Duchenne muscular dystrophy in a 4-year-old girl due to heterozygous frame shift deletion of the dystrophin gene and skewed X-inactivation

Duchenne muscular dystrophy caused by a deletion (c.5021del) in exon 35 of the DMD gene: A case report and review of the literature

Duchenne muscular dystrophy (DMD MIM#310200) is a degenerative muscle disease caused by mutations in the dystrophin gene located on Xp21.2. The clinical features encompass muscle weakness and markedly elevated serum creatine kinase levels. An 8-year-old Chinese boy was diagnosed with Duchenne muscular dystrophy (DMD). Whole exome gene sequencing was conducted and the Sanger method was used to validate sequencing. A deletion (c.5021del) in exon 35 of the dystrophin gene was identified, which was predicted to generate a frameshift mutation and create an early termination codon (p.Leu1674CysfsTer47). It has a pathogenic effect against dystrophin in the muscle cell membrane of the patient. As such, prednisone treatment at a dose of 0.75 mg/kg.d was administered. After one month, a notable reduction in fall frequency was observed. Our new finding will expand the pathogenic mutation spectrum causing DMD.

Night Activity Reduction is a Signature Physiological Biomarker for Duchenne Muscular Dystrophy Dogs

BACKGROUND

Duchenne muscular dystrophy (DMD) is an X-linked lethal muscle disease. Dystrophic dogs are excellent models to test novel therapies for DMD. However, the use of the dog model has been hindered by the lack of an effective method to evaluate whole-body mobility. We recently showed that night activity is a good indicator of dog mobility. However, our published method relies on frame-by-frame manual processing of a 12-hour video for each dog. This labor-intensive and time-consuming approach makes it unrealistic to use this assay as a routine outcome measurement.

OBJECTIVE

To solve this problem, we developed an automatic video-capturing/imaging processing system. The new system reduces the data analysis time over 1,000 fold and also provides a more detailed activity profile of the dog.

METHODS

Using the new system, we analyzed more than 120 twelve-hour recordings from 12 normal and 22 affected dogs.

RESULTS

We observed similar activity profiles during repeated recording of the same dog. Throughout the night, normal dogs were in motion 10.4 ± 0.9% of the time while affected dogs were in motion 4.6 ± 0.2% of the time (p < 0.0001). Further, normal dogs made significantly more movements (p < 0.0001) while affected dogs rested significantly longer (p < 0.0001) during the period of recording (from 6 pm to 6 am next day). Importantly, statistical significance persisted irrespective of the coat color, gender and mutation type.

CONCLUSIONS

Our results suggest that night activity reduction is a robust, quantitative physiological biomarker for dystrophic dogs. The new system may be applicable to study mobility in other species.

Clinical characteristics of Scottie Cramp in 31 cases

OBJECTIVE

To report the clinical features, with response to therapy and long-term outcome of Scottie Cramp as described by owners.

METHODS

Owners of affected dogs provided a description of clinical signs, age of onset and disease progression. Medical records, pedigrees and videotapes of cramp episodes were evaluated.

RESULTS

Thirty-one dogs were recruited; 19 showed generalised spasticity and 12 exhibited only hind limb spasticity and skipping. Episodes were noted in the first year of life in 76% of dogs and were triggered by excitement, stress and exercise. Episode frequency and severity decreased over time with behaviour modification and decreased exposure to triggers playing a role in their development. One dog was euthanased because of severe refractory signs. Fluoxetine reduced the frequency and duration of episodes in seven dogs, but not in one severely affected dog. Female dogs were over-represented with only eight affected males in the study cohort, and the presence of dogs with cerebellar degeneration in the same pedigrees may suggest a more complex mode of inheritance than previously reported.

CLINICAL SIGNIFICANCE

The disorder recognised as Scottie Cramp by dog owners includes dogs with hind limb spasticity in addition to generalised cramping. Signs usually improve over time without specific treatment.