; IKERBASQUE, The Basque Foundation for Science, Bilbao, Spain
| | - Adolfo López de Munain
- Neuroscience Area, Biodonostia Research Institute, San Sebastián, Gipuzkoa, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Madrid, Spain; Neurology Department, Donostia University Hospital, Donostia-San Sebastian, Gipuzkoa, Spain; Neurosciences Department, University of the Basque Country (UPV/EHU), Donostia-San Sebastian, Gipuzkoa, Spain
| | - Andone Sistiaga
- Neuroscience Area, Biodonostia Research Institute, San Sebastián, Gipuzkoa, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Madrid, Spain; Personality, Assessment and psychological treatment department; Psychology Faculty, University of the Basque Country (UPV/EHU), San Sebastian, Gipuzkoa, Spain
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24
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Lindeblad G, Kroksmark AK, Ekström AB. Cognitive and adaptive functioning in congenital and childhood forms of myotonic dystrophy type 1: a longitudinal study. Dev Med Child Neurol 2019; 61:1214-1220. [PMID: 30706460 DOI: 10.1111/dmcn.14161] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2018] [Indexed: 11/27/2022]
Abstract
AIM To conduct a longitudinal follow-up of the development of global cognitive abilities and adaptive skills in individuals with congenital and childhood forms of myotonic dystrophy type 1 (DM1). METHOD Fifty-one participants (29 males, 22 females, mean age 19y 5mo, SD 4y 11mo, range 10y 10mo-28y 11mo) were divided into severe congenital (n=16), mild congenital (n=17), and childhood DM1 (n=18) subgroups. The average time between the first and second assessments was 7 years 8 months. Adaptive skills were evaluated using the Vineland Adaptive Behavior Scales and global cognitive functioning using Wechsler scales. RESULTS There was no statistically significant decline in cognitive abilities and adaptive behaviour. A tendency of decline regarding the level of intellectual disability was found in the congenital DM1 groups but not in the childhood group. In the congenital DM1 groups, the gap in relation to typically developing peers in cognitive and adaptive functioning increased. Predictors of change over time in adaptive skills were age and current level of intellectual disability: individuals with severe intellectual disability and younger individuals deteriorated the most. However, when raw scores were compared, no actual regression in adaptive functioning was found. INTERPRETATION The participants had not lost any important adaptive skills. Greater cognitive and adaptive development was found in the childhood group than in the congenital groups. WHAT THIS PAPER ADDS There is no absolute decline in cognitive and adaptive abilities in individuals with congenital and childhood myotonic dystrophy type 1. Pace of development is slow in comparison with normative data. The childhood group tended to show greater cognitive and adaptive development than the congenital groups.
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Affiliation(s)
| | - Anna-Karin Kroksmark
- Department of Health and Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Regional Pediatric Rehabilitation Center, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Anne-Berit Ekström
- Regional Pediatric Rehabilitation Center, Queen Silvia Children's Hospital, Gothenburg, Sweden
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25
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Labayru G, Aliri J, Zulaica M, López de Munain A, Sistiaga A. Age-related cognitive decline in myotonic dystrophy type 1: An 11-year longitudinal follow-up study. J Neuropsychol 2019; 14:121-134. [PMID: 31407859 PMCID: PMC7078919 DOI: 10.1111/jnp.12192] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 07/24/2019] [Indexed: 12/15/2022]
Abstract
Background Myotonic dystrophy type 1 (DM1) is an inherited multi‐systemic disease involving the central nervous system (CNS) and is consequently characterized by a range of cognitive impairments. However, whether this cognitive profile progresses over time is still a matter of debate. The aim of this study was to longitudinally assess a DM1 sample, in order to compare, for the first time, this progression with that of a control group. Clinical and socio‐demographic predictive factors potentially implicated in this possible decline are analysed. Method Seventy‐five DM1 patients with childhood, juvenile, adult, and late‐onset, and 54 control participants were re‐assessed in an 11‐year follow‐up with a comprehensive neuropsychological battery. The analyses employed were mixed ANOVA for repeated measures to test intergroup comparisons over time and multiple linear regression for predictive variable analysis. Results Myotonic dystrophy type 1 patients significantly worsened in visuospatial/visuoconstructive abilities and visual memory compared with controls. Multiple linear regression revealed that progression of cognitive impairment measured by copy of the Rey–Osterrieth complex figure was predicted by muscular impairment, whilst on the block design test age predicted the change with a cut‐off at 31 years of age. Discussion A domain‐specific progressive cognitive decline was found in DM1, with visuospatial/visuoconstructive abilities showing the greatest vulnerability to the passage of time. In addition to important clinical implications, these results suggest the need for the scientific community to delve deeper into the potential mechanisms underlying early cognitive decline in this population.
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Affiliation(s)
- Garazi Labayru
- Neuroscience Area, Biodonostia Health Research Institute, Donostia-San Sebastian, Gipuzkoa, Spain.,Personality, Assessment and Psychological Treatment Department, Psychology Faculty, University of the Basque Country (UPV/EHU), Donostia-San Sebastian, Gipuzkoa, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Madrid, Spain
| | - Jone Aliri
- Department of Social Psychology and Methodology of Behavioral Sciences, University of the Basque Country (UPV/EHU), Donostia-San Sebastian, Gipuzkoa, Spain
| | - Miren Zulaica
- Neuroscience Area, Biodonostia Health Research Institute, Donostia-San Sebastian, Gipuzkoa, Spain
| | - Adolfo López de Munain
- Neuroscience Area, Biodonostia Health Research Institute, Donostia-San Sebastian, Gipuzkoa, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Madrid, Spain.,Neurology Department, Donostia University Hospital, Donostia-San Sebastian, Gipuzkoa, Spain.,Neurosciences Department, University of the Basque Country (UPV/EHU), Donostia-San Sebastian, Gipuzkoa, Spain
| | - Andone Sistiaga
- Neuroscience Area, Biodonostia Health Research Institute, Donostia-San Sebastian, Gipuzkoa, Spain.,Personality, Assessment and Psychological Treatment Department, Psychology Faculty, University of the Basque Country (UPV/EHU), Donostia-San Sebastian, Gipuzkoa, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Institute Carlos III, Madrid, Spain
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Woo J, Lee HW, Park JS. Differences in the pattern of cognitive impairments between juvenile and adult onset myotonic dystrophy type 1. J Clin Neurosci 2019; 68:92-96. [PMID: 31371188 DOI: 10.1016/j.jocn.2019.07.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/06/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To understand the different patterns of neuropsychological dysfunction observed between juvenile onset (jDM1) and adult onset (aDM1) myotonic dystrophy type 1. METHOD We enrolled 19 genetically confirmed DM1 patients, and neuropsychological tests-Wechsler Adult Intelligence Scale-Revised short form; Rey-Kim memory test; and Executive Intelligence Test for evaluating intelligence, memory, and executive function-were performed. Clinical parameters including cytosine-thymine-guanine (CTG) repeats, creatinine kinase level, pulmonary function test, six-minute walk test, motor scales, and cardiac function were evaluated. RESULTS Verbal intelligence was significantly lower in the jDM1 than the aDM1 group (7.50 ± 1.64 vs. 11.00 ± 2.54, respectively; p = 0.009), while no difference was observed in performance intelligence. There was significant differences between the two groups (p = 0.022) with respect to memory function, as specifically revealed by the pattern of lower function in the verbal memory of the jDM1 group. However, the executive function test showed no intergroup differences. CONCLUSION Verbal memory impairment significantly deteriorated in the jDM1 group as compared to the aDM1 group, reflecting a more profound neurodevelopmental change in the juvenile type.
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Affiliation(s)
- Jungmin Woo
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Ho-Won Lee
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Jin-Sung Park
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, South Korea.
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Holmøy AKT, Johannessen CH, Hope S, van Walsem MR, Aanonsen NO, Hassel B. Uncovering health and social care needs among myotonic dystrophy patients: Utility of the Needs and Provisions Complexity Scale. Acta Neurol Scand 2019; 139:526-532. [PMID: 30848487 DOI: 10.1111/ane.13086] [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: 12/21/2018] [Revised: 02/21/2019] [Accepted: 03/04/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Myotonic dystrophy type 1 (DM1) is a slowly progressive multisystem disorder. Guidelines recommend multidisciplinary follow-up. We aimed to investigate the presence of unmet health and social care needs among patients with DM1 and whether unmet needs correlated with motor function, cognitive impairments, or quality of life. MATERIAL AND METHODS Patients were 22 adults with DM1. "Needs and Provisions Complexity Scale" (NPCS) was applied to evaluate the individual's needs and provision of health and social services. The Muscular Impairment Rating Scale (MIRS) was used to measure motor function and disease stage. All patients underwent neuropsychological testing. The EQ-5D-3L questionnaire was used to evaluate the patients' health-related quality of life (HRQoL). RESULTS Median time from diagnosis was 11 years (range: 1-40). Twenty patients had developed needs related to social care, personal care, and rehabilitation that had not been met, whereas need for medical follow-up was largely met. The more pronounced the muscular impairment, the more unmet needs were experienced by DM1 patients (r = 0.50, P = 0.019). Degree of unmet needs did not correlate with full-scale IQ (r = -0.27, P = 0.23) or HRQoL (r = -0.14, P = 0.55). CONCLUSION Using NPCS, we discovered that patients with DM1 had unmet needs with respect to social care, personal care, and rehabilitation although their need for medical follow-up was met. Thus, the use of NPCS helped bring our practice in better accordance with guidelines. A higher MIRS grade should alert the clinician to the likelihood of unmet needs.
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Affiliation(s)
| | - Cecilie Haggag Johannessen
- Department of Neurohabilitation Oslo University Hospital Ullevål Oslo Norway
- NORMENT, KG Jebsen Centre of Psychosis Research, Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Sigrun Hope
- Department of Neurohabilitation Oslo University Hospital Ullevål Oslo Norway
- NORMENT, KG Jebsen Centre of Psychosis Research, Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Marleen R. van Walsem
- Department of Neurohabilitation Oslo University Hospital Ullevål Oslo Norway
- Research center for Habilitation and Rehabilitation Models and Services, Institute of Health and Society University of Oslo Oslo Norway
| | - Nils Olav Aanonsen
- Department of Neurohabilitation Oslo University Hospital Ullevål Oslo Norway
| | - Bjørnar Hassel
- Department of Neurohabilitation Oslo University Hospital Ullevål Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
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Angelini C, Pinzan E. Advances in imaging of brain abnormalities in neuromuscular disease. Ther Adv Neurol Disord 2019; 12:1756286419845567. [PMID: 31105770 PMCID: PMC6503605 DOI: 10.1177/1756286419845567] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 03/05/2019] [Indexed: 01/18/2023] Open
Abstract
Brain atrophy, white matter abnormalities, and ventricular enlargement have been described in different neuromuscular diseases (NMDs). We aimed to provide a comprehensive overview of the substantial advancement of brain imaging in neuromuscular diseases by consulting the main libraries (Pubmed, Scopus and Google Scholar) including the more common forms of muscular dystrophies such as dystrophinopathies, dystroglycanopathies, myotonic dystrophies, facioscapulohumeral dystrophy, limb-girdle muscular dystrophy, congenital myotonia, and congenital myopathies. A consistent, widespread cortical and subcortical involvement of grey and white matter was found. Abnormalities in the functional connectivity in brain networks and metabolic alterations were observed with positron emission tomography (PET) and single photon emission computed tomography (SPECT). Pathological brain changes with cognitive dysfunction seemed to be frequently associated in NMDs. In particular, in congenital muscular dystrophies (CMDs), skeletal muscular weakness, severe hypotonia, WM abnormalities, ventricular dilatation and abnormalities in cerebral gyration were observed. In dystroglycanopathy 2I subtype (LGMD2I), adult patients showed subcortical atrophy and a WM periventricular involvement, moderate ventriculomegaly, and enlargement of subarachnoid spaces. Correlations with clinical features have been observed with brain imaging characteristics and alterations were prominent in congenital or childhood onset cases. In myotonic dystrophy type 2 (DM2) symptoms seem to be less severe than in type 1 (DM1). In Duchenne and Becker muscular dystrophies (DMD, BMD) cortical atrophy is associated with minimal ventricular dilatation and WM abnormalities. Late-onset glycogenosis type II (GSD II) or Pompe infantile forms are characterized by delayed myelination. Only in a few cases of oculopharyngeal muscular dystrophy (OPMD) central nervous system involvement has been described and associated with executive functions impairment.
