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García-Gutiérrez AS, Pérez-Padilla AE, Leon-Rojas JE, Ramos-Gonzales E, Ramírez I, Trujillo MB. Complicated Traumatic Nerve Injury Treated with Tendon Transfers in a Patient with Myotonic Dystrophy: First Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00135. [PMID: 34170885 DOI: 10.2106/jbjs.cc.21.00100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report a right-handed 37-year-old woman, with myotonic dystrophy type 1 (MD1), presenting with a posterior interosseus nerve injury because of a penetrating trauma in the right forearm. The tendon transfer technique was chosen based on tendon response and functionality of the arms during the surgery. The patient has been able return to her daily life activities with proper fine and gross motor control. CONCLUSION Despite tendon transfer surgery being a common technique for radial nerve palsy reconstruction, its use has not been extensively described in the literature in patients with muscular dystrophies such as MD1.
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Affiliation(s)
- Alex S García-Gutiérrez
- NeurALL Research Group, Medical School, Faculty of Health and Life Sciences, Universidad Internacional del Ecuador, Quito, Ecuador.,Plastic and Reconstructive Surgery Department, Hospital "Dr. Enrique Garcés," Quito, Ecuador
| | - Adriana E Pérez-Padilla
- Plastic and Reconstructive Surgery Department, Hospital "Dr. Enrique Garcés," Quito, Ecuador.,Plastic and Reconstructive Surgery Department, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Jose E Leon-Rojas
- NeurALL Research Group, Medical School, Faculty of Health and Life Sciences, Universidad Internacional del Ecuador, Quito, Ecuador
| | - Edison Ramos-Gonzales
- Plastic and Reconstructive Surgery Department, Hospital "Dr. Enrique Garcés," Quito, Ecuador.,Plastic and Reconstructive Surgery Department, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Iván Ramírez
- NeurALL Research Group, Medical School, Faculty of Health and Life Sciences, Universidad Internacional del Ecuador, Quito, Ecuador
| | - María B Trujillo
- Plastic and Reconstructive Surgery Department, Hospital "Dr. Enrique Garcés," Quito, Ecuador
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2
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Leonardis L. Peripheral neuropathy in patients with myotonic dystrophy type 2. Acta Neurol Scand 2017; 135:568-575. [PMID: 27401721 DOI: 10.1111/ane.12635] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Myotonic dystrophy type 2 (dystrophia myotonica type 2-DM2) is an autosomal dominant multi-organ disorder. The involvement of the peripheral nervous system was found in 25%-45% of patients with myotonic dystrophy type 1, although limited data are available concerning polyneuropathy in patients with DM2, which was the aim of this study with a thorough presentation of the cases with peripheral neuropathy. MATERIAL AND METHODS Patients with genetically confirmed DM2 underwent motor nerve conduction studies of the median, ulnar, tibial and fibular nerves and sensory nerve conduction studies of the median (second finger), ulnar (fifth finger), radial (forearm) and sural nerves. RESULTS Seventeen adult patients with DM2 participated in the study. Fifty-three percent (9/17) of our patients had abnormality of one or more attributes (latency, amplitude or conduction velocity) in two or more separate nerves. Four types of neuropathies were found: (i) predominantly axonal motor and sensory polyneuropathy, (ii) motor polyneuropathy, (iii) predominantly demyelinating motor and sensory polyneuropathy and (iv) mutilating polyneuropathy with ulcers. The most common forms are axonal motor and sensory polyneuropathy (29%) and motor neuropathy (18% of all examined patients). No correlations were found between the presence of neuropathy and age, CCTG repeats, blood glucose or HbA1C. CONCLUSIONS Peripheral neuropathy is common in patients with DM2 and presents one of the multisystemic manifestations of DM2.
