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Karaa A, Johnson N, Clarkson I, Newman W, Dorenbaum A, Cohen BH. Characterization of Fatigue in Primary Mitochondrial Myopathies: Findings From a Qualitative Interview Study. Neurol Clin Pract 2024; 14:e200229. [PMID: 38229875 PMCID: PMC10790285 DOI: 10.1212/cpj.0000000000200229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 11/04/2023] [Indexed: 01/18/2024]
Abstract
Background and Objectives Primary mitochondrial myopathies are genetic disorders that primarily affect peripheral skeletal muscles. Patients with primary mitochondrial myopathies often experience muscle weakness, fatigue, and other significant impacts on health-related quality of life. The aim of this noninterventional qualitative study was to collect the most bothersome fatigue-related symptoms and impacts reported by patients with primary mitochondrial myopathies and determine whether the questions included in an existing patient-reported outcome measure, the Modified Fatigue Impact Scale, are relevant and interpretable for this population. Methods The interviews contained a concept elicitation exercise to understand the most bothersome primary mitochondrial myopathies symptoms and impacts and a cognitive debriefing section to review the questions included in the Modified Fatigue Impact Scale for relevance and interpretability. Transcripts were coded using ATLAS.ti software. Results Interviews were conducted with 16 patients who were aged 16 years and older with a genetically confirmed and clinical diagnosis of symptomatic primary mitochondrial myopathies. Concept elicitation interviews established that while patients with mitochondrial myopathies reported a wide variety of symptoms and impacts, one of the most impactful symptoms discussed was fatigue. Cognitive debriefing interview results confirmed that the Modified Fatigue Impact Scale items were relevant, were interpretable, and largely captured patients' experience with fatigue. Discussion Fatigue was one of the most widely discussed experiences discussed by participants and was considered the most important symptom/impact to treat by most of the participants. The Modified Fatigue Impact Scale could be used in future clinical trials to measure treatment benefit in fatigue-related impacts.
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Affiliation(s)
- Amel Karaa
- Division of Genetics (AK), Massachusetts General Hospital, Pediatric Department, Harvard Medical School; Endpoint Outcomes (NJ, IC), Boston, MA; Reneo Pharmaceuticals, Inc (WN, AD), San Diego, CA; and Akron Children's Hospital (BHC), Department of Pediatrics and Integrative Medical Sciences, Northeast Ohio Medical University
| | - Nathan Johnson
- Division of Genetics (AK), Massachusetts General Hospital, Pediatric Department, Harvard Medical School; Endpoint Outcomes (NJ, IC), Boston, MA; Reneo Pharmaceuticals, Inc (WN, AD), San Diego, CA; and Akron Children's Hospital (BHC), Department of Pediatrics and Integrative Medical Sciences, Northeast Ohio Medical University
| | - Ian Clarkson
- Division of Genetics (AK), Massachusetts General Hospital, Pediatric Department, Harvard Medical School; Endpoint Outcomes (NJ, IC), Boston, MA; Reneo Pharmaceuticals, Inc (WN, AD), San Diego, CA; and Akron Children's Hospital (BHC), Department of Pediatrics and Integrative Medical Sciences, Northeast Ohio Medical University
| | - Wendy Newman
- Division of Genetics (AK), Massachusetts General Hospital, Pediatric Department, Harvard Medical School; Endpoint Outcomes (NJ, IC), Boston, MA; Reneo Pharmaceuticals, Inc (WN, AD), San Diego, CA; and Akron Children's Hospital (BHC), Department of Pediatrics and Integrative Medical Sciences, Northeast Ohio Medical University
| | - Alejandro Dorenbaum
- Division of Genetics (AK), Massachusetts General Hospital, Pediatric Department, Harvard Medical School; Endpoint Outcomes (NJ, IC), Boston, MA; Reneo Pharmaceuticals, Inc (WN, AD), San Diego, CA; and Akron Children's Hospital (BHC), Department of Pediatrics and Integrative Medical Sciences, Northeast Ohio Medical University
| | - Bruce H Cohen
- Division of Genetics (AK), Massachusetts General Hospital, Pediatric Department, Harvard Medical School; Endpoint Outcomes (NJ, IC), Boston, MA; Reneo Pharmaceuticals, Inc (WN, AD), San Diego, CA; and Akron Children's Hospital (BHC), Department of Pediatrics and Integrative Medical Sciences, Northeast Ohio Medical University
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Chin HL, Lai PS, Tay SKH. A clinical approach to diagnosis and management of mitochondrial myopathies. Neurotherapeutics 2024; 21:e00304. [PMID: 38241155 PMCID: PMC10903095 DOI: 10.1016/j.neurot.2023.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/11/2023] [Indexed: 01/21/2024] Open
Abstract
This paper provides an overview of the different types of mitochondrial myopathies (MM), associated phenotypes, genotypes as well as a practical clinical approach towards disease diagnosis, surveillance, and management. nDNA-related MM are more common in pediatric-onset disease whilst mtDNA-related MMs are more frequent in adults. Genotype-phenotype correlation in MM is challenging due to clinical and genetic heterogeneity. The multisystemic nature of many MMs adds to the diagnostic challenge. Diagnostic approaches utilizing genetic sequencing with next generation sequencing approaches such as gene panel, exome and genome sequencing are available. This aids molecular diagnosis, heteroplasmy detection in MM patients and furthers knowledge of known mitochondrial genes. Precise disease diagnosis can end the diagnostic odyssey for patients, avoid unnecessary testing, provide prognosis, facilitate anticipatory management, and enable access to available therapies or clinical trials. Adjunctive tests such as functional and exercise testing could aid surveillance of MM patients. Management requires a multi-disciplinary approach, systemic screening for comorbidities, cofactor supplementation, avoidance of substances that inhibit the respiratory chain and exercise training. This update of the current understanding on MMs provides practical perspectives on current diagnostic and management approaches for this complex group of disorders.
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Affiliation(s)
- Hui-Lin Chin
- Division of Genetics and Metabolism, Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Poh San Lai
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Stacey Kiat Hong Tay
- Division of Genetics and Metabolism, Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore.
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