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Holm-Yildiz S, Krag T, Dysgaard T, Pedersen BS, Medeiros E, Vissing J. Quality of life in hypokalemic periodic paralysis - a survey. Neuromuscul Disord 2024; 41:24-28. [PMID: 38870649 DOI: 10.1016/j.nmd.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/03/2024] [Accepted: 05/29/2024] [Indexed: 06/15/2024]
Abstract
Primary hypokalemic periodic paralysis (HypoPP) is a skeletal muscle channelopathy most commonly caused by pathogenic variants in the calcium channel gene, CACNA1S. HypoPP can present with attacks of paralysis and/or permanent muscle weakness. Previous studies have shown that patients with HypoPP can have impaired quality of life (QoL). In this cross-sectional study, we aimed to describe the QoL in patients with HypoPP caused by pathogenic variants in CACNA1S using The Individualized Neuromuscular Quality of Life (INQoL) questionnaire, a validated tool to measure the QoL of patients with neuromuscular diseases (higher score, worse QoL). We showed that muscle weakness and fatigue were the symptoms with the greatest impact on participants' lives and that "activities", in the life domain of the INQoL, was most affected by HypoPP. Furthermore, we showed that the total INQoL score increased with age. Low QoL was primarily driven by progressive permanent muscle weakness and not attacks of paralysis, although half of the participants reported that attacks of paralysis challenged their daily life. The results suggest that special attention should be given to muscle weakness and fatigue in patients with HypoPP.
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Affiliation(s)
- Sonja Holm-Yildiz
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen 8077, Inge Lehmanns Vej 8, DK-2100 Copenhagen, Denmark.
| | - Thomas Krag
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen 8077, Inge Lehmanns Vej 8, DK-2100 Copenhagen, Denmark
| | - Tina Dysgaard
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen 8077, Inge Lehmanns Vej 8, DK-2100 Copenhagen, Denmark
| | - Brit Stævnsbo Pedersen
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen 8077, Inge Lehmanns Vej 8, DK-2100 Copenhagen, Denmark
| | - Estephani Medeiros
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen 8077, Inge Lehmanns Vej 8, DK-2100 Copenhagen, Denmark
| | - John Vissing
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen 8077, Inge Lehmanns Vej 8, DK-2100 Copenhagen, Denmark
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Jacobsen LN, Stemmerik MG, Skriver SV, Pedersen JJ, Løkken N, Vissing J. Contractile properties and magnetic resonance imaging-assessed fat replacement of muscles in myotonia congenita. Eur J Neurol 2024; 31:e16207. [PMID: 38270354 DOI: 10.1111/ene.16207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/18/2023] [Accepted: 12/28/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND AND PURPOSE Myotonia congenita (MC) is a muscle channelopathy in which pathogenic variants in a key sarcolemmal chloride channel Gene (CLCN1) cause myotonia. This study used muscle magnetic resonance imaging (MRI) to quantify contractile properties and fat replacement of muscles in a Danish cohort of MC patients. METHODS Individuals with the Thomsen (dominant) and Becker (recessive) variants of MC were studied. Isometric muscle strength, whole-body MRI, and clinical data were collected. The degree of muscle fat replacement of thigh, calf, and forearm muscles was quantitively calculated on Dixon MRI as fat fractions (FFs). Contractility was evaluated as the muscle strength per contractile muscle cross-sectional area (PT/CCSA). Muscle contractility was compared with clinical data. RESULTS Intramuscular FF was increased and contractility reduced in calf and in forearm muscles compared with controls (FF = 7.0-14.3% vs. 5.3-9.6%, PT/CCSA = 1.1-4.9 Nm/cm2 vs. 1.9-5.8 Nm/cm2 [p < 0.05]). Becker individuals also showed increased intramuscular FF and reduced contractility of thigh muscles (FF = 11.9% vs. 9.2%, PT/CCSA = 1.9 Nm/cm2 vs. 3.2 Nm/cm2 [p < 0.05]). Individual muscle analysis showed that increased FF was limited to seven of 18 examined muscles (p < 0.05). There was a weak correlation between reduced contractility and severity of symptoms. CONCLUSIONS Individuals with MC have increased fat replacement and reduced contractile properties of muscles. Nonetheless, changes were small and likely did not impact clinically on their myotonic symptoms.
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Affiliation(s)
- Laura Nørager Jacobsen
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Mads Godtfeldt Stemmerik
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sofie Vinther Skriver
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jonas Jalili Pedersen
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nicoline Løkken
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - John Vissing
- Copenhagen Neuromuscular Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Holm-Yildiz S, Krag T, Witting N, Pedersen BS, Dysgaard T, Sloth L, Pedersen J, Kjær R, Kannuberg L, Dahlqvist J, de Stricker Borch J, Solheim T, Fornander F, Eisum AS, Vissing J. Hypokalemic periodic paralysis: a 3-year follow-up study. J Neurol 2023; 270:6057-6063. [PMID: 37656291 PMCID: PMC10632268 DOI: 10.1007/s00415-023-11964-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Primary hypokalemic periodic paralysis (HypoPP) is an inherited channelopathy most commonly caused by mutations in CACNA1S. HypoPP can present with different phenotypes: periodic paralysis (PP), permanent muscle weakness (PW), and mixed weakness (MW) with both periodic and permanent weakness. Little is known about the natural history of HypoPP. METHODS In this 3-year follow-up study, we used the MRC scale for manual muscle strength testing and whole-body muscle MRI (Mercuri score) to assess disease progression in individuals with HypoPP-causing mutations in CACNA1S. RESULTS We included 25 men (mean age 43 years, range 18-76 years) and 12 women (mean age 42 years, range 18-76 years). Two participants were asymptomatic, 21 had PP, 12 MW, and two PW. The median number of months between baseline and follow-up was 42 (range 26-52). Muscle strength declined in 11 patients during follow-up. Four of the patients with a decline in muscle strength had no attacks of paralysis during follow-up, and two of these patients had never had attacks of paralysis. Fat replacement of muscles increased in 27 patients during follow-up. Eight of the patients with increased fat replacement had no attacks of paralysis during follow-up, and two of these patients had never had attacks of paralysis. DISCUSSION The study demonstrates that HypoPP can be a progressive myopathy in both patients with and without attacks of paralysis.
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Affiliation(s)
- Sonja Holm-Yildiz
- Copenhagen Neuromuscular Center, Department of Neurology 8077, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark.
| | - Thomas Krag
- Copenhagen Neuromuscular Center, Department of Neurology 8077, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark
| | - Nanna Witting
- Copenhagen Neuromuscular Center, Department of Neurology 8077, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark
| | - Britt Stævnsbo Pedersen
- Copenhagen Neuromuscular Center, Department of Neurology 8077, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark
| | - Tina Dysgaard
- Copenhagen Neuromuscular Center, Department of Neurology 8077, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark
| | - Louise Sloth
- Copenhagen Neuromuscular Center, Department of Neurology 8077, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark
| | - Jonas Pedersen
- Copenhagen Neuromuscular Center, Department of Neurology 8077, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark
| | - Rebecca Kjær
- Copenhagen Neuromuscular Center, Department of Neurology 8077, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark
| | - Linda Kannuberg
- Copenhagen Neuromuscular Center, Department of Neurology 8077, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark
| | - Julia Dahlqvist
- Copenhagen Neuromuscular Center, Department of Neurology 8077, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark
| | - Josefine de Stricker Borch
- Copenhagen Neuromuscular Center, Department of Neurology 8077, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark
| | - Tuva Solheim
- Copenhagen Neuromuscular Center, Department of Neurology 8077, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark
| | - Freja Fornander
- Copenhagen Neuromuscular Center, Department of Neurology 8077, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark
| | - Anne-Sofie Eisum
- Copenhagen Neuromuscular Center, Department of Neurology 8077, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark
| | - John Vissing
- Copenhagen Neuromuscular Center, Department of Neurology 8077, Rigshospitalet, University of Copenhagen, Inge Lehmanns Vej 8, 2100, Copenhagen, Denmark
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Vicino A, Brugnoni R, Maggi L. Diagnostics in skeletal muscle channelopathies. Expert Rev Mol Diagn 2023; 23:1175-1193. [PMID: 38009256 DOI: 10.1080/14737159.2023.2288258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/22/2023] [Indexed: 11/28/2023]
Abstract
INTRODUCTION Skeletal muscle channelopathies (SMCs) are a heterogenous group of disorders, caused by mutations in skeletal ion channels leading to abnormal muscle excitability, resulting in either delayed muscle relaxation (myotonia) which characterizes non-dystrophic myotonias (NDMs), or membrane transient inactivation, causing episodic weakness, typical of periodic paralyses (PPs). AREAS COVERED SMCs include myotonia congenita, paramyotonia congenita, and sodium-channel myotonia among NDMs, and hyper-normokalemic, hypokalemic, or late-onset periodic paralyses among PPs. When suspecting an SMC, a structured diagnostic approach is required. Detailed personal and family history and clinical examination are essential, while neurophysiological tests should confirm myotonia and rule out alternative diagnosis. Moreover, specific electrodiagnostic studies are important to further define the phenotype of de novo cases and drive molecular analyses together with clinical data. Definite diagnosis is achieved through genetic testing, either with Sanger sequencing or multigene next-generation sequencing panel. In still unsolved patients, more advanced techniques, as exome-variant sequencing or whole-genome sequencing, may be considered in expert centers. EXPERT OPINION The diagnostic approach to SMC is still mainly based on clinical data; moreover, definite diagnosis is sometimes complicated by the difficulty to establish a proper genotype-phenotype correlation. Lastly, further studies are needed to allow the genetic characterization of unsolved patients.
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Affiliation(s)
- Alex Vicino
- Neurology IV Unit, Neuroimmunology and Neuromuscular Diseases, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Nerve-Muscle Unit, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Raffaella Brugnoni
- Neurology IV Unit, Neuroimmunology and Neuromuscular Diseases, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Lorenzo Maggi
- Neurology IV Unit, Neuroimmunology and Neuromuscular Diseases, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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