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Martí Y, Aponte Ribero V, Batson S, Mitchell S, Gorni K, Gusset N, Oskoui M, Servais L, Deconinck N, McGrattan KE, Mercuri E, Sutherland CS. A Systematic Literature Review of the Natural History of Respiratory, Swallowing, Feeding, and Speech Functions in Spinal Muscular Atrophy (SMA). J Neuromuscul Dis 2024:JND230248. [PMID: 38943396 DOI: 10.3233/jnd-230248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
Background Respiratory and bulbar dysfunctions (including swallowing, feeding, and speech functions) are key symptoms of spinal muscular atrophy (SMA), especially in its most severe forms. Demonstrating the long-term efficacy of disease-modifying therapies (DMTs) necessitates an understanding of SMA natural history. Objective This study summarizes published natural history data on respiratory, swallowing, feeding, and speech functions in patients with SMA not receiving DMTs. Methods Electronic databases (Embase, MEDLINE, and Evidence-Based Medicine Reviews) were searched from database inception to June 27, 2022, for studies reporting data on respiratory and/or bulbar function outcomes in Types 1-3 SMA. Data were extracted into a predefined template and a descriptive summary of these data was provided. Results Ninety-one publications were included: 43 reported data on respiratory, swallowing, feeding, and/or speech function outcomes. Data highlighted early loss of respiratory function for patients with Type 1 SMA, with ventilatory support typically required by 12 months of age. Patients with Type 2 or 3 SMA were at risk of losing respiratory function over time, with ventilatory support initiated between the first and fifth decades of life. Swallowing and feeding difficulties, including choking, chewing problems, and aspiration, were reported in patients across the SMA spectrum. Swallowing and feeding difficulties, and a need for non-oral nutritional support, were reported before 1 year of age in Type 1 SMA, and before 10 years of age in Type 2 SMA. Limited data relating to other bulbar functions were collated. Conclusions Natural history data demonstrate that untreated patients with SMA experience respiratory and bulbar function deterioration, with a more rapid decline associated with greater disease severity. This study provides a comprehensive repository of natural history data on bulbar function in SMA, and it highlights that consistent assessment of outcomes in this area is necessary to benefit understanding and approval of new treatments.
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Affiliation(s)
| | | | | | | | | | - Nicole Gusset
- SMA Europe, Freiburg, Germany
- SMA Schweiz, Heimberg, Switzerland
| | - Maryam Oskoui
- Departments of Pediatrics and Neurology Neurosurgery, McGill University, Montreal, Canada
| | - Laurent Servais
- MDUK Oxford Neuromuscular Centre & NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- Division of Child Neurology, Centre de Références des Maladies Neuromusculaires, Department of Pediatrics, University Hospital Liège & University of Liège, Liège, Belgium
| | - Nicolas Deconinck
- Neuromuscular Reference Center, UZ Gent, Ghent, Belgium
- Centre de Références des Maladies Neuromusculaires, Department Paediatric Neurology, Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Katlyn Elizabeth McGrattan
- Department of Speech-Language-Hearing Science, University of Minnesota, Minneapolis, MN, USA
- Department of Rehabilitation, Masonic Children's Hospital, Minneapolis, MN, USA
| | - Eugenio Mercuri
- Pediatric Neurology Institute, Catholic University and Nemo Pediatrico, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
- Centro Clinico Nemo, Fondazione Policlinico Gemelli, IRCCS, Rome, Italy
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Kokaliaris C, Evans R, Hawkins N, Mahajan A, Scott DA, Sutherland CS, Nam J, Sajeev G. Long-Term Comparative Efficacy and Safety of Risdiplam and Nusinersen in Children with Type 1 Spinal Muscular Atrophy. Adv Ther 2024; 41:2414-2434. [PMID: 38705943 PMCID: PMC11133132 DOI: 10.1007/s12325-024-02845-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/13/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Spinal muscular atrophy (SMA) is a severe genetic neuromuscular disease characterized by a loss of motor neurons and progressive muscle weakness. Children with untreated type 1 SMA never sit independently and require increasing levels of ventilatory support as the disease progresses. Without intervention, and lacking ventilatory support, death typically occurs before the age of 2 years. There are currently no head-to-head trials comparing available treatments in SMA. Indirect treatment comparisons are therefore needed to provide information on the relative efficacy and safety of SMA treatments for healthcare decision-making. METHODS The long-term efficacy and safety of risdiplam versus nusinersen in children with type 1 SMA was evaluated using indirect treatment comparison methodology to adjust for differences between population baseline characteristics, to reduce any potential bias in the comparative analysis. An unanchored matching-adjusted indirect comparison was conducted using risdiplam data from 58 children in FIREFISH (NCT02913482) and published aggregate nusinersen data from 81 children obtained from the ENDEAR (NCT02193074) and SHINE (NCT02594124) clinical trials with at least 36 months of follow-up. RESULTS Children with type 1 SMA treated with risdiplam had a 78% reduction in the rate of death, an 81% reduction in the rate of death or permanent ventilation, and a 57% reduction in the rate of serious adverse events compared with children treated with nusinersen. Children treated with risdiplam also had a 45% higher rate of achieving a Hammersmith Infant Neurological Examination, Module 2 motor milestone response and a 186% higher rate of achieving a ≥ 4-point improvement in Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders compared with children treated with nusinersen. CONCLUSION Long-term data supported risdiplam as a superior alternative to nusinersen in children with type 1 SMA. Video abstract available for this article. Video abstract (MP4 184542 KB).
