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Rathore G, Kang PB. Pediatric Neuromuscular Diseases. Pediatr Neurol 2023; 149:1-14. [PMID: 37757659 DOI: 10.1016/j.pediatrneurol.2023.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/25/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023]
Abstract
The diagnostic and referral workflow for children with neuromuscular disorders is evolving, particularly as newborn screening programs are expanding in tandem with novel therapeutic developments. However, for the children who present with symptoms and signs of potential neuromuscular disorders, anatomic localization, guided initially by careful history and physical examination, continues to be the cardinal initial step in the diagnostic evaluation. It is important to consider whether the localization is more likely to be in the lower motor neuron, peripheral nerve, neuromuscular junction, or muscle. After that, disease etiologies can be divided broadly into inherited versus acquired categories. Considerations of localization and etiologies will help generate a differential diagnosis, which in turn will guide diagnostic testing. Once a diagnosis is made, it is important to be aware of current treatment options, as a number of new therapies for some of these disorders have been approved in recent years. Families are also increasingly interested in clinical research, which may include natural history studies and interventional clinical trials. Such research has proliferated for rare neuromuscular diseases, leading to exciting advances in diagnostic and therapeutic technologies, promising dramatic changes in the landscape of these disorders in the years to come.
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Affiliation(s)
- Geetanjali Rathore
- Division of Neurology, Department of Pediatrics, University of Nebraska College of Medicine, Omaha, Nebraska
| | - Peter B Kang
- Paul and Sheila Wellstone Muscular Dystrophy Center and Department of Neurology, University of Minnesota Medical School, Minneapolis, Minnesota; Institute for Translational Neuroscience, University of Minnesota, Minneapolis, Minnesota.
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2
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Le Tanno P, Latypova X, Rendu J, Fauré J, Bourg V, Gauthier M, Billy-Lopez G, Jouk PS, Dieterich K. Diagnostic workup in children with arthrogryposis: description of practices from a single reference centre, comparison with literature and suggestion of recommendations. J Med Genet 2023; 60:13-24. [PMID: 34876503 DOI: 10.1136/jmedgenet-2021-107823] [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: 03/02/2021] [Accepted: 11/18/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Arthrogryposis multiplex congenita (AMC) refers to a clinical presentation of congenital contractures involving two or more body areas. More than 400 distinct conditions may lead to AMC, making the aetiological diagnosis challenging. The objective of this work was to set up evidence-based recommendations for the diagnosis of AMC by taking advantage of both data from our nation-wide cohort of children with AMC and from the literature. MATERIAL AND METHODS We conducted a retrospective single-centre observational study. Patients had been evaluated at least once at a paediatric age in the AMC clinic of Grenoble University Hospital between 2007 and 2019. After gathering data about their diagnostic procedure, a literature review was performed for each paraclinical investigation to discuss their relevance. RESULTS One hundred and twenty-five patients were included, 43% had Amyoplasia, 27% had distal arthrogryposis and 30% had other forms. A definitive aetiological diagnosis was available for 66% of cases. We recommend a two-time diagnostic process: first, non-invasive investigations that aim at classifying patients into one of the three groups, and second, selected investigations targeting a subset of patients. CONCLUSION The aetiological management for patients with AMC remains arduous. This process will be facilitated by the increasing use of next-generation sequencing combined with detailed phenotyping. Invasive investigations should be avoided because of their limited yield.
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Affiliation(s)
- Pauline Le Tanno
- Univ. Grenoble Alpes, Inserm, U1209, CHU Grenoble Alpes, Institut of Advanced Biosciences, 38000 Grenoble, France
| | - Xenia Latypova
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institute of Neurosciences, 38000 Grenoble, France
| | - John Rendu
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institute of Neurosciences, 38000 Grenoble, France
| | - Julien Fauré
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institute of Neurosciences, 38000 Grenoble, France
| | - Véronique Bourg
- Service de Médecine Physique et Réhabilitation pédiatrique, CHU Grenoble Alpes, 38000 Grenoble, France
| | - Marjolaine Gauthier
- Service de Génétique, Génomique et Procréation, CHU Grenoble Alpes, 38000 Grenoble, France
| | - Gipsy Billy-Lopez
- Service de Génétique, Génomique et Procréation, CHU Grenoble Alpes, 38000 Grenoble, France
| | - Pierre-Simon Jouk
- Service de Génétique, Génomique et Procréation, CHU Grenoble Alpes, 38000 Grenoble, France
| | - Klaus Dieterich
- Univ. Grenoble Alpes, Inserm, U1209, CHU Grenoble Alpes, Institut of Advanced Biosciences, 38000 Grenoble, France
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3
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Hoei-Hansen CE, Tygesen MLB, Dunø M, Vissing J, Ballegaard M, Born AP. Combined Muscle Biopsy and Comprehensive Electrophysiology in General Anesthesia is Valuable in Diagnosis of Neuromuscular Disease in Children. Neuropediatrics 2021; 52:462-468. [PMID: 33706403 DOI: 10.1055/s-0041-1726120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM The diagnostic workup in patients with delayed motor milestones suspected of having either myopathy or a congenital myasthenic syndrome is complex. Our hypothesis was that performance of a muscle biopsy and neurophysiology including stimulated single-fiber electromyography during an anesthetic procedure, combined with genetic testing has a high diagnostic quality. MATERIALS AND METHODS Clinical and paraclinical data were retrospectively collected from 24 patients aged from 1 month to 10 years (median: 5.2 years). RESULTS Neurophysiology examination was performed in all patients and was abnormal in 11 of 24. No patients had findings suggestive of a myasthenic syndrome. Muscle biopsy was performed in 21 of 24 and was normal in 16. Diagnostic findings included nemaline rods, inclusion bodies, fiber size variability, and type-II fiber atrophy. Genetic testing with either a gene panel or exome sequencing was performed in 18 of 24 patients, with pathogenic variants detected in ACTA1, NEB, SELENON, GRIN2B, SCN8A, and COMP genes. CONCLUSION Results supporting a neuromuscular abnormality were found in 15 of 24. In six patients (25%), we confirmed a genetic diagnosis and 12 had a clinical neuromuscular diagnosis. The study suggests that combined use of neurophysiology and muscle biopsy in cases where genetic testing does not provide a diagnosis can be useful in children with delayed motor milestones and clinical evidence of a neuromuscular disease.