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Affiliation(s)
- L. Leonardis
- Institute of Clinical Neurophysiology; University Medical Center Ljubljana; Ljubljana Slovenia
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3
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Banach M, Antczak J, Rola R. Association of peripheral neuropathy with sleep-related breathing disorders in myotonic dystrophies. Neuropsychiatr Dis Treat 2017; 13:133-140. [PMID: 28138246 PMCID: PMC5238763 DOI: 10.2147/ndt.s123908] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Myotonic dystrophy (DM) type 1 and type 2 are inherited diseases characterized by myotonia and myopathy. Additional symptoms include, among others, peripheral neuropathy and sleep-related breathing disorders (SRBDs). There is growing evidence for a complex association between DM1 and DM2, which was described in patients with diabetes mellitus and in the general population. In this study, we investigated whether there is an association between peripheral neuropathy and SRBDs also in the population of patients with DM. METHODS The study included 16 patients with DM1 (mean age, 37.9±14.1 years; 20-69 years) and eight patients with DM2 (mean age, 47.6±14.1 years; 20-65 years), who underwent a sensory and motor nerve conduction study (NCS) and diagnostic screening for SRBDs. In both groups, the NCS parameters were correlated with respiratory parameters. RESULTS In both groups, the amplitude of the ulnar sensory nerve action potential (SNAP) correlated with the mean arterial oxygen saturation (SaO2). In addition, in the DM2 group, the median SNAP correlated with the mean SaO2. In the DM1 group, the median SNAP and the distal motor latency (DML) of the ulnar nerve correlated with the apnea-hypopnea index, while the oxygen desaturation index correlated with the DML of the tibial nerve and with conduction velocity in the sural nerve. CONCLUSION Our results indicate a complex association between neuropathy and SRBDs in DM1 and DM2. Axonal degeneration may contribute to nocturnal hypoxemia and vice versa. Neuropathy may contribute to muscle weakness, which in turn may cause respiratory events.
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Affiliation(s)
| | | | - Rafał Rola
- First Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
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4
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Ghosh PS, Sorenson EJ. Use of Clinical and Electrical Myotonia to Differentiate Childhood Myopathies. J Child Neurol 2015; 30:1300-6. [PMID: 25637645 DOI: 10.1177/0883073814559646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 10/22/2014] [Indexed: 11/15/2022]
Abstract
We retrospectively reviewed 2030 childhood electromyograms performed over an 11-year period (2004-2014). Twenty children (1%) with myotonic discharges were identified and placed into 2 groups. Group A (electrical and clinical myotonia) comprised 9 children (8 with myotonia congenita and 1 with paramyotonia congenita); all of them had diffuse myotonic discharges without clinical weakness or elevated creatine kinase. Group B (electrical myotonia without clinical myotonia) comprised 11 children (4 with inflammatory myopathy; 3, congenital myopathy, 3, muscular dystrophy; and 1, congenital muscular dystrophy). Clinical weakness was demonstrated in all of them and elevated creatine kinase in 6; all had a myopathic electromyogram and scattered myotonic discharges. We conclude that myotonic discharges are a rare but characteristic spontaneous discharge identified during electrodiagnostic studies in children. The presence of electrical and clinical myotonia provides helpful clues to differentiate between various muscle disorders in children.
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Affiliation(s)
- Partha S Ghosh
- Department of Neurology, Mayo Clinic, Rochester, MN, USA Department of Neurology, Boston Children's Hospital, Boston, MA, USA
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5
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Nojszewska M, Łusakowska A, Szmidt-Salkowska E, Gaweł M, Lipowska M, Sułek A, Krysa W, Rajkiewicz M, Seroka A, Kaczmarek K, Kamińska AM. Peripheral nerve involvement in myotonic dystrophy type 2 - similar or different than in myotonic dystrophy type 1? Neurol Neurochir Pol 2015; 49:164-70. [PMID: 26048604 DOI: 10.1016/j.pjnns.2015.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 03/28/2015] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Multisystem manifestations of myotonic dystrophies type 1 (DM1) and 2 (DM2) are well known. Peripheral nerve involvement has been reported in DM1 but not in genetically confirmed DM2. The aim of our study was to assess peripheral nerve involvement in DM2 using nerve conduction studies and to compare these results with findings in DM1. METHODS We prospectively studied patients with genetically confirmed DM2 (n=30) and DM1 (n=32). All patients underwent detailed neurological examination and nerve conduction studies. RESULTS Abnormalities in electrophysiological studies were found in 26.67% of patients with DM2 and in 28.13% of patients with DM1 but the criteria of polyneuropathy were fulfilled in only 13.33% of patients with DM2 and 12.5% of patients with DM1. The polyneuropathy was subclinical, and no correlation was found between its presence and patient age or disease duration. CONCLUSIONS Peripheral nerves are quite frequently involved in DM2, but abnormalities meeting the criteria of polyneuropathy are rarely found. The incidence of peripheral nerve involvement is similar in both types of myotonic dystrophy.
