1
|
Khurana S, Vats A, Gourie-Devi M, Sharma A, Verma S, Faruq M, Dhawan U, Taneja V. Clinical and Genetic Analysis of A Father-Son Duo with Monomelic Amyotrophy: Case Report. Ann Indian Acad Neurol 2023; 26:983-988. [PMID: 38229655 PMCID: PMC10789418 DOI: 10.4103/aian.aian_609_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 01/18/2024] Open
Abstract
Monomelic Amyotrophy (MMA) is a rare neurological disorder restricted to one upper limb, predominantly affecting young males with an unknown aetiopathogenesis. We report a familial case of father-son duo affected by MMA. Whole exome sequencing identified genetic variations in SLIT1, RYR3 and ARPP21 involved in axon guidance, calcium homeostasis and regulation of calmodulin signaling respectively. This is the first attempt to define genetic modifiers associated with MMA from India and advocates to extend genetic screening to a larger cohort. Deciphering the functional consequences of variations in these genes will be crucial for unravelling the pathogenesis of MMA.
Collapse
Affiliation(s)
- Shiffali Khurana
- Department of Biotechnology and Research, Sir Ganga Ram Hospital, Delhi, India
- Department of Biomedical Science, Bhaskaracharya College of Applied Sciences, University of Delhi, Delhi, India
| | - Abhishek Vats
- Department of Biotechnology and Research, Sir Ganga Ram Hospital, Delhi, India
| | - Mandaville Gourie-Devi
- Department of Neurophysiology, Sir Ganga Ram Hospital, Delhi, India
- Department of Neurology, Sir Ganga Ram Hospital, Delhi, India
| | - Ankkita Sharma
- Department of Neurophysiology, Sir Ganga Ram Hospital, Delhi, India
| | - Sagar Verma
- Department of Biotechnology and Research, Sir Ganga Ram Hospital, Delhi, India
| | - Mohammed Faruq
- Council of Scientific and Industrial Research, Institute of Genomics and Integrative Biology, Delhi, India
| | - Uma Dhawan
- Department of Biomedical Science, Bhaskaracharya College of Applied Sciences, University of Delhi, Delhi, India
| | - Vibha Taneja
- Department of Biotechnology and Research, Sir Ganga Ram Hospital, Delhi, India
| |
Collapse
|
2
|
Polavarapu K, Preethish-Kumar V, Nashi S, Vengalil S, Prasad C, Bhattacharya K, Verma A, Pruthi N, Bhat DI, Nalini A. Intrafamilial phenotypic variations in familial cases of cervical flexion induced myelopathy/Hirayama disease. Amyotroph Lateral Scler Frontotemporal Degener 2017; 19:38-49. [PMID: 28938856 DOI: 10.1080/21678421.2017.1374977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Hirayama disease is generally considered to be a sporadic disorder, except for a few reports of familial occurrence. In this study, we describe eight patients from four families with cervical flexion induced myelopathy (CFIM)/Hirayama disease (HD) and intra-familial phenotypic variations. All underwent clinical and electrophysiological evaluation, while seven of them had contrast MR imaging of cervical spine in flexion. There was significant intra-familial variability: distal bimelic form in four patients, classical monomelic form in three and proximo-distal form in one. Irrespective of the clinical phenotype, MRI showed characteristic dynamic changes of posterior dural detachment with prominent epidural enhancement extending variably from C3 vertebral level to dorsal spine in six patients. One patient with 28 years of illness, had only lower cervical cord atrophy without dynamic changes while another patient demonstrated forward dural displacement with epidural enhancement even after 38 years of disease duration.