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Affiliation(s)
- Corrado Angelini
- Fondazione Ospedale San Camillo IRCCS, Via
Alberoni 70, Venezia, 30126, Italia
| | - Elena Pinzan
- Fondazione Ospedale San Camillo IRCCS, Venezia,
Italia
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Tracking the brain in myotonic dystrophies: A 5-year longitudinal follow-up study. PLoS One 2019; 14:e0213381. [PMID: 30845252 PMCID: PMC6405094 DOI: 10.1371/journal.pone.0213381] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 02/19/2019] [Indexed: 12/05/2022] Open
Abstract
Objectives The aim of this study was to examine the natural history of brain involvement in adult-onset myotonic dystrophies type 1 and 2 (DM1, DM2). Methods We conducted a longitudinal observational study to examine functional and structural cerebral changes in myotonic dystrophies. We enrolled 16 adult-onset DM1 patients, 16 DM2 patients, and 17 controls. At baseline and after 5.5 ± 0.4 years participants underwent neurological, neuropsychological, and 3T-brain MRI examinations using identical study protocols that included voxel-based morphometry and diffusion tensor imaging. Data were analyzed by (i) group comparisons between patients and controls at baseline and follow-up, and (ii) group comparisons using difference maps (baseline–follow-up in each participant) to focus on disease-related effects over time. Results We found minor neuropsychological deficits with mild progression in DM1 more than DM2. Daytime sleepiness was restricted to DM1, whereas fatigue was present in both disease entities and stable over time. Comparing results of cross-sectional neuroimaging analyses at baseline and follow-up revealed an unchanged pattern of pronounced white matter alterations in DM1. There was mild additional gray matter reduction in DM1 at follow-up. In DM2, white matter reduction was of lesser extent, but there were some additional alterations at follow-up. Gray matter seemed unaffected in DM2. Intriguingly, longitudinal analyses using difference maps and comparing them between patients and controls did not reveal any significant differences of cerebral changes over time between patients and controls. Conclusion The lack of significant disease-related progression of gray and white matter involvement over a period of five years in our cohort of DM1 and DM2 patients suggests either a rather slowly progressive process or even a stable course of cerebral changes in middle-aged adult-onset patients. Being the first longitudinal neuroimaging trial in DM1 and DM2, this study provides useful additional information regarding the natural history of brain involvement.
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Myotonic Dystrophy: an RNA Toxic Gain of Function Tauopathy? ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1184:207-216. [PMID: 32096040 DOI: 10.1007/978-981-32-9358-8_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Myotonic dystrophies (DM) are rare inherited neuromuscular disorders linked to microsatellite unstable expansions in non-coding regions of ubiquitously expressed genes. The DMPK and ZNF9/CNBP genes which mutations are responsible for DM1 and DM2 respectively. DM are multisystemic disorders with brain affection and cognitive deficits. Brain lesions consisting of neurofibrillary tangles are often observed in DM1 and DM2 brain. Neurofibrillary tangles (NFT) made of aggregates of hyper and abnormally phosphorylated isoforms of Tau proteins are neuropathological lesions common to more than 20 neurological disorders globally referred to as Tauopathies. Although NFT are observed in DM1 and DM2 brain, the question of whether DM1 and DM2 are Tauopathies remains a matter of debate. In the present review, several pathophysiological processes including, missplicing, nucleocytoplasmic transport disruption, RAN translation which are common mechanisms implicated in neurodegenerative diseases will be described. Together, these processes including the missplicing of Tau are providing evidence that DM1 and DM2 are not solely muscular diseases but that their brain affection component share many similarities with Tauopathies and other neurodegenerative diseases. Understanding DM1 and DM2 pathophysiology is therefore valuable to more globally understand other neurodegenerative diseases such as Tauopathies but also frontotemporal lobar neurodegeneration and amyotrophic lateral sclerosis.