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Affiliation(s)
- Monika Nojszewska
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Anna Łusakowska
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | | | - Małgorzata Gaweł
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland.
| | - Marta Lipowska
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Anna Sułek
- Department of Genetics, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Wioletta Krysa
- Department of Genetics, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Marta Rajkiewicz
- Department of Genetics, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Andrzej Seroka
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | | | - Anna M Kamińska
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
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6
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Correlation between distribution of muscle weakness, electrophysiological findings and CTG expansion in myotonic dystrophy. J Clin Neurosci 2013; 21:1123-6. [PMID: 24417793 DOI: 10.1016/j.jocn.2013.09.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Revised: 09/09/2013] [Accepted: 09/24/2013] [Indexed: 11/22/2022]
Abstract
Myotonic dystrophy type 1 (DM-1) is a multi-system disorder affecting the muscles, brain, cardiovascular system, endocrine system, eyes and skin. Diagnosis is made by clinical, electrodiagnostic and genetic studies. This study aimed to determine the correlation between CTG expansion and distribution of muscle weakness and clinical and electrophysiological findings. Genetically confirmed DM-1 patients presenting to Shariati Hospital between 2005 and 2011 were included in this study. Clinical, electrodiagnostic and genetic testing was performed and the correlation between CTG expansion and distribution of muscle weakness and clinical and electromyographic findings was studied. Thirty-three genetically confirmed DM-1 patients were enrolled. Myotonia, bifacial weakness and distal upper limb weakness were seen in all patients. Diabetes mellitus was found in one patient (3%), cardiac disturbance in eight (24.2%), cataracts in eight (24.2%), hypogonadism in five (15.2%), frontal baldness in 13 (39.4%), temporalis wasting in 14 (42.4%), temporomandibular joint disorder in seven (21.2%) and mental retardation in eight (24.2%). The mean number of CTG repeats, measured by Southern blot, was 8780 (range 500-15,833). A negative correlation was found between CTG expansion and age of onset. Temporalis wasting and mental retardation were positively correlated with CTG expansion. No relationship was found between weakness distribution, electromyographic findings, other systemic features and CTG expansion. In this study of DM-1 in Iran, we found a correlation between CTG expansion and age of onset, temporalis wasting and mental disability. No correlation between CTG expansion and electrodiagnostic and other clinical findings were detected.