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Affiliation(s)
| | | | - Neil Hawkins
- Visible Analytics, Oxford, UK
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | | | | | | | - Julian Nam
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, 4070, Basel, Switzerland
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Fernandes BD, D'Athayde Rodrigues F, Cardoso Cirilo HN, Borges SS, Krug BC, Probst LF, Zimmermann I. Cost-Effectiveness of Onasemnogene Abeparvovec Compared With Nusinersen and Risdiplam in Patients With Spinal Muscular Atrophy Type 1 in Brazil: Custo-Efetividade do Onasemnogeno Abeparvoveque (AVXS-101) em Comparação ao Nusinersena e Risdiplam em Pacientes com Atrofia Muscular Espinhal Tipo 1 no Brasil. Value Health Reg Issues 2024; 40:108-117. [PMID: 38181723 DOI: 10.1016/j.vhri.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 11/01/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVES This study aimed to evaluate the cost-effectiveness of the onasemnogene abeparvovec in relation to nusinersen and risdiplam in the treatment of spinal muscular atrophy type 1 from the perspective of the Brazilian Unified Health System. METHODS A Markov model was built on a lifetime horizon. Short-term data were obtained from clinical trials of the technologies and from published cohort survival curves (long term). Costs were measured in current 2022 local currency (R$) values and benefits in quality-adjusted life-years (QALYs). Utility values were derived from type 1 spinal muscular atrophy literature, whereas costs related to technologies and maintenance care in each health state were obtained from official sources of reimbursement in Brazil. Deterministic and probabilistic, as well as scenario, sensitivity analyses were performed. RESULTS Compared with the less costly strategy (nusinersen), the use of onasemnogene abeparvovec resulted in an incremental cost of R$2.468.448,06 ($975 671.169 - purchasing power parity [PPP]) and a 3-QALY increment and incremental cost-effectiveness ratio of R$742.890,92 ($293 632.774 - PPP)/QALY. Risdiplam had an extended dominance from other strategies, resulting in an incremental cost-effectiveness ratio of R$926.586,22 ($366 239.612 - PPP)/QALY compared with nusinersen. Sensitivity analysis showed a significant impact of the follow-up time of the cohort and the cost of acquiring onasemnogene abeparvovec. CONCLUSIONS Over a lifetime horizon, onasemnogene abeparvovec seems to be a potentially more effective option than nusinersen and risdiplam, albeit with an incremental cost. Such a trade-off should be weighed in efficiency criteria during decision making and outcome monitoring from the perspective of the Brazilian Unified Health System.
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Affiliation(s)
- Brígida Dias Fernandes
- Unidade de Avaliação de Tecnologias em Saúde, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
| | | | - Hérica Núbia Cardoso Cirilo
- Núcleo de Avaliação de Tecnologias em Saúde, Hospital das Clínicas da Universidade Federal de Goiás/Ebserh, Goiânia - GO
| | - Stéfani Sousa Borges
- Unidade de Avaliação de Tecnologias em Saúde, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
| | - Bárbara Corrêa Krug
- Secretaria Estadual da Saúde do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | - Livia Fernandes Probst
- Unidade de Avaliação de Tecnologias em Saúde, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
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Hann SH, Kim SY, Kim YL, Jo YW, Kang JS, Park H, Choi SY, Kong YY. Depletion of SMN protein in mesenchymal progenitors impairs the development of bone and neuromuscular junction in spinal muscular atrophy. eLife 2024; 12:RP92731. [PMID: 38318851 PMCID: PMC10945524 DOI: 10.7554/elife.92731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
Spinal muscular atrophy (SMA) is a neuromuscular disorder characterized by the deficiency of the survival motor neuron (SMN) protein, which leads to motor neuron dysfunction and muscle atrophy. In addition to the requirement for SMN in motor neurons, recent studies suggest that SMN deficiency in peripheral tissues plays a key role in the pathogenesis of SMA. Using limb mesenchymal progenitor cell (MPC)-specific SMN-depleted mouse models, we reveal that SMN reduction in limb MPCs causes defects in the development of bone and neuromuscular junction (NMJ). Specifically, these mice exhibited impaired growth plate homeostasis and reduced insulin-like growth factor (IGF) signaling from chondrocytes, rather than from the liver. Furthermore, the reduction of SMN in fibro-adipogenic progenitors (FAPs) resulted in abnormal NMJ maturation, altered release of neurotransmitters, and NMJ morphological defects. Transplantation of healthy FAPs rescued the morphological deterioration. Our findings highlight the significance of mesenchymal SMN in neuromusculoskeletal pathogenesis of SMA and provide insights into potential therapeutic strategies targeting mesenchymal cells for the treatment of SMA.
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Affiliation(s)
- Sang-Hyeon Hann
- School of Biological Sciences, Seoul National University, Seoul, Republic of Korea
| | - Seon-Yong Kim
- Department of Physiology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Republic of Korea
| | - Ye Lynne Kim
- School of Biological Sciences, Seoul National University, Seoul, Republic of Korea
| | - Young-Woo Jo
- School of Biological Sciences, Seoul National University, Seoul, Republic of Korea
| | - Jong-Seol Kang
- School of Biological Sciences, Seoul National University, Seoul, Republic of Korea
| | - Hyerim Park
- School of Biological Sciences, Seoul National University, Seoul, Republic of Korea
| | - Se-Young Choi
- Department of Physiology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Republic of Korea
| | - Young-Yun Kong
- School of Biological Sciences, Seoul National University, Seoul, Republic of Korea
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Nabil D, Tawfik II, AbdelHakim KM, Hawthorne KM, Tadros MAR. Malnutrition in Spinal Muscular Atrophy Type I: Case Report of a Novel Nutritional Intervention With Improved Growth and Function While Receiving Parallel Gene Splicing Therapies. Pediatr Neurol 2024; 151:76-79. [PMID: 38118381 DOI: 10.1016/j.pediatrneurol.2023.08.007] [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: 04/28/2023] [Revised: 08/04/2023] [Accepted: 08/05/2023] [Indexed: 12/22/2023]
Abstract
Children with spinal muscular atrophy (SMA) frequently experience feeding intolerance and diminished growth. Although splicing modulators to prevent symptoms are available worldwide, adequate nutrition to support growth, development, and improved quality of life remains essential. We present a case study of a one-year-old malnourished male with SMA type I who achieved improved growth and feeding tolerance with a human milk (HM)-derived nutrition intervention. Despite feeding with appropriately balanced semielemental formula, he remained severely malnourished after two months of hospitalization. Feeds were partially replaced with HM-based diet plus a HM-based fat modular. Feeding tolerance, fecal calprotectin levels, and z scores for weight and length improved while receiving the HM-based intervention. We hypothesize that the HM-based feeding reduced intestinal inflammation by diminishing pathogenic elements of his microbiome. Owing to their aberrant fatty acid metabolism, patients with SMA are uniquely positioned to benefit from HM-based nutrient acquisition even while receiving splicing modulators to stabilize the disease process.