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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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Callus E, Bertoldo EG, Beretta M, Boveri S, Cardani R, Fossati B, Brigonzi E, Meola G. Neuropsychological and Psychological Functioning Aspects in Myotonic Dystrophy Type 1 Patients in Italy. Front Neurol 2018; 9:751. [PMID: 30298045 PMCID: PMC6160752 DOI: 10.3389/fneur.2018.00751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 08/17/2018] [Indexed: 12/12/2022] Open
Abstract
Introduction: Myotonic Dystrophy Type 1 (DM1) is an autosomal dominant genetic illness, characterized by a progressive loss of strength. Important deficits in cognitive functioning and a significant prevalence of psychiatric disorders have been previously reported. Methods:A neuropsychological and psychological assessment was carried out in 31 DM1 patients (61% males) in order to measure the cognitive functioning and explore their personality profiles. The MMSE Mini-Mental State Examination, Frontal Assessment Battery (FAB), ENB-2 Battery assessing memory (short term, long term and working memory), integration capacities, visual-spatial ability, attention (selective, divided, shifting/switching) executive functions, praxis, discrimination and logic capabilities and psychopathology Symptom Check List 90-R (SCL-90-R) were administered. The neuropsychological and psychological evaluation of DM1 patients was carried out taking into consideration the clinical parameters (CTG repeat, age at onset, disease duration, Muscular Impairment Rate Scale (MIRS), Medical Research Council Scale (MRC) and the Epworth Sleepiness Scales (EPS)). Results: Regarding psychopathology 19.4% of patients scored a moderate or high level of symptoms intensity index (GSI), 12.9% reported a high number of symptoms (PST) and 16.1% reported a high intensity level of the perceived symptoms (PSDI). Fatigue and daytime sleepiness resulted as being associated with higher levels of psychoticism (PSY). Only 1 patient reported a severe impairment in the spatial and temporal orientation, memory, language, praxis, attention and calculation. Longer disease duration was also associated with cognitive impairment evaluated through ENB-2 (p < 0.05). Discussions and Conclusions:There are indications of the utility of neuropsychological and psychological screening and support for these patients and their families due to the link between disease duration and cognitive performances. A proposal of a clinical protocol, with an illustration of a clinical case report of a family is presented.
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Affiliation(s)
- Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Enrico G Bertoldo
- Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Maria Beretta
- Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Sara Boveri
- Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Rosanna Cardani
- Laboratory of Muscle Histopathology and Molecular Biology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Barbara Fossati
- Department of Neurology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Elisa Brigonzi
- Department of Neurology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Giovanni Meola
- Department of Neurology, IRCCS Policlinico San Donato, San Donato Milanese, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Okkersen K, Jimenez-Moreno C, Wenninger S, Daidj F, Glennon J, Cumming S, Littleford R, Monckton DG, Lochmüller H, Catt M, Faber CG, Hapca A, Donnan PT, Gorman G, Bassez G, Schoser B, Knoop H, Treweek S, van Engelen BGM. Cognitive behavioural therapy with optional graded exercise therapy in patients with severe fatigue with myotonic dystrophy type 1: a multicentre, single-blind, randomised trial. Lancet Neurol 2018; 17:671-680. [PMID: 29934199 DOI: 10.1016/s1474-4422(18)30203-5] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/08/2018] [Accepted: 05/16/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Myotonic dystrophy type 1 is the most common form of muscular dystrophy in adults and leads to severe fatigue, substantial physical functional impairment, and restricted social participation. In this study, we aimed to determine whether cognitive behavioural therapy optionally combined with graded exercise compared with standard care alone improved the health status of patients with myotonic dystrophy type 1. METHODS We did a multicentre, single-blind, randomised trial, at four neuromuscular referral centres with experience in treating patients with myotonic dystrophy type 1 located in Paris (France), Munich (Germany), Nijmegen (Netherlands), and Newcastle (UK). Eligible participants were patients aged 18 years and older with a confirmed genetic diagnosis of myotonic dystrophy type 1, who were severely fatigued (ie, a score of ≥35 on the checklist-individual strength, subscale fatigue). We randomly assigned participants (1:1) to either cognitive behavioural therapy plus standard care and optional graded exercise or standard care alone. Randomisation was done via a central web-based system, stratified by study site. Cognitive behavioural therapy focused on addressing reduced patient initiative, increasing physical activity, optimising social interaction, regulating sleep-wake patterns, coping with pain, and addressing beliefs about fatigue and myotonic dystrophy type 1. Cognitive behavioural therapy was delivered over a 10-month period in 10-14 sessions. A graded exercise module could be added to cognitive behavioural therapy in Nijmegen and Newcastle. The primary outcome was the 10-month change from baseline in scores on the DM1-Activ-c scale, a measure of capacity for activity and social participation (score range 0-100). Statistical analysis of the primary outcome included all participants for whom data were available, using mixed-effects linear regression models with baseline scores as a covariate. Safety data were presented as descriptives. This trial is registered with ClinicalTrials.gov, number NCT02118779. FINDINGS Between April 2, 2014, and May 29, 2015, we randomly assigned 255 patients to treatment: 128 to cognitive behavioural therapy plus standard care and 127 to standard care alone. 33 (26%) of 128 assigned to cognitive behavioural therapy also received the graded exercise module. Follow-up continued until Oct 17, 2016. The DM1-Activ-c score increased from a mean (SD) of 61·22 (17·35) points at baseline to 63·92 (17·41) at month 10 in the cognitive behavioural therapy group (adjusted mean difference 1·53, 95% CI -0·14 to 3·20), and decreased from 63·00 (17·35) to 60·79 (18·49) in the standard care group (-2·02, -4·02 to -0·01), with a mean difference between groups of 3·27 points (95% CI 0·93 to 5·62, p=0·007). 244 adverse events occurred in 65 (51%) patients in the cognitive behavioural therapy group and 155 in 63 (50%) patients in the standard care alone group, the most common of which were falls (155 events in 40 [31%] patients in the cognitive behavioural therapy group and 71 in 33 [26%] patients in the standard care alone group). 24 serious adverse events were recorded in 19 (15%) patients in the cognitive behavioural therapy group and 23 in 15 (12%) patients in the standard care alone group, the most common of which were gastrointestinal and cardiac. INTERPRETATION Cognitive behavioural therapy increased the capacity for activity and social participation in patients with myotonic dystrophy type 1 at 10 months. With no curative treatment and few symptomatic treatments, cognitive behavioural therapy could be considered for use in severely fatigued patients with myotonic dystrophy type 1. FUNDING The European Union Seventh Framework Programme.
