Retrospective cohort study comparing the efficacy of prednisolone and deflazacort in children with muscular dystrophy: A 6 years' experience in a South Indian teaching hospital

Clinical practice with steroid therapy for Duchenne muscular dystrophy: An expert survey in Asia and Oceania

BACKGROUND

Several studies on clinical practice for Duchenne muscular dystrophy (DMD) have been conducted in Western countries. However, there have been only a few similar studies in Asia and Oceania. Here, we investigate the steroid therapy-related clinical practice for DMD among the local experts. In 2015, we conducted a DMD expert survey in Asia and Oceania to acquire information regarding patients with DMD and to assess current clinical practice with the cooperation of Asian and Oceanian Myology Centre, a neuromuscular disease research network.

RESULTS

We obtained survey responses from 87 out of 148 clinicians (62%) from 13 countries and regions. In China, 1385 DMD patients were followed-up by 5 respondent neurologists, and 84% were between 0 and 9 years of age (15% were 10-19 years, 1% > 19 years). While in Japan, 1032 patients were followed-up by 20 clinicians, and the age distribution was similar between the 3 groups (27% were 0-9 years, 35% were 10-19 years, 38% were >19 years). Most respondent clinicians (91%) were aware of DMD standard of care recommendations. Daily prednisolone/prednisone administration was used most frequently at initiation (N = 45, 64%). Inconsistent opinion on steroid therapy after loss of ambulation and medication for bone protection was observed.

CONCLUSIONS

Rare disease research infrastructures have been underdeveloped in many of Asian and Oceanian countries. In this situation, our results show the snapshots of current medical situation and clinical practice in DMD. For further epidemiological studies, expansion of DMD registries is necessary.

[Morphological characteristics of paravertebral muscles in patients with scoliosis caused by primaryprogressive muscular dystrophies]

OBJECTIVE

To identify the morphological features of paraspinal muscles in patients with spinal pathology caused by progressive muscular dystrophy.

SUBJECT AND METHODS

The Traumatologic-and-Orthopedic Department of Axial Skeleton Pathology examined patients with scoliotic spinal deformity due to muscular dystrophy: 1) severe Duchenne X-linked muscular dystrophy (n=7); 2) Erb-Roth's autosomal recessive muscular dystrophy (n=2); 3) Landouzy-Dejerine facioscapulohumeral muscular dystrophy (n=2). For histopathological analysis of paraspinal muscles, an excisional biopsy was performed in the region of the apex of the strain angle (the convex side), and the specimens were fixed with 10% neutral formalin. Paraffin sections were stained with hematoxylin and eosin according to the Van Gieson and Masson trichrome staining methods. The preparations were examined using an AxioScope.A1 stereo microscope and an AxioCam digital camera ('Carl Zeiss MicroImaging GmbH', Germany).

RESULTS

Sluggish moderate paraparesis and grade IV progressive neurogenic thoracolumbar scoliosis were predominant in the clinical picture of the disease. The muscle biopsy specimens were established to have muscle fiber profiles with lost polygonality, increased diameter variability, and centrally positioned or numerous internal nuclei (myophagy) and to be characterized by fiber contractures, fatty degeneration fields, interstitial fibrosis, and signs of axonopathy of intramuscular nerve conductors. The arterial blood vessels were spastic with fibrotic t. media and t. adventicia; the venous bed vessels were dilated, thin-walled, full-blooded, which causes blood corpuscle transudation and numerous hemorrhages.

CONCLUSION

The identified morphopathological characteristics of muscle tissue in patients with progressive muscular dystrophy are very similar. However, Duchenne muscular dystrophy is the most severe pathology, in which fatty degeneration and sclerotization of muscle tissue and perimysial vessels are most pronounced. To solve this problem, there is a need for the integration of geneticists, biochemists, molecular biologists, pharmacologists, and histologists.