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Affiliation(s)
- Dina Nabil
- International Medical Center, Pediatrics/Clinical Nutrition Department Cairo University, Cairo, Egypt
| | - Ihab Ibrahim Tawfik
- International Medical Center, Pediatrics/Clinical Nutrition Department Cairo University, Cairo, Egypt
| | - Kamal Mohamed AbdelHakim
- International Medical Center, Pediatrics/Clinical Nutrition Department Cairo University, Cairo, Egypt
| | - Keli M Hawthorne
- Department of Pediatrics, Dell Medical School, University of Texas at Austin, Austin, Texas.
| | - Mourad Alfy Ramzy Tadros
- International Medical Center, Pediatrics/Clinical Nutrition Department Cairo University, Cairo, Egypt
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Alotaibi KM, Alsuhaibani M, Al-Essa KS, Bamaga AK, Mukhtar AS, Alrumaih AM, Al-Hasinah HF, Aldossary S, Alghamdi F, Temsah MH, Abanmy N, Alwhaibi M, Asiri Y, AlRuthia Y. The socioeconomic burden of spinal muscular atrophy in Saudi Arabia: a cross-sectional pilot study. Front Public Health 2024; 12:1303475. [PMID: 38362212 PMCID: PMC10867838 DOI: 10.3389/fpubh.2024.1303475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/05/2024] [Indexed: 02/17/2024] Open
Abstract
Background Spinal muscular atrophy (SMA) is a rare debilitating condition with a significant burden for patients and society. However, little is known about how it affects Saudi Arabia's population. The socioeconomic and medical characteristics of affected SMA patients and their caregivers are lacking. Purpose This study aimed to describe the socioeconomic and medical characteristics of SMA patients and caregivers in Saudi Arabia. Patients and methods A cross-sectional questionnaire-based study was conducted using snowball sampling. Assessment tools including EuroQol (EQ-5D-5L) and visual analog scale (EQ-VAS), Generalized Anxiety Disorder 7-item (GAD-7), Patient Health Questionnaire (PHQ-9), and Costs for Patients Questionnaire (CoPaQ) were used to assess the quality of life (QoL), anxiety, depression, and out-of-pocket expenditures. Results Sixty-four caregivers of SMA patients participated. Type I patients had higher sibling concordance, ICU hospitalization, and mechanical support needs. Type III patients had better QoL. Type I patients' caregivers had higher depression scores. Type III patients' caregivers had higher out-of-pocket expenditures. Forty-eight percent received supportive care, while others received SMA approved therapies. Conclusion SMA imposes a significant socioeconomic burden on patients and caregivers, requiring more attention from the healthcare system. Access to innovative therapies varied across SMA types. Pre-marital screening and early detection are crucial to reduce disease incidence and ensure timely treatment.
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Affiliation(s)
- Khloud Mubark Alotaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mohannad Alsuhaibani
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Khalid S. Al-Essa
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed Khamis Bamaga
- Neurology Division, Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amnah S. Mukhtar
- Pharmaceutical Care Department, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Ali Mohammed Alrumaih
- Pharmaceutical Care Department, General Directorate for Health Services, Riyadh, Saudi Arabia
| | - Huda F. Al-Hasinah
- Department of Pharmacy, Prince Sultan Medical City, Riyadh, Saudi Arabia
| | - Shaikhah Aldossary
- Department of Pediatric Neurology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Fouad Alghamdi
- Department of Pediatric Neurology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Mohamad-Hani Temsah
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Norah Abanmy
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Monira Alwhaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Yousif Asiri
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Wolfe A, Stimpson G, Ramsey D, Coratti G, Dunaway Young S, Mayhew A, Pane M, Rohwer A, Muni Lofra R, Duong T, O'Reilly E, Milev E, Civitello M, Sansone VA, D'Amico A, Bertini E, Messina S, Bruno C, Albamonte E, Mazzone E, Main M, Montes J, Glanzman AM, Zolkipli-Cunningham Z, Pasternak A, Marini-Bettolo C, Day JW, Darras BT, De Vivo DC, Baranello G, Scoto M, Finkel RS, Mercuri E, Muntoni F. Disease Trajectories in the Revised Hammersmith Scale in a Cohort of Untreated Patients with Spinal Muscular Atrophy types 2 and 3. J Neuromuscul Dis 2024; 11:665-677. [PMID: 38427497 DOI: 10.3233/jnd-230211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
Background Spinal muscular atrophy (SMA) is a neuromuscular disorder characterised by progressive motor function decline. Motor function is assessed using several functional outcome measures including the Revised Hammersmith Scale (RHS). Objective In this study, we present longitudinal trajectories for the RHS in an international cohort of 149 untreated paediatric SMA 2 and 3 patients (across 531 assessments collected between March 2015 and July 2019). Methods We contextualise these trajectories using both the Hammersmith Functional Motor Scale Expanded (HFMSE) and Revised Upper Limb Module (RULM). At baseline, this cohort included 50% females and 15% of patients had undergone spinal fusion surgery. Patient trajectories were modelled using a natural cubic spline with age, sex, and random effects for each patient. Results RHS and HFMSE scores show similar trends over time in this cohort not receiving disease modifying therapies. The results confirm the strong correlation between the RHS and RULM previously observed in SMA types 2 and 3a. Scoliosis surgery is associated with a reduction of 3 points in the RHS, 4.5 points in the HFMSE for the SMA 2 population, and a reduction of 11.8 points in the RHS, and 13.4 points in the HFMSE for the SMA 3a populations. When comparing the RHS and RULM, there is a lower correlation in the type 3a's than the type 2 patients. In the SMA 2 population, there is no significant difference between the sexes in either the RHS or HFMSE trajectories. There is no significant difference in the RULM trajectory in the SMA 2 or 3a participants by sex. Conclusions This study demonstrates that the RHS could be used in conjunction with other functional measures such as the RULM to holistically detect SMA disease progression. This will assist with fully understanding changes that occur with treatments, further defining trajectories and therapy outcomes.