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Affiliation(s)
- Kees Okkersen
- Department of Neurology, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands.
| | | | - Stephan Wenninger
- Friedrich-Baur-Institute, Department of Neurology, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Ferroudja Daidj
- Neuromuscular Reference Centre, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jeffrey Glennon
- Department of Cognitive Neuroscience, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Sarah Cumming
- Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - Darren G Monckton
- Institute of Molecular, Cell and Systems Biology, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Hanns Lochmüller
- Institute of Genetic Medicine, University of Newcastle, Newcastle, UK; Department of Neuropediatrics and Muscle Disorders, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany; Centro Nacional de Análisis Genómico, Center for Genomic Regulation, Barcelona Institute of Science and Technology, Barcelona, Catalonia, Spain
| | - Michael Catt
- National Innovation Centre for Ageing, University of Newcastle, Newcastle, UK; Catt-Sci, Wellingborough, UK
| | - Catharina G Faber
- Department of Neurology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Adrian Hapca
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Peter T Donnan
- Tayside Clinical Trials Unit, University of Dundee, Dundee, UK
| | - Gráinne Gorman
- Institute of Neuroscience, University of Newcastle, Newcastle, UK
| | - 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
| | - Hans Knoop
- Academic Medical Center, University of Amsterdam, Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Baziel G M van Engelen
- Department of Neurology, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
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Chakraborty M, Llamusi B, Artero R. Modeling of Myotonic Dystrophy Cardiac Phenotypes in Drosophila. Front Neurol 2018; 9:473. [PMID: 30061855 PMCID: PMC6054993 DOI: 10.3389/fneur.2018.00473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/31/2018] [Indexed: 01/07/2023] Open
Abstract
After respiratory distress, cardiac dysfunction is the second most common cause of fatality associated with the myotonic dystrophy (DM) disease. Despite the prevalance of heart failure in DM, physiopathological studies on heart symptoms have been relatively scarce because few murine models faithfully reproduce the cardiac disease. Consequently, only a small number of candidate compounds have been evaluated in this specific phenotype. To help cover this gap Drosophila combines the amenability of its invertebrate genetics with the possibility of quickly acquiring physiological parameters suitable for meaningful comparisons with vertebrate animal models and humans. Here we review available descriptions of cardiac disease in DM type 1 and type 2, and three recent papers reporting the cardiac toxicity of non-coding CUG (DM1) and CCUG (DM2) repeat RNA in flies. Notably, flies expressing CUG or CCUG RNA in their hearts developed strong arrhythmias and had reduced fractional shortening, which correlates with similar phenotypes in DM patients. Overexpression of Muscleblind, which is abnormally sequestered by CUG and CCUG repeat RNA, managed to strongly suppress arrhythmias and fractional shortening, thus demonstrating that Muscleblind depletion causes cardiac phenotypes in flies. Importantly, small molecules pentamidine and daunorubicin were able to rescue cardiac phenotypes by releasing Muscleblind from sequestration. Taken together, fly heart models have the potential to make important contributions to the understanding of the molecular causes of cardiac dysfunction in DM and in the quick assessment of candidate therapeutics.
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Affiliation(s)
- Mouli Chakraborty
- Translational Genomics Group, Incliva Health Research Institute, Valencia, Spain.,Interdisciplinary Research Structure for Biotechnology and Biomedicine (ERI BIOTECMED), University of Valencia, Valencia, Spain.,CIPF-INCLIVA Joint Unit, Valencia, Spain
| | - Beatriz Llamusi
- Translational Genomics Group, Incliva Health Research Institute, Valencia, Spain.,Interdisciplinary Research Structure for Biotechnology and Biomedicine (ERI BIOTECMED), University of Valencia, Valencia, Spain.,CIPF-INCLIVA Joint Unit, Valencia, Spain
| | - Ruben Artero
- Translational Genomics Group, Incliva Health Research Institute, Valencia, Spain.,Interdisciplinary Research Structure for Biotechnology and Biomedicine (ERI BIOTECMED), University of Valencia, Valencia, Spain.,CIPF-INCLIVA Joint Unit, Valencia, Spain
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A 9-year follow-up study of quantitative muscle strength changes in myotonic dystrophy type 1. J Neurol 2018; 265:1698-1705. [PMID: 29785524 DOI: 10.1007/s00415-018-8898-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/30/2018] [Accepted: 05/08/2018] [Indexed: 10/16/2022]
Abstract
Myotonic dystrophy type 1 (DM1) is a neuromuscular disorder presenting with major muscle impairments. However, few studies have addressed muscle strength progression using quantitative methods. The aims of this study were to document muscle strength changes in eight muscle groups among adults with DM1 over a 9-year period, and to compare this progression between phenotypes (adult and late-onset) and sex. Patients with a genetic diagnosis of DM1 with the late-onset or the adult phenotype were recruited at baseline through the clinical registry of the Saguenay Neuromuscular Clinic. The maximum isometric muscle strength was measured at baseline and 9 years later using a standardized protocol of quantitative muscle testing. Muscle groups included were shoulder abductors, elbow flexors/extensors, wrist extensors, hip flexors, knee flexors/extensors, and ankle dorsiflexors. For the whole group, a mean loss of 24.5-52.8% was observed over the 9-year period for all muscle groups, except for hip flexors which remained stable. Generally, men were stronger and showed a significant greater rate of decline of muscle strength than women. The adult and late-onset phenotypes taken separately also showed a significant and similar decline over the 9-year period, except for the wrist and knee extensors where muscle strength of participants with the adult phenotype decreased faster than in the late-onset phenotype. The similar rate of decline of muscle strength loss observed between phenotypes highlights the need to develop interventions to prevent this decline, even for patients with the late-onset phenotype who are often considered as mildly impaired, and therefore neglected by the rehabilitation services.