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7
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Peric S, Stojanovic VR, Nikolic A, Kacar A, Basta I, Pavlovic S, Lavrnic D. Peripheral neuropathy in patients with myotonic dystrophy type 1. Neurol Res 2013; 35:331-5. [DOI: 10.1179/1743132812y.0000000144] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Stojan Peric
- Neurology ClinicClinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Ana Nikolic
- Neurology ClinicClinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Kacar
- Neurology ClinicClinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Basta
- Neurology ClinicClinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sanja Pavlovic
- Neurology ClinicClinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragana Lavrnic
- Neurology ClinicClinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
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8
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Gawel M, Szmidt-Salkowska E, Lusakowska A, Nojszewska M, Sulek A, Krysa W, Rajkiewicz M, Seroka A, Kaminska AM. Value of short exercise and short exercise with cooling tests in the diagnosis of myotonic dystrophies (DM1 AND DM2). Muscle Nerve 2013; 49:277-83. [DOI: 10.1002/mus.23908] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Malgorzata Gawel
- Department of Neurology; Medical University of Warsaw; Banacha 1A Warsaw 02-097 Poland
| | | | - Anna Lusakowska
- Department of Neurology; Medical University of Warsaw; Banacha 1A Warsaw 02-097 Poland
| | - Monika Nojszewska
- Department of Neurology; Medical University of Warsaw; Banacha 1A Warsaw 02-097 Poland
| | - Anna Sulek
- Department of Genetics; Institute of Psychiatry and Neurology; Warsaw Poland
| | - Wioletta Krysa
- Department of Genetics; Institute of Psychiatry and Neurology; Warsaw Poland
| | - Marta Rajkiewicz
- Department of Genetics; Institute of Psychiatry and Neurology; Warsaw Poland
| | - Andrzej Seroka
- Department of Neurology; Medical University of Warsaw; Banacha 1A Warsaw 02-097 Poland
| | - Anna M. Kaminska
- Department of Genetics; Institute of Psychiatry and Neurology; Warsaw Poland
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9
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Shah DU, Darras BT, Markowitz JA, Jones HR, Kang PB. The spectrum of myotonic and myopathic disorders in a pediatric electromyography laboratory over 12 years. Pediatr Neurol 2012; 47:97-100. [PMID: 22759684 DOI: 10.1016/j.pediatrneurol.2012.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 05/09/2012] [Indexed: 11/25/2022]
Abstract
This study assessed the spectrum of disorders associated with electrophysiologic myotonia in a pediatric electromyography laboratory. Records of 2234 patients observed in the Electromyography Laboratory at Boston Children's Hospital from 2000-2011 were screened retrospectively for electrophysiologic diagnoses of myotonia and myopathy. Based on electromyography, 11 patients manifested myotonic discharges alone, eight exhibited both myotonic discharges and myopathic motor unit potentials, and 54 demonstrated myopathic motor unit potentials alone. The final diagnoses of patients with myotonic discharges alone included myotonia congenita, paramyotonia congenita, congenital myopathy, and Pompe disease (acid maltase deficiency). The diagnoses of patients with both myotonic discharges and myopathic motor unit potentials included congenital myopathy and non-Pompe glycogen storage diseases. Myotonic discharges are rarely observed in a pediatric electromyography laboratory, but constitute useful findings when present. The presence or absence of concurrent myopathic motor unit potentials may help narrow the differential diagnosis further.
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Affiliation(s)
- Disha U Shah
- Electromyography Laboratory, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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10
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Peripheral neuropathy is linked to a severe form of myotonic dystrophy in transgenic mice. J Neuropathol Exp Neurol 2011; 70:678-85. [PMID: 21760538 DOI: 10.1097/nen.0b013e3182260939] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Myotonic dystrophy type 1 (DM1) is a multisystem disorder with a variable phenotype. The involvement of peripheral nerves in DM1 disease is controversial. The DM1 animal model DM300 transgenic mice that carry 350 to 500 CTG repeats express a mild DM1 phenotype but do not exhibit motor or sensory pathology. Here, we investigated the presence or absence of peripheral neuropathy in transgenic mice (DMSXL) that carry more than 1,300 CTG repeats and display a severe form of DM1. Electrophysiologic, histologic, and morphometric methods were used to investigate the structure and function of peripheral nerves. We observed lower compound muscle action potentials recorded from hind limb muscles and slowing of sciatic nerve conduction velocity in DMSXL versus control mice. Morphometric analyses showed an axonopathy and neuronopathy in the DMSXL mice characterized by a decrease in numbers of myelinated motor axons in sciatic nerve and in spinal cord motor neurons. Pathologic alterations in the structure of hind limb neuromuscular junctions were also detected in the DMSXL mice. These results suggest that peripheral neuropathy can be linked to a large CTG expansion and a severe form of DM1.
