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Schäfer B, Beier JP, Bahm J. [Nerve Transfers in Children with Non-traumatic Amyoplasia]. HANDCHIR MIKROCHIR P 2024; 56:55-64. [PMID: 38508206 DOI: 10.1055/a-2240-4781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND The treatment of obstetric brachial plexus palsy through primary reconstruction and nerve transfers has been established in the past decades. In the case of non-traumatic diseases that lead to flaccid paralysis and the inability to move the extremities, such as transverse myelitis (TM) or arthrogryposis multiplex congenita (AMC), which can have a wide variety of causes, the focus has been on rehabilitative therapy so far, while surgical interventions have been used to a lesser extent, e. g., in the form of osteotomies or muscle transfers. Our aim is to establish nerve transfers as a surgical option to improve mobility in non-traumatic amyoplasia. PATIENTS This work presents the needs-adapted treatment of a total of 23 patients (aged 4 months to 64 months, 18 with AMC and 5 with TM) using nerve transfers on the upper extremity. RESULTS We were able to show that early nerve transfers in the upper extremity enabled the reanimation of muscles in both AMC and TM. CONCLUSION This work shows that the treatment of non-traumatic amyoplasia in children with selective nerve grafts is a successful method. Nerve transfers allow patients to gain or regain important functions for managing independent everyday life. The surgical methods have been established in the treatment of traumatic nerve injuries. They are well-known and can be carried out safely. We believe that this is an important treatment option for paediatric patients with paralysis associated with TM or AMC, which should also be known to the treating physicians.
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Affiliation(s)
- Benedikt Schäfer
- Department of Plastic Surgery, Hand Surgery - Burn Center, Division for Plexus Surgery, University Hospital RWTH Aachen, Germany
- Department of Plastic Surgery, Hand Surgery - Burn Center, Division for Plexus Surgery, University Hospital RWTH Aachen, Germany
| | - Justus P Beier
- Department of Plastic Surgery, Hand Surgery - Burn Center, Division for Plexus Surgery, University Hospital RWTH Aachen, Germany
| | - Jörg Bahm
- Department of Plastic Surgery, Hand Surgery - Burn Center, Division for Plexus Surgery, University Hospital RWTH Aachen, Germany
- Department of Plastic Surgery, Hand Surgery - Burn Center, Division for Plexus Surgery, University Hospital RWTH Aachen, Germany
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Annicchiarico-López W, Peña-Pardo LX, Miranda-Quintero JE. Prenatal diagnosis of Freeman-Sheldon syndrome using ultrasound and genetic testing. Case report. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2023; 74:310-316. [PMID: 38421226 PMCID: PMC10911420 DOI: 10.18597/rcog.4019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 12/04/2023] [Indexed: 03/02/2024]
Abstract
Objectives To describe a case of prenatal diagnosis of Freeman-Sheldon syndrome based on ultrasound findings and complete fetal exome sequencing. Materials and methods A 33-year-old patient currently on treatment for hypothyroidism in whom a 19-week detailed anatomical ultrasound scan showed fetal deformities in more than two body areas (upper and lower limbs), suggesting a diagnosis of arthrogryposis. Genetic counseling was provided and amniocentesis was performed at 20 weeks for fluorescence in situ hybridization (FISH) analysis and complete fetal exome sequencing, with the latter allowing the identification of a heterozygous pathogenic variant of the MYH3 gene which is associated with type 2A distal arthrogryposis. Conclusions Complete fetal exome sequencing was a key factor in identifying the MYH3 gene mutation and confirmed that the deformities seen on ultrasound were associated with type 2A distal arthrogryposis. It is important to perform complete fetal exome sequencing in cases of joint malformations seen on prenatal ultrasound.
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Dorado-Fernández E, Herrerín-López J, Ramírez-González I, Parro-González L, Isidro-Llorens A. Survival in Mudejar Spain in the Middle Ages (thirteenth-fourteenth centuries): Ancient Rare Diseases-an uncommon diagnosis in archaeological human remains. INTERNATIONAL ORTHOPAEDICS 2023; 47:2869-2875. [PMID: 37294431 DOI: 10.1007/s00264-023-05863-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE The finding of severe skeletal alterations in ancient remains could give us useful information not only about the pathologies of the individual per se, as it could infer the state of health of a population. METHODS From the findings of the Mudéjar Cemetery of Uceda (Guadalajara, Central Spain) where a total of 116 burials with almost complete skeleton were recovered, an interesting individual is presented (palaeopathological perspective). The individual 114UC corresponds to a male of 20-25 years old and its age goes back to the thirteenth-fourteenth centuries. RESULTS The first inspection showed the presence of serious alterations especially in the lumbar spine and pelvic girdle. Seven vertebrae (from T11 to L5) showed an unusual posterior fusion only in the postzygapophyseal joints. The pelvis, after being accurately assembled and congruence verified by X-ray and CT scan, showed a noticeable asymmetry of both iliac wings together with a coxa magna protusa (Otto's pelvis), severe anteversion of both cup hips and osteochondritis of the right femoral head. The posterior-slope of both tibias reached about 10°. CONCLUSIONS The differential diagnoses lead us to think of Arthrogryposis Multiplex Congenita as the most probable diagnosis. We analyzed the same biomechanical aspects after taking into account some patterns that give us information about a possible mobility in the first stage of life. We discuss the very few other cases described both from artworks and in the palaeopathological record. To our knowledge, this case could be the oldest published case of AMC worldwide.
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Affiliation(s)
| | - Jesús Herrerín-López
- Departamento de Biología, Unidad de Antropología Física, Universidad Autónoma de Madrid, Madrid, Spain
| | | | | | - Albert Isidro-Llorens
- Hospital Universitari Sagrat Cor, Quironsalud/Universitat de Barcelona, Barcelona, Spain.