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West SD, Lochmüller H, Hughes J, Atalaia A, Marini-Bettolo C, Baudouin SV, Anderson KN. Sleepiness and Sleep-related Breathing Disorders in Myotonic Dystrophy and Responses to Treatment: A Prospective Cohort Study. J Neuromuscul Dis 2018; 3:529-537. [PMID: 27911338 DOI: 10.3233/jnd-160191] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We conducted prospective assessments in people with myotonic dystrophy type 1 (DM1) with daytime sleepiness, provided targeted therapies and assessed response. METHODS Patients had overnight sleep assessments. Treatment with continuous positive airway pressure (CPAP) for OSA, non-invasive ventilation (NIV) for respiratory failure, modafinil for excessive daytime sleepiness were commenced. RESULTS 120 people were studied: mean age 46.9 years (SD 13.2, range 18-74), body mass index 27.9 kg/m2 (7.2, 16-53), Epworth Sleepiness Score (ESS) 13.1 (4.7, 2-24). Twenty one people (18% of group) had OSA: mean age 49.6, BMI 31.1, ESS 14.3, ODI 22, pO2 11.3, pCO2 5.4. All were offered CPAP; seven continued with benefit but 14 had intolerance or no benefit. Thirty-three people (27%) had respiratory failure and abnormal sleep study: mean age 51.5, BMI 31.3, ESS 13.9, ODI 22.9, pO2 8.7, pCO2 6.8. All were offered NIV; 12 continued with benefit but 18 had intolerance or no benefit, 1 died and 2 declined commencement. Thirty-six people (30%) had predominantly sleepiness: mean age 44.8, BMI 24.6, ESS 14.1, ODI 9.2, pO2 11.7, pCO2 5.4. All were offered modafinil; 12 continued this with benefit but 10 had intolerance or no benefit, one was unkeen to start, 11 did not attend further clinic and two had other sleep disorders. Comparing means of treatment responders to non-responders showed no significant difference in any variable, except ESS: 15.9 vs.11.9 respectively, p < 0.0001. CONCLUSIONS Causes of sleepiness are variable in DM1, but include obstructive sleep apnoea, respiratory failure and sleepiness with a normal sleep study; 29% of this studied cohort benefited from targeted sleep therapies.
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Affiliation(s)
- Sophie D West
- Newcastle Regional Sleep Service, Newcastle upon Tyne Hospitals NHS Trust, NE7 7DN, UK
| | - Hanns Lochmüller
- Institute of Genetic Medicine, The John Walton Muscular Dystrophy Research Centre, MRC Centre for Neuromuscular Diseases, Newcastle University, Newcastle upon Tyne, NE1 3BZ, UK
| | - Joan Hughes
- Newcastle Regional Sleep Service, Newcastle upon Tyne Hospitals NHS Trust, NE7 7DN, UK
| | - Antonio Atalaia
- Institute of Genetic Medicine, The John Walton Muscular Dystrophy Research Centre, MRC Centre for Neuromuscular Diseases, Newcastle University, Newcastle upon Tyne, NE1 3BZ, UK
| | - Chiara Marini-Bettolo
- Institute of Genetic Medicine, The John Walton Muscular Dystrophy Research Centre, MRC Centre for Neuromuscular Diseases, Newcastle University, Newcastle upon Tyne, NE1 3BZ, UK
| | - Simon V Baudouin
- Newcastle Regional Sleep Service, Newcastle upon Tyne Hospitals NHS Trust, NE7 7DN, UK
| | - Kirstie N Anderson
- Newcastle Regional Sleep Service, Newcastle upon Tyne Hospitals NHS Trust, NE7 7DN, UK
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Sugiyama A, Sone D, Sato N, Kimura Y, Ota M, Maikusa N, Maekawa T, Enokizono M, Mori-Yoshimura M, Ohya Y, Kuwabara S, Matsuda H. Brain gray matter structural network in myotonic dystrophy type 1. PLoS One 2017; 12:e0187343. [PMID: 29095898 PMCID: PMC5667809 DOI: 10.1371/journal.pone.0187343] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/18/2017] [Indexed: 11/18/2022] Open
Abstract
This study aimed to investigate abnormalities in structural covariance network constructed from gray matter volume in myotonic dystrophy type 1 (DM1) patients by using graph theoretical analysis for further clarification of the underlying mechanisms of central nervous system involvement. Twenty-eight DM1 patients (4 childhood onset, 10 juvenile onset, 14 adult onset), excluding three cases from 31 consecutive patients who underwent magnetic resonance imaging in a certain period, and 28 age- and sex- matched healthy control subjects were included in this study. The normalized gray matter images of both groups were subjected to voxel based morphometry (VBM) and Graph Analysis Toolbox for graph theoretical analysis. VBM revealed extensive gray matter atrophy in DM1 patients, including cortical and subcortical structures. On graph theoretical analysis, there were no significant differences between DM1 and control groups in terms of the global measures of connectivity. Betweenness centrality was increased in several regions including the left fusiform gyrus, whereas it was decreased in the right striatum. The absence of significant differences between the groups in global network measurements on graph theoretical analysis is consistent with the fact that the general cognitive function is preserved in DM1 patients. In DM1 patients, increased connectivity in the left fusiform gyrus and decreased connectivity in the right striatum might be associated with impairment in face perception and theory of mind, and schizotypal-paranoid personality traits, respectively.
