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Hoskens J, Paulussen S, Goemans N, Feys H, De Waele L, Klingels K. Early motor, cognitive, language, behavioural and social emotional development in infants and young boys with Duchenne Muscular Dystrophy- A systematic review. Eur J Paediatr Neurol 2024; 52:29-51. [PMID: 39003996 DOI: 10.1016/j.ejpn.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/11/2024] [Accepted: 07/03/2024] [Indexed: 07/16/2024]
Abstract
Duchenne Muscular Dystrophy (DMD) is an X-linked recessive disorder caused by mutations in the dystrophin gene. Deficiency of the dystrophin protein causes not only motor, but also cognitive, language, behavioural and social emotional problems. This is the first systematic review investigating five early developmental domains in boys with DMD between 0 and 6 years old. Interactions between different domains and links with mutation types and sites were explored. A systematic search was performed in PubMed, Web of Science and Scopus. An adapted version of the Scottish Intercollegiate Guidelines Network (SIGN) Checklists for case-control and cohort studies was used to evaluate quality. Fifty-five studies of high or acceptable quality were included. One was an RCT of level 1b; 50 were cohort studies of level 2b; and four were an aggregation of case-control and cohort studies receiving levels 2b and 3b. We found that young boys with DMD experienced problems in all five developmental domains, with significant interactions between these. Several studies also showed relationships between mutation sites and outcomes. We conclude that DMD is not only characterised by motor problems but by a more global developmental delay with a large variability between boys. Our results emphasise the need for harmonisation in evaluation and follow-up of young boys with DMD. More high-quality research is needed on the different early developmental domains in young DMD to facilitate early detection of difficulties and identification of associated early intervention strategies.
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Affiliation(s)
- Jasmine Hoskens
- Faculty of Rehabilitation Sciences, Rehabilitation Research Centre (REVAL), UHasselt, Campus Diepenbeek, Agoralaan, 3590, Diepenbeek, Hasselt, Belgium; Department of Rehabilitation Sciences, Research Group for Neurorehabilitation (eNRGy), KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Silke Paulussen
- Faculty of Rehabilitation Sciences, Rehabilitation Research Centre (REVAL), UHasselt, Campus Diepenbeek, Agoralaan, 3590, Diepenbeek, Hasselt, Belgium
| | - Nathalie Goemans
- Department of Child Neurology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, Research Group for Neurorehabilitation (eNRGy), KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Liesbeth De Waele
- Department of Child Neurology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, 3000, Leuven, Belgium
| | - Katrijn Klingels
- Faculty of Rehabilitation Sciences, Rehabilitation Research Centre (REVAL), UHasselt, Campus Diepenbeek, Agoralaan, 3590, Diepenbeek, Hasselt, Belgium; Department of Rehabilitation Sciences, Research Group for Neurorehabilitation (eNRGy), KU Leuven, Herestraat 49, 3000, Leuven, Belgium
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Hellebrekers DMJ, Lionarons JM, Faber CG, Klinkenberg S, Vles JSH, Hendriksen JGM. Instruments for the Assessment of Behavioral and Psychosocial Functioning in Duchenne and Becker Muscular Dystrophy; a Systematic Review of the Literature. J Pediatr Psychol 2019; 44:1205-1223. [DOI: 10.1093/jpepsy/jsz062] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 07/03/2019] [Accepted: 07/05/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
This systematic review aims to provide an overview of instruments used to assess behavioral and psychosocial functioning of patients with Duchenne and Becker muscular dystrophy, as well as to review the psychometric properties and applicability of these instruments.
Methods
Five databases (Embase, Psyc.info, ERIC, Pubmed/Medline, and Cochrane) were searched from inception to June, 2018. Potential articles were rated by two independent reviewers. A predefined PROSPERO form (CRD42017074518) was used to extract data from included articles.
Results
Sixty-one instruments were used in 54 studies. The Child Behavior Checklist is commonly used, but it lacks disease specific psychometric information. Sixteen instruments that contained disease specific psychometric information were included for final evaluation. The results displayed three instruments that are potentially valid for screening of psychosocial problems: The Psychosocial Adjustment and Role Skills Scale 3rd edition, the Pediatric Quality of Life Inventory Generic module, and the Life Satisfaction Index for Adolescents with Duchenne muscular dystrophy. Appropriate instruments for screening of behavioral problems may be: the Strengths and Difficulties Questionnaire, the Generalized Anxiety Disorder-7 item questionnaire, and the Patient Health Questionnaire-9 item questionnaire.
Conclusions
Further research on psychometric properties of screening instruments is crucial to ascertain a gold standard for clinical and research purposes. Meanwhile, for definite diagnostics purposes we recommend a multimethod, multisource, multisetting assessment in this high-risk population.
