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Verhoeven JI, Kramer J, Seeger J, Molenaar JP, Braakman H, Kamsteeg EJ, Rodenburg RJ, Kusters B, Koudijs S, Van Engelen BG, Erasmus CE, Voermans NC. Brody Disease, an Early-Onset Myopathy With Delayed Relaxation and Abnormal Gait: A Case Series of 9 Children. Neurology 2024; 102:e209164. [PMID: 38373275 DOI: 10.1212/wnl.0000000000209164] [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: 08/28/2023] [Accepted: 12/18/2023] [Indexed: 02/21/2024] Open
Abstract
Brody disease is a rare autosomal recessive myopathy, caused by pathogenic variants in the ATP2A1 gene. It is characterized by an exercise-induced delay in muscle relaxation, often reported as muscle stiffness. Children may manifest with an abnormal gait and difficulty running. Delayed relaxation is commonly undetected, resulting in a long diagnostic delay. Almost all published cases so far were adults with childhood onset and adult diagnosis. With diagnostic next-generation sequencing, an increasing number of patients are diagnosed in childhood. We describe the clinical and genetic features of 9 children from 6 families with Brody disease. All presented with exercise-induced delayed relaxation, reported as difficulty running and performing sports. Muscle strength and mass was normal, and several children even had an athletic appearance. However, the walking and running patterns were abnormal. The diagnostic delay ranged between 2 and 7 years. Uniformly, a wide range of other disorders were considered before genetic testing was performed, revealing pathogenic genetic variants in ATP2A1. To conclude, this case series is expected to improve clinical recognition and timely diagnosis of Brody disease in children. We propose that ATP2A1 should be added to gene panels for congenital myopathies, developmental and movement disorders, and muscle channelopathies.
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Affiliation(s)
- Jamie I Verhoeven
- From the Department of Neurology (J.I.V., J.K., J.P.M., B.G.V.E., N.C.V.), Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands; Sozialpädiatrisches Zentrum Frankfurt Mitte (J.S.), Neuromuskuläres Zentrum, Frankfurt, Germany; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Department of Pediatric Neurology (H.B., C.E.E.); Department of Genetics (E.-J.K.); Department of Laboratory Medicine (R.J.R.); Department of Pathology (B.K.), Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen; and Department of Pediatric Neurology (S.K.), Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jasper Kramer
- From the Department of Neurology (J.I.V., J.K., J.P.M., B.G.V.E., N.C.V.), Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands; Sozialpädiatrisches Zentrum Frankfurt Mitte (J.S.), Neuromuskuläres Zentrum, Frankfurt, Germany; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Department of Pediatric Neurology (H.B., C.E.E.); Department of Genetics (E.-J.K.); Department of Laboratory Medicine (R.J.R.); Department of Pathology (B.K.), Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen; and Department of Pediatric Neurology (S.K.), Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Juergen Seeger
- From the Department of Neurology (J.I.V., J.K., J.P.M., B.G.V.E., N.C.V.), Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands; Sozialpädiatrisches Zentrum Frankfurt Mitte (J.S.), Neuromuskuläres Zentrum, Frankfurt, Germany; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Department of Pediatric Neurology (H.B., C.E.E.); Department of Genetics (E.-J.K.); Department of Laboratory Medicine (R.J.R.); Department of Pathology (B.K.), Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen; and Department of Pediatric Neurology (S.K.), Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Joery P Molenaar
- From the Department of Neurology (J.I.V., J.K., J.P.M., B.G.V.E., N.C.V.), Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands; Sozialpädiatrisches Zentrum Frankfurt Mitte (J.S.), Neuromuskuläres Zentrum, Frankfurt, Germany; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Department of Pediatric Neurology (H.B., C.E.E.); Department of Genetics (E.-J.K.); Department of Laboratory Medicine (R.J.R.); Department of Pathology (B.K.), Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen; and Department of Pediatric Neurology (S.K.), Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Hilde Braakman
- From the Department of Neurology (J.I.V., J.K., J.P.M., B.G.V.E., N.C.V.), Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands; Sozialpädiatrisches Zentrum Frankfurt Mitte (J.S.), Neuromuskuläres Zentrum, Frankfurt, Germany; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Department of Pediatric Neurology (H.B., C.E.E.); Department of Genetics (E.-J.K.); Department of Laboratory Medicine (R.J.R.); Department of Pathology (B.K.), Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen; and Department of Pediatric Neurology (S.K.), Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Erik-Jan Kamsteeg
- From the Department of Neurology (J.I.V., J.K., J.P.M., B.G.V.E., N.C.V.), Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands; Sozialpädiatrisches Zentrum Frankfurt Mitte (J.S.), Neuromuskuläres Zentrum, Frankfurt, Germany; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Department of Pediatric Neurology (H.B., C.E.E.); Department of Genetics (E.-J.K.); Department of Laboratory Medicine (R.J.R.); Department of Pathology (B.K.), Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen; and Department of Pediatric Neurology (S.K.), Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Richard J Rodenburg
- From the Department of Neurology (J.I.V., J.K., J.P.M., B.G.V.E., N.C.V.), Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands; Sozialpädiatrisches Zentrum Frankfurt Mitte (J.S.), Neuromuskuläres Zentrum, Frankfurt, Germany; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Department of Pediatric Neurology (H.B., C.E.E.); Department of Genetics (E.-J.K.); Department of Laboratory Medicine (R.J.R.); Department of Pathology (B.K.), Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen; and Department of Pediatric Neurology (S.K.), Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Benno Kusters
- From the Department of Neurology (J.I.V., J.K., J.P.M., B.G.V.E., N.C.V.), Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands; Sozialpädiatrisches Zentrum Frankfurt Mitte (J.S.), Neuromuskuläres Zentrum, Frankfurt, Germany; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Department of Pediatric Neurology (H.B., C.E.E.); Department of Genetics (E.-J.K.); Department of Laboratory Medicine (R.J.R.); Department of Pathology (B.K.), Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen; and Department of Pediatric Neurology (S.K.), Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Suzanne Koudijs
- From the Department of Neurology (J.I.V., J.K., J.P.M., B.G.V.E., N.C.V.), Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands; Sozialpädiatrisches Zentrum Frankfurt Mitte (J.S.), Neuromuskuläres Zentrum, Frankfurt, Germany; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Department of Pediatric Neurology (H.B., C.E.E.); Department of Genetics (E.-J.K.); Department of Laboratory Medicine (R.J.R.); Department of Pathology (B.K.), Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen; and Department of Pediatric Neurology (S.K.), Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Baziel G Van Engelen
- From the Department of Neurology (J.I.V., J.K., J.P.M., B.G.V.E., N.C.V.), Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands; Sozialpädiatrisches Zentrum Frankfurt Mitte (J.S.), Neuromuskuläres Zentrum, Frankfurt, Germany; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Department of Pediatric Neurology (H.B., C.E.E.); Department of Genetics (E.-J.K.); Department of Laboratory Medicine (R.J.R.); Department of Pathology (B.K.), Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen; and Department of Pediatric Neurology (S.K.), Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Corrie E Erasmus
- From the Department of Neurology (J.I.V., J.K., J.P.M., B.G.V.E., N.C.V.), Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands; Sozialpädiatrisches Zentrum Frankfurt Mitte (J.S.), Neuromuskuläres Zentrum, Frankfurt, Germany; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Department of Pediatric Neurology (H.B., C.E.E.); Department of Genetics (E.-J.K.); Department of Laboratory Medicine (R.J.R.); Department of Pathology (B.K.), Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen; and Department of Pediatric Neurology (S.K.), Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Nicol C Voermans
- From the Department of Neurology (J.I.V., J.K., J.P.M., B.G.V.E., N.C.V.), Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands; Sozialpädiatrisches Zentrum Frankfurt Mitte (J.S.), Neuromuskuläres Zentrum, Frankfurt, Germany; Department of Neurology (J.P.M.), Rijnstate Hospital, Arnhem; Department of Pediatric Neurology (H.B., C.E.E.); Department of Genetics (E.-J.K.); Department of Laboratory Medicine (R.J.R.); Department of Pathology (B.K.), Radboud University Medical Centre, Amalia Children's Hospital, Nijmegen; and Department of Pediatric Neurology (S.K.), Erasmus University Medical Centre, Rotterdam, The Netherlands
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Velardo D, Antognozzi S, Rimoldi M, Pagliarani S, Cogiamanian F, Barbieri S, Corti S, Comi GP, Ronchi D. Case report: Clinical and molecular characterization of two siblings affected by Brody myopathy. Front Neurol 2023; 14:1170071. [PMID: 37332993 PMCID: PMC10272758 DOI: 10.3389/fneur.2023.1170071] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Exercise-induced muscle stiffness is the hallmark of Brody disease, an autosomal recessive myopathy due to biallelic pathogenic variants in ATP2A1, encoding the sarcoplasmic/endoplasmic reticulum Ca2+ ATPase SERCA1. About 40 patients have been reported so far. Our knowledge about the natural history of this disorder, genotype-phenotype correlations and the effect of symptomatic treatment is partial. This results