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Affiliation(s)
- Atsuhiko Sugiyama
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Daichi Sone
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Noriko Sato
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan
- * E-mail:
| | - Yukio Kimura
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Miho Ota
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Norihide Maikusa
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Tomoko Maekawa
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Mikako Enokizono
- Department of Radiology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | | | - Yasushi Ohya
- Department of Neurology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroshi Matsuda
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
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The cognitive profile of myotonic dystrophy type 1: A systematic review and meta-analysis. Cortex 2017; 95:143-155. [DOI: 10.1016/j.cortex.2017.08.008] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/11/2017] [Accepted: 08/05/2017] [Indexed: 12/13/2022]
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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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Peric S, Brajkovic L, Belanovic B, Ilic V, Salak-Djokic B, Basta I, Rakocevic Stojanovic V. Brain positron emission tomography in patients with myotonic dystrophy type 1 and type 2. J Neurol Sci 2017; 378:187-192. [DOI: 10.1016/j.jns.2017.05.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 04/24/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
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41
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Gourdon G, Meola G. Myotonic Dystrophies: State of the Art of New Therapeutic Developments for the CNS. Front Cell Neurosci 2017; 11:101. [PMID: 28473756 PMCID: PMC5397409 DOI: 10.3389/fncel.2017.00101] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 03/27/2017] [Indexed: 12/12/2022] Open
Abstract
Myotonic dystrophies are multisystemic diseases characterized not only by muscle and heart dysfunction but also by CNS alteration. They are now recognized as brain diseases affecting newborns and children for myotonic dystrophy type 1 and adults for both myotonic dystrophy type 1 and type 2. In the past two decades, much progress has been made in understanding the mechanisms underlying the DM symptoms allowing development of new molecular therapeutic tools with the ultimate aim of curing the disease. This review describes the state of the art for the characterization of CNS related symptoms, the development of molecular strategies to target the CNS as well as the available tools for screening and testing new possible treatments.
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Affiliation(s)
- Genevieve Gourdon
- Institut National de la Santé et de la Recherche Médicale UMR1163Paris, France.,Laboratory CTGDM, Institut Imagine, Université Paris Descartes-Sorbonne Paris CitéParis, France
| | - Giovanni Meola
- Department of Biomedical Sciences for Health, Policlinico San Donato (IRCCS), University of MilanMilan, Italy
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Peric S, Rakocevic Stojanovic V, Mandic Stojmenovic G, Ilic V, Kovacevic M, Parojcic A, Pesovic J, Mijajlovic M, Savic-Pavicevic D, Meola G. Clusters of cognitive impairment among different phenotypes of myotonic dystrophy type 1 and type 2. Neurol Sci 2016; 38:415-423. [DOI: 10.1007/s10072-016-2778-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/18/2016] [Indexed: 11/30/2022]
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Smith CA, Gutmann L. Myotonic Dystrophy Type 1 Management and Therapeutics. Curr Treat Options Neurol 2016; 18:52. [DOI: 10.1007/s11940-016-0434-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gallais B, Gagnon C, Mathieu J, Richer L. Cognitive decline over time in adults with myotonic dystrophy type 1: A 9-year longitudinal study. Neuromuscul Disord 2016; 27:61-72. [PMID: 27919548 DOI: 10.1016/j.nmd.2016.10.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 09/20/2016] [Accepted: 10/11/2016] [Indexed: 11/18/2022]
Abstract
Myotonic dystrophy type 1 (DM1) is an inherited neuromuscular disease with multisystemic involvement including the central nervous system. The evolution of the cognitive profile is a matter of debate, whether an eventual decline could be global or process-specific. Study aims are to describe, compare and document the clinical relevance of the progression of cognitive abilities in DM1 patients with adult and late-onset phenotypes. A total of 115 DM1 patients (90 adult; 25 late-onset) were assessed twice within a 9-year period on cognitive abilities (language, memory, visual attention, processing speed, visuoconstructive abilities and executive functions) and intellectual functioning (WAIS-R 7). A significant worsening over time was observed for verbal memory, visual attention, and processing speed. The progression in cognitive scores correlated with age and disease duration, but not with nCTG, muscular impairment nor education at baseline. Intellectual functioning remained stable. The rate of decline was higher among the late-onset phenotype than in the adult phenotype. Results showed that executive functions, language, and visual memory are impaired earlier in adult life, while verbal memory, visual attention, and processing speed decline later. Globally, results suggest an early and accelerated normal ageing process. This longitudinal study was based on the largest sample and the longest time period studied to date. These findings are highly relevant for clinical practice and genetic counselling.
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Affiliation(s)
- Benjamin Gallais
- Groupe de Recherche Interdisciplinaire sur les Maladies Neuromusculaires (GRIMN), Jonquière, Québec, Canada; Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada.
| | - Cynthia Gagnon
- Groupe de Recherche Interdisciplinaire sur les Maladies Neuromusculaires (GRIMN), Jonquière, Québec, Canada; Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Jean Mathieu
- Groupe de Recherche Interdisciplinaire sur les Maladies Neuromusculaires (GRIMN), Jonquière, Québec, Canada; Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Louis Richer
- Groupe de Recherche Interdisciplinaire sur les Maladies Neuromusculaires (GRIMN), Jonquière, Québec, Canada; Département des Sciences de la Santé, Université du Québec à Chicoutimi, Chicoutimi, Québec, Canada
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Winblad S, Samuelsson L, Lindberg C, Meola G. Cognition in myotonic dystrophy type 1: a 5-year follow-up study. Eur J Neurol 2016; 23:1471-6. [DOI: 10.1111/ene.13062] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 05/13/2016] [Indexed: 01/10/2023]
Affiliation(s)
- S. Winblad
- Department of Psychology; University of Gothenburg; Gothenburg Sweden
- Neuromuscular Centre; Department of Neurology; Sahlgrenska University Hospital; Gothenburg Sweden
| | - L. Samuelsson
- Department of Clinical Genetics; Sahlgrenska University Hospital; Gothenburg Sweden
| | - C. Lindberg
- Neuromuscular Centre; Department of Neurology; Sahlgrenska University Hospital; Gothenburg Sweden
- Department of Clinical Genetics; Sahlgrenska University Hospital; Gothenburg Sweden
| | - G. Meola
- Department of Biomedical Sciences for Health; IRCCS Policlinico San Donato; University of Milan; San Donato Milanese Italy
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Gagnon C, Meola G, Hébert LJ, Laberge L, Leone M, Heatwole C. Report of the second Outcome Measures in Myotonic Dystrophy type 1 (OMMYD-2) international workshop San Sebastian, Spain, October 16, 2013. Neuromuscul Disord 2015; 25:603-16. [DOI: 10.1016/j.nmd.2015.01.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 01/13/2015] [Accepted: 01/20/2015] [Indexed: 11/15/2022]
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Petitclerc É, Hébert LJ, Desrosiers J, Gagnon C. Lower limb muscle impairment in myotonic dystrophy type 1: the need for better guidelines. Muscle Nerve 2015; 51:473-8. [PMID: 25399769 DOI: 10.1002/mus.24521] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2014] [Indexed: 11/11/2022]
Abstract
In myotonic dystrophy type 1 (DM1), leg muscle weakness is a major impairment. There are challenges to obtaining a clear portrait of muscle strength impairment. A systematic literature review was conducted on lower limb strength impairment in late-onset and adult phenotypes to document variables which affect strength measurement. Thirty-two articles were reviewed using the COSMIN guidelines. Only a third of the studies described a reproducible protocol. Only 2 muscle groups have documented reliability for quantitative muscle testing and only 1 total score for manual muscle testing. Variables affecting muscle strength impairment are not described in most studies. This review illustrates the variability in muscle strength assessment in relation to DM1 characteristics and the questionable validity of the results with regard to undocumented methodological properties. There is therefore a clear need to adopt a consensus on the use of a standardized muscle strength assessment protocol.