Collapse
Affiliation(s)
- Kiran Polavarapu
- a Department of Neurology , National Institute of Mental Health and Neurosciences , Bengaluru , India.,b Department of Clinical Neurosciences , National Institute of Mental Health and Neurosciences , Bengaluru , India
| | - Veeramani Preethish-Kumar
- a Department of Neurology , National Institute of Mental Health and Neurosciences , Bengaluru , India.,b Department of Clinical Neurosciences , National Institute of Mental Health and Neurosciences , Bengaluru , India
| | - Saraswati Nashi
- a Department of Neurology , National Institute of Mental Health and Neurosciences , Bengaluru , India
| | - Seena Vengalil
- a Department of Neurology , National Institute of Mental Health and Neurosciences , Bengaluru , India
| | - Chandrajit Prasad
- c Department of Neuro Imaging and Interventional Radiology , National Institute of Mental Health and Neurosciences , Bengaluru , India , and
| | - Kajari Bhattacharya
- c Department of Neuro Imaging and Interventional Radiology , National Institute of Mental Health and Neurosciences , Bengaluru , India , and
| | - Abha Verma
- c Department of Neuro Imaging and Interventional Radiology , National Institute of Mental Health and Neurosciences , Bengaluru , India , and
| | - Nupur Pruthi
- d Department of Neurosurgery , National Institute of Mental Health and Neurosciences , Bengaluru , India
| | - Dhananjay I Bhat
- d Department of Neurosurgery , National Institute of Mental Health and Neurosciences , Bengaluru , India
| | - Atchayaram Nalini
- a Department of Neurology , National Institute of Mental Health and Neurosciences , Bengaluru , India
| |
Collapse
|
3
|
Park YM, Lim YM, Kim DS, Lee JK, Kim KK. Association of the X-linked Androgen Receptor Leu57Gln Polymorphism with Monomelic Amyotrophy. Genomics Inform 2011. [DOI: 10.5808/gi.2011.9.2.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
4
|
|
5
|
Chen TH, Hung CH, Hsieh TJ, Lu SR, Yang SN, Jong YJ. Symmetric atrophy of bilateral distal upper extremities and hyperIgEaemia in a male adolescent with Hirayama disease. J Child Neurol 2010; 25:371-4. [PMID: 19779209 DOI: 10.1177/0883073809336876] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hirayama disease is a rare neuromuscular disorder with peak age of onset at 15 to 17 years among young males. We report a male adolescent presenting with symmetric weakness and atrophy of bilateral upper extremities progressing for 2 years before stabilizing. Otherwise, he did not complain of any sensory disturbance. Electrophysiological findings revealed motor neuron damage at the C7-T1 spinal segments. Cervical magnetic resonance imaging revealed a high-signal mass of posterior dural sac at the C5-T5 vertebral level during neck flexion. Specifically, he had elevated serum total immunoglobulin E level, which had been postulated to be a precipitating factor in Hirayama disease. Early recognition and intervention of this unique neuromuscular disorder is important to avoid ongoing damage to motor neurons. Through this report, we would like to emphasize the crucial role of a pediatric neurologist in averting the progression of Hirayama disease at an early stage.
Collapse
Affiliation(s)
- Tai-Heng Chen
- Division of Pediatric Emergency, Department of Emergency, Kaohsiung Medical University, Graduate Institute of Medicine, Kaohsiung, Taiwan
| | | | | | | | | | | |
Collapse
|
6
|
Juvenile Muscular Atrophy of the Distal Upper Extremity (Hirayama Disease) in Two Lanky Look-Alike Brothers. Neurologist 2009; 15:220-2. [DOI: 10.1097/nrl.0b013e3181942880] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
7
|
Gamez J, Also E, Alias L, Corbera-Bellalta M, Barceló MJ, Centeno M, Raguer N, Gratacós M, Baiget M, Tizzano EF. Investigation of the role of SMN1 and SMN2 haploinsufficiency as a risk factor for Hirayama's disease: Clinical, neurophysiological and genetic characteristics in a Spanish series of 13 patients. Clin Neurol Neurosurg 2007; 109:844-8. [PMID: 17850955 DOI: 10.1016/j.clineuro.2007.07.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2007] [Revised: 07/25/2007] [Accepted: 07/26/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The effect of the number of copies in the SMN1 and SMN2 genes - the most extensively studied susceptibility and modifying genetic factors in adult onset motor neuron diseases - as a genetic risk factor for Hirayama's disease (HirD) has never been studied. The purpose of this study was to investigate the influence of the number of copies of the SMN1/SMN2 genes on the resulting phenotype in 13 HirD Spanish patients. PATIENTS AND METHODS We performed a qualitative and quantitative SMN1/SMN2 gene analysis in 13 unrelated HirD patients. The phenotype-genotype correlation was investigated, paying particular attention to the effect of the SMN1/SMN2 copy number on the disease's phenotype. RESULTS No patient had a homozygous deletion of the SMN1 or SMN2. No differences were found when comparing the SMN1 and SMN2 copy number distributions of the healthy population and HirD patients, and they do not therefore appear to be a susceptibility factor. There was also no correlation found between the number of copies of the SMN1 and SMN2 and the severity of the resulting phenotype. CONCLUSION Our results suggest that SMN1 and SMN2 are not predisposing factors for HirD and therefore support a lack of association between these genes and the resulting phenotype.