in incomplete recognition and underdiagnosis of the disease. Here, we report the clinical, instrumental, and molecular features of two siblings presenting childhood-onset exercise-induced muscle stiffness without pain. Both the probands display difficulty in climbing stairs and running, frequent falls, delayed muscle relaxation after exertion. Cold temperatures worsen these symptoms. No myotonic discharges were observed at electromyography. Whole Exome Sequencing analysis in the probands revealed the presence of two ATP2A1 variants: the previously reported frameshift microdeletion c.2464delC and the likely pathogenic novel splice-site variant c.324 + 1G > A, whose detrimental effect was demonstrated in ATP2A1 transcript analysis. The bi-allelic inheritance was verified by Sanger sequencing in the unaffected parents. This study expands the molecular defects associated with Brody myopathy.
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Affiliation(s)
- Daniele Velardo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neuromuscular and Rare Disease Unit, Milan, Italy
| | - Sara Antognozzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Martina Rimoldi
- Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Serena Pagliarani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Filippo Cogiamanian
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurophysiology Unit, Milan, Italy
| | - Sergio Barbieri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurophysiology Unit, Milan, Italy
| | - Stefania Corti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
- Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giacomo Pietro Comi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neuromuscular and Rare Disease Unit, Milan, Italy
- Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Dario Ronchi
- Dino Ferrari Center, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Molenaar JP, Verhoeven JI, Rodenburg RJ, Kamsteeg EJ, Erasmus CE, Vicart S, Behin A, Bassez G, Magot A, Péréon Y, Brandom BW, Guglielmi V, Vattemi G, Chevessier F, Mathieu J, Franques J, Suetterlin K, Hanna MG, Guyant-Marechal L, Snoeck MM, Roberts ME, Kuntzer T, Fernandez-Torron R, Martínez-Arroyo A, Seeger J, Kusters B, Treves S, van Engelen BG, Eymard B, Voermans NC, Sternberg D. Clinical, morphological and genetic characterization of Brody disease: an international study of 40 patients. Brain 2020; 143:452-466. [PMID: 32040565 PMCID: PMC7009512 DOI: 10.1093/brain/awz410] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/30/2019] [Accepted: 11/16/2019] [Indexed: 11/17/2022] Open
Abstract
Brody disease is an autosomal recessive myopathy characterized by exercise-induced muscle stiffness due to mutations in the ATP2A1 gene. Almost 50 years after the initial case presentation, only 18 patients have been reported and many questions regarding the clinical phenotype and results of ancillary investigations remain unanswered, likely leading to incomplete recognition and consequently under-diagnosis. Additionally, little is known about the natural history of the disorder, genotype-phenotype correlations, and the effects of symptomatic treatment. We studied the largest cohort of Brody disease patients to date (n = 40), consisting of 22 new patients (19 novel mutations) and all 18 previously published patients. This observational study shows that the main feature of Brody disease is an exercise-induced muscle stiffness of the limbs, and often of the eyelids. Onset begins in childhood and there was no or only mild progression of symptoms over time. Four patients had episodes resembling malignant hyperthermia. The key finding at physical examination was delayed relaxation after repetitive contractions. Additionally, no atrophy was seen, muscle strength was generally preserved, and some patients had a remarkable athletic build. Symptomatic treatment was mostly ineffective or produced unacceptable side effects. EMG showed silent contractures in approximately half of the patients and no myotonia. Creatine kinase was normal or mildly elevated, and muscle biopsy showed mild myopathic changes with selective type II atrophy. Sarcoplasmic/endoplasmic reticulum Ca2+ ATPase (SERCA) activity was reduced and western blot analysis showed decreased or absent SERCA1 protein. Based on this cohort, we conclude that Brody disease should be considered in cases of exercise-induced muscle stiffness. When physical examination shows delayed relaxation, and there are no myotonic discharges at electromyography, we recommend direct sequencing of the ATP2A1 gene or next generation sequencing with a myopathy panel. Aside from clinical features, SERCA activity measurement and SERCA1 western blot can assist in proving the pathogenicity of novel ATP2A1 mutations. Finally, patients with Brody disease may be at risk for malignant hyperthermia-like episodes, and therefore appropriate perioperative measures are recommended. This study will help improve understanding and recognition of Brody disease as a distinct myopathy in the broader field of calcium-related myopathies.
