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Abstract
Many neuromuscular disorders preexist or occur during pregnancy. In some cases, pregnancy unmasks a latent hereditary disorder. Most available information is based on case reports or series or retrospective clinical experience or patient surveys. Of special interest are pregnancy-induced changes in disease course or severity and likelihood for baseline recovery of function postpartum. Labor and delivery present special challenges in many conditions that affect skeletal but not smooth (uterine) muscle; so labor complications must be anticipated. Anesthesia for cesarean section surgery requires special precautions in many disorders. The types of conditions reviewed are broad and include examples of autoimmune, hereditary, and compressive/mechanical processes. Disorders include carpal tunnel syndrome and other focal neuropathies, Bell palsy, myasthenia gravis, and other neuromuscular junction disorders, acute and chronic inflammatory neuropathy, hereditary and acquired muscle diseases, spinal muscular atrophy, amyotrophic lateral sclerosis, channelopathies, autonomic neuropathy, and dysautonomia. Many commonly used therapies have fetal animal but no proven human toxicity concerns, complicating treatment and risk decisions. Weaning off effective therapeutic agents or preemptive aggressive treatment or surgery prior to planned pregnancy is an option in some conditions.
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Affiliation(s)
- Louis H. Weimer
- Correspondence to: Louis H. Weimer, M.D., Neurological Institute of New York, 710 W. 168th Street, New York, NY 10032, United States. Tel: + 1-212-305-1516, Fax: + 1-212-305-4268
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Oliveira Santos M, Evangelista T, Conceição I. Enzyme replacement therapy with alglucosidase alfa in a late-onset Pompe disease patient during pregnancy. Neuromuscul Disord 2018; 28:965-968. [DOI: 10.1016/j.nmd.2018.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 07/23/2018] [Accepted: 08/06/2018] [Indexed: 12/23/2022]
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3
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Holbeck-Brendel M, Poulsen BK. Treatment with enzyme replacement therapy during pregnancy in a patient with Pompe disease. Neuromuscul Disord 2017; 27:956-958. [DOI: 10.1016/j.nmd.2017.06.556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 05/09/2017] [Accepted: 06/30/2017] [Indexed: 10/19/2022]
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van der Ploeg AT, Kruijshaar ME, Toscano A, Laforêt P, Angelini C, Lachmann RH, Pascual Pascual SI, Roberts M, Rösler K, Stulnig T, van Doorn PA, Van den Bergh PYK, Vissing J, Schoser B. European consensus for starting and stopping enzyme replacement therapy in adult patients with Pompe disease: a 10-year experience. Eur J Neurol 2017; 24:768-e31. [PMID: 28477382 DOI: 10.1111/ene.13285] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 02/21/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE Pompe disease is a rare inheritable muscle disorder for which enzyme replacement therapy (ERT) has been available since 2006. Uniform criteria for starting and stopping ERT in adult patients were developed and reported here. METHODS Three consensus meetings were organized through the European Pompe Consortium, a network of experts from 11 European countries in the field of Pompe disease. A systematic review of the literature was undertaken to determine the effectiveness of ERT in adult patients on a range of clinical outcome measures and quality of life. A narrative synthesis is presented. RESULTS Consensus was reached on how the diagnosis of Pompe disease should be confirmed, when treatment should be started, reasons for stopping treatment and the use of ERT during pregnancy. This was based on expert opinion and supported by the literature. One clinical trial and 43 observational studies, covering a total of 586 individual adult patients, provided evidence of a beneficial effect of ERT at group level. At individual patient level, the response to treatment varied, but factors associated with a patient's response to ERT were not described in many studies. Eleven observational studies focused on more severely affected patients, suggesting that ERT can also be beneficial in these patients. There are no studies on the effects of ERT in pre-symptomatic patients. CONCLUSIONS This is the first European consensus recommendation for starting and stopping ERT in adult patients with Pompe disease, based on the extensive experience of experts from different countries.
