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De T, Sharma P, Upilli B, Vivekanand A, Bari S, Sonakar AK, Srivastava AK, Faruq M. Spinocerebellar ataxia type 27B (SCA27B) in India: insights from a large cohort study suggest ancient origin. Neurogenetics 2024:10.1007/s10048-024-00770-y. [PMID: 38976084 DOI: 10.1007/s10048-024-00770-y] [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: 03/07/2024] [Accepted: 06/25/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND The ethnic diversity of India provides a unique opportunity to study the history of the origin of mutations of genetic disorders. Spinocerebellar ataxia type 27B (SCA27B), a recently identified dominantly inherited cerebellar disorder is caused by GAA-repeat expansions in intron 1 of Fibroblast Growth Factor 14 (FGF14). Predominantly reported in the European population, we aimed to screen this mutation and study the founder haplotype of SCA27B in Indian ataxia patients. METHODS We have undertaken screening of GAA repeats in a large Indian cohort of ~ 1400 uncharacterised ataxia patients and kindreds and long-read sequencing-based GAA repeat length assessment. High throughput genotyping-based haplotype analysis was also performed. We utilized ~ 1000 Indian genomes to study the GAA at-risk expansion alleles. FINDINGS We report a high frequency of 1.83% (n = 23) of SCA27B in the uncharacterized Indian ataxia cohort. We observed several biallelic GAA expansion mutations (n = 5) with younger disease onset. We observed a risk haplotype (AATCCGTGG) flanking the FGF14-GAA locus over a 74 kb region in linkage disequilibrium. We further studied the frequency of this risk haplotype across diverse geographical population groups. The highest prevalence of the risk haplotype was observed in the European population (29.9%) followed by Indians (21.5%). The observed risk haplotype has existed through ~ 1100 generations (~ 22,000 years), assuming a correlated genealogy. INTERPRETATION This study provides valuable insights into SCA27B and its Upper Paleolithic origin in the Indian subcontinent. The high occurrence of biallelic expansion is probably relevant to the endogamous nature of the Indian population.
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Affiliation(s)
- Tiyasha De
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, Mall road, New Delhi, 110007, India
| | - Pooja Sharma
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, Mall road, New Delhi, 110007, India
- Academy of Scientific and Innovative Research (AcSIR), Sector-19, Kamla Nehru Nagar, Ghaziabad, Uttar Pradesh, 201002, India
| | - Bharathram Upilli
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, Mall road, New Delhi, 110007, India
- Academy of Scientific and Innovative Research (AcSIR), Sector-19, Kamla Nehru Nagar, Ghaziabad, Uttar Pradesh, 201002, India
| | - A Vivekanand
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, Mall road, New Delhi, 110007, India
- Academy of Scientific and Innovative Research (AcSIR), Sector-19, Kamla Nehru Nagar, Ghaziabad, Uttar Pradesh, 201002, India
| | - Shreya Bari
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, Mall road, New Delhi, 110007, India
| | - Akhilesh Kumar Sonakar
- Neurology Department, Neuroscience Centre, All India Institute of Medical Sciences, Ansari Nagar, 110029, India
| | - Achal Kumar Srivastava
- Neurology Department, Neuroscience Centre, All India Institute of Medical Sciences, Ansari Nagar, 110029, India
| | - Mohammed Faruq
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, Mall road, New Delhi, 110007, India.
- Academy of Scientific and Innovative Research (AcSIR), Sector-19, Kamla Nehru Nagar, Ghaziabad, Uttar Pradesh, 201002, India.
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Ostojić S, Kovačević G, Meola G, Pešović J, Savić-Pavićević D, Brkušanin M, Kravljanac R, Perić M, Martić J, Pejić K, Ristić S, Perić S. Main features and disease outcome of congenital myotonic dystrophy - experience from a single tertiary center. Neuromuscul Disord 2024; 40:16-23. [PMID: 38810326 DOI: 10.1016/j.nmd.2024.05.002] [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: 02/11/2024] [Revised: 04/05/2024] [Accepted: 05/08/2024] [Indexed: 05/31/2024]
Abstract
Congenital myotonic dystrophy type 1 (CDM1) is a rare neuromuscular disease. The aim of our study was to evaluate clinical variability of CDM1 and factors that may influence survival in CDM1. Research included 24 pediatric patients with CDM1. Most of our patients had some form of hypoxic ischemic encephalopathy (HIE) (74 %), from mild to severe. Prolonged and complicated deliveries (75 %), high percentage of children resuscitated at birth (57 %) and respiratory insufficiency (46 %) with consequent hypoxia were the main reasons that could explain high percentage of HIE. Therapeutic hypothermia was applied in three children with poor outcome. Median survival of all CDM1 was 14.2 ± 1.5 years. Six patients had a fatal outcome (25 %). Their mean age of death was 3.0 ± 2.8 years. Poor prognostic factors for the survival of our CDM1 patients were: preterm delivery, resuscitation at birth, severe HIE, hypothermia treatment and permanent mechanical ventilation. Respiratory insufficiency was the main life-threatening factor. Our data clearly indicates the need to develop natural history studies in CDM1 in order to enhance the standards of care and to develop clinical trials investigating causative therapies in pediatric patients with CDM1.
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Affiliation(s)
- Slavica Ostojić
- Neurology Department, Institute for Mother and Child Health Care of Serbia "Dr. Vukan Cupic", Faculty of Medicine, University of Belgrade, Serbia.
| | - Gordana Kovačević
- Neurology Department, Institute for Mother and Child Health Care of Serbia "Dr. Vukan Cupic", Faculty of Medicine, University of Belgrade, Serbia
| | - Giovanni Meola
- Department of Neurorehabilitation Sciences, Casa Di Cura Igea, Department of Biomedical Sciences for Health, University of Milan, Fondazione Malattie Miotoniche-FMM, Milan Italy
| | - Jovan Pešović
- University of Belgrade-Faculty of Biology, Center for Human Molecular Genetics, Belgrade, Serbia
| | - Dušanka Savić-Pavićević
- University of Belgrade-Faculty of Biology, Center for Human Molecular Genetics, Belgrade, Serbