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Ikeda K, Mori-Yoshimura M, Yamamoto T, Sonoo M, Suzuki S, Kondo Y, Nakamura H, Mitsuhashi K, Maeda MH, Shimizu J, Hayashi YK, Nishino I, Oya Y, Murata M. Chronic Myopathy Associated With Anti-Signal Recognition Particle Antibodies Can Be Misdiagnosed As Facioscapulohumeral Muscular Dystrophy. J Clin Neuromuscul Dis 2016; 17:197-206. [PMID: 27224434 DOI: 10.1097/cnd.0000000000000115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To report cases of chronic autoimmune necrotizing myopathy with anti-signal recognition particle antibodies (anti-SRP myopathy) initially misdiagnosed as muscular dystrophy, in particular, facioscapulohumeral muscular dystrophy (FSHD). METHODS Medical records of patients with anti-SRP myopathy in our institution were retrospectively reviewed. RESULTS All 6 patients were initially diagnosed with muscular dystrophy because of the long-term clinical course and lack of inflammation on biopsy; 5 were diagnosed with FSHD based on a winged scapula. However, the following features suggested an alternative diagnosis, leading to anti-SRP antibody measurement: (1) lack of family history, (2) lack of facial involvement and asymmetry, (3) prominent dysphagia, and (4) profuse spontaneous activities on needle electromyography. All patients showed improvement with immunomodulating therapy. CONCLUSIONS Anti-SRP antibody measurement should be considered in patients diagnosed with FSHD if they present with diagnostic hallmarks of anti-SRP myopathy listed above, to avoid oversight of this potentially treatable disorder.
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Affiliation(s)
- Kensuke Ikeda
- *Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan; †Department of Neurology, Teikyo University School of Medicine, Tokyo, Japan; ‡Department of Neurology, Keio University School of Medicine, Tokyo, Japan; §Department of Neurology, Toranomon Hospital, Tokyo, Japan; ¶Department of Neurology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan; ‖Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan; **Department of Pathophysiology, Tokyo Medical University, Tokyo, Japan; and ††Medical Genome Center, National Center of Neurology and Psychiatry, Tokyo, Japan
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Tawil R, Kissel JT, Heatwole C, Pandya S, Gronseth G, Benatar M. Evidence-based guideline summary: Evaluation, diagnosis, and management of facioscapulohumeral muscular dystrophy: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the Practice Issues Review Panel of the American Association of Neuromuscular & Electrodiagnostic Medicine. Neurology 2015; 85:357-64. [PMID: 26215877 PMCID: PMC4520817 DOI: 10.1212/wnl.0000000000001783] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 01/21/2015] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To develop recommendations for the evaluation, diagnosis, prognostication, and treatment of facioscapulohumeral muscular dystrophy (FSHD) from a systematic review and analysis of the evidence. METHODS Relevant articles were analyzed in accordance with the American Academy of Neurology classification of evidence schemes for diagnostic, prognostic, and treatment studies. Recommendations were linked to the strength of the evidence and other factors. RESULTS AND RECOMMENDATIONS Available genetic testing for FSHD type 1 is highly sensitive and specific. Although respiratory insufficiency occurs rarely in FSHD, patients with severe FSHD should have routine pulmonary function testing. Routine cardiac screening is not necessary in patients with FSHD without cardiac symptoms. Symptomatic retinal vascular disease is very rare in FSHD. Exudative retinopathy, however, is potentially preventable, and patients with large deletions should be screened through dilated indirect ophthalmoscopy. The prevalence of clinically relevant hearing loss is not clear. In clinical practice, patients with childhood-onset FSHD may have significant hearing loss. Because undetected hearing loss may impair language development, screening through audiometry is recommended for such patients. Musculoskeletal pain is common in FSHD and treating physicians should routinely inquire about pain. There is at present no effective pharmacologic intervention in FSHD. Available studies suggest that scapular fixation is safe and effective. Surgical scapular fixation might be cautiously offered to selected patients. Aerobic exercise in FSHD appears to be safe and potentially beneficial. On the basis of the evidence, patients with FSHD might be encouraged to engage in low-intensity aerobic exercises.
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Affiliation(s)
- Rabi Tawil
- From the MDA Neuromuscular Disease Clinic (R.T.) and the Department of Neurology (C.H., S.P.), School of Medicine and Dentistry, University of Rochester Medical Center, NY; the Department of Neurology (J.T.K.), Wexner Medical Center, Ohio State University, Columbus; the Department of Neurology (G.G.), University of Kansas School of Medicine, Kansas City; and the Department of Neurology (M.B.), Miller School of Medicine, University of Miami, OH
| | - John T Kissel
- From the MDA Neuromuscular Disease Clinic (R.T.) and the Department of Neurology (C.H., S.P.), School of Medicine and Dentistry, University of Rochester Medical Center, NY; the Department of Neurology (J.T.K.), Wexner Medical Center, Ohio State University, Columbus; the Department of Neurology (G.G.), University of Kansas School of Medicine, Kansas City; and the Department of Neurology (M.B.), Miller School of Medicine, University of Miami, OH
| | - Chad Heatwole
- From the MDA Neuromuscular Disease Clinic (R.T.) and the Department of Neurology (C.H., S.P.), School of Medicine and Dentistry, University of Rochester Medical Center, NY; the Department of Neurology (J.T.K.), Wexner Medical Center, Ohio State University, Columbus; the Department of Neurology (G.G.), University of Kansas School of Medicine, Kansas City; and the Department of Neurology (M.B.), Miller School of Medicine, University of Miami, OH
| | - Shree Pandya
- From the MDA Neuromuscular Disease Clinic (R.T.) and the Department of Neurology (C.H., S.P.), School of Medicine and Dentistry, University of Rochester Medical Center, NY; the Department of Neurology (J.T.K.), Wexner Medical Center, Ohio State University, Columbus; the Department of Neurology (G.G.), University of Kansas School of Medicine, Kansas City; and the Department of Neurology (M.B.), Miller School of Medicine, University of Miami, OH
| | - Gary Gronseth
- From the MDA Neuromuscular Disease Clinic (R.T.) and the Department of Neurology (C.H., S.P.), School of Medicine and Dentistry, University of Rochester Medical Center, NY; the Department of Neurology (J.T.K.), Wexner Medical Center, Ohio State University, Columbus; the Department of Neurology (G.G.), University of Kansas School of Medicine, Kansas City; and the Department of Neurology (M.B.), Miller School of Medicine, University of Miami, OH
| | - Michael Benatar
- From the MDA Neuromuscular Disease Clinic (R.T.) and the Department of Neurology (C.H., S.P.), School of Medicine and Dentistry, University of Rochester Medical Center, NY; the Department of Neurology (J.T.K.), Wexner Medical Center, Ohio State University, Columbus; the Department of Neurology (G.G.), University of Kansas School of Medicine, Kansas City; and the Department of Neurology (M.B.), Miller School of Medicine, University of Miami, OH
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Luo X, Kranzler H, Lappalainen J, Rosenheck R, Charney D, Zuo L, Erdos J, van Kammen DP, Gelernter J. CALCYON gene variation, schizophrenia, and cocaine dependence. Am J Med Genet B Neuropsychiatr Genet 2004; 125B:25-30. [PMID: 14755439 DOI: 10.1002/ajmg.b.20092] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Calcyon is a brain-specific D1 dopamine receptor-interacting protein, with a potential role in D1-mediated physiological processes, including motor control, reward mechanisms, and cognitive processes. Our objective was to investigate the relationship between polymorphism of the CALCYON gene and (1) schizophrenia and (2) cocaine dependence in African-American (AA) and European-American (EA) subjects. Two single nucleotide polymorphisms (SNPs) at the CALCYON locus were genotyped in 70 AA and 206 EA individuals with schizophrenia and 90 AA and 118 EA individuals with cocaine dependence. The control group was comprised of 46 AA and 207 EA subjects screened to exclude those with psychiatric or substance use disorders. The specific polymorphisms studied were markers +295214G/A and +297151T/G. Comparisons of allele and haplotype frequencies between cases and controls were performed with the Fisher's Exact Test. Linkage disequilibrium (LD) between these two SNPs was calculated with the 3LOCUS program. No alleles or haplotypes were found to be associated with schizophrenia or cocaine dependence either in AA or EA subjects. The markers +295214G/A and +297151T/G are in the same haplotype block in all subgroups. Allele and haplotype frequencies differed significantly between EA and AA subjects. These results suggest that these two genetic variants in the CALCYON gene do not play a major role in predisposition to either schizophrenia or cocaine dependence in AA or EA subjects. Furthermore, these findings begin to establish a haplotype map for this gene in the AA and EA populations.
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Affiliation(s)
- Xingguang Luo
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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Vielhaber S, Jakubiczka S, Schröder JM, Sailer M, Feistner H, Heinze HJ, Wieacker P, Bettecken T. Facioscapulohumeral muscular dystrophy with EcoRI/BlnI fragment size of more than 32 kb. Muscle Nerve 2002; 25:540-8. [PMID: 11932972 DOI: 10.1002/mus.10070] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Facioscapulohumeral muscular dystrophy (FSHD) is associated with the deletion of a variable number of 3.3-kb subunits of a tandemly arranged repeat (D4Z4) on chromosome 4q35. EcoRI/BlnI fragments in the range of 10-35 kb are currently defined as disease-associated. Diagnosis of FSHD is frequently complicated by interchromosomal exchange with a homologous locus on 10q26. We present clinical and laboratory data of six subjects from two unrelated families with a marked FSHD phenotype and EcoRI/BlnI fragments of 39 and 33 kb, respectively. Origin on chromosome 4q35 was confirmed by haplotype analysis in the first family and was supported by pulsed field gel electrophoresis data in the second family. Our data further confirm the existence of a region of overlap of normal and pathological fragments. Fragments from this region can obviously be associated with marked FSHD phenotypes. Furthermore, application of linked markers and resolution of all EcoRI/BlnI fragments by pulsed field gel electrophoresis in addition to routine laboratory tests considerably augments the information obtained from molecular tests, upon which genetic counselling can then be based.
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MESH Headings
- Adult
- Aged
- Base Sequence/genetics
- Chromosomes, Human, Pair 10/genetics
- Chromosomes, Human, Pair 4/genetics
- DNA Fragmentation/genetics
- DNA Mutational Analysis
- Deoxyribonuclease EcoRI/genetics
- Deoxyribonucleases, Type II Site-Specific/genetics
- Female
- Gene Deletion
- Genetic Testing
- Humans
- Male
- Middle Aged
- Molecular Weight
- Muscle, Skeletal/pathology
- Muscle, Skeletal/physiopathology
- Muscular Dystrophy, Facioscapulohumeral/genetics
- Muscular Dystrophy, Facioscapulohumeral/pathology
- Muscular Dystrophy, Facioscapulohumeral/physiopathology
- Mutation/genetics
- Pedigree
- Recombination, Genetic/genetics
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Affiliation(s)
- Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University Magdeburg, Medical Center, Leipziger Strasse 44, D-39120 Magdeburg, Germany.
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Abstract
Extraordinary breakthroughs in the molecular pathogenesis of muscle and nerve disease have resulted in an evolving genetic classification of neuromuscular disorders and the development of new diagnostic methods. This remarkable progress has introduced new genetic tests and has changed the indications for use of certain invasive diagnostic procedures in the evaluation of children with presumed disorders of the motor unit. In this review, we present the current diagnostic approach to the more common neuromuscular diseases of infancy and childhood and define the diagnostic role of muscle biopsy and pediatric electromyography/nerve conduction studies in the era of genetic analysis.
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Affiliation(s)
- B T Darras
- Neuromuscular Program, Department of Neurology, Children's Hospital;, Boston, Massachusetts 02115, USA
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Busse K, Köhler J, Stegmann K, Pongratz D, Koch MC, Schreiber H. An inherited 4q35-EcoRI-DNA-fragment of 35 kb in a family with a sporadic case of facioscapulohumeral muscular dystrophy (FSHD). Neuromuscul Disord 2000; 10:178-81. [PMID: 10734264 DOI: 10.1016/s0960-8966(99)00102-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We present a case of an adult male patient showing clinical, neurophysiological and histological signs consistent with the phenotype of facioscapulohumeral muscular dystrophy. On molecular testing with a 4q35-DNA-probe p13E-11 (D4F104S1), the patient, his clinically unaffected mother and two sisters shared a 4q35-EcoRI-DNA-fragment of 35 kb on the transition between FSHD1A-associated and polymorphic fragments. Explanatory hypotheses, such as reduced penetrance in females or a phenotype unlinked to the 4q35-locus are considered. Alternatively, additional changes in the unidentified FSHD1A gene could have caused the phenotype. Thus, in such rare cases, the diagnostic evidence of 4q35-EcoRI-fragments is still limited.
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Affiliation(s)
- K Busse
- Klinik für Neurologie, Universität Ulm, Steinhövelstrasse 9, D-89075, Ulm, Germany
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