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Affiliation(s)
- A T van der Ploeg
- Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - M E Kruijshaar
- Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - A Toscano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - P Laforêt
- Paris-Est, Referral Center for Neuromuscular Disorders, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - C Angelini
- Fondazione S. Camillo Hospital, IRCCS, Venice, Italy
| | - R H Lachmann
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - S I Pascual Pascual
- Servicio de Neuropediatria, Hospital Universitario, La Paz, Madrid.,Department of Paediatrics, Universidad Autónoma de Madrid, Madrid, Spain
| | - M Roberts
- Department of Neurology, Salford Royal NHS Foundation Trust, Salford, UK
| | - K Rösler
- Neuromuscular Centre, University Department of Neurology, Inselspital, Bern, Switzerland
| | - T Stulnig
- Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - P A van Doorn
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - P Y K Van den Bergh
- Department of Neurology, Neuromuscular Reference Centre, University Hospitals St-Luc, Brussels, Belgium
| | - J Vissing
- Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - B Schoser
- Friedrich-Baur-Institute, Ludwig-Maximilians-University, Munich, Germany
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Kłos J, Kwaśniak-Butowska M, Sławek J. Alglucosidase alfa therapy for Pompe disease in pregnancy - Case report. J Neurol Sci 2017; 375:167-169. [PMID: 28320122 DOI: 10.1016/j.jns.2017.01.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/22/2017] [Accepted: 01/25/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Justyna Kłos
- Department of Neurology, COPERNICUS Podmiot Leczniczy Sp. z o.o. Szpital św. Wojciecha, Al. Jana Pawła II 50, 80-462 Gdańsk, Poland.
| | - Magdalena Kwaśniak-Butowska
- Department of Neurology, COPERNICUS Podmiot Leczniczy Sp. z o.o. Szpital św. Wojciecha, Al. Jana Pawła II 50, 80-462 Gdańsk, Poland
| | - Jarosław Sławek
- Department of Neurology, COPERNICUS Podmiot Leczniczy Sp. z o.o. Szpital św. Wojciecha, Al. Jana Pawła II 50, 80-462 Gdańsk, Poland; Department of Neurological and Psychiatric Nursing, Medical University of Gdańsk, ul. Dębinki 7, 80-952 Gdańsk, Poland
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Perniconi B, Vauthier-Brouzes D, Morélot-Panzini C, Dommergues M, Nizard J, Taouagh N, Hogrel JY, Canal A, Servais L, Laforêt P. Multidisciplinary care allowing uneventful vaginal delivery in a woman with Pompe disease. Neuromuscul Disord 2016; 26:610-3. [DOI: 10.1016/j.nmd.2016.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
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Llerena Junior JC, Nascimento OJM, Oliveira ASB, Dourado Junior MET, Marrone CD, Siqueira HH, Sobreira CFR, Dias-Tosta E, Werneck LC. Guidelines for the diagnosis, treatment and clinical monitoring of patients with juvenile and adult Pompe disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 74:166-76. [DOI: 10.1590/0004-282x20150194] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/25/2015] [Indexed: 01/30/2023]
Abstract
ABSTRACT Pompe disease (PD) is a potentially lethal illness involving irreversible muscle damage resulting from glycogen storage in muscle fiber and activation of autophagic pathways. A promising therapeutic perspective for PD is enzyme replacement therapy (ERT) with the human recombinant enzyme acid alpha-glucosidase (Myozyme®). The need to organize a diagnostic flowchart, systematize clinical follow-up, and establish new therapeutic recommendations has become vital, as ERT ensures greater patient longevity. A task force of experienced clinicians outlined a protocol for diagnosis, monitoring, treatment, genetic counseling, and rehabilitation for PD patients. The study was conducted under the coordination of REBREPOM, the Brazilian Network for Studies of PD. The meeting of these experts took place in October 2013, at L’Hotel Port Bay in São Paulo, Brazil. In August 2014, the text was reassessed and updated. Given the rarity of PD and limited high-impact publications, experts submitted their views.
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Plöckinger U, Tiling N, Bosanska L, Temmesfeld-Wollbrueck B, Irlbacher K, Mezger V, Gossing G. Multiple, Successful Pregnancies in Pompe Disease. JIMD Rep 2015; 28:111-118. [PMID: 26572913 DOI: 10.1007/8904_2015_518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/14/2015] [Accepted: 10/22/2015] [Indexed: 12/03/2022] Open
Abstract
Pompe disease is an autosomal recessive lysosomal storage disease characterized in adult patients by slowly progressive limb-girdle muscle weakness and respiratory insufficiency. Data on pregnancy in women with Pompe disease, intrauterine development of the fetus and parturition are rare. Here we describe a twin pregnancy followed by a second pregnancy in a 38-year-old female patient with Pompe disease. We report the impact of pregnancy on muscle and respiratory functions as well as the neurological and endocrine systems and discuss the medical consequences for anaesthetic management at parturition.
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Affiliation(s)
- Ursula Plöckinger
- Kompetenzzentrum Seltene Stoffwechselkrankheiten, Interdisziplinäres Stoffwechsel-Centrum: Endokrinologie, Diabetes und Stoffwechsel, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Nikolaus Tiling
- Kompetenzzentrum Seltene Stoffwechselkrankheiten, Interdisziplinäres Stoffwechsel-Centrum: Endokrinologie, Diabetes und Stoffwechsel, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Lenka Bosanska
- Kompetenzzentrum Seltene Stoffwechselkrankheiten, Interdisziplinäres Stoffwechsel-Centrum: Endokrinologie, Diabetes und Stoffwechsel, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Bettina Temmesfeld-Wollbrueck
- Med. Klinik m. S. Infektiologie und Pneumologie, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Kerstin Irlbacher
- Klinik für Neurologie, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Viktor Mezger
- Klinik für Anästhesiologie m. S. Operative Intensivmedizin, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
| | - Gabriele Gossing
- Klinik für Gynäkologie, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
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Dasouki M, Jawdat O, Almadhoun O, Pasnoor M, McVey AL, Abuzinadah A, Herbelin L, Barohn RJ, Dimachkie MM. Pompe disease: literature review and case series. Neurol Clin 2015; 32:751-76, ix. [PMID: 25037089 DOI: 10.1016/j.ncl.2014.04.010] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Pompe disease is a rare multi-systemic metabolic myopathy caused by autosomal recessive mutations in the acidic alpha glucosidase (GAA) gene. Significant progress had been made in the diagnosis and management of patients with Pompe disease. Here, we describe our experience with 12 patients with various forms of Pompe disease including 4 potentially pathogenic, novel GAA variants. We also review the recent the recent advances in the pathogenesis, diagnosis, and treatment of individuals with Pompe disease.
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Affiliation(s)
- Majed Dasouki
- Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; Department of Genetics, King Faisal Specialist Hospital & Research Center, MBC-03-30, PO Box 3354, Riyadh 11211, Saudi Arabia.
| | - Omar Jawdat
- Department of Neurology, University of Kansas Medical Center, Mailstop 2012, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Osama Almadhoun
- Department of Pediatrics, University of Kansas Medical Center, Mailstop 4004, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Mamatha Pasnoor
- Department of Neurology, University of Kansas Medical Center, Mailstop 2012, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - April L McVey
- Department of Neurology, University of Kansas Medical Center, Mailstop 2012, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Ahmad Abuzinadah
- Department of Neurology, University of Kansas Medical Center, Mailstop 2012, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Laura Herbelin
- Department of Neurology, University of Kansas Medical Center, Mailstop 2012, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Richard J Barohn
- Department of Neurology, University of Kansas Medical Center, Mailstop 2012, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
| | - Mazen M Dimachkie
- Department of Neurology, University of Kansas Medical Center, Mailstop 2012, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA
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