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Waseem A, Shah AM, Hussain AA, Kumar S, Fatima K. A rare case of arthrogryposis multiplex congenita in a 2-year-old boy case report. SAGE Open Med Case Rep 2023; 11:2050313X231200418. [PMID: 37771653 PMCID: PMC10524061 DOI: 10.1177/2050313x231200418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/24/2023] [Indexed: 09/30/2023] Open
Abstract
Arthrogryposis multiplex congenita (AMC) is an uncommon condition present from birth that is marked by a combination of weakened muscles and multiple joint contractures. We present a case of a 2-year-old boy with AMC, who was born to consanguineous parents in Saudi Arabia. He presented with musculoskeletal abnormalities of all four limbs, including symmetric contractures in multiple joints of the body, bilateral developmental dysplasia of the hip, and vertical talus. Dysmorphic features included low-set ears, chin recession, triangular face, and nevus flammeus on the face. The child also had lactose intolerance, gastritis, inguinal hernia, and right-sided undescended testis. Surgical interventions were planned after a multidisciplinary team discussion. This case report highlights the good prognosis of AMC with all four-limb involvement and the importance of a thorough physical examination and a multidisciplinary approach to the diagnosis and management of AMC.
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Affiliation(s)
- Asfia Waseem
- Department of Internal Medicine, Civil Hospital Karachi, Karachi, SD, Pakistan
| | - Aresha Masood Shah
- Department of Internal Medicine, Jinnah Post Graduate Medical Centre, Karachi, SD, Pakistan
| | - Abbas Ali Hussain
- Department of Internal Medicine, Jinnah Post Graduate Medical Centre, Karachi, SD, Pakistan
| | | | - Kiran Fatima
- Jinnah Sindh Medical University, Karachi, SD, Pakistan
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Verhofste BP, Emans JB, Miller PE, Birch CM, Thompson GH, Samdani AF, Sanchez Perez-Grueso FJ, McClung AM, Glotzbecker MP. Growth-Friendly Spine Surgery in Arthrogryposis Multiplex Congenita. J Bone Joint Surg Am 2021; 103:715-726. [PMID: 33475309 DOI: 10.2106/jbjs.20.00600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arthrogryposis multiplex congenita (AMC) is a condition that describes neonates born with ≥2 distinct congenital contractures. Despite spinal deformity in 3% to 69% of patients, inadequate data exist on growth-friendly instrumentation (GFI) in AMC. Our study objectives were to describe current GFI trends in children with AMC and early-onset scoliosis (EOS) and to compare long-term outcomes with a matched idiopathic EOS (IEOS) cohort to determine whether spinal rigidity or extremity contractures influenced outcomes. METHODS Children with AMC and spinal deformity of ≥30° who were treated with GFI for ≥24 months were identified from a multicenter EOS database (1993 to 2017). Propensity scoring matched 35 patients with AMC to 112 patients with IEOS with regard to age, sex, construct, and curve. Multivariable linear mixed modeling compared changes in spinal deformity and the 24-item Early Onset Scoliosis Questionnaire (EOSQ-24) across cohorts. Cohort complications and reoperations were analyzed using multivariable Poisson regression. RESULTS Preoperatively, groups did not differ with regard to age (p = 0.87), sex (p = 0.96), construct (p = 0.62), rate of nonoperative treatment (p = 0.54), and major coronal curve magnitude (p = 0.96). After the index GFI, patients with AMC had reduced percentage of coronal correction (35% compared with 44%; p = 0.01), larger residual coronal curves (49° compared with 42°; p = 0.03), and comparable percentage of kyphosis correction (17% compared with 21%; p = 0.52). In GFI graduates (n = 81), final coronal curve magnitude (55° compared with 43°; p = 0.22) and final sagittal curve magnitude (47° compared with 47°; p = 0.45) were not significantly different at the latest follow-up after definitive surgery. The patients with AMC had reduced T1-S1 length (p < 0.001), comparable T1-S1 growth velocity (0.66 compared with 0.85 mm/month; p = 0.05), and poorer EOSQ-24 scores at the time of the latest follow-up (64 compared with 83 points; p < 0.001). After adjusting for ambulatory status and GFI duration, patients with AMC developed 51% more complications (incidence rate ratio, 1.51 [95% confidence interval (CI), 1.11 to 2.04]; p = 0.009) and 0.2 more complications/year (95% CI, 0.02 to 0.33 more; p = 0.03) compared with patients with IEOS. CONCLUSIONS Patients with AMC and EOS experienced less initial deformity correction after the index surgical procedure, but final GFI curve magnitudes and total T1-S1 growth during active treatment were statistically and clinically comparable with IEOS. Nonambulatory patients with AMC with longer GFI treatment durations developed the most complications. Multidisciplinary perioperative management is necessary to optimize GFI and to improve quality of life in this complex population. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Bram P Verhofste
- Department of Orthopaedic Surgery, Boston Children's Hospital (Harvard Teaching Hospital), Boston, Massachusetts
| | - John B Emans
- Department of Orthopaedic Surgery, Boston Children's Hospital (Harvard Teaching Hospital), Boston, Massachusetts
| | - Patricia E Miller
- Department of Orthopaedic Surgery, Boston Children's Hospital (Harvard Teaching Hospital), Boston, Massachusetts
| | - Craig M Birch
- Department of Orthopaedic Surgery, Boston Children's Hospital (Harvard Teaching Hospital), Boston, Massachusetts
| | - George H Thompson
- Department of Orthopaedic Surgery, Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Amer F Samdani
- Shriners Hospital for Children, Philadelphia, Pennsylvania
| | | | | | - Michael P Glotzbecker
- Department of Orthopaedic Surgery, Rainbow Babies and Children's Hospital, Cleveland, Ohio
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Prognostic significance of prenatal ultrasound in fetal arthrogryposis multiplex congenita. Arch Gynecol Obstet 2020; 303:943-953. [PMID: 33090266 PMCID: PMC7985050 DOI: 10.1007/s00404-020-05828-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/29/2020] [Indexed: 11/25/2022]
Abstract
Purpose Fetal arthrogryposis multiplex congenita (AMC) describes a heterogeneous disease entity characterized by multiple contractures affecting at least two different body areas. The aim of our study was to identify additional sonographic abnormalities in fetuses with AMC Type I–III associated with an unfavorable prognosis and to describe when those signs were first detected. Methods This retrospective study included 41 pregnancies of suspected AMC diagnosed 1999–2017 at our tertiary referral center. The affected pregnancies were divided into the 3 AMC subgroups; the time of detection and outcome were analyzed. Prenatal sonograms, pediatric charts, genetic tests, and autopsy reports were studied. Results Pregnancy outcome data were verifiable in 34 out of 41 cases; in 27 cases, AMC was confirmed. Hydrops was present in 50% of postnatally deceased fetuses, 53% of cases resulting in termination of pregnancy vs. 0% of the surviving 8 children. Absent stomach filling was found in 67% of the children with neonatal death. After subcategorization, the limb-involvement-only-group, 8% showed hydrops vs. 100% in system anomaly group vs. 70% in neuromuscular dysfunction cohort (p = 0.001). Scoliosis, nuchal edema, and absent stomach filling were significantly indicating for a neurological etiology. Conclusion In addition to disease-defining sonographic findings, those with prognostic significance were identified. Hydrops, nuchal edema, scoliosis and absent stomach filling were associated with unfavorable outcomes implicating a neuromuscular etiology. This knowledge can help to predict the further course of the disease and support patient counseling.