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11
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Hermans MCE, Faber CG, Vanhoutte EK, Bakkers M, De Baets MH, de Die-Smulders CEM, Merkies ISJ. Peripheral neuropathy in myotonic dystrophy type 1. J Peripher Nerv Syst 2011; 16:24-9. [PMID: 21504499 DOI: 10.1111/j.1529-8027.2011.00313.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Myotonic dystrophy 1 (DM1) is characterized by a wide range of clinical features. We aimed to verify the presence of peripheral nerve involvement in a large cohort of DM1 patients and to determine clinical consequences. A total of 93 patients underwent detailed neurological examination and nerve conduction studies. Additionally, balance impairment was assessed with the Berg Balance Scale and health status was evaluated with the SF-36 health survey. Sensory symptoms were not reported and mild sensory signs were found in six patients. Electrophysiological abnormalities consistent with a diagnosis of neuropathy were found in 16 patients (17%). Peripheral nerve involvement was significantly associated with decreased muscle strength (p = 0.001) and absence of Achilles-tendon reflexes (p = 0.003), but not with age or duration of neuromuscular symptoms. It had no significant effect on balance, mental or physical health. In conclusion, peripheral nerve involvement may be one of the multisystemic manifestations of DM1, but is usually subclinical. Other causes should be excluded when sensory symptoms or signs are severe.
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Affiliation(s)
- Mieke C E Hermans
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands.
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12
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Bae JS, Kim SG, Lim JC, Chung EJ, Kim OK. Peripheral nerve axon involvement in myotonic dystrophy type 1, measured using the automated nerve excitability test. J Clin Neurol 2011; 7:90-5. [PMID: 21779297 PMCID: PMC3131544 DOI: 10.3988/jcn.2011.7.2.90] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 12/23/2010] [Accepted: 12/23/2010] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose Primary involvement of the peripheral nerves in myotonic dystrophy type I (MyD1) is controversial. We investigated whether the involvement of peripheral nerves is a primary event of MyD1 or secondary to another complication such as diabetes mellitus (DM). Methods The subjects comprised 12 patients with MyD1, 12 with DM and no peripheral nerve involvement, and 25 healthy volunteers. We measured multiple excitability indices in the median motor axons. The strength-duration time constant was calculated from the duration-charge curve, the threshold electrotonus and current-threshold relationships were calculated from the sequential subthreshold current, and the recovery cycle was derived from double suprathreshold stimulation. Results The depolarizing and hyperpolarizing threshold electrotonus were significantly reduced and exhibited increased refractoriness in the MyD1 group compared with the DM and control groups. The SDTC, superexcitability, and subexcitability were not significantly altered in the MyD1 group. Conclusions The MyD1 group exhibited a depolarized axonal membrane potential. The significant differences in peripheral nerve excitability between the MyD1 group and the DM and normal control groups suggest that peripheral neuropathy is a primary event in MyD1 rather than a secondary complication of DM.
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Affiliation(s)
- Jong Seok Bae
- Department of Neurology, Inje University College of Medicine, Busan, Korea.
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13
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Young NP, Daube JR, Sorenson EJ, Milone M. Absent, unrecognized, and minimal myotonic discharges in myotonic dystrophy type 2. Muscle Nerve 2010; 41:758-62. [PMID: 20513102 DOI: 10.1002/mus.21615] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The purpose of this study was to describe the frequency of absent, unrecognized, or minimal myotonic discharges (MDs) in myotonic dystrophy type 2 (DM2). We performed a retrospective review of needle electromyography (EMG) data prior to genetic diagnosis in 49 DM2 patients at the Mayo Clinic. MDs were not reported on first or repeat EMG studies (n = 8) and not found in archived recordings of 4 patients (8%); archived EMG recordings (n = 4) confirmed the absence of MDs (n = 2), including 1 patient with normal insertional activity in all muscles, and misinterpretation of MDs as slow fibrillation potentials (n = 1) and complex repetitive discharge (CRD) activity (n = 1). Eight (16%) patients had minimal classic MDs with diffusely increased insertional activity, including waning-only MDs in all patients in this group with archived EMG recordings (n = 5). Diffuse MDs were found in 33 (67%) patients. Absent or minimal MDs do not exclude DM2. Over-reliance on diffuse MDs in patients who present with myopathy may lead to delay in genetic diagnosis of DM2.
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Affiliation(s)
- Nathan P Young
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.