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Affiliation(s)
- Christina E Hoei-Hansen
- Department of Paediatrics, Copenhagen University Hospital, Rigshospitalet, Denmark.,Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Marie L B Tygesen
- Department of Paediatrics, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Morten Dunø
- Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - John Vissing
- Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Martin Ballegaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Neurophysiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Alfred P Born
- Department of Paediatrics, Copenhagen University Hospital, Rigshospitalet, Denmark
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4
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Kang PB, McMillan HJ, Kuntz NL, Lehky TJ, Alter KE, Fitzpatrick KF, El Kosseifi C, Quijano-Roy S. Utility and practice of electrodiagnostic testing in the pediatric population: An AANEM consensus statement. Muscle Nerve 2020; 61:143-155. [PMID: 31724199 DOI: 10.1002/mus.26752] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/06/2019] [Indexed: 12/17/2022]
Abstract
Nerve conduction studies and needle electromyography, collectively known as electrodiagnostic (EDX) studies, have been available for pediatric patients for decades, but the accessibility of this diagnostic modality and the approach to testing vary significantly depending on the physician and institution. The maturation of molecular diagnostic approaches and other diagnostic technologies such as neuromuscular ultrasound indicate that an analysis of current needs and practices for EDX studies in the pediatric population is warranted. The American Association of Neuromuscular & Electrodiagnostic Medicine convened a consensus panel to perform literature searches, share collective experiences, and develop a consensus statement. The panel found that electrodiagnostic studies continue to have high utility for the diagnosis of numerous childhood neuromuscular disorders, and that standardized approaches along with the use of high-quality reference values are important to maximize the diagnostic yield of these tests in infants, children, and adolescents.
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Affiliation(s)
- Peter B Kang
- Division of Pediatric Neurology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida.,Department of Neurology, University of Florida College of Medicine, Gainesville, Florida
| | - Hugh J McMillan
- Department of Pediatrics, University of Ottawa and Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Nancy L Kuntz
- Department of Pediatrics, Northwestern University Feinberg School of Medicine and Lurie Children's Hospital, Chicago, Illinois
| | - Tanya J Lehky
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland
| | - Katharine E Alter
- Functional and Applied Biomechanics Section, Rehabilitation Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Kevin F Fitzpatrick
- Inova Neuroscience and Spine Institute, Inova Fairfax Hospital, Falls Church, Virginia
| | - Charbel El Kosseifi
- Centre de Référence Maladies Neuromusculaires, Service de Neurologie, Réanimation et Réeducation Pédiatriques, Hôpital Raymond Poincaré, Garches, France
| | - Susana Quijano-Roy
- Centre de Référence Maladies Neuromusculaires, Service de Neurologie, Réanimation et Réeducation Pédiatriques, Hôpital Raymond Poincaré, Garches, France
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5
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Wang A, Xiao Y, Huang P, Liu L, Xiong J, Li J, Mao D, Liu L. Novel NtA and LG1 Mutations in Agrin in a Single Patient Causes Congenital Myasthenic Syndrome. Front Neurol 2020; 11:239. [PMID: 32328026 PMCID: PMC7160337 DOI: 10.3389/fneur.2020.00239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/12/2020] [Indexed: 12/27/2022] Open
Abstract
Congenital myasthenic syndrome (CMS) is a group of genetic disorders of neuromuscular transmission that is characterized by muscle weakness. A mutation in the gene encoding agrin (AGRN) is a rare cause of CMS, and only a few families or isolated cases have been reported. We reported a pediatric proband exhibiting muscle weakness in the trunk and limbs with skeletal malformation and intellectual disability and performed whole-exome sequencing (WES) of the proband parent-offspring trio. Results revealed a new compound heterozygous mutation in AGRN: c.125A>C (p.Glu42Ala) in the N-terminal agrin domain (NtA) and c.4516G>A (p.Ala1506Thr) in the laminin G1 domain (LG1). Bioinformatic analysis predicted the mutation as possibly pathogenic. The new compound heterozygous mutation in AGRN may disrupt agrin's known function of bridging laminin and α-dystroglycan and undermine the formation and maintenance of the neuromuscular junction (NMJ) via both muscular and neural agrin pathways. It may also induce secondary peripheral neuropathy and skeletal malformation.