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El-Dessouky SH, Issa MY, Aboulghar MM, Gaafar HM, Elarab AE, Ateya MI, Omar HH, Beetz C, Zaki MS. Prenatal delineation of a distinct lethal fetal syndrome caused by a homozygous truncating KIDINS220 variant. Am J Med Genet A 2020; 182:2867-2876. [PMID: 32909676 DOI: 10.1002/ajmg.a.61858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/19/2020] [Accepted: 08/22/2020] [Indexed: 02/06/2023]
Abstract
Kinase D-interacting substrate of 220 kDa (KIDINS220) is a transmembrane protein playing integral role in growth mediating pathways in the nervous and cardiovascular systems. KIDINS220 heterozygous truncating variants that affect the protein's C-terminus have been associated with a phenotype, so far described only in few unrelated children, including spastic paraplegia, intellectual disability, nystagmus, and obesity. More recently, a homozygous, more N-terminal truncating variant in KIDINS220 gene was suggested to be associated with enlarged cerebral ventricles and limb contractures in three fetuses from a consanguineous family. We confirm the latter finding by presenting the first detailed prenatal identification of a fetal phenotype associated with novel homozygous deleterious frameshift variant in KIDINS220 gene in a consanguineous healthy Egyptian couple. History of unexplained seven miscarriages and a similar stillbirth were recorded. Prenatal ultrasonography revealed limb contractions and ventriculomegaly; in addition to previously unreported cerebellar anomalies, cardiac anomalies and hydrops fetalis. These findings represent an expansion of clinical and molecular spectrum associated with KIDINS220 variants and broaden our understanding of genotype-phenotype relationships in lethal congenital contractures syndromes and associated severe abnormal embryological development. More generally, our study adds KIDINS220 to the rare group of genes which may cause disease by either of two distinct mutational mechanisms.
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Affiliation(s)
- Sara H El-Dessouky
- Prenatal Diagnosis and Fetal Medicine Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt
| | - Mahmoud Y Issa
- Clinical Genetics Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt
| | - Mona M Aboulghar
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, Cairo University, Cairo, Egypt
| | - Hassan M Gaafar
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, Cairo University, Cairo, Egypt
| | - Ahmed Ezz Elarab
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, Cairo University, Cairo, Egypt
| | - Mohamed I Ateya
- Department of Obstetrics and Gynecology, Fetal Medicine Unit, Cairo University, Cairo, Egypt
| | - Heba H Omar
- Diagnostic and Research Department, Centogene AG, Rostock, Germany
| | - Christian Beetz
- Diagnostic and Research Department, Centogene AG, Rostock, Germany
| | - Maha Saad Zaki
- Clinical Genetics Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt
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Sandweiss AJ, Patel S, Bader MY, Kylat RI. A Truncating Variant of CHRNG as a Cause of Escobar Syndrome: A Multiple Pterygium Syndrome Subtype. J Pediatr Genet 2020; 11:144-146. [DOI: 10.1055/s-0040-1715640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
Abstract
AbstractEscobar syndrome is a milder variant of multiple pterygium syndrome characterized by pterygia, scoliosis, and multiple congenital contractures. It is most frequently due to a genetic variant in CHRNG, which encodes the γ-subunit of the nicotinic acetylcholine receptor. Though the subunit is considered a “fetal” form and transitions to the “adult” ε-subunit by 33 weeks' gestation, the pathogenic musculoskeletal effects during fetal development render children with this condition permanently affected. We report a neonate with homozygous CHRNG c.117dupC and discuss some of the downstream clinical effects we observed with this variant.
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Affiliation(s)
- Alexander J. Sandweiss
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona, United States
- Section of Neurology and Developmental Neurosciences, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States
| | - Shalinkumar Patel
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona, United States
| | - Mohammad Y. Bader
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona, United States
| | - Ranjit I. Kylat
- Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona, United States
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10
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Cachecho S, Elfassy C, Hamdy R, Rosenbaum P, Dahan-Oliel N. Arthrogryposis multiplex congenita definition: Update using an international consensus-based approach. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2019; 181:280-287. [PMID: 31452331 DOI: 10.1002/ajmg.c.31739] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 08/09/2019] [Accepted: 08/09/2019] [Indexed: 11/08/2022]
Abstract
Arthrogryposis multiplex congenita (AMC) has been described and defined in thousands of articles, but the terminology used has been inconsistent. Some have described it as a diagnosis or syndrome, others as a term or clinical finding. This lack of common language can lead to confusion in clinical and research communities. The aim of this study was to develop a consensus-based definition for AMC using international expert opinion. A consensus-based definition will help harmonize research and clinical endeavors and will facilitate communication among families, clinicians, and researchers. This article describes the methodology used leading to a proposed definition of AMC. First, a literature review was conducted to identify AMC definitions used in included studies. The most commonly used words in the definitions were extracted. Second, a group of eight experts in AMC was selected to identify elements considered critically important to the definition of AMC. Third, based on these critical elements and the literature review, a definition was drafted by the research team. Fourth, a modified Delphi consensus process was conducted using electronic surveys with 25 experts in the field of AMC from eight countries. Survey results were analyzed quantitatively and qualitatively and drafts were modified accordingly. Three rounds of surveys were completed until consensus was reached on a definition of AMC. An annotation of this definition, developed by a panel of international experts, is provided in a separate manuscript in this special issue.