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Affiliation(s)
- Amy Wolfe
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, UK
- Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK
- National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Georgia Stimpson
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, UK
- National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | | | - Giorgia Coratti
- Pediatric Neurology Unit, Catholic University, Rome, Italy
- Centro Clinico Nemo, U.O.C. Neuropsichiatria Infantile Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Anna Mayhew
- John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK
| | - Marika Pane
- Pediatric Neurology Unit, Catholic University, Rome, Italy
- Centro Clinico Nemo, U.O.C. Neuropsichiatria Infantile Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Annemarie Rohwer
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, UK
- National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Robert Muni Lofra
- John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK
| | | | - Emer O'Reilly
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, UK
- National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Evelin Milev
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, UK
- National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Matthew Civitello
- St. Jude Children's Research Hospital, Memphis, USA
- Nemours Children's Hospital and University of Central Florida College of Medicine, Orlando, USA
| | - Valeria A Sansone
- The NEMO Center in Milan, Neurorehabilitation Unit, University of Milan, ASST Niguarda Hospital, Milan, Italy
| | - Adele D'Amico
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Enrico Bertini
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sonia Messina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Claudio Bruno
- Center of Translational and Experimental Myology and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, IRCCS Istituto Giannina Gaslini and University of Genoa, Genoa, Italy
| | - Emilio Albamonte
- The NEMO Center in Milan, Neurorehabilitation Unit, University of Milan, ASST Niguarda Hospital, Milan, Italy
| | - Elena Mazzone
- Pediatric Neurology Unit, Catholic University, Rome, Italy
- Centro Clinico Nemo, U.O.C. Neuropsichiatria Infantile Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marion Main
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | | | | | - Amy Pasternak
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Chiara Marini-Bettolo
- John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University, Integrated Laboratory Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK
| | | | - Basil T Darras
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Giovanni Baranello
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, UK
- National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Mariacristina Scoto
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, UK
- National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Richard S Finkel
- St. Jude Children's Research Hospital, Memphis, USA
- Nemours Children's Hospital and University of Central Florida College of Medicine, Orlando, USA
| | - Eugenio Mercuri
- Pediatric Neurology Unit, Catholic University, Rome, Italy
- Centro Clinico Nemo, U.O.C. Neuropsichiatria Infantile Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Muntoni
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, London, UK
- National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, UK
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Trucco F, Salmin F, Lizio A, Coratti G, Albamonte E, Frisoni MC, Mauro L, Carraro E, Palazzo G, Lops J, Cattaneo C, Pozzi S, Casiraghi J, Di Bari A, Berti B, Stanca G, Ricci M, Pane M, Heatwole C, Dilek N, Mercuri E, Sansone VA. Assessing Prevalence and Characteristics of Oro-bulbar Involvement in Children and Adults with SMA Type 2 and 3 Using a Multimodal Approach. Dysphagia 2023; 38:1568-1580. [PMID: 37289231 PMCID: PMC10611831 DOI: 10.1007/s00455-023-10584-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/21/2023] [Indexed: 06/09/2023]
Abstract
Bulbar and jaw muscles are impaired in patients with Spinal Muscular Atrophy (SMA) but the assessment of their severity and progression are limited by the lack of age-appropriate and disease-specific measures. We investigated mastication and swallowing in children and adults with SMA, sitters and walkers. In a 2-year multicentre cross-sectional prospective study, lip and tongue strength (Iowa Oral Performance Instrument), chewing and swallowing (Test of Masticating and Swallowing Solids), active mouth opening (aMMO) were compared to age-appropriate normative data. The perceived burden of oro-bulbar involvement (SMA-Health Index) was recorded. 78 patients were included, 45 children (median age 7.4 years),22 adults (median age 26.8 years) on nusinersen and 11 untreated (median age 32.7 years). Forty-three percent children had reduced mouth opening, 50% had prolonged total time to eat. These issues were more prominent in sitters than in walkers (p = 0.019, p = 0.014). Sixty-six percent needed increased swallows for bolus clearance. Nusinersen treated adults had median aMMO, tongue strength and total time at TOMASS values within normal range (z score: -1.40, -1.22, -1.32, respectively) whereas untreated adults had reduced aMMO (z score: -2.68) and tongue strength (z score: -2.20). Only a minority of children (2/17) and treated adults (5/21) reported burden in swallowing or mastication compared to all untreated adults (5/5). After 16 months, mastication and swallowing were stable in treated children and adults, whether sitters or walkers. The reported multimodal approach to assess oro-bulbar functions demonstrate that swallowing and mastication are impaired in SMA despite patients' perception. These results suggest a trend towards stabilization of oro-bulbar function in patients on long-term treatment with nusinersen.
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Affiliation(s)
- Federica Trucco
- Neurorehabilitation Unit, The NeMo Clinical Center in Milan, University of Milan, ASST Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
- Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital, London, UK
- Dept Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | | | - Andrea Lizio
- Centro Clinico Nemo, Fondazione Serena Onlus, Milan, Italy
| | - Giorgia Coratti
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | | | - Luca Mauro
- Centro Clinico Nemo, Fondazione Serena Onlus, Milan, Italy
| | - Elena Carraro
- Centro Clinico Nemo, Fondazione Serena Onlus, Milan, Italy
| | | | - Jessica Lops
- Centro Clinico Nemo, Fondazione Serena Onlus, Milan, Italy
| | | | - Susanna Pozzi
- Centro Clinico Nemo, Fondazione Serena Onlus, Milan, Italy
| | | | | | - Beatrice Berti
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giulia Stanca
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Martina Ricci
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Marika Pane
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Chad Heatwole
- Center for Health and Technology (CHeT), The University of Rochester Medical Center, Rochester, NY, USA
| | - Nuran Dilek
- Center for Health and Technology (CHeT), The University of Rochester Medical Center, Rochester, NY, USA
| | - Eugenio Mercuri
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Valeria Ada Sansone
- Neurorehabilitation Unit, The NeMo Clinical Center in Milan, University of Milan, ASST Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy.
- Centro Clinico Nemo, Fondazione Serena Onlus, Milan, Italy.
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9
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Dipasquale V, Morello R, Romano C. Gastrointestinal and nutritional care in pediatric neuromuscular disorders. World J Clin Pediatr 2023; 12:197-204. [PMID: 37753494 PMCID: PMC10518748 DOI: 10.5409/wjcp.v12.i4.197] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/04/2023] [Accepted: 08/09/2023] [Indexed: 09/06/2023] Open
Abstract
Neuromuscular diseases (NMDs) affect the development and growth of the neuromuscular system in children. The pathology can occur anywhere along the neuromuscular pathway, from the brain to the nerves to the muscle fibers. These diseases have a profound impact on the quality of life not only of children but also of their families. The predominant manifestation in NMDs is hypotonia, which leads to muscle weakness and fatigue, reduced mobility, and decreased physical performance. However, multiple organ systems can be affected, with resulting orthopedic, cardiac, infectious, respiratory, and nutritional problems. Children with NMD present an increased risk for several dietary and feeding difficulties because of their neuromuscular diagnosis, presentation, and severity. These problems include chronic gastrointestinal issues (constipation, dysphagia, gastroesophageal reflux, and diarrhea), dysphagia, malnutrition, and body composition alterations. As a result, compared to the overall pediatric population, infants and children with NMD are more likely to be malnourished, ranging from failure to thrive to overweight or obesity. Disease-specific guidelines vary in level of detail and recommendations for dietary management. Overall, nutritional data available are sparse, with the exception of Duchenne muscular dystrophy, spinal muscular atrophy, and congenital muscular dystrophy. The purpose of this review is to describe the spectrum of nutritional challenges in children with NMD and to summarize the main dietary and gastrointestinal recommendations for each neuromuscular disorder to provide guidance for daily clinical practice.