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Affiliation(s)
- Aiping Wang
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China.,Department of Pediatrics Neurology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yangyang Xiao
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China.,Department of Pediatrics Neurology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Peng Huang
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China.,Department of Pediatrics Neurology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lingjuan Liu
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China.,Department of Pediatrics Neurology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jie Xiong
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China.,Department of Pediatrics Neurology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jian Li
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China.,Department of Pediatrics Neurology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ding'an Mao
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China.,Department of Pediatrics Neurology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Liqun Liu
- Department of Pediatrics, The Second Xiangya Hospital, Central South University, Changsha, China.,Department of Pediatrics Neurology, Children's Medical Center, The Second Xiangya Hospital, Central South University, Changsha, China
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Siddiqui SH, Ahmed R, Awan S, Zain A, Khan S. Yield of Muscle Biopsy in Patients with Findings of Myopathy on Electrodiagnostic Testing. J Neurosci Rural Pract 2019; 10:489-493. [PMID: 31595122 PMCID: PMC6779540 DOI: 10.1055/s-0039-1698301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background The evaluation of neuromuscular diseases includes detailed clinical assessment, blood testing, electrodiagnostic studies (EDS), biopsy, and genetic tests. EDS alone cannot provide a specific diagnosis. Further testing in the form of genetic tests or muscle biopsy (MB) is required. Objective The objective of the study is to evaluate the yield of MB in patients with findings of myopathy on electrodiagnostic testing and assess the factors affecting an abnormal biopsy outcome. Methods Electromyography (EMG)/nerve conduction studies (NCS) performed for suspected myopathy over 5 years from 2011 to 2016, at the neurophysiology department of a tertiary care center in Pakistan, were reviewed. Based on inclusion criteria, records of 58 patients were retrospectively reviewed. Results After an EMG/NCS diagnosis of myopathy, the frequency of MB testing was only 10.1%. The median age of patients was 26.5 years. The clinically suspected diagnosis was categorized into hereditary myopathy (n = 15, 25.9%) and acquired myopathy (n = 18, 31%). The positive predictive value of EMG is 77.2%. Twenty-eight (48.2%) patients had abnormal MB whereas 20 (34.4%) revealed normal findings. Factors significantly influencing an abnormal outcome of biopsy included moderate-to-severe elevation of creatine kinase (>2,000 U/L),presence of denervation changes, and severe myopathy on EMG. Conclusion Even though the overall yield of MB testing may not be very high in our setting due to the unavailability of special techniques and expertise, certain factors can help to improve the diagnostic yield. Clinicians should encourage MB testing, especially in cases with strong clinical, laboratory and electrodiagnostic suspicion, and absence of genetic testing for suspected myopathy.
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Affiliation(s)
| | - Raheel Ahmed
- Department of Neurophysiology, Aga Khan University, Karachi, Pakistan
| | - Safia Awan
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Ambreen Zain
- Department of Neurophysiology, Aga Khan University, Karachi, Pakistan
| | - Sara Khan
- Department of Neurophysiology, Aga Khan University, Karachi, Pakistan
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7
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Dieterich K, Le Tanno P, Kimber E, Jouk PS, Hall J, Giampietro P. The diagnostic workup in a patient with AMC: Overview of the clinical evaluation and paraclinical analyses with review of the literature. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2019; 181:337-344. [PMID: 31368648 DOI: 10.1002/ajmg.c.31730] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 11/10/2022]
Abstract
Arthrogryposis multiplex congenita, or AMC, is a clinical sign defined as congenital contractures of at least two joint levels. These joint contractures are always secondary to diminished fetal movement which can have numerous causes that affect any part of the anatomical structures implicated in movement: the central nervous system, the anterior horn cell, the nerve, the neuromuscular junction, the muscle, or the joint itself. Make a precise diagnosis of the cause in a patient with multiple joint contractures is therefore challenging. The aim of this article is to summarize the use and diagnostic value of common examinations and analyses performed postnatally in patients affected by AMC from a literature review. We also compare this data with results from our clinical practice. Even though it is difficult to give precise guidelines today, it appears that genetic studies, such as whole exome or genome analysis in all patients and chromosomal microarray analysis in patients with intellectual disability and AMC should be preferred as first tier investigations over EMG and muscle biopsy.