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14
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Kurt S, Karaer H, Kaplan Y, Akat I, Battaloglu E, Eruslu D, Basak AN. Combination of myotonic dystrophy and hereditary motor and sensory neuropathy. J Neurol Sci 2009; 288:197-9. [PMID: 19846120 DOI: 10.1016/j.jns.2009.09.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Revised: 09/23/2009] [Accepted: 09/23/2009] [Indexed: 10/20/2022]
Abstract
Myotonic Dystrophy Type 1 (DM1) in combination with demyelinating neuropathy is very rare in literature. In this study, DM1 and demyelinating neuropathy were demonstrated clinically and electromyographically in a 43-year-old female patient from Turkey. In the patient an expanded CTG repeat in the Myotonic Dystrophy Protein Kinase (DMPK) gene was confirmed in combination with a duplication in the Charcot-Marie-Tooth Disease (CMT1A) gene. DM1 was also determined in her 25-year-old son.
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Affiliation(s)
- Semiha Kurt
- Gaziosmanpasa University, Medical Faculty, Department of Neurology, Tokat, Turkey.
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15
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Bae JS, Kim OK, Kim SJ, Kim BJ. Abnormalities of nerve conduction studies in myotonic dystrophy type 1: Primary involvement of nerves or incidental coexistence? J Clin Neurosci 2008; 15:1120-4. [DOI: 10.1016/j.jocn.2007.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2007] [Revised: 10/24/2007] [Accepted: 11/06/2007] [Indexed: 11/29/2022]
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Abstract
Inflammatory myopathies (IM) are a heterogeneous group of diseases characterized by immune-mediated damage to skeletal muscle. Sensory abnormalities are rare in patients with IM. We report two patients, one with dermatomyositis and the other with inclusion-body myositis, who presented with unexpected sensory abnormalities due to probable immune-mediated damage to dorsal root ganglia. We emphasize the importance of combined neuroimaging and neurophysiological assessment for proper diagnosis.
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Affiliation(s)
- Marcondes C França
- Department of Neurology, School of Medical Sciences, Campinas State University, Zeferino Vaz, Campinas, SP 13083-970, Brazil
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Logigian EL, Ciafaloni E, Quinn LC, Dilek N, Pandya S, Moxley RT, Thornton CA. Severity, type, and distribution of myotonic discharges are different in type 1 and type 2 myotonic dystrophy. Muscle Nerve 2007; 35:479-85. [PMID: 17230537 DOI: 10.1002/mus.20722] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
To characterize and compare electrical myotonia in myotonic dystrophy type 1 (DM1) and type 2 (DM2), 16 patients with genetically confirmed DM1 and 17 patients with DM2 underwent standardized concentric needle electromyography of deltoid, biceps, extensor digitorum communis, first dorsal interosseous, tensor fascia lata (TFL), vastus lateralis (VL), tibialis anterior, and thoracic paraspinal muscles. Eight needle insertions per muscle were made by electromyographers blinded to DM type who recorded the presence and type of myotonia (e.g., classic waxing-waning or less specific waning discharges). Manual muscle testing was performed by a physical therapist. Overall, myotonia was more elicitable in DM1 than DM2; only in VL and TFL was myotonia more elicitable in DM2 than DM1. The major type of myotonia was waxing-waning in DM1, and waning in DM2. Four DM2 (24%), but no DM1 patients had only waning myotonia. In the arms, myotonia was distally predominant in both DM1 and DM2. In the legs, it was distally predominant in DM1, but both proximal and distal in DM2. The severity of myotonia was positively correlated with muscle weakness and with the presence of waxing and waning discharges in DM1, but with neither in DM2. Thus, myotonia is qualitatively and quantitatively different in DM1 than DM2. Except for proximal leg muscles, myotonia is more evocable in DM1 than DM2. It tends to be waxing-waning in DM1 but waning in DM2, thus making electrodiagnosis of DM2 more challenging. Its severity correlates with muscle weakness and the presence of waxing-waning discharges in DM1 but not DM2.
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Affiliation(s)
- Eric L Logigian
- Neuromuscular Division, Department of Neurology, Box 673, 601 Elmwood Avenue, University of Rochester Medical Center, Rochester, New York 14642, USA.
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