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Affiliation(s)
- Sarah Cachecho
- Rehabilitation Department, Shriners Hospital for Children-Canada, Montreal, Quebec, Canada
| | - Caroline Elfassy
- Rehabilitation Department, Shriners Hospital for Children-Canada, Montreal, Quebec, Canada
| | - Reggie Hamdy
- Shriners Hospital for Children-Canada, Division of Pediatric Orthopaedics, Department of Orthopaedics, McGill University, Montreal, Quebec, Canada
| | - Peter Rosenbaum
- Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Noémi Dahan-Oliel
- Clinical Research Department, Shriners Hospital for Children-Canada, School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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Niles KM, Blaser S, Shannon P, Chitayat D. Fetal arthrogryposis multiplex congenita/fetal akinesia deformation sequence (FADS)-Aetiology, diagnosis, and management. Prenat Diagn 2019; 39:720-731. [PMID: 31218730 DOI: 10.1002/pd.5505] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/21/2019] [Accepted: 06/04/2019] [Indexed: 01/01/2023]
Abstract
Arthrogryposis multiplex congenita (AMC) refers to an aetiologically heterogenous condition, which consists of joint contractures affecting two or more joints starting prenatally. The incidence is approximately one in 3000 live births; however, the prenatal incidence is higher, indicating a high intrauterine mortality. Over 320 genes have been implicated showing the genetic heterogeneity of the condition. AMC can be of extrinsic aetiology resulting from intrauterine crowding secondary to congenital structural uterine abnormalities (eg, bicornuate or septate uterus), uterine tumors (eg, fibroid), or multifetal pregnancy or intrinsic/primary/fetal aetiology, due to functional abnormalities in the brain, spinal cord, peripheral nerves, neuromuscular junction, muscles, bones, restrictive dermopathies, tendons and joints. Unlike many of the intrinsic/primary/fetal causes which are difficult to treat, secondary AMC can be treated by physiotherapy with good response. Primary cases may present prenatally with fetal akinesia associated with joint contractures and occasionally brain abnormalities, decreased muscle bulk, polyhydramnios, and nonvertex presentation while the secondary cases usually present with isolated contractures. Complete prenatal and postnatal investigations are needed to identify an underlying aetiology and provide information regarding its prognosis and inheritance, which is critical for the obstetrical care providers and families to optimize the pregnancy management and address future reproductive plans.
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Affiliation(s)
- Kirsten M Niles
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Susan Blaser
- Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada
| | - Patrick Shannon
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - David Chitayat
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.,The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.,Division of Clinical and Metabolic Genetics, University of Toronto, Toronto, ON, Canada
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Hall JG, Kimber E, Dieterich K. Classification of arthrogryposis. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2019; 181:300-303. [DOI: 10.1002/ajmg.c.31716] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/05/2019] [Accepted: 06/11/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Judith G. Hall
- Department of Medical Genetics and PediatricsUniversity of British Columbia and BC Children's Hospital Vancouver British Columbia Canada
| | - Eva Kimber
- Department of PediatricsInstitute of Clinical Sciences at Sahlgrenska Academy, The Queen Silvia Children's Hospital Gothenburg Sweden
| | - Klaus Dieterich
- Grenoble Institut des neurosciences, University of Grenoble La Tronche France
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Delaney S, Ussakli C, Fligner C. Rare etiology of arthrogryposis multiplex congenita at term: congenital cytomegalovirus infection. CASE REPORTS IN PERINATAL MEDICINE 2019. [DOI: 10.1515/crpm-2018-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Arthrogryposis multiplex congenita is the presence of multiple congenital contractures of two or more body parts. Congenital cytomegalovirus (CMV) infection is a rare etiology of arthrogryposis.
Case presentation
We report a case of intrauterine fetal akinesia and arthrogryposis multiplex congenita delivered at term with subsequent neonatal demise. Placental pathology and autopsy revealed congenital CMV infection.
Conclusions
Evaluation for potential CMV infection is an important part of the arthrogryposis evaluation which is often missed due to lack of maternal infectious symptoms during pregnancy.
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Tinklenberg J, Beatka M, Bain JLW, Siebers EM, Meng H, Pearsall RS, Lawlor MW, Riley DA. Use Of Ankle Immobilization In Evaluating Treatments To Promote Longitudinal Muscle Growth In Mice. Muscle Nerve 2018; 58:718-725. [PMID: 29981243 DOI: 10.1002/mus.26296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 06/12/2018] [Accepted: 07/02/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Difficulty in modeling congenital contractures (deformities of muscle-tendon unit development that include shortened muscles and lengthened tendons) has limited research of new treatments. METHODS Early immobilization of the ankle in prepuberal mice was used to produce deformities similar to congenital contractures. Stretch treatment, electrostimulation, and local intramuscular injection of a follistatin analog (FST-288) were assessed as therapeutic interventions for these deformities. RESULTS Ankle immobilization at full plantarflexion and 90 ° created tendon lengthening and muscle shortening in the tibialis anterior and soleus. Stretch treatment produced minimal evidence for longitudinal muscle growth and electrostimulation provided no additional benefit. Stretch treatment with FST-288 produced greater longitudinal muscle growth and less tendon lengthening, constituting the best treatment response. DISCUSSION Ankle immobilization recapitulates key morphologic features of congenital contracture, and these features can be mitigated by a combination of stretch and pharmacological approaches that may be useful in patients. Muscle Nerve 58: 718-725, 2018.