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Affiliation(s)
- Klaus Dieterich
- University of Grenoble Alpes, Inserm, U1216, GIN, Grenoble, France.,Department of Medical Genetics, CHU Grenoble Alpes, Génétique Médicale, Grenoble, France
| | - Pauline Le Tanno
- Department of Medical Genetics, CHU Grenoble Alpes, Génétique Médicale, Grenoble, France
| | - Eva Kimber
- Department of Pediatrics, Sahlgrenska Academy, Goteborg, Sweden
| | - Pierre-Simon Jouk
- Department of Medical Genetics, CHU Grenoble Alpes, Génétique Médicale, Grenoble, France
| | - Judith Hall
- Children's & Women's Health Centre of BC, Medical Genetics, UBC, Vancouver, British Columbia, Canada
| | - Philip Giampietro
- Robert Wood Johnson School of Medicine, Rutgers University, New Brunswick, New Jersey, USA
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8
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Chiou HJ, Yeh CK, Hwang HE, Liao YY. Efficacy of Quantitative Muscle Ultrasound Using Texture-Feature Parametric Imaging in Detecting Pompe Disease in Children. ENTROPY 2019; 21:e21070714. [PMID: 33267428 PMCID: PMC7515229 DOI: 10.3390/e21070714] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/18/2019] [Accepted: 07/21/2019] [Indexed: 12/12/2022]
Abstract
Pompe disease is a hereditary neuromuscular disorder attributed to acid α-glucosidase deficiency, and accurately identifying this disease is essential. Our aim was to discriminate normal muscles from neuropathic muscles in children affected by Pompe disease using a texture-feature parametric imaging method that simultaneously considers microstructure and macrostructure. The study included 22 children aged 0.02-54 months with Pompe disease and six healthy children aged 2-12 months with normal muscles. For each subject, transverse ultrasound images of the bilateral rectus femoris and sartorius muscles were obtained. Gray-level co-occurrence matrix-based Haralick's features were used for constructing parametric images and identifying neuropathic muscles: autocorrelation (AUT), contrast, energy (ENE), entropy (ENT), maximum probability (MAXP), variance (VAR), and cluster prominence (CPR). Stepwise regression was used in feature selection. The Fisher linear discriminant analysis was used for combination of the selected features to distinguish between normal and pathological muscles. The VAR and CPR were the optimal feature set for classifying normal and pathological rectus femoris muscles, whereas the ENE, VAR, and CPR were the optimal feature set for distinguishing between normal and pathological sartorius muscles. The two feature sets were combined to discriminate between children with and without neuropathic muscles affected by Pompe disease, achieving an accuracy of 94.6%, a specificity of 100%, a sensitivity of 93.2%, and an area under the receiver operating characteristic curve of 0.98 ± 0.02. The CPR for the rectus femoris muscles and the AUT, ENT, MAXP, and VAR for the sartorius muscles exhibited statistically significant differences in distinguishing between the infantile-onset Pompe disease and late-onset Pompe disease groups (p < 0.05). Texture-feature parametric imaging can be used to quantify and map tissue structures in skeletal muscles and distinguish between pathological and normal muscles in children or newborns.
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Affiliation(s)
- Hong-Jen Chiou
- Division of Ultrasound and Breast Imaging, Department of Radiology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- School of Medicine, National Yang Ming University, Taipei 11221, Taiwan
- National Defense Medical Center, Taipei 11490, Taiwan
| | - Chih-Kuang Yeh
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu 30013, Taiwan
| | - Hsuen-En Hwang
- Department of Radiology, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Yin-Yin Liao
- Department of Biomedical Engineering, Hungkuang University, Taichung 43302, Taiwan
- Correspondence: ; Tel.: +886-4-26318652
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9
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Constantinides VC, Papahatzaki MM, Papadimas GK, Karandreas N, Zambelis T, Kokotis P, Manda P. Diagnostic Accuracy of Muscle Biopsy and Electromyography in 123 Patients with Neuromuscular Disorders. In Vivo 2019; 32:1647-1652. [PMID: 30348729 DOI: 10.21873/invivo.11427] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Diagnostic accuracy of muscle biopsy and electromyography (EMG) in patients with myopathy varies widely among studies. The goal of this study was to examine the diagnostic accuracy of each method in the diagnosis of patients with suspected myopathy, and determine the level of agreement between the two methods. PATIENTS AND METHODS The files of all patients with a presumed myopathy were retrospectively reviewed. All patients with detailed muscle biopsy and EMG data were included. RESULTS A total of 123 patients were included. Accuracy of biopsy was 80.4% compared to 70.7% for EMG. Biopsy was sensitive and specific in all neuromuscular disorders. EMG was accurate in neurogenic disorders. Biopsy and EMG agreement was 70.7%. CONCLUSION Muscle biopsy is more accurate than EMG in patients with myopathy. Muscle biopsy-EMG discordance can be attributed to different muscle sampling and to disorders with both neurogenic and myopathic features, such as acquired and mitochondrial myopathies.
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Affiliation(s)
- Vasilios C Constantinides
- First Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, Athens, Greece
| | - Maria Martha Papahatzaki
- First Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, Athens, Greece
| | - Georgios K Papadimas
- First Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, Athens, Greece
| | - Nikos Karandreas
- First Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, Athens, Greece
| | - Thomas Zambelis
- First Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, Athens, Greece
| | - Panagiotis Kokotis
- First Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, Athens, Greece
| | - Panagiota Manda
- First Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, Eginition Hospital, Athens, Greece
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10
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Hafner P, Phadke R, Manzur A, Smith R, Jaiser S, Schutz P, Sewry C, Muntoni F, Pitt M. Electromyography and muscle biopsy in paediatric neuromuscular disorders – Evaluation of current practice and literature review. Neuromuscul Disord 2019; 29:14-20. [DOI: 10.1016/j.nmd.2018.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 12/14/2022]
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11
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Lee HN, Lee YM. Integrated diagnostic approach of pediatric neuromuscular disorders. ACTA ACUST UNITED AC 2018. [DOI: 10.5734/jgm.2018.15.2.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Ha Neul Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Mock Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
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12
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Naddaf E, Milone M, Mauermann ML, Mandrekar J, Litchy WJ. Muscle Biopsy and Electromyography Correlation. Front Neurol 2018; 9:839. [PMID: 30356714 PMCID: PMC6189315 DOI: 10.3389/fneur.2018.00839] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/18/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: In myopathies, the correlation of individual electromyographic and histopathologic findings remains poorly explored, as most previous studies have focused on the ability of muscle biopsy and electromyography to distinguish the neuropathic vs. myopathic nature of the underlying neuromuscular disease. Methods: We identified 100 patients who had a muscle biopsy and electromyography performed on identical muscles. We used a detailed grading system ranging from 0- normal to 4- severe; and graded 16 histopathologic findings in each biopsy. Electromyography findings were also graded from 0 to 4 according to the standard protocol in our EMG laboratory. We used Kendall's tau for non-parametric ordinal correlation analysis. Results: Fibrillation potentials correlated with atrophic, necrotic, and regenerating fibers, fibers harboring vacuoles, fiber splitting, fibers reacting for non-specific esterase, fibers with congophilic inclusions, inflammation (endoymysial and perimysial), and increased endomysial connective tissue. Short-duration motor unit potentials correlated with atrophic, necrotic, and regenerating fibers, increased endomysial connective tissue, and perimysial inflammation. Long-duration motor unit potentials correlated with fiber-type grouping. Increased phases of motor unit potentials correlated with atrophic fibers, increased endomysial connective tissue, and fibers reacting for non-specific esterase; while increased turns correlated with atrophic and regenerating fibers, increased endomysial connective tissue and target formations. Rapid recruitment correlated with regenerating fibers, perimysial inflammation, and increased endomysial connective tissue. Discussion: By demonstrating a clear correlation of various electromyographic and histopathologic findings, this study improves interpreting electrodiagnostic testing in myopathies, and serves as the basis to further assess the correlation between clinical, electromyographic, and histopathologic findings.