Collapse
Affiliation(s)
- Josep Gamez
- Department of Neurology, Hospital Gral. Vall d'Hebron, UAB, Passeig Vall d'Hebron 119-135, 08035 Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Fetoni V, Briem E, Carrara F, Mora M, Zeviani M. Monomelic amyotrophy associated with the 7472insC mutation in the mtDNA tRNASer(UCN) gene. Neuromuscul Disord 2004; 14:723-6. [PMID: 15482956 DOI: 10.1016/j.nmd.2004.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2004] [Revised: 07/05/2004] [Accepted: 07/08/2004] [Indexed: 11/19/2022]
Abstract
We describe a 49-year-old male patient who experienced progressive amyotrophy with no sensorial abnormality in the left arm since 45 years of age. The neuromuscular syndrome was identical to that known as Hirayama disease, a rare form of focal lower motor neuron disease affecting the C7-C8-T1 metamers of the spinal cord. Asymmetric neurosensorial hearing loss was present since age 35 in the patient, and was also documented in an elder sister and in the mother. A muscle biopsy showed cytochrome c oxidase (COX) negative fibers but no ragged-red fibers, and mild reduction of COX was confirmed biochemically. The patient was found to have high levels of a known pathogenic mutation of mtDNA, the 7472insC in the gene encoding the tRNA(Ser(UCN)). Investigation on several family members showed a correlation between mutation load and clinical severity. This is the second report documenting the association of lower motor neurone involvement with a specific mtDNA.
Collapse
Affiliation(s)
- Vincenza Fetoni
- Unit of Neurology, Public Health Hospital, Melegnano (Milan), Italy
| | | | | | | | | |
Collapse
|
9
|
Nalini A, Lokesh L, Ratnavalli E. Familial monomelic amyotrophy: a case report from India. J Neurol Sci 2004; 220:95-8. [PMID: 15140613 DOI: 10.1016/j.jns.2004.02.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2003] [Revised: 01/23/2004] [Accepted: 02/23/2004] [Indexed: 12/01/2022]
Abstract
Monomelic amyotrophy (MMA) is a benign lower motor neuron disorder in the young with male preponderance. It is characterized by insidious onset and progressive weakness and wasting of a distal extremity over a few years followed by spontaneous arrest. The exact pathogenesis is unknown. It is predominantly a sporadic disorder but rarely familial forms have been documented. In this report, we describe the phenotype of a 21-year-old man and his mother who were diagnosed to have MMA. The index case presented with left upper limb weakness and wasting of 3 years duration while his mother had right upper limb amyotrophy and weakness of 34 years. A total of 190 patients were diagnosed to have MMA in our institute over the last 27 years and this is the first case of familial MMA.
Collapse
Affiliation(s)
- A Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore 560 029, India.
| | | | | |
Collapse
|
10
|
Villanova M, Malandrini A, Louboutin JP, Palmeri S, Ginanneschi F, Six J, Volterrani L, Guazzi G. Selective bilateral amyotrophy of the anterior tibial muscle: a case report. Muscle Nerve 1997; 20:1335-6. [PMID: 9324098 DOI: 10.1002/(sici)1097-4598(199710)20:10<1335::aid-mus26>3.0.co;2-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
11
|
Abstract
Monomelic amyotrophy is a rare form of motor neuron disease usually presenting as painless asymmetric weakness and atrophy in the distal upper extremities of young adults. Only rarely are the legs involved and pyramidal findings are uncommon. Monomelic amyotrophy is most often observed in people of Japanese and Indian heritage and affects men almost exclusively. Most cases are sporadic. Laboratory testing is frequently normal or nonspecific except for electrophysiologic studies which typically demonstrate reduced compound muscle action potential amplitudes, fasciculations, and features consistent with acute and chronic denervation in distal upper extremity muscles. Necropsy in 1 patient identified anterior horn cell shrinkage, necrosis, and gliosis in appropriate spinal cord segments. Symptoms and signs often progress for several years before spontaneously arresting. The differential diagnosis for monomelic amyotrophy is broad, including processes which affect the cervical cord, roots, brachial plexus, and individual or multiple nerves in the upper extremity.
Collapse
Affiliation(s)
- P D Donofrio
- Department of Neurology, Bowman Gray School of Medicine, Winston-Salem, North Carolina
| |
Collapse
|