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Affiliation(s)
- Jennifer Tinklenberg
- Division of Pediatric Pathology, Department of Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Margaret Beatka
- Division of Pediatric Pathology, Department of Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - James L W Bain
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Emily M Siebers
- Division of Pediatric Pathology, Department of Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Hui Meng
- Division of Pediatric Pathology, Department of Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Michael W Lawlor
- Division of Pediatric Pathology, Department of Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Neuroscience Research Center, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Danny A Riley
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Novel Type of Complicated Autosomal Dominant Hereditary Spastic Paraplegia Associated with Congenital Distal Arthrogryposis Type I. Brain Sci 2018; 8:brainsci8070136. [PMID: 30029526 PMCID: PMC6071261 DOI: 10.3390/brainsci8070136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/09/2018] [Accepted: 07/14/2018] [Indexed: 12/15/2022] Open
Abstract
Hereditary spastic paraplegia (HSP) is one of the most genetically heterogeneous neurological disorders. HSP is classified as pure when only a spastic weakness of the lower extremities is present. Complex HSP comes with additional neurological or systemic abnormalities. Complex HSP with skeletal abnormalities is rare and mostly seen in autosomal recessive HSP. Autosomal dominant (AD) complex HSP with skeletal abnormalities are consistently seen only in SPG9 (spastic gait type 9). In this paper, we report a kindred condition with AD HSP among four living affected individuals who had progressive, adult onset spastic paraparesis that was associated with a distal arthrogryposis (DA) in every affected individual. They also had episodes of rhabdomyolysis without any clinical signs of myopathy. Exhaustive genetic analysis including targeted sequencing of known HSP and DA genes and whole exome sequencing did not identify the disease-causing gene. It excluded all known HSP and DA genes. We propose that this is a novel genetic type of complex AD HSP. Elucidation of a genetic cause of this type of HSP will further contribute to our understanding of axonal degeneration and skeletal abnormalities.
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Bildner A, Jackson D. Prenatal Sonographic Detection of Multiple Congenital Anomalies: A Case of Severe Arthrogryposis Multiplex Congenita (AMC). JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2018. [DOI: 10.1177/8756479317743208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This case study describes an obstetrical patient who presented for a routine second-trimester morphology sonogram in which the fetus was found to have arthrogryposis multiplex congenita. Other abnormalities visualized included a single umbilical artery, hypoplastic nasal bone, polyhydramnios, and poorly visualized lateral ventricles. Amniocentesis demonstrated a normal microarray with a negative result for cytomegalovirus and toxoplasmosis. This case study highlights the utility of prenatal sonography to identify functional abnormalities of the fetal musculoskeletal system.
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Affiliation(s)
- Amy Bildner
- University of Missouri Women’s and Children, Columbia, MO, USA
| | - Daniel Jackson
- University of Missouri Women’s and Children, Columbia, MO, USA
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Hall ML, Lobo MA. Design and development of the first exoskeletal garment to enhance arm mobility for children with movement impairments. Assist Technol 2018; 30:251-258. [PMID: 28541832 PMCID: PMC9835012 DOI: 10.1080/10400435.2017.1320690] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Children with a variety of diagnoses have impairments that limit their arm function. Despite the fact that arm function is important for early learning and activities of daily living, there are few tools to assist movement for these children, and existing devices have challenges related to cost, accessibility, comfort, and aesthetics. In this article, we describe the design process and development of the first garment-based exoskeleton to assist arm movement in young children with movement impairments: the Playskin LiftTM. We outline our design process, which contrasts with the traditional medical model in that it is interdisciplinary, user-centered, and addresses the broad needs of users, rather than device function alone. Then we report the results of field-testing with the initial prototype with respect to our design metrics on a toddler with significant bilateral arm movement impairments. Finally, we summarize our ongoing development aimed at increasing comfort, aesthetics, and accessibility of the garment. The interdisciplinary, user-centered approach to assistive technology design presented here can result in innovative and impactful design solutions that translate to the real world.
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Affiliation(s)
- Martha L. Hall
- Department of Fashion & Apparel Studies, University of Delaware, Newark, Delaware, USA,Department of Physical Therapy, University of Delaware, Newark, Delaware, USA,Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA
| | - Michele A. Lobo
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA,Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA
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Ahmed AA, Skaria P, Safina NP, Thiffault I, Kats A, Taboada E, Habeebu S, Saunders C. Arthrogryposis and pterygia as lethal end manifestations of genetically defined congenital myopathies. Am J Med Genet A 2017; 176:359-367. [DOI: 10.1002/ajmg.a.38577] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 11/16/2017] [Accepted: 11/17/2017] [Indexed: 12/16/2022]
Affiliation(s)
- Atif A. Ahmed
- Department of PathologyChildren's Mercy HospitalKansas CityMissouri
- University of Missouri‐Kansas City School of MedicineKansas CityMissouri
| | - Priya Skaria
- University of Missouri‐Kansas City School of MedicineKansas CityMissouri
| | - Nicole P. Safina
- University of Missouri‐Kansas City School of MedicineKansas CityMissouri
- Center for Pediatric Genomic MedicineChildren's Mercy HospitalKansas CityMissouri
- Division of Clinical GeneticsChildren's Mercy HospitalKansas CityMissouri
| | - Isabelle Thiffault
- Department of PathologyChildren's Mercy HospitalKansas CityMissouri
- University of Missouri‐Kansas City School of MedicineKansas CityMissouri
- Center for Pediatric Genomic MedicineChildren's Mercy HospitalKansas CityMissouri
| | - Alex Kats
- Department of PathologyChildren's Mercy HospitalKansas CityMissouri
- University of Missouri‐Kansas City School of MedicineKansas CityMissouri
| | - Eugenio Taboada
- Department of PathologyChildren's Mercy HospitalKansas CityMissouri
- University of Missouri‐Kansas City School of MedicineKansas CityMissouri
| | - Sultan Habeebu
- Department of PathologyChildren's Mercy HospitalKansas CityMissouri
- University of Missouri‐Kansas City School of MedicineKansas CityMissouri
| | - Carol Saunders
- Department of PathologyChildren's Mercy HospitalKansas CityMissouri
- University of Missouri‐Kansas City School of MedicineKansas CityMissouri
- Center for Pediatric Genomic MedicineChildren's Mercy HospitalKansas CityMissouri
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Skaria P, Dahl A, Ahmed A. Arthrogryposis multiplex congenita in utero: radiologic and pathologic findings. J Matern Fetal Neonatal Med 2017; 32:502-511. [PMID: 28954562 DOI: 10.1080/14767058.2017.1381683] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Arthrogryposis multiplex congenita (AMC) refers to the development of multiple joint contractures affecting two or more areas of the body prior to birth. It affects approximately 1 in 3000 individuals, mostly reported in individuals of Asian, African and European descent with equal incidence in males and females. Arthrogryposis is associated with over 400 medical conditions and 350 known genes with considerable variability in phenotypic expression. The primary underlying mechanism is decreased fetal movement during development. Prenatal imaging is crucial in early diagnosis by identifying fetal movement limitations and the presence of club foot or joint contractures. Postnatal autopsy confirms the diagnosis and extent of associated congenital anomalies and provides a valuable source of DNA material. Molecular methods are particularly useful in delineating novel gene mutations, locus heterogeneity and phenotype genotype correlation. Prenatal evaluation with early diagnosis via image scanning and further genetic surveillance give the opportunity for family counseling concerning future pregnancy management and expected neonatal morbidity and mortality.