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Affiliation(s)
- Elie Naddaf
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | | | | | - Jayawant Mandrekar
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - William J Litchy
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
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Thavorntanaburt S, Tanboon J, Likasitwattanakul S, Sangruchi T, Nishino I, Ngerncham M, Tantemsapya N, Sanmaneechai O. Impact of muscle biopsy on diagnosis and management of children with neuromuscular diseases: A 10-year retrospective critical review. J Pediatr Surg 2018; 53:489-492. [PMID: 28651826 DOI: 10.1016/j.jpedsurg.2017.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/01/2017] [Accepted: 06/11/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Muscle biopsy facilitates morphologic, biochemical, and ultrastructural analysis of muscle for the purpose of making definitive neuromuscular diagnosis. However, muscle biopsy is an expensive, invasive, time-consuming, and resource-dependent procedure. The need for general anesthesia in children also increases the risks associated with this procedure. The aim of this study was to investigate the benefits of muscle biopsies performed over a 10-year period, with a focus on indications, suspected and histopathologic diagnosis, and impact on diagnosis and management decisions. METHODS We retrospectively reviewed results of muscle biopsies performed in children at our center during the 2004 to 2014 study period. Clinical presentations, biopsy complications, pathologic results, and changes in management decision were reviewed and analyzed. RESULTS Biopsies from 92 patients were included. Mean age of patients was 7.1years, and 66.3% were male. There were no perioperative complications, and definitive diagnosis was made in 74 patients. Regardless of whether pathologic changes were found or not, information gained from muscle biopsy significantly impacted prognosis and subsequent genetic counseling. CONCLUSIONS Muscle biopsy is a safe and useful diagnostic tool in children suspected of having neuromuscular diseases, especially in those with muscle diseases. Definitive pathologic diagnosis helps to optimize treatment, counseling, and surveillance. THE TYPE OF STUDY AND LEVEL OF EVIDENCE Study of diagnostic test: level 1.
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Affiliation(s)
- Sivapol Thavorntanaburt
- Division of Neurology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jantima Tanboon
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Neurogenetic Network, Division of Health Service Research and Development, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Surachai Likasitwattanakul
- Division of Neurology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Neurogenetic Network, Division of Health Service Research and Development, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tumtip Sangruchi
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Neurogenetic Network, Division of Health Service Research and Development, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Monawat Ngerncham
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Niramol Tantemsapya
- Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Oranee Sanmaneechai
- Division of Neurology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Neurogenetic Network, Division of Health Service Research and Development, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Al Harrach M, Boudaoud S, Carriou V, Laforet J, Letocart AJ, Grosset JF, Marin F. Investigation of the HD-sEMG probability density function shapes with varying muscle force using data fusion and shape descriptors. Comput Biol Med 2017; 89:44-58. [PMID: 28783537 DOI: 10.1016/j.compbiomed.2017.07.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/26/2017] [Accepted: 07/28/2017] [Indexed: 10/19/2022]
Abstract
This work presents an evaluation of the High Density surface Electromyogram (HD-sEMG) Probability Density Function (PDF) shape variation according to contraction level. On that account, using PDF shape descriptors: High Order Statistics (HOS) and Shape Distances (SD), we try to address the absence of a consensus for the sEMG non-Gaussianity evolution with force variation. This is motivated by the fact that PDF shape information are relevant in physiological assessment of the muscle architecture and function, such as contraction level classification, in complement to classical amplitude parameters. Accordingly, both experimental and simulation studies are presented in this work. For data fusion, the watershed image processing technique was used. This technique allowed us to find the dominant PDF shape variation profiles from the 64 signals. The experimental protocol consisted of three isometric isotonic contractions of 30, 50 and 70% of the Maximum Voluntary Contraction (MVC). This protocol was performed by six subjects and recorded using an 8 × 8 HD-sEMG grid. For the simulation study, the muscle modeling was done using a fast computing cylindrical HD-sEMG generation model. This model was personalized by morphological parameters obtained by sonography. Moreover, a set of the model parameter configurations were compared as a focused sensitivity analysis of the PDF shape variation. Further, monopolar, bipolar and Laplacian electrode configurations were investigated in both experimental and simulation studies. Results indicated that sEMG PDF shape variations according to force increase are mainly dependent on the Motor Unit (MU) spatial recruitment strategy, the MU type distribution within the muscle, and the used electrode arrangement. Consequently, these statistics can give us an insight into non measurable parameters and specifications of the studied muscle primarily the MU type distribution.