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Affiliation(s)
- Danique M J Hellebrekers
- Kempenhaeghe Centre for Neurological Learning Disabilities, Heeze, The Netherlands
- Maastricht University, School for Mental Health and Neuroscience, Maastricht, The Netherlands
| | - Judith M Lionarons
- Kempenhaeghe Centre for Neurological Learning Disabilities, Heeze, The Netherlands
- Maastricht University, School for Mental Health and Neuroscience, Maastricht, The Netherlands
| | - Catharina G Faber
- Maastricht University, School for Mental Health and Neuroscience, Maastricht, The Netherlands
- Maastricht University Medical Centre, Department of Neurology, Maastricht, The Netherlands
| | - Sylvia Klinkenberg
- Kempenhaeghe Centre for Neurological Learning Disabilities, Heeze, The Netherlands
- Maastricht University, School for Mental Health and Neuroscience, Maastricht, The Netherlands
- Maastricht University Medical Centre, Department of Neurology, Maastricht, The Netherlands
| | - Johan S H Vles
- Maastricht University, School for Mental Health and Neuroscience, Maastricht, The Netherlands
| | - Jos G M Hendriksen
- Kempenhaeghe Centre for Neurological Learning Disabilities, Heeze, The Netherlands
- Maastricht University, School for Mental Health and Neuroscience, Maastricht, The Netherlands
- Duchenne Centre Netherlands
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Remmelink E, Aartsma-Rus A, Smit AB, Verhage M, Loos M, van Putten M. Cognitive flexibility deficits in a mouse model for the absence of full-length dystrophin. GENES BRAIN AND BEHAVIOR 2017; 15:558-67. [PMID: 27220066 DOI: 10.1111/gbb.12301] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 05/14/2016] [Accepted: 05/20/2016] [Indexed: 11/28/2022]
Abstract
Duchenne muscular dystrophy (DMD) is a progressive muscle-wasting disorder, caused by mutations in the DMD gene and the resulting lack of dystrophin. The DMD gene has seven promoters, giving rise to multiple full-length and shorter isoforms. Besides the expression of dystrophin in muscles, the majority of dystrophin isoforms is expressed in brain and dystrophinopathy can lead to cognitive deficits, including intellectual impairments and deficits in executive function. In contrast to the muscle pathology, the impact of the lack of dystrophin on the brain is not very well studied. Here, we study the behavioral consequences of a lack of full-length dystrophin isoforms in mdx mice, particularly with regard to domains of executive functions and anxiety. We observed a deficit in cognitive flexibility in mdx mice in the absence of motor dysfunction or general learning impairments using two independent behavioral tests. In addition, increased anxiety was observed, but its expression depended on the context. Overall, these results suggest that the absence of full-length dystrophin in mice has specific behavioral effects that compare well to deficits observed in DMD patients.
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Affiliation(s)
- E Remmelink
- Sylics (Synaptologics B.V.), The Netherlands.,Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus Amsterdam, VU University, The Netherlands.,Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus Amsterdam, VU University Amsterdam, The Netherlands
| | - A Aartsma-Rus
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - A B Smit
- Department of Molecular and Cellular Neurobiology, Center for Neurogenomics and Cognitive Research, Neuroscience Campus Amsterdam, VU University, The Netherlands
| | - M Verhage
- Department of Functional Genomics, Center for Neurogenomics and Cognitive Research, Neuroscience Campus Amsterdam, VU University Amsterdam, The Netherlands
| | - M Loos
- Sylics (Synaptologics B.V.), The Netherlands
| | - M van Putten
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
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Sienko S, Buckon C, Fowler E, Bagley A, Staudt L, Sison-Williamson M, Zebracki K, McDonald CM, Sussman M. Prednisone and Deflazacort in Duchenne Muscular Dystrophy: Do They Play a Different Role in Child Behavior and Perceived Quality of Life? PLOS CURRENTS 2016; 8:ecurrents.md.7628d9c014bfa29f821a5cd19723bbaa. [PMID: 27525172 PMCID: PMC4972246 DOI: 10.1371/currents.md.7628d9c014bfa29f821a5cd19723bbaa] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The aim of this study was to determine whether prednisone and deflazacort play a different role in child behavior and perceived health related psychosocial quality of life in ambulant boys with Duchenne Muscular Dystrophy. As part of a prospective natural-history study, parents of sixty-seven ambulant boys with DMD (27 taking prednisone, 15 taking deflazacort, 25 were steroid naïve) completed the Child Behavior Checklist (CBCL) for assessment of behavioral, emotional and social problems and both parents and boys with DMD completed the PedsQL™4.0 generic core scale short form. Boys with DMD had higher rates of general behavioral problems than age-matched peers. No significant differences were found among the groups for any of the CBCL syndrome scales raw scores, including internalizing and externalizing behaviors; however, on average boys taking deflazacort demonstrated more withdrawn behaviors than those taking prednisone, while on average the boys taking prednisone demonstrated more aggressive behaviors than boys taking deflazacort. Age, internalizing and externalizing behaviors accounted for 39 and 48% of the variance in psychosocial quality of life for both parents and boys with DMD, respectively. Overall, the use of steroids was not associated with more behavioral problems in boys with DMD. As behavior played a significant role in psychosocial quality of life, comprehensive assessment and treatment of behavioral problems is crucial in this population.