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Affiliation(s)
- Valeria Dipasquale
- Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University Hospital “G. Martino”, Messina 98124, Italy
| | - Rossella Morello
- Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University Hospital “G. Martino”, Messina 98124, Italy
| | - Claudio Romano
- Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University Hospital “G. Martino”, Messina 98124, Italy
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10
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René CA, Parks RJ. Expanding the Availability of Onasemnogene Abeparvovec to Older Patients: The Evolving Treatment Landscape for Spinal Muscular Atrophy. Pharmaceutics 2023; 15:1764. [PMID: 37376212 DOI: 10.3390/pharmaceutics15061764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/06/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
Spinal muscular atrophy (SMA) is a devastating neuromuscular disorder caused by mutations in the survival of motor neuron 1 (SMN1) gene, which leads to a reduced level in the SMN protein within cells. Patients with SMA suffer from a loss of alpha motor neurons in the spinal cord leading to skeletal muscle atrophy in addition to deficits in other tissues and organs. Patients with severe forms of the disease require ventilator assistance and typically succumb to the disease due to respiratory failure. Onasemnogene abeparvovec is an adeno-associated virus (AAV)-based gene therapeutic that has been approved for infants and young children with SMA, and it is delivered through intravenous administration using a dose based on the weight of the patient. While excellent outcomes have been observed in treated patients, the greater viral dose necessary to treat older children and adults raises legitimate safety concerns. Recently, onasemnogene abeparvovec use was investigated in older children through a fixed dose and intrathecal administration, a route that provides a more direct delivery to affected cells in the spinal cord and central nervous system. The promising results observed in the STRONG trial may support approval of onasemnogene abeparvovec for a greater proportion of patients with SMA.
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Affiliation(s)
- Charlotte A René
- Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
- Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, ON K1H 8M5, Canada
- Centre for Neuromuscular Disease, University of Ottawa, Ottawa, ON K1H 8M5, Canada
| | - Robin J Parks
- Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
- Department of Biochemistry, Microbiology, and Immunology, University of Ottawa, Ottawa, ON K1H 8M5, Canada
- Centre for Neuromuscular Disease, University of Ottawa, Ottawa, ON K1H 8M5, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
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11
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Bianco A, Antonacci Y, Liguori M. Sex and Gender Differences in Neurodegenerative Diseases: Challenges for Therapeutic Opportunities. Int J Mol Sci 2023; 24:ijms24076354. [PMID: 37047320 PMCID: PMC10093984 DOI: 10.3390/ijms24076354] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/16/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
The term “neurodegenerative diseases” (NDs) identifies a group of heterogeneous diseases characterized by progressive loss of selectively vulnerable populations of neurons, which progressively deteriorates over time, leading to neuronal dysfunction. Protein aggregation and neuronal loss have been considered the most characteristic hallmarks of NDs, but growing evidence confirms that significant dysregulation of innate immune pathways plays a crucial role as well. NDs vary from multiple sclerosis, in which the autoimmune inflammatory component is predominant, to more “classical” NDs, such as Parkinson’s disease, Alzheimer’s disease, amyotrophic lateral sclerosis, and spinal muscular atrophy. Of interest, many of the clinical differences reported in NDs seem to be closely linked to sex, which may be justified by the significant changes in immune mechanisms between affected females and males. In this review, we examined some of the most studied NDs by looking at their pathogenic and phenotypical features to highlight sex-related discrepancies, if any, with particular interest in the individuals’ responses to treatment. We believe that pointing out these differences in clinical practice may help achieve more successful precision and personalized care.
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12
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Corsello A, Scatigno L, Govoni A, Zuccotti G, Gottrand F, Romano C, Verduci E. Gut dysmotility in children with neurological impairment: the nutritional management. Front Neurol 2023; 14:1200101. [PMID: 37213895 PMCID: PMC10196023 DOI: 10.3389/fneur.2023.1200101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/20/2023] [Indexed: 05/23/2023] Open
Abstract
Intestinal motility disorders represent a frequent problem in children with neurological impairment. These conditions are characterized by abnormal movements of the gut, which can result in symptoms such as constipation, diarrhea, reflux, and vomiting. The underlying mechanisms leading to dysmotility are various, and the clinical manifestations are often nonspecific. Nutritional management is an important aspect of care for children with gut dysmotility, as it can help to improve their quality of life. Oral feeding, when safe and in the absence of risk of ingestion or severe dysphagia, should always be encouraged. When oral nutrition is insufficient or potentially harmful, it is necessary to switch to an enteral by tube or parenteral nutrition before the onset of malnutrition. In most cases, children with severe gut dysmotility may require feeding via a permanent gastrostomy tube to ensure adequate nutrition and hydration. Drugs may be necessary to help manage gut dysmotility, such as laxatives, anticholinergics and prokinetic agents. Nutritional management of patients with neurological impairment often requires an individualized care plan to optimize growth and nutrition and to improve overall health outcomes. This review tries to sum up most significant neurogenetic and neurometabolic disorders associated with gut dysmotility that may require a specific multidisciplinary care, identifying a proposal of nutritional and medical management.