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Affiliation(s)
- Mariam Al Harrach
- Sorbonne Universities, Universite de Technologie de Compiegne, CNRS UMR 7338 Biomechanics and Bioengineering, Centre de recherche Royallieu, CS 60203 Compiegne cedex, France.
| | - Sofiane Boudaoud
- Sorbonne Universities, Universite de Technologie de Compiegne, CNRS UMR 7338 Biomechanics and Bioengineering, Centre de recherche Royallieu, CS 60203 Compiegne cedex, France
| | - Vincent Carriou
- Sorbonne Universities, Universite de Technologie de Compiegne, CNRS UMR 7338 Biomechanics and Bioengineering, Centre de recherche Royallieu, CS 60203 Compiegne cedex, France
| | - Jeremy Laforet
- Sorbonne Universities, Universite de Technologie de Compiegne, CNRS UMR 7338 Biomechanics and Bioengineering, Centre de recherche Royallieu, CS 60203 Compiegne cedex, France
| | - Adrien J Letocart
- Sorbonne Universities, Universite de Technologie de Compiegne, CNRS UMR 7338 Biomechanics and Bioengineering, Centre de recherche Royallieu, CS 60203 Compiegne cedex, France
| | - Jean-François Grosset
- Sorbonne Universities, Universite de Technologie de Compiegne, CNRS UMR 7338 Biomechanics and Bioengineering, Centre de recherche Royallieu, CS 60203 Compiegne cedex, France; Universite de Paris 13, Université Sorbonne Paris Cité, UFR Health, Medicine and Human Biology, 93017 Bobigny, France
| | - Frédéric Marin
- Sorbonne Universities, Universite de Technologie de Compiegne, CNRS UMR 7338 Biomechanics and Bioengineering, Centre de recherche Royallieu, CS 60203 Compiegne cedex, France
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15
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[Congenital neuromuscular diseases with neonatal respiratory failure excluding myotonic dystrophy type 1 and infantile spinal muscular atrophy. Diagnosis strategy according to a 19-child series]. Arch Pediatr 2016; 23:878-86. [PMID: 27375179 DOI: 10.1016/j.arcped.2016.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 01/22/2016] [Accepted: 05/08/2016] [Indexed: 11/20/2022]
Abstract
UNLABELLED Apart from spinal muscular atrophy (SMA) and myotonic dystrophy type 1 (DM1), congenital neuromuscular diseases with early neonatal symptoms mean diagnostic and prognostic challenges mainly when infants require ventilatory support. OBJECTIVES Consider a standardized strategy for infants suspected of congenital neuromuscular disease from analysis of the literature and retrospective experience with floppy and ventilatory support-dependent infants, after exclusion of well-known diseases (DM1, SMA). PATIENTS AND METHODS Floppy infants requiring ventilatory support in their 1st month of life, but showing no evidence of DM1, SMA, Prader-Willi syndrome, or encephalopathy. The retrospective multicenter study was based on the response of regional referent neuropediatricians in the Reference Centre for Neuromuscular Diseases of Greater Southwest France to an inquiry about prenatal and perinatal history, investigations, diagnosis, and outcome of the child and family. It was conducted between 2007 and 2012. RESULTS Among the 19 newborns studied, all had severe hypotonia. Prenatal and perinatal features were similar. Their outcome was generally severe: the median survival as measured by the Kaplan-Meier method was 6.9 months. Thirteen children died at a median age of 61 days; ten of them were treated with a palliative procedure. Five children had achieved respiratory independence but suffered from a small delay in motor development. Among the three children who continuously required ventilatory support, only one survived (follow-up period: 23 months); he was the only one undergoing tracheostomy in the cohort. Diagnostic processes were different, leading to pathological and genetic diagnosis for only six infants. There was only histological orientation for seven and no specific diagnostic orientation for the last six. These difficulties have led us to propose an exploration process based on the literature. CONCLUSION This study highlights difficulties in obtaining a diagnosis and a precise prognosis for floppy ventilated infants. An exploration-standardized process for infants suspected of congenital neuromuscular diseases was made in order to standardize procedures. It could be used as a tool for all professionals involved.
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Das AS, Agamanolis DP, Cohen BH. Use of next-generation sequencing as a diagnostic tool for congenital myasthenic syndrome. Pediatr Neurol 2014; 51:717-20. [PMID: 25194721 DOI: 10.1016/j.pediatrneurol.2014.07.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 07/29/2014] [Accepted: 07/31/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The clinical presentation of congenital myasthenic syndromes is similar to many other neuromuscular disorders of infancy, and with 12 known discrete genetic forms of congenital myasthenic syndromes, both the diagnosis and treatment decisions present clinical challenges. PATIENT DESCRIPTION We report a 20-month-old boy with rapsyn deficiency. At birth, he presented with a weak cry, hypotonia, joint contractures, and facial deformity. Because of respiratory difficulty associated with muscle fatigue, he spent a total of 71 days in the neonatal intensive care unit and 47 days in the pediatric intensive care unit. Imaging study results were normal, along with a battery of metabolic tests and electrodiagnostic studies. A limited genetic evaluation for reversible cytochrome c oxidase deficiency was negative, as was the oligonucleotide microarray. A muscle biopsy demonstrated myofiber atrophy in a pattern consistent with early denervation. Based on nonspecific and nondiagnostic results, whole-exome (next generation) sequencing was performed. This study identified two confirmed pathogenic mutations in the RAPSN gene that are associated with congenital myasthenic syndrome (OMIM 608931). The patient was treated with pyridostigmine at 16 months of age, which resulted in a dramatic improvement in muscle tone and strength and a steady resolution of joint contractures. Four months after treatment was initiated, he was beginning to bear weight and was able to sit unsupported and vocalize full words. CONCLUSIONS This patient serves to highlight next-generation sequencing as an important diagnostic tool that can result in life-saving treatment.