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Affiliation(s)
- Priya Skaria
- a Department of Pathology , University of Missouri , Kansas City , MO , USA.,b Department of Pathology , Children's Mercy Hospital , Kansas City , MO , USA
| | - Amy Dahl
- c Department of Radiology , Children's Mercy Hospital , Kansas City , MO , USA
| | - Atif Ahmed
- a Department of Pathology , University of Missouri , Kansas City , MO , USA.,b Department of Pathology , Children's Mercy Hospital , Kansas City , MO , USA
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Abstract
Maternal autoantibodies can cross the placenta and cause fetal damage. This article summarizes the development and management of fetal thyroid goiter in response to maternal Graves' disease and/or its treatment with antithyroid medication, fetal heart block due to maternal anti-Ro and anti-La antibodies, fetal athrogryposis multiplex congenita in association with maternal myasthenia gravis and fetal brain hemorrhage due to maternal autoimmune thrombocytopenia.
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Affiliation(s)
| | - Kypros Nicolaides
- a Fetal Medicine Research Institute , King's College Hospital , London , UK
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21
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Bray JJH, Crosswell S, Brown R. Congenital talipes equinovarus and congenital vertical talus secondary to sacral agenesis. BMJ Case Rep 2017; 2017:bcr-2017-219786. [PMID: 28476907 DOI: 10.1136/bcr-2017-219786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Sacral agenesis is a rare congenital defect which is associated with foot deformities such as congenital talipes equinovarus (CTEV) and less commonly congenital vertical talus (CVT). We report a 3-year-old Caucasian girl who was born with right CTEV and left CVT secondary to sacral agenesis. Her right foot was managed with a Ponseti casting method at 2 weeks, followed by an Achilles tenotomy at 4 months. The left foot was initially managed with a nocturnal dorsi-flexion splint. Both feet remained resistant and received open foot surgery at 10 months producing plantigrade feet with neutral hindfeet. At 19 months, she failed to achieve developmental milestones and examinations revealed abnormal lower limb reflexes. A full body MRI was performed which identified the sacral agenesis. We advocate early MRI of the spine to screen for spinal defects when presented with resistant foot deformities, especially when bilateral.
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Affiliation(s)
- Jonathan James Hyett Bray
- Trauma and Orthopaedic Department, Cheltenham General Hospital, Cheltenham, UK.,Bristol Royal Infirmary, University of Bristol Academy, Bristol, UK
| | - Sebastien Crosswell
- Department of General Surgery, The Royal Shrewsbury Hospital, Shrewsbury, UK
| | - Rick Brown
- Trauma and Orthopaedic Department, Cheltenham General Hospital, Cheltenham, UK
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Alisch F, Weichert A, Kalache K, Paradiso V, Longardt AC, Dame C, Hoffmann K, Horn D. Familial Gordon syndrome associated with aPIEZO2mutation. Am J Med Genet A 2016; 173:254-259. [DOI: 10.1002/ajmg.a.37997] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 09/23/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Franz Alisch
- Institut für Medizinische Genetik und Humangenetik; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Alexander Weichert
- Klinik für Geburtsmedizin; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Karim Kalache
- Sidra Medical and Research Center; Obstetrics and Gynecology Department; Doha Qatar
| | - Viola Paradiso
- Institut für Humangenetik; Martin-Luther Universität Halle; Berlin Germany
| | | | - Christof Dame
- Klinik für Neonatologie; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Katrin Hoffmann
- Institut für Humangenetik; Martin-Luther Universität Halle; Berlin Germany
| | - Denise Horn
- Institut für Medizinische Genetik und Humangenetik; Charité-Universitätsmedizin Berlin; Berlin Germany
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Kowalczyk B, Feluś J. Arthrogryposis: an update on clinical aspects, etiology, and treatment strategies. Arch Med Sci 2016; 12:10-24. [PMID: 26925114 PMCID: PMC4754365 DOI: 10.5114/aoms.2016.57578] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 03/04/2014] [Indexed: 11/20/2022] Open
Abstract
Arthrogryposes - multiple joint contractures - are a clinically and etiologically heterogeneous class of diseases, where accurate diagnosis, recognition of the underlying pathology and classification are of key importance for the prognosis as well as for selection of appropriate management. This treatment remains challenging and optimally in arthrogrypotic patients should be carried out by a team of specialists familiar with all aspects of arthrogryposis pathology and treatment modalities: rehabilitation, orthotics and surgery. In this comprehensive review article, based on literature and clinical experience, the authors present an update on current knowledge on etiology, classifications and treatment options for skeletal deformations possible in arthrogryposis.