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Affiliation(s)
- Antonio Corsello
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy
| | - Lorenzo Scatigno
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy
| | - Annalisa Govoni
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy
- Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Milan, Italy
| | - Frédéric Gottrand
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, CHU Lille, University of Lille, Lille, France
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Elvira Verduci
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy
- Department of Health Science, University of Milan, Milan, Italy
- *Correspondence: Elvira Verduci,
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13
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McGrattan KE, Shell RD, Hurst-Davis R, Young SD, O’Brien E, Lavrov A, Wallach S, LaMarca N, Reyna SP, Darras BT. Patients with Spinal Muscular Atrophy Type 1 Achieve and Maintain Bulbar Function Following Onasemnogene Abeparvovec Treatment. J Neuromuscul Dis 2023; 10:531-540. [PMID: 37092232 PMCID: PMC10357176 DOI: 10.3233/jnd-221531] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Improvement and maintenance of bulbar function are goals of disease-modifying treatments for spinal muscular atrophy (SMA). Lack of standardized measures and a widely accepted definition of bulbar function represents a gap in SMA care. OBJECTIVE A multidisciplinary team conducted post-hoc analyses of pooled data from one phase 1 (START) and two phase 3 (STR1VE-US, STR1VE-EU) studies to define and evaluate bulbar function of infants with SMA type 1 after receiving one-time gene replacement therapy, onasemnogene abeparvovec. METHODS We defined bulbar function as the ability to meet nutritional needs while maintaining airway protection and the ability to communicate verbally. Four endpoints represented adequate bulbar function: (1) absence of clinician-identified physiologic swallowing impairment, (2) receiving full oral nutrition, (3) absence of adverse events indicating pulmonary instability, and (4) the ability to vocalize at least two different, distinct vowel sounds. We descriptively assessed numbers/percentages of patients who achieved each endpoint and all four collectively. Patients were followed until 18 months old (STR1VE-US and STR1VE-EU) or 24 months (START) post-infusion. RESULTS Overall, 65 patients were analyzed for swallowing, nutrition intake, and adverse events, and 20 were analyzed for communication. At study end, 92% (60/65) of patients had a normal swallow, 75% (49/65) achieved full oral nutrition, 92% (60/65) had no evidence of pulmonary instability, 95% (19/20) met the communication endpoint, and 75% (15/20) achieved all four bulbar function components in the composite endpoint. CONCLUSIONS In these three clinical trials, patients with SMA type 1 who received onasemnogene abeparvovec achieved and maintained the bulbar function criteria utilized within this investigation.
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Affiliation(s)
| | - Richard D. Shell
- Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | | | | | | | | | | | | | | | - Basil T. Darras
- Department of Neurology, Boston Children’s Hospital, Boston, MA, USA
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14
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Sun J, Harrington MA, Porter B. Sex Difference in Spinal Muscular Atrophy Patients - are Males More Vulnerable? J Neuromuscul Dis 2023; 10:847-867. [PMID: 37393514 PMCID: PMC10578261 DOI: 10.3233/jnd-230011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Sex is a significant risk factor in many neurodegenerative disorders. A better understanding of the molecular mechanisms behind sex differences could help develop more targeted therapies that would lead to better outcomes. Untreated spinal muscular atrophy (SMA) is the leading genetic motor disorder causing infant mortality. SMA has a broad spectrum of severity ranging from prenatal death to infant mortality to normal lifespan with some disability. Scattered evidence points to a sex-specific vulnerability in SMA. However, the role of sex as a risk factor in SMA pathology and treatment has received limited attention. OBJECTIVE Systematically investigate sex differences in the incidence, symptom severity, motor function of patients with different types of SMA, and in the development of SMA1 patients. METHODS Aggregated data of SMA patients were obtained from the TREAT-NMD Global SMA Registry and the Cure SMA membership database by data enquiries. Data were analyzed and compared with publicly available standard data and data from published literature. RESULTS The analysis of the aggregated results from the TREAT-NMD dataset revealed that the male/female ratio was correlated to the incidence and prevalence of SMA from different countries; and for SMA patients, more of their male family members were affected by SMA. However, there was no significant difference of sex ratio in the Cure SMA membership dataset. As quantified by the clinician severity scores, symptoms were more severe in males than females in SMA types 2 and 3b. Motor function scores measured higher in females than males in SMA types 1, 3a and 3b. The head circumference was more strongly affected in male SMA type 1 patients. CONCLUSIONS The data in certain registry datasets suggest that males may be more vulnerable to SMA than females. The variability observed indicates that more investigation is necessary to fully understand the role of sex differences in SMA epidemiology, and to guide development of more targeted treatments.
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Affiliation(s)
- Jianli Sun
- Delaware Center for Neuroscience Research, Delaware State University, Dover, DE, USA
- Department of Biological Sciences, Delaware State University, Dover, DE, USA
| | - Melissa A. Harrington
- Delaware Center for Neuroscience Research, Delaware State University, Dover, DE, USA
| | - Ben Porter
- TREAT-NMD Services Limited, Newcastle upon Tyne, UK
| | - on behalf of the TREAT-NMD Global Registry Network for SMA
- Delaware Center for Neuroscience Research, Delaware State University, Dover, DE, USA
- Department of Biological Sciences, Delaware State University, Dover, DE, USA
- TREAT-NMD Services Limited, Newcastle upon Tyne, UK
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15
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O'Connor G, Edel L, Raquq S, Bowerman M, Szmurlo A, Simpson Z, Hardy I, Fewtrell M, Baranello G. Open-labelled study to monitor the effect of an amino acid formula on symptom management in children with spinal muscular atrophy type I: The SMAAF pilot study. Nutr Clin Pract 2022. [PMID: 36504203 DOI: 10.1002/ncp.10940] [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: 07/28/2022] [Revised: 11/02/2022] [Accepted: 11/05/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND An increasing number of families with children who have spinal muscular atrophy (SMA) are incorporating a special amino acid diet into their child's feeding regimens. Characteristics of the diet include high-carbohydrate and low-fat content with added probiotics. However, because of insufficient evidenced-based research, clinicians are unable to prescribe or endorse this diet. Our aim was to assess the tolerability of an adapted version of the traditional amino acid diet in children with SMA type I. METHODS Children with SMA type I were recruited if they were enterally fed and experienced at least one gastrointestinal symptom (reflux, vomiting, constipation, and/or diarrhea). Children were transitioned to an amino acid formula (Neocate Syneo-Nutricia) for 8 weeks. Feeding tolerance was measured weekly by telephone consultation to monitor reflux, vomiting, stool consistency, and frequency. RESULTS Fourteen children were recruited, the mean age was 4.1 years (±1.2 SD), and 64% of participants were female. The mean resting energy expenditure determined by indirect calorimetry was 51.5 kcal/kg (±7 SD). The most common gastrointestinal complaint before switching to the amino acid formula was constipation, which was reported in 12 of 14 (85%) patients, of which 10 of the 12 (83%) children required daily stool softeners/laxatives to help regulate bowel function. After 8 weeks on the amino acid formula, 10 out of 12 (83%) children stopped or reduced constipation medication. CONCLUSION Children with SMA type I who display gastrointestinal symptoms such as constipation and reflux may benefit from an amino acid formula that is fortified with probiotics.