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Affiliation(s)
- Alvin S Das
- Northeast Ohio Medical University, Rootstown, Ohio
| | - Dimitri P Agamanolis
- Department of Pathology and Laboratory Medicine, Akron Children's Hospital, Akron, Ohio; Department of Pathology, Northeast Ohio Medical University, Rootstown, Ohio
| | - Bruce H Cohen
- Division of Neurology, NeuroDevelopmental Science Center, Akron Children's Hospital, Akron, Ohio; Department of Pediatrics, Northeast Ohio Medical University, Rootstown, Ohio.
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Ghosh PS, Sorenson EJ. Diagnostic yield of electromyography in children with myopathic disorders. Pediatr Neurol 2014; 51:215-9. [PMID: 24950662 DOI: 10.1016/j.pediatrneurol.2014.04.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 04/08/2014] [Accepted: 04/12/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Interpretation of pediatric electromyography interpretation in myopathic disorders is technically challenging. We assessed our electromyographic experience with respect to sensitivity and specificity in pediatric myopathy. METHODS We did a retrospective chart review of patients ≤18 years between 2009 and 2013. Two hundred twenty-four electromyographic studies were reviewed with the following referral diagnoses: myopathy, muscle weakness, neuromuscular disorders, myositis, myalgia, myoglobinuria, myasthenia, myotonia, cramps, periodic paralysis, hypotonia, and developmental delay. Only children who had an electromyography and muscle biopsy were included for analysis. Patients with neurogenic electromyography and neuromuscular junction disorders were excluded. Myopathic electromyography was defined as short duration, low amplitude, polyphasic motor unit potentials with rapid recruitment. RESULTS Seventy-two patients were included (age range, 6 months-18 years). The following observations were made: group A: myopathic electromyography or pathognomonic of muscle disease and biopsy or genetically confirmed myopathy (32 cases); group B: myopathic electromyography but biopsy normal or nondiagnostic (12 cases); group C: normal electromyography but biopsy or genetically confirmed myopathy (three cases, all with metabolic myopathy); and group D: electromyography normal and biopsy normal or nondiagnostic (25 cases). The most common diagnoses were congenital myopathy (seven cases), metabolic myopathy (six cases), muscular dystrophy (six cases), genetically confirmed myopathy (five cases), myopathy, undefined (five cases), and inflammatory myopathy (four cases). CONCLUSIONS Pediatric electromyography was 91% sensitive and 67% specific in myopathic disorders. The metabolic myopathies were commonly missed by electromyography.
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Affiliation(s)
- Partha S Ghosh
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
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18
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Karakis I, Liew W, Darras BT, Jones HR, Kang PB. Referral and diagnostic trends in pediatric electromyography in the molecular era. Muscle Nerve 2014; 50:244-9. [DOI: 10.1002/mus.24152] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 12/11/2013] [Accepted: 12/18/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Ioannis Karakis
- Department of Neurology; Boston Children's Hospital, Harvard Medical School; 300 Longwood Avenue Boston Massachusetts 02115 USA
- Department of Neurology; Lahey Clinic Burlington Massachusetts USA
- Department of Neurology; Emory University School of Medicine; Atlanta Georgia USA
| | - Wendy Liew
- Department of Neurology; Boston Children's Hospital, Harvard Medical School; 300 Longwood Avenue Boston Massachusetts 02115 USA
| | - Basil T. Darras
- Department of Neurology; Boston Children's Hospital, Harvard Medical School; 300 Longwood Avenue Boston Massachusetts 02115 USA
| | - H. Royden Jones
- Department of Neurology; Boston Children's Hospital, Harvard Medical School; 300 Longwood Avenue Boston Massachusetts 02115 USA
- Department of Neurology; Lahey Clinic Burlington Massachusetts USA
| | - Peter B. Kang
- Department of Neurology; Boston Children's Hospital, Harvard Medical School; 300 Longwood Avenue Boston Massachusetts 02115 USA
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Pavone P, Praticò AD, Pavone V, Falsaperla R. Congenital familial myasthenic syndromes: disease and course in an affected dizygotic twin pair. BMJ Case Rep 2013; 2013:bcr-2012-007651. [PMID: 23365176 DOI: 10.1136/bcr-2012-007651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The present report describes clinical variability in an affected dizygotic twin pair. Twin 1 showed classical features of the congenital myasthenic syndromes (CMS), that is, ptosis, dysphonia, asthenia and hypotonia. In twin 2, these clinical signs were less pronounced, but subtle resulting in severe lumbar hyperlordosis. Molecular analysis, performed for both twins, revealed the presence of three polymorphisms in the heterozygous form in RAPSN gene. The present report highlights the clinical variability of the CMS.
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Affiliation(s)
- Piero Pavone
- Unit of Pediatrics and Pediatric Emergency, University Hospital OVE-Policlinico, Catania, Italy.
