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Goselink RJM, Voermans NC, Okkersen K, Brouwer OF, Padberg GW, Nikolic A, Tupler R, Dorobek M, Mah JK, van Engelen BGM, Schreuder THA, Erasmus CE. Early onset facioscapulohumeral dystrophy - a systematic review using individual patient data. Neuromuscul Disord 2017; 27:1077-1083. [PMID: 29102079 DOI: 10.1016/j.nmd.2017.09.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/16/2017] [Accepted: 09/14/2017] [Indexed: 01/28/2023]
Abstract
Infantile or early onset is estimated to occur in around 10% of all facioscapulohumeral dystrophy (FSHD) patients. Although small series of early onset FSHD patients have been reported, comprehensive data on the clinical phenotype is missing. We performed a systematic literature search on the clinical features of early onset FSHD comprising a total of 43 articles with individual data on 227 patients. Additional data from four cohorts was provided by the authors. Mean age at reporting was 18.8 years, and 40% of patients were wheelchair-dependent at that age. Half of the patients had systemic features, including hearing loss (40%), retinal abnormalities (37%) and developmental delay (8%). We found an inverse correlation between repeat size and disease severity, similar to adult-onset FSHD. De novo FSHD1 mutations were more prevalent than in adult-onset FSHD. Compared to adult FSHD, our findings indicate that early onset FSHD is overall characterized by a more severe muscle phenotype and a higher prevalence of systemic features. However, similar as in adults, a significant clinical heterogeneity was observed. Based on this, we consider early onset FSHD to be on the severe end of the FSHD disease spectrum. We found natural history studies and treatment studies to be very scarce in early onset FSHD, therefore longitudinal studies are needed to improve prognostication, clinical management and trial-readiness.
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Affiliation(s)
- Rianne J M Goselink
- Department of Neurology, Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Nicol C Voermans
- Department of Neurology, Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kees Okkersen
- Department of Neurology, Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Oebele F Brouwer
- Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - George W Padberg
- Department of Neurology, Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ana Nikolic
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Rossella Tupler
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy; Department of Molecular, Cell and Cancer Biology, University of Massachusetts Medical School, Worcester, USA
| | - Malgorzata Dorobek
- Department of Neurology, Central Clinical Hospital of the Ministry of Interior in Warsaw, Warsaw, Poland
| | - Jean K Mah
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Baziel G M van Engelen
- Department of Neurology, Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Tim H A Schreuder
- Department of Neurology, Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Corrie E Erasmus
- Department of Neurology, Donders Centre for Medical Neuroscience, Radboud University Medical Centre, Nijmegen, The Netherlands
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Nikolic A, Ricci G, Sera F, Bucci E, Govi M, Mele F, Rossi M, Ruggiero L, Vercelli L, Ravaglia S, Brisca G, Fiorillo C, Villa L, Maggi L, Cao M, D'Amico MC, Siciliano G, Antonini G, Santoro L, Mongini T, Moggio M, Morandi L, Pegoraro E, Angelini C, Di Muzio A, Rodolico C, Tomelleri G, Grazia D'Angelo M, Bruno C, Berardinelli A, Tupler R. Clinical expression of facioscapulohumeral muscular dystrophy in carriers of 1-3 D4Z4 reduced alleles: experience of the FSHD Italian National Registry. BMJ Open 2016; 6:e007798. [PMID: 26733561 PMCID: PMC4716236 DOI: 10.1136/bmjopen-2015-007798] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 06/22/2015] [Accepted: 07/15/2015] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Facioscapulohumeral muscular dystrophy type 1 (FSHD1) has been genetically linked to reduced numbers (≤ 8) of D4Z4 repeats at 4q35. Particularly severe FSHD cases, characterised by an infantile onset and presence of additional extra-muscular features, have been associated with the shortest D4Z4 reduced alleles with 1-3 repeats (1-3 DRA). We searched for signs of perinatal onset and evaluated disease outcome through the systematic collection of clinical and anamnestic records of de novo and familial index cases and their relatives, carrying 1-3 DRA. SETTING Italy. PARTICIPANTS 66 index cases and 33 relatives carrying 1-3 DRA. OUTCOMES The clinical examination was performed using the standardised FSHD evaluation form with validated inter-rater reliability. To investigate the earliest signs of disease, we designed the Infantile Anamnestic Questionnaire (IAQ). Comparison of age at onset was performed using the non-parametric Wilcoxon rank-sum or Kruskal-Wallis test. Comparison of the FSHD score was performed using a general linear model and Wald test. Kaplan-Meier survival analysis was used to estimate the age-specific cumulative motor impairment risk. RESULTS No patients had perinatal onset. Among index cases, 36 (54.5%) showed the first signs by 10 years of age. The large majority of patients with early disease onset (26 out of 36, 72.2%) were de novo; whereas the majority of patients with disease onset after 10 years of age were familial (16, 53.3%). Comparison of the disease severity outcome between index cases with age at onset before and over 10 years of age, failed to detect statistical significance (Wald test p value=0.064). Of 61 index cases, only 17 (27.9%) presented extra-muscular conditions. Relatives carrying 1-3 DRA showed a large clinical variability ranging from healthy subjects, to patients with severe motor impairment. CONCLUSIONS The size of the D4Z4 allele is not always predictive of severe clinical outcome. The high degree of clinical variability suggests that additional factors contribute to the phenotype complexity.
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Affiliation(s)
- Ana Nikolic
- Department of Science of Life, Institute of Biology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia Ricci
- Department of Science of Life, Institute of Biology, University of Modena and Reggio Emilia, Modena, Italy
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy
| | - Francesco Sera
- MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, UK
| | - Elisabetta Bucci
- Department of Neurology, S Andrea Hospital, Mental Health and Sensory Organs (NESMOS), University of Rome ‘Sapienza’, Rome, Italy
| | - Monica Govi
- Department of Science of Life, Institute of Biology, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabiano Mele
- Department of Science of Life, Institute of Biology, University of Modena and Reggio Emilia, Modena, Italy
| | - Marta Rossi
- Department of Child Neurology and Psychiatry, IRCCS Institute ‘C Mondino’ Foundation, Pavia, Italy
| | - Lucia Ruggiero
- Department of Neurosciences and Reproductive and Odontostomatologic Sciences, University Federico II, Naples, Italy
| | - Liliana Vercelli
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, Turin, Italy
| | - Sabrina Ravaglia
- Department of Public Health and Neurosciences, University of Pavia, Pavia, Italy
| | - Giacomo Brisca
- Department of Muscular and Neurodegenerative Disease, IRCCS Institute Giannina Gaslini, Genoa, Italy
| | - Chiara Fiorillo
- Department of Molecular Medicine and Neuromuscular Disorders, IRCCS Institute Stella Maris, Pisa, Italy
| | - Luisa Villa
- IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Lorenzo Maggi
- IRCCS Foundation, C Besta Neurological Institute, Milan, Italy
| | | | | | - Gabriele Siciliano
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Pisa, Italy
| | - Giovanni Antonini
- Department of Neurology, S Andrea Hospital, Mental Health and Sensory Organs (NESMOS), University of Rome ‘Sapienza’, Rome, Italy
| | - Lucio Santoro
- Department of Neurosciences and Reproductive and Odontostomatologic Sciences, University Federico II, Naples, Italy
| | - Tiziana Mongini
- Department of Neurosciences “Rita Levi Montalcini”, University of Turin, Turin, Italy
| | - Maurizio Moggio
- IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Lucia Morandi
- IRCCS Foundation, C Besta Neurological Institute, Milan, Italy
| | - Elena Pegoraro
- Department of Neurosciences, University of Padua, Padua, Italy
| | | | - Antonio Di Muzio
- Center for Neuromuscular Disease, University ‘G d'Annunzio’, Chieti, Italy
| | - Carmelo Rodolico
- Department of Neurosciences, University of Messina, Messina, Italy
| | - Giuliano Tomelleri
- Department of Neurological and Movement Sciences, University of Verona, Verona, Italy
| | - Maria Grazia D'Angelo
- Department of Neurorehabilitation, IRCCS Institute Eugenio Medea Ca’ Granada Ospedale Maggiore, Bosisio Parini, Italy
| | - Claudio Bruno
- Department of Muscular and Neurodegenerative Disease, IRCCS Institute Giannina Gaslini, Genoa, Italy
| | - Angela Berardinelli
- Department of Child Neurology and Psychiatry, IRCCS Institute ‘C Mondino’ Foundation, Pavia, Italy
| | - Rossella Tupler
- Department of Science of Life, Institute of Biology, University of Modena and Reggio Emilia, Modena, Italy
- Department of Molecular, Cell and Cancer Biology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Felice KJ, Jones JM, Conway SR. Facioscapulohumeral dystrophy presenting as infantile facial diplegia and late-onset limb-girdle myopathy in members of the same family. Muscle Nerve 2005; 32:368-72. [PMID: 15880682 DOI: 10.1002/mus.20344] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report a family with markedly variable myopathic weakness due to facioscapulohumeral muscular dystrophy (FSHD). The proband developed mild late-onset proximal limb weakness. Her two daughters had severe infantile facial diplegia, initially diagnosed as Möbius syndrome, and mild childhood-onset limb weakness and scapular winging. Results of facial muscle electromyography and muscle histopathology supported a myopathic disorder. This case study further highlights the broad clinical spectrum and intrafamily variability in FSHD, and the occasional absence of a positive correlation between fragment size and disease onset. Moreover, this study underscores the importance of considering FSHD in cases of infantile facial diplegia, especially in patients not demonstrating the full clinical features of Möbius syndrome. In difficult cases, facial muscle electromyography may help to differentiate myopathic from neuropathic weakness, and help guide further diagnostic studies.
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MESH Headings
- Adolescent
- Age of Onset
- Biopsy
- Chromosomes, Human, Pair 4/genetics
- Electromyography
- Facial Muscles/physiopathology
- Gene Deletion
- Genetic Predisposition to Disease/genetics
- Humans
- Infant
- Male
- Middle Aged
- Mobius Syndrome/diagnosis
- Muscle Weakness/congenital
- Muscle Weakness/etiology
- Muscle Weakness/physiopathology
- Muscle, Skeletal/pathology
- Muscle, Skeletal/physiopathology
- Muscular Dystrophies, Limb-Girdle/complications
- Muscular Dystrophies, Limb-Girdle/diagnosis
- Muscular Dystrophies, Limb-Girdle/physiopathology
- Muscular Dystrophy, Facioscapulohumeral/complications
- Muscular Dystrophy, Facioscapulohumeral/congenital
- Muscular Dystrophy, Facioscapulohumeral/physiopathology
- Mutation/genetics
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Affiliation(s)
- Kevin J Felice
- Department of Neurology, University of Connecticut School of Medicine, Farmington, Connecticut 06030-1840, USA.
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