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Affiliation(s)
- Joery P Molenaar
- Department of Neurology, Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jamie I Verhoeven
- Department of Neurology, Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Richard J Rodenburg
- Department of Pediatrics, Translational Metabolic Laboratory, Radboud Center for Mitochondrial Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Erik J Kamsteeg
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Corrie E Erasmus
- Department of Neurology, Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Savine Vicart
- Assistance Publique-Hôpitaux de Paris, Centre de Référence des Canalopathies Musculaires, Centre de Référence des Maladies Neuromusculaires-Paris Est et Service de Génétique, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Anthony Behin
- Assistance Publique-Hôpitaux de Paris, Centre de Référence des Canalopathies Musculaires, Centre de Référence des Maladies Neuromusculaires-Paris Est et Service de Génétique, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Guillaume Bassez
- Assistance Publique-Hôpitaux de Paris, Centre de Référence des Canalopathies Musculaires, Centre de Référence des Maladies Neuromusculaires-Paris Est et Service de Génétique, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Armelle Magot
- CHU Nantes, Centre de Référence Maladies Neuromusculaires AOC, Nantes, France
| | - Yann Péréon
- CHU Nantes, Centre de Référence Maladies Neuromusculaires AOC, Nantes, France
| | - Barbara W Brandom
- Department of Anesthesiology, Children's Hospital, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Valeria Guglielmi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Neurology, University of Verona, Verona, Italy
| | - Gaetano Vattemi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Neurology, University of Verona, Verona, Italy
| | | | - Jean Mathieu
- Neuromuscular Clinic, Centre de Réadaptation en Déficience Physique de Jonquière, Jonquière, Québec, Canada
| | - Jérôme Franques
- Centre de référence des maladies neuromusculaires et de la SLA, hôpital La Timone, AP-HM, Aix-Marseille université, avenue Jean-Moulin, Marseille, France
| | - Karen Suetterlin
- MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Michael G Hanna
- MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | | | - Marc M Snoeck
- Department of Anaesthesiology, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - Mark E Roberts
- Department of Neurology, Salford Royal NHS Foundation Trust, Greater Manchester, UK
| | - Thierry Kuntzer
- Nerve-Muscle Unit, Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Roberto Fernandez-Torron
- Neuromuscular Area, Biodonostia Health Research Institute, Department of Neurology, University Hospital Donostia, CIBERNED, San Sebastián, Spain
| | | | - Juergen Seeger
- Sozialpädiatrisches Zentrum Frankfurt Mitte, Neuromuskulares Zentrum, Frankfurt, Germany
| | - Benno Kusters
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Susan Treves
- Departments of Anesthesia and Biomedicine, Basel University and Basel University Hospital, Basel, Switzerland.,Department of Life Sciences, University of Ferrara, Ferrara, Italy
| | - Baziel G van Engelen
- Department of Neurology, Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Bruno Eymard
- Assistance Publique-Hôpitaux de Paris, Centre de Référence des Canalopathies Musculaires, Centre de Référence des Maladies Neuromusculaires-Paris Est et Service de Génétique, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Nicol C Voermans
- Department of Neurology, Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Damien Sternberg
- Assistance Publique-Hôpitaux de Paris, Centre de Référence des Canalopathies Musculaires, Centre de Référence des Maladies Neuromusculaires-Paris Est et Service de Génétique, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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