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Affiliation(s)
- Graeme O'Connor
- Dietetic Department, Great Ormond Street Hospital Foundation Trust, London, UK
| | - Lisa Edel
- Physiotherapy Department, Great Ormond Street Hospital Foundation Trust, London, UK
| | - Sarah Raquq
- Developmental Neuroscience Research & Teaching Department, Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, NHS Foundation Trust, London, UK
| | - Melissa Bowerman
- School of Medicine, Keele University, Keele, Staffordshire, UK.,Wolfson Centre for Inherited Neuromuscular Disease, Oswestry, Shropshire, UK
| | - Agnieszka Szmurlo
- Dietetic Department, Great Ormond Street Hospital Foundation Trust, London, UK
| | - Zoe Simpson
- Dietetic Department, Great Ormond Street Hospital Foundation Trust, London, UK
| | - Isobel Hardy
- Dietetic Department, Great Ormond Street Hospital Foundation Trust, London, UK
| | - Mary Fewtrell
- Population, Policy & Practice Department, UCL Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, London, UK
| | - Giovanni Baranello
- Developmental Neuroscience Research & Teaching Department, Dubowitz Neuromuscular Centre, UCL Great Ormond Street Institute of Child Health, NHS Foundation Trust, London, UK
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16
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Wang W, Feng Y, Long Q, Chen F, Chen Y, Ma M, Mao S. A comparative analysis of body composition assessment by BIA and DXA in children with type II and III spinal muscular atrophy. Front Neurol 2022; 13:1034894. [PMID: 36468044 PMCID: PMC9715747 DOI: 10.3389/fneur.2022.1034894] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 10/27/2022] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Body composition analysis is a valuable tool for assessing and monitoring the nutritional status of children with spinal muscular atrophy (SMA). This study was designed to compare the consistency of bioelectrical impedance analysis (BIA) and dual-energy X-ray absorptiometry (DXA), as the gold standard method for assessing body composition in clinical practice when treating children with type II and III SMA. METHODS From 2019 to 2021, we performed a retrospective analysis of body composition by DXA and BIA measurement methods in patients with type II and III SMA treated at a Chinese tertiary children's hospital. Fat mass (FM), muscle mass (MM), bone mineral content (BMC), and visceral fat area (VFA) were compared using paired sample t-tests. We calculated Lin's concordance correlation coefficient (CCC) and Spearman correlation coefficient to verify the correlation between DXA and BIA measurements. Bland-Altman analysis was used to assess the consistency of the two methods. RESULTS Fifty-seven children with type II and III SMA were recruited. Compared with body composition measured by DXA, the average FM measured by BIA is significantly lower (P <0.001), whereas the average MM, BMC, and VFA measured by BIA are significantly higher (P < 0.001) in children with SMA. Overall, the difference between MM (Delta [BIA-DAX] = 1.6 kg) and FM (Delta [BIA-DAX] = -1.6 kg) measured by DXA and BIA was minor, whereas the difference of VFA (Delta [BIA-DAX] = -43.5 cm) was significantly large. Correlation analysis indicated a substantial correlation of MM (CCC = 0.96 [95% confidence interval (CI) = 0.93-0.98], r = 0.967 [P < 0.0001]) and FM (CCC = 0.95 [95% CI = 0.92-0.97], r = 0.953 [P < 0.0001]), and poor correlation of BMC (CCC = 0.61 [95% CI = 0.42-0.75], r = 0.612 [P < 0.0001]) and VFA (CCC = 0.54 [95% CI = 0.33-0.70], r = 0.689 [P < 0.0001]) measurements between the two methods. The Bland-Altman analysis suggests that the majority of participants were within LOA. In addition, differences in MM and VFA measurements between BIA and DAX increased according to patients' increasing height, whereas differences in FM and BMC did not differ with height. CONCLUSION BIA overestimates MM and underestimates the FM, BMC, and VFA in children with SMA compared with DXA measurements. Overall, the non-invasive, easy-to-use, and repeatable BIA measurements were found to be in good agreement with DXA measurements, especially for FM and MM, which are essential parameters for the nutritional evaluation of children with SMA.
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Affiliation(s)
- Wenqiao Wang
- Department of Clinical Nutrition, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yijie Feng
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Qi Long
- Department of Clinical Nutrition, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Fei Chen
- Department of Clinical Nutrition, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yuzhi Chen
- Department of Clinical Nutrition, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Ming Ma
- Department of Clinical Nutrition, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Shanshan Mao
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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17
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Darras BT, Guye S, Hoffart J, Schneider S, Gravestock I, Gorni K, Fuerst-Recktenwald S, Scalco RS, Finkel RS, De Vivo DC. Distribution of weight, stature, and growth status in children and adolescents with spinal muscular atrophy: An observational retrospective study in the United States. Muscle Nerve 2022; 66:84-90. [PMID: 35385150 PMCID: PMC9325433 DOI: 10.1002/mus.27556] [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: 03/02/2021] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 11/10/2022]
Abstract
Introduction/Aims Data regarding weight, height/length, and growth status of patients with spinal muscular atrophy (SMA) who have received only supportive care are limited. This cross‐sectional study describes these measurements in patients with Type 1 and Types 2/3 SMA and compares them with reference values from typically developing children. Methods Retrospective baseline data from three sites in the Pediatric Neuromuscular Clinical Research Network (Boston, New York, Philadelphia) were used. Descriptive statistics for weight, height/length, body mass index‐for‐age, as well as weight‐for‐length and absolute and relative deviations from reference values (ie, 50th percentile from World Health Organization/Centers for Disease Control growth charts) were calculated. Furthermore, growth status was reported. Results A total of 91 genetically confirmed patients with SMA receiving optimal supportive care and without any disease‐modifying treatment were stratified into Types 1 (n = 28) and 2/3 SMA (n = 63). Patients with Type 1 SMA weighed significantly less (median = −7.5%) compared with reference values and patients with Types 2/3 SMA were significantly shorter (mean = −3.0%) compared with reference values. The median weight was considerably below the 50th percentile in both groups of patients, even if they received a high standard of care and proactive feeding support. Discussion More research is needed to understand which factors influence growth longitudinally, and how to accurately capture growth in patients with SMA. Further research should investigate the best time to provide feeding support to avoid underweight, especially in patients with Type 1, and how to avoid the risk of overfeeding, especially in patients with Types 2/3 SMA.