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20
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Chang J, Park YG, Choi YC, Choi JH, Moon JH. Correlation of Electromyogram and Muscle Biopsy in Myopathy of Young Age. Arch Phys Med Rehabil 2011; 92:780-4. [DOI: 10.1016/j.apmr.2010.12.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 12/07/2010] [Accepted: 12/08/2010] [Indexed: 11/26/2022]
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Cetin E, Cuisset JM, Tiffreau V, Vallée L, Hurtevent JF, Thevenon A. The value of electromyography in the aetiological diagnosis of hypotonia in infants and toddlers. Ann Phys Rehabil Med 2009; 52:546-55. [PMID: 19713169 DOI: 10.1016/j.rehab.2009.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Accepted: 06/23/2009] [Indexed: 11/27/2022]
Abstract
INTRODUCTION During the first two years of life, hypotonia may be the only symptom of a central or peripheral nervous system disorder. We propose to assess the sensitivity of electroneuromyography (ENMG) in the aetiological diagnosis of hypotonia of neuromuscular origin in infants and toddlers. METHOD This is a retrospective, single-centre study with revision of the files of the 37 children aged between zero and 24 months who, between 1994 and 2006, underwent an ENMG in the etiological approach of their hypotonia and had a final diagnosis of neuromuscular disease. RESULTS All the 13 patients with spinal muscular atrophy or Charcot Marie-Tooth disease displayed neurogenic alterations on the electromyography (EMG). Among the 24 children ultimately diagnosed with myopathies, five only displayed myogenic alterations when tested before the age of two. Sixteen had normal EMG results and three showed neurogenic alterations. DISCUSSION AND CONCLUSION In infants presenting with hypotonia, ENMG is useful for the diagnosis of peripheral neuropathy. Normal ENMG is relatively common for confirmed muscle disorders in infants whereas myogenic alterations seem more unusual, so that muscle biopsy appears unquestionable. In a few cases, early onset myopathies may present with a neurogenic ENMG pattern. Such a result should not invalidate the clinically presumed diagnosis of myopathy and would indicate on the contrary the need for a muscle biopsy.
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Affiliation(s)
- E Cetin
- Physical Medicine and Rehabilitation department, Lille University Hospital, André-Verhaghe street, 59037 Lille cedex, France
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Yis U, Kurul SH, Oztura I, Ozden O, Akinci G, Dirik E. Temporary diazepam responsive apneic attacks and congenital myasthenic syndrome. J Child Neurol 2009; 24:895-8. [PMID: 19289695 DOI: 10.1177/0883073808331083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Congenital myasthenic syndromes are a genetically and phenotypically heterogeneous group of hereditary disorders affecting neuromuscular junction. Mutations in the gene encoding choline acetyltransferase cause presynaptic defects. The missense mutation I336T has been identified in Turkish population, and most of the cases carrying this mutation present with exercise-induced fatigability and ptosis. Although apneic attacks occur in these cases during febrile illness in childhood, the number of reported respiratory distress episodes during infancy is scarce. Another important feature of these cases is that response to esterase inhibitors is satisfactory. We present a case of congenital myasthenic syndrome with I336T choline acetyltransferase mutation who presented with numerous attacks of respiratory distress in the infancy period. Interestingly, the patient had myopathic findings on electromyography and diazepam decreased severity of apneic attacks. There was also no improvement with esterase inhibitors.
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Affiliation(s)
- Uluç Yis
- Division of Child Neurology, Gaziantep Children's Hospital, Gaziantep, Turkey.
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Jamshidi R, Harrison MR, Lee H, Nobuhara KK, Farmer DL. Indication for pediatric muscle biopsy determines usefulness. J Pediatr Surg 2008; 43:2199-201. [PMID: 19040934 DOI: 10.1016/j.jpedsurg.2008.08.066] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Accepted: 08/29/2008] [Indexed: 12/01/2022]
Abstract
PURPOSE Diagnostic skeletal muscle biopsy is an invasive procedure used for evaluation of neuromuscular disorders. We hypothesize that the yield of biopsy varies with its indication or suspected diagnosis. METHODS Retrospective review of all muscle biopsies was performed at an academic tertiary care center between January 1, 1996, and August 1, 2006. RESULTS A total of 142 muscle biopsies were performed on 127 children. Mean age at biopsy was 5.3 years (median, 3.3; range, 8 days-21 years) with 48% female. Follow-up was maintained for a mean 3.4 years (median, 2.2; range, 1 month-10.4 years). Specific pathological diagnoses were obtained from 33 (23%) of 142. Changes in therapy resulted from 11 (8%) of 142 biopsies. Treatment changed for all patients with prebiopsy suspicion of inflammatory or neoplastic processes (7/7, 100%); these accounted for 7 (64%) of 11 patients with treatment changes. Thirteen patients underwent multiple biopsies, with 1 (8%) patient's treatment adjusted as a result. Fifteen neonates (<100 days) underwent a total of 17 biopsies; none changed treatment plans. CONCLUSIONS Muscle biopsy for neuromuscular disorders is inconsistently useful. Specific diagnoses are occasionally revealed, but treatment changes are infrequent except in those patients with suspected neoplastic or inflammatory disease. Ongoing study is required to determine the most rational indications for this procedure.
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Affiliation(s)
- Ramin Jamshidi
- Department of Surgery, University of California, San Francisco, CA 94143-0570, USA
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Current world literature. Curr Opin Neurol 2008; 21:615-24. [PMID: 18769258 DOI: 10.1097/wco.0b013e32830fb782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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