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Affiliation(s)
- Susan Sienko
- Clinical Research, Shriners Hospitals for Children, Portland, Oregon, USA
| | - Cathleen Buckon
- Clinical Research, Shriners Hospitals for Children, Portland, Oregon, USA
| | - Eileen Fowler
- Orthopaedic Surgery, University of California, Los Angeles, California, USA
| | - Anita Bagley
- Motion Analysis Laboratory, Shriners Hospitals for Children Northern California, Sacramento, California, USA
| | - Loretta Staudt
- Orthopaedic Surgery, University of California, Los Angeles, California, USA
| | - Mitell Sison-Williamson
- Center for HealthCare Quality Licensing & Certification Division, California Department of Public Health, Sacramento, California, USA
| | - Kathy Zebracki
- Shriners Hospitals for Children, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Craig M McDonald
- Department of Physical Medicine and Rehabilitation, University of California, Davis, Sacramento, California, USA
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de Valle KL, Davidson ZE, Kennedy RA, Ryan MM, Carroll KM. Physical activity and the use of standard and complementary therapies in Duchenne and Becker muscular dystrophies. J Pediatr Rehabil Med 2016; 9:55-63. [PMID: 26966801 DOI: 10.3233/prm-160364] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To record the use and perceived benefits of mainstream allied health services, complementary therapies, nutritional supplements and structured physical activity in a paediatric population of males with Duchenne or Becker muscular dystrophy. METHOD A questionnaire was distributed to 125 parents of males with a dystrophinopathy within a tertiary neuromuscular clinic population in Melbourne, Australia. RESULTS Response rate to the survey was 41%. Most families (73%) reported use of allied health services: physiotherapy (65%), occupational therapy (47%), and psychology (25%). The most commonly used complementary therapy was massage (31%). Sixty-five percent of families reported using nutritional supplements. Fifty-one and 38% of families reported participation in swimming and other organised sports, respectively. Physical and psychological benefits of sporting activities were identified by families. Participation in physical activity was lowest in those transitioning to full-time wheelchair use. CONCLUSIONS Access to allied health services by boys with dystrophinopathies is variable and inconsistent with published international standards of care. There is frequent use of complementary therapies, despite a lack of proven efficacy. Studies of the effects of such therapies would support provision of evidence-based advice to families. Continued involvement in physical activity for those boys with declining function should be supported by clinicians.
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Affiliation(s)
- Katy L de Valle
- Neurology Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Zoe E Davidson
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Rachel A Kennedy
- Neurology Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Monique M Ryan
- Neurology Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Victoria, Australia
| | - Kate M Carroll
- Neurology Department, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
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Dystrophin induced cognitive impairment: mechanisms, models and therapeutic strategies. Ann Neurosci 2015; 22:108-18. [PMID: 26130916 PMCID: PMC4480258 DOI: 10.5214/ans.0972.7531.221210] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 01/19/2015] [Accepted: 03/05/2015] [Indexed: 12/13/2022] Open
Abstract
Existence of conserved domains in dystrophin and its associated complexes provide an opportunity to understand the role of dystrophin associated signalling and its association with neuronal metabolism in a variety of model organisms. We critically reviewed the studies till 2013 through established search engines and databases. Thus, we review the role of dystrophin and its isoforms in different animal models at developmental stages in the neuronal metabolism to enhance the therapeutic strategies. Dystrophin interacts with other proteins in such a way that, when affected, it results in co-morbidities including autism and other neuropsychiatric disorders. It is speculated that various signalling molecules may converge to disrupt neuronal metabolism not adequately studied. TGF-β, RhoGAP and CAM mediated signalling molecules are the chief cause of mortalities due to respiratory and cardiac involvement but remain underevaluated targets for cognitive impairment in DMD/BMD. Manipulation of these signalling pathways could be potent intervention in dystrophin induced cognitive impairment while complementary therapeutic approaches may also be helpful in the treatment of cognitive impairment associated with DMD/BMD.
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