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Affiliation(s)
- Basil T Darras
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | - Ksenija Gorni
- PDMA, Neuroscience and Rare Disease, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | | | - Renata S Scalco
- Pharma Development Neurology, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Richard S Finkel
- Center for Experimental Neurotherapeutics, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Darryl C De Vivo
- Departments of Neurology and Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
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18
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Detering NT, Zambon A, Hensel N, Kothary R, Swoboda K, Gillingwater TH, Baranello G. 264th ENMC International Workshop: Multi-system involvement in Spinal Muscular Atrophy Hoofddorp, The Netherlands, November 19th – 21th 2021. Neuromuscul Disord 2022; 32:697-705. [DOI: 10.1016/j.nmd.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 06/16/2022] [Indexed: 11/24/2022]
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19
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Ferrantini G, Coratti G, Onesimo R, Lucibello S, Bompard S, Turrini I, Cicala G, Caprarelli M, Pera MC, Bravetti C, Berti B, Giorgio V, Bruno C, Brolatti N, Panicucci C, D’Amico A, Longo A, Leoni C, Sansone VA, Albamonte E, Messina S, Sframeli M, Bertini E, Pane M, Mercuri E. Body mass index in type 2 spinal muscular atrophy: a longitudinal study. Eur J Pediatr 2022; 181:1923-1932. [PMID: 35048179 PMCID: PMC9056453 DOI: 10.1007/s00431-021-04325-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/09/2021] [Accepted: 11/19/2021] [Indexed: 11/03/2022]
Abstract
UNLABELLED The aim of this retrospective study was to review body mass index (BMI) in a large cohort of Italian pediatric type 2 spinal muscular atrophy (SMA) patients, aged between 0 and 20 years and to establish possible differences in relation to a number of variables such as ventilation, motor function, and survival motor neuron 2 gene copies. Cross-sectional data were collected from 102 patients for a total of 344 visits. Standard growth charts for height and weight were used as reference, with age adjusted BMI calculated using the Center for Disease and Prevention Children's BMI Tool. In the 344 visits, weight ranged between 3.90 and 83 kg, and the BMI between 8.4 and 31.6 with a BMI/age z-scores < - 2SD present in 28% and BMI/age z-scores > + 2SD in 9% of the measurements. The BMI/age z-scores were relatively stable < 5 years of age with an increasing number of patients < - 2SD after the age of 5, and a wider range of BMI/age z-scores after the age of 13. A difference on the BMI/age z-scores was found among the different age subgroups (< 5, 5-12, ≥ 13 years). A multivariate analysis in 58 patients with longitudinal assessments showed that baseline BMI/age z-scores and gender were significantly contributing to the changes while other variables were not. CONCLUSION Our results confirm that careful surveillance of weight and BMI/age z-scores is needed in type 2 SMA. Further studies, including assessments of chewing and swallowing and of lean/fat body mass, will help to better understand the possible mechanisms underlying weight issues. WHAT IS KNOWN • Feeding difficulties have been reported in a few studies and were invariably found in patients with type 1 SMA. • Type 2 SMA patients often have low BMI with a relevant number of patients requiring tube feeding. WHAT IS NEW • Reduction in BMI/age z-score overtime appeared to depend on baseline BMI/age z-score and gender. • Patients with a low BMI/age z-score were at higher risk of developing further reduction.
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Affiliation(s)
- Gloria Ferrantini
- grid.8142.f0000 0001 0941 3192Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy ,grid.477103.6Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giorgia Coratti
- grid.8142.f0000 0001 0941 3192Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy ,grid.477103.6Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Roberta Onesimo
- grid.414603.4Pediatric Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Simona Lucibello
- grid.8142.f0000 0001 0941 3192Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy ,grid.477103.6Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Sarah Bompard
- grid.8142.f0000 0001 0941 3192Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ida Turrini
- grid.8142.f0000 0001 0941 3192Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Graziamaria Cicala
- grid.8142.f0000 0001 0941 3192Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Michela Caprarelli
- grid.8142.f0000 0001 0941 3192Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Carmela Pera
- grid.8142.f0000 0001 0941 3192Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy ,grid.477103.6Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Chiara Bravetti
- grid.8142.f0000 0001 0941 3192Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy ,grid.477103.6Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Beatrice Berti
- grid.477103.6Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Valentina Giorgio
- grid.414603.4Pediatric Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudio Bruno
- grid.419504.d0000 0004 1760 0109Center of Experimental and Translational Myology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Noemi Brolatti
- grid.419504.d0000 0004 1760 0109Center of Experimental and Translational Myology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Chiara Panicucci
- grid.419504.d0000 0004 1760 0109Center of Experimental and Translational Myology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Adele D’Amico
- grid.414125.70000 0001 0727 6809Unit of Neuromuscular and Neurodegenerative Disorders, Department of Neurosciences, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Antonella Longo
- grid.414125.70000 0001 0727 6809Unit of Neuromuscular and Neurodegenerative Disorders, Department of Neurosciences, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Chiara Leoni
- grid.414603.4Pediatric Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valeria A. Sansone
- Neurorehabilitation Unit, University of Milan, Neuromuscular Omnicentre Clinical Center, Niguarda Hospital, Milan, Italy
| | - Emilio Albamonte
- Neurorehabilitation Unit, University of Milan, Neuromuscular Omnicentre Clinical Center, Niguarda Hospital, Milan, Italy
| | - Sonia Messina
- grid.10438.3e0000 0001 2178 8421Department of Clinical and Experimental Medicine and Centro Clinico Nemo Sud, University of Messina, Messina, Italy
| | - Maria Sframeli
- grid.10438.3e0000 0001 2178 8421Department of Clinical and Experimental Medicine and Centro Clinico Nemo Sud, University of Messina, Messina, Italy
| | - Enrico Bertini
- grid.414125.70000 0001 0727 6809Unit of Neuromuscular and Neurodegenerative Disorders, Department of Neurosciences, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Marika Pane
- grid.8142.f0000 0001 0941 3192Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy ,grid.477103.6Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Eugenio Mercuri
- Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy. .,Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
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