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Affiliation(s)
- Émilie Petitclerc
- Faculty of Medecine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
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Jean S, Richer L, Laberge L, Mathieu J. Comparisons of intellectual capacities between mild and classic adult-onset phenotypes of myotonic dystrophy type 1 (DM1). Orphanet J Rare Dis 2014; 9:186. [PMID: 25424323 PMCID: PMC4247010 DOI: 10.1186/s13023-014-0186-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/07/2014] [Indexed: 11/15/2022] Open
Abstract
Background Myotonic dystrophy type 1 (DM1) is an autosomal dominant genetic multisystem disorder and the commonest adult-onset form of muscular dystrophy. DM1 results from the expansion of an unstable trinucleotide cytosine-thymine-guanine (CTG) repeat mutation. CTG repeats in DM1 patients can range from 50 to several thousands, with a tendency toward increased repeats with successive generations (anticipation). Associated findings can include involvements in almost every systems, including the brain, and cognitive abnormalities occur in the large majority of patients. The objectives are to describe and compare the intellectual abilities of a large sample of DM1 patients with mild and classic adult-onset phenotypes, to estimate the validity of the Wechsler Adult Intelligence Scale-Revised (WAIS-R) in DM1 patients with muscular weakness, and to appraise the relationship of intelligence quotient (IQ) to CTG repeat length, age at onset of symptoms, and disease duration. Methods A seven-subtest WAIS-R was administered to 37 mild and 151 classic adult-onset DM1 patients to measure their Full-Scale (FSIQ), Verbal (VIQ) and Performance IQ (PIQ). To control for potential bias due to muscular weakness, Standard Progressive Matrices (SPM), a motor-independent test of intelligence, were also completed. Results Total mean FSIQ was 82.6 corresponding to low average IQ, and 82% were below an average intelligence. Mild DM1 patients had a higher mean FSIQ (U=88.7 vs 81.1, p<0.001), VIQ (U=87.8 vs 82.3, p=0.001), and PIQ (U=94.8 vs 83.6, p<0.001) than classic adult-onset DM1 patients. In both mild and classic adult-onset patients, all subtests mean scaled scores were below the normative sample mean. FSIQ also strongly correlate with SPM (rs=0.67, p<0.001), indicating that low intelligence scores are not a consequence of motor impairment. FSIQ scores decreased with both the increase of (CTG)n (rs=−0.41, p<0.001) and disease duration (rs=−0.26, p=0.003). Conclusions Results show that intellectual impairment is an extremely common and important feature in DM1, not only among the classic adult-onset patients but also among the least severe forms of DM1, with low IQ scores compared to general reference population. Health care providers involved in the follow-up of these patients should be aware of their intellectual capacities and should adapt their interventions accordingly.
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Affiliation(s)
- Stéphane Jean
- Clinique des maladies neuromusculaires, Centre de réadaptation en déficience physique Le Parcours, Centre de santé et de services sociaux de Jonquière, 2230, rue de l'Hôpital, C.P. 1200, Jonquière, Québec, G7X 7X2, Canada.
| | - Louis Richer
- Département des sciences de la santé, Université du Québec à Chicoutimi, 555, boul. de l'Université, Chicoutimi, Québec, G7H 2B1, Canada.
| | - Luc Laberge
- Département des sciences de la santé, Université du Québec à Chicoutimi, 555, boul. de l'Université, Chicoutimi, Québec, G7H 2B1, Canada. .,ÉCOBES - Recherche et transfert, Cégep de Jonquière, Québec, Canada. .,Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Québec, Canada.
| | - Jean Mathieu
- Clinique des maladies neuromusculaires, Centre de réadaptation en déficience physique Le Parcours, Centre de santé et de services sociaux de Jonquière, 2230, rue de l'Hôpital, C.P. 1200, Jonquière, Québec, G7X 7X2, Canada. .,Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Québec, Canada.
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Frontostriatal dysexecutive syndrome: a core cognitive feature of myotonic dystrophy type 2. J Neurol 2014; 262:142-8. [DOI: 10.1007/s00415-014-7545-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 09/24/2014] [Accepted: 10/15/2014] [Indexed: 01/27/2023]
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50
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Turner C, Hilton-Jones D, Lochmüller H, Hanna M. MRC Centre for Neuromuscular Diseases 1st (1st December 2010), and 2nd (2nd May 2012) myotonic dystrophy workshops, London, UK and the myotonic dystrophy standards of care and national registry meeting, Newcastle, UK July 2011. Neuromuscul Disord 2013; 23:1069-80. [DOI: 10.1016/j.nmd.2013.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 07/15/2013] [Indexed: 02/08/2023]
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