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Affiliation(s)
| | - Jarosław Feluś
- Department of Orthopedics, University Children's Hospital, Krakow, Poland
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Prenatal diagnosis of fetal akinesia deformation sequence (FADS): a study of 79 consecutive cases. Arch Gynecol Obstet 2016; 294:697-707. [DOI: 10.1007/s00404-016-4017-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 01/05/2016] [Indexed: 10/22/2022]
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Dohrn N, Le VQ, Petersen A, Skovbo P, Pedersen IS, Ernst A, Krarup H, Petersen MB. ECEL1 mutation causes fetal arthrogryposis multiplex congenita. Am J Med Genet A 2015; 167A:731-43. [PMID: 25708584 DOI: 10.1002/ajmg.a.37018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 01/28/2015] [Indexed: 12/14/2022]
Abstract
Arthrogryposis multiplex congenita (AMC) is a descriptor for the clinical finding of congenital fixation of multiple joints. We present a consanguineous healthy couple with two pregnancies described with AMC due to characteristic findings on ultrasonography of fixated knee extension and reduced fetal movement at the gestational age of 13 weeks + 2 days and 12 weeks + 4 days. Both pregnancies were terminated and postmortem examinations were performed. The postmortem examinations confirmed AMC and suggested a diagnosis of centronuclear myopathy (CNM) due to characteristic histological findings in muscle biopsies. Whole exome sequencing (WES) was performed on all four individuals and the outcome was filtered by application of multiple filtration parameters satisfying a recessive inheritance pattern. Only one gene, ECEL1, was predicted damaging and had previously been associated with neuromuscular disease or AMC. The variant found ECEL1 is a missense mutation in a highly conserved residue and was predicted pathogenic by prediction software. The finding expands the molecular basis of congenital contractures and the phenotypic spectrum of ECEL1 mutations. The histological pattern suggestive of CNM in the fetuses can expand the spectrum of genes causing CNM, as we propose that mutations in ECEL1 can cause CNM or a condition similar to this. Further investigation of this is needed and we advocate that future patients with similar clinical presentation or proven ECEL1 mutations are examined with muscle biopsy. Secondly, this study illustrates the great potential of the clinical application of WES in couples with recurrent abortions or stillborn neonates.
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Affiliation(s)
- N Dohrn
- Department of Clinical Genetics, Aalborg University Hospital, Aalborg, Denmark
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Mendelian disorders of PI metabolizing enzymes. Biochim Biophys Acta Mol Cell Biol Lipids 2014; 1851:867-81. [PMID: 25510381 DOI: 10.1016/j.bbalip.2014.12.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 11/18/2014] [Accepted: 12/01/2014] [Indexed: 12/18/2022]
Abstract
More than twenty different genetic diseases have been described that are caused by mutations in phosphoinositide metabolizing enzymes, mostly in phosphoinositide phosphatases. Although generally ubiquitously expressed, mutations in these enzymes, which are mainly loss-of-function, result in tissue-restricted clinical manifestations through mechanisms that are not completely understood. Here we analyze selected disorders of phosphoinositide metabolism grouped according to the principle tissue affected: the nervous system, muscle, kidney, the osteoskeletal system, the eye, and the immune system. We will highlight what has been learnt so far from the study of these disorders about not only the cellular and molecular pathways that are involved or are governed by phosphoinositides, but also the many gaps that remain to be filled to gain a full understanding of the pathophysiological mechanisms underlying the clinical manifestations of this steadily growing class of diseases, most of which still remain orphan in terms of treatment. This article is part of a Special Issue entitled Phosphoinositides.
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Du J, Aichmair A, Lykissas M, Girardi F. Cervical stenosis in a patient with arthrogryposis: case report. EVIDENCE-BASED SPINE-CARE JOURNAL 2014; 5:57-62. [PMID: 24715873 PMCID: PMC3969424 DOI: 10.1055/s-0034-1368669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 12/16/2013] [Indexed: 10/27/2022]
Abstract
Study Design Case report. Objective Amyoplasia-type arthrogryposis is a rare congenital disease that presents as multiple contractures involving various areas of the body. To the authors' knowledge, there have been no reports of adults with amyoplasia in the current literature. We report a case of an adult patient with cervical stenosis in the setting of amyoplasia. Patients and Methods A 48-year-old patient with amyoplasia and over 30 previous orthopedic reconstructive surgeries presented with neck pain radiating down his left shoulder and into the fingers, dysesthesia in his fingertips, and left-sided periauricular headache. A diagnosis of central spinal canal stenosis and bilateral foraminal stenosis at C3-C7 with radiculopathy was made based on computed tomography scans. Because of a prior right-side sternocleidomastoid muscle transfer, a left-side C3-C4, C5-C7 anterior cervical discectomy and fusion procedure was performed. Results The patient experienced significant improvement in symptoms that was transient. Symptoms returned to preoperative values after 1 year, despite significant and persistent improvement in stenosis. Conclusions Both amyoplasia and cervical stenosis can manifest in neurologic symptoms. Distinguishing the causing pathology can be challenging. The radiographic improvement of cervical stenosis in a patient with amyoplasia is not always associated with long-standing pain relief.
