The identification of Landouzy-Dejerine disease: an investigative history

The other face of facioscapulohumeral muscular dystrophy: Exploring orofacial weakness using muscle ultrasound

INTRODUCTION/AIMS

One of the most distinct clinical features of facioscapulohumeral muscular dystrophy (FSHD) is facial weakness. It leads to diminished facial expression and functional impairments. Despite its clinical relevance, little else is known about orofacial muscle involvement. We therefore evaluated orofacial muscle involvement in a sizeable cohort of FSHD participants with muscle ultrasound.

METHODS

Muscle ultrasound images of the following orofacial muscles were scored visually and quantitatively: depressor anguli oris (DAO), orbicularis oris (OO), buccinator, temporalis, masseter, digastric, zygomaticus major and minor bilaterally, and the geniohyoid. Reliability analyses of both visual and quantitative evaluations were performed. Ultrasound results were correlated with other measures: the FSHD clinical score, facial weakness score, and facial function scale.

RESULTS

We included 107 FSHD participants (male 54%; age 52 ± 14 years), of whom 92% showed signs of facial weakness. The reliability of visual ultrasound analysis varied widely (κ 0.0-1.0). Quantitative ultrasound reliability was high (intraclass correlation analysis ≥ 0.96). The DAO, buccinator, OO, temporalis, and zygomaticus minor muscles were affected most often (15%-39%). The digastric, geniohyoid, zygomaticus major, and masseter muscles were least often affected (<5%). The ultrasound compound score correlated weakly to moderately with other outcome measures used (ρ = 0.3-0.7).

DISCUSSION

This study adds to the understanding of orofacial weakness in FSHD, confirming the involvement of the muscles of facial expression in FSHD using ultrasound. We showed that orofacial muscle ultrasound is feasible and reliable when quantitatively assessed. Future studies should evaluate orofacial muscle ultrasound longitudinally, alongside clinical and patient-reported facial weakness outcome measures, to assess their potential as outcome measures.

[Morphological characteristics of paravertebral muscles in patients with scoliosis caused by primaryprogressive muscular dystrophies]

OBJECTIVE

To identify the morphological features of paraspinal muscles in patients with spinal pathology caused by progressive muscular dystrophy.

SUBJECT AND METHODS

The Traumatologic-and-Orthopedic Department of Axial Skeleton Pathology examined patients with scoliotic spinal deformity due to muscular dystrophy: 1) severe Duchenne X-linked muscular dystrophy (n=7); 2) Erb-Roth's autosomal recessive muscular dystrophy (n=2); 3) Landouzy-Dejerine facioscapulohumeral muscular dystrophy (n=2). For histopathological analysis of paraspinal muscles, an excisional biopsy was performed in the region of the apex of the strain angle (the convex side), and the specimens were fixed with 10% neutral formalin. Paraffin sections were stained with hematoxylin and eosin according to the Van Gieson and Masson trichrome staining methods. The preparations were examined using an AxioScope.A1 stereo microscope and an AxioCam digital camera ('Carl Zeiss MicroImaging GmbH', Germany).

RESULTS

Sluggish moderate paraparesis and grade IV progressive neurogenic thoracolumbar scoliosis were predominant in the clinical picture of the disease. The muscle biopsy specimens were established to have muscle fiber profiles with lost polygonality, increased diameter variability, and centrally positioned or numerous internal nuclei (myophagy) and to be characterized by fiber contractures, fatty degeneration fields, interstitial fibrosis, and signs of axonopathy of intramuscular nerve conductors. The arterial blood vessels were spastic with fibrotic t. media and t. adventicia; the venous bed vessels were dilated, thin-walled, full-blooded, which causes blood corpuscle transudation and numerous hemorrhages.

CONCLUSION

The identified morphopathological characteristics of muscle tissue in patients with progressive muscular dystrophy are very similar. However, Duchenne muscular dystrophy is the most severe pathology, in which fatty degeneration and sclerotization of muscle tissue and perimysial vessels are most pronounced. To solve this problem, there is a need for the integration of geneticists, biochemists, molecular biologists, pharmacologists, and histologists.