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Affiliation(s)
- Jerry Du
- Weill Cornell Medical College, New York, New York, United States
| | - Alexander Aichmair
- Department of Spine and Scoliosis Surgery, Hospital for Special Surgery, New York, New York, United States
| | - Marios Lykissas
- Department of Spine and Scoliosis Surgery, Hospital for Special Surgery, New York, New York, United States
| | - Federico Girardi
- Weill Cornell Medical College, New York, New York, United States ; Department of Spine and Scoliosis Surgery, Hospital for Special Surgery, New York, New York, United States
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Baroni M, Pedrotti P, Nava S, Giannattasio C, Roghi A. Cardiac Magnetic Resonance Imaging of Left Ventricular Apical Hypoplasia in Two Complex Congenital Clinical Syndromes. Circ J 2014; 78:1507-9. [DOI: 10.1253/circj.cj-13-1555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Matteo Baroni
- Cardiac MR Laboratory, Cardiology IV, Cardiovascular “A.De Gasperis” Department, Niguarda Ca’’ Granda Hospital, and Milano-Bicocca University
| | - Patrizia Pedrotti
- Cardiac MR Laboratory, Cardiology IV, Cardiovascular “A.De Gasperis” Department, Niguarda Ca’’ Granda Hospital, and Milano-Bicocca University
| | - Stefano Nava
- Cardiac MR Laboratory, Cardiology IV, Cardiovascular “A.De Gasperis” Department, Niguarda Ca’’ Granda Hospital, and Milano-Bicocca University
| | - Cristina Giannattasio
- Cardiac MR Laboratory, Cardiology IV, Cardiovascular “A.De Gasperis” Department, Niguarda Ca’’ Granda Hospital, and Milano-Bicocca University
| | - Alberto Roghi
- Cardiac MR Laboratory, Cardiology IV, Cardiovascular “A.De Gasperis” Department, Niguarda Ca’’ Granda Hospital, and Milano-Bicocca University
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Abstract
Introduction: The second trimester ultrasound remains an important screening tool for detecting fetal abnormalities. This pictorial guide for the second trimester ultrasound is designed to assist practitioners to produce a high quality diagnostic survey of the fetus by demonstrating and describing recommended images. Methods: Each image is discussed in detail and has an associated drawn line diagram to aid in the identification of the important features of that image. There is a description of the salient landmarks and relevant measurements. Result: The authors hope this article may act as a useful guide to all practitioners performing second trimester ultrasounds.
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Affiliation(s)
- Michael Bethune
- Medical Imaging DepartmentThe Mercy Hospital for WomenMelbourneVictoriaAustralia; Specialist Women's Ultrasound Box HillMelbourneVictoriaAustralia
| | - Ekaterina Alibrahim
- Medical Imaging Department The Mercy Hospital for Women Melbourne Victoria Australia
| | - Braidy Davies
- Medical Imaging Department The Mercy Hospital for Women Melbourne Victoria Australia
| | - Eric Yong
- Medical Imaging Department The Mercy Hospital for Women Melbourne Victoria Australia
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Engel S, Ferrara G. Obstetric outcomes in women who sustained a spinal cord injury during pregnancy. Spinal Cord 2012; 51:170-1. [PMID: 23247014 DOI: 10.1038/sc.2012.125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
STUDY DESIGN Case report. SETTING Prince of Wales Spinal Cord Injuries Unit, Sydney, Australia. METHODS Interrogation of our unit database identified only two women who became spinal cord injured while pregnant; their medical records were reviewed and an unstructured follow-up telephone interview conducted 6 years after discharge. Case 1: CC sustained a fracture dislocation with paraplegia at the sixth thoracic level (T6) in a motorbike accident while she was pregnant, 12-week gestational age (GA). Profound shock and hypoxia complicated the injury and recurrent urinary tract infections complicated the rest of her pregnancy. A baby with arthrogryposis multiplex congenita was delivered at full term. Severe cerebral palsy (CP) and deafness were present at follow-up 6 years later. Case 2: A 33-year-old multigravida, 27 weeks GA, developed sudden, spontaneous onset of paraplegia (T3 ASIA B) due to an extradural haematoma, which was evacuated on the day of admission. Systolic blood pressure was maintained above 90 mm Hg during and after surgery. A normal, healthy boy was delivered by caesarean section at 40 weeks GA and remained so at 6 years. CONCLUSION Traumatic spinal cord injury (SCI) with its attendant multiple potential insults to the developing foetus results in a high risk of foetal loss and malformation particularly in the first trimester. However, if the injury occurs later in pregnancy and if blood pressure and oxygenation are maintained, the risk of foetal loss and abnormality may be substantially reduced.
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Affiliation(s)
- S Engel
- Department of Spinal Medicine Prince of Wales Hospital, Sydney, New South Wales, Australia.
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Kalampokas E, Kalampokas T, Sofoudis C, Deligeoroglou E, Botsis D. Diagnosing arthrogryposis multiplex congenita: a review. ISRN OBSTETRICS AND GYNECOLOGY 2012; 2012:264918. [PMID: 23050160 PMCID: PMC3461621 DOI: 10.5402/2012/264918] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 08/26/2012] [Indexed: 11/23/2022]
Abstract
Arthrogryposis multiplex congenita (AMC) refers either to a syndromic or to a nonsyndromic group of conditions with varied etiology and complex clinical features, including multiple congenital contractures in different body areas. Its etiology still remains unclear but generally any cause that leads to reduced fetal movement may lead to congenital contractures and in severe cases to fetal akinesia deformation sequence (FADS).
It affects approximately 1 in 2-3000 live births with an approximately equal gender ratio. There are many known subgroups of AMC differing in signs, symptoms, and causes. The primary diagnosis is made when a lack of mobility and an abnormal position is noted in routine ultrasound scanning. Early diagnosis, prenatal evaluation, and further surveillance via image scanning (ultrasound and MRI) give the opportunity for family counseling concerning neonatal morbidity and mortality and labor or delivery planning. Better understanding of the ultrasound findings and the etiology of this clinical situation offers the opportunity for careful prenatal assessment.
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Affiliation(s)
- Emmanouil Kalampokas
- Second Department of Obstetrics and Gynecology, Aretaieion University Hospital, University of Athens, 76 Vas. Sofias Avenue, 11528 Athens, Greece
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Prenatal diagnosis and genetic analysis of fetal akinesia deformation sequence and multiple pterygium syndrome associated with neuromuscular junction disorders: A review. Taiwan J Obstet Gynecol 2012; 51:12-7. [DOI: 10.1016/j.tjog.2012.01.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2012] [Indexed: 12/30/2022] Open
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Prenatal Ultrasound and Magnetic Resonance Imaging Findings of Fetal Akinesia Deformation Sequence with Multiple Pterygium Syndrome. J Med Ultrasound 2012. [DOI: 10.1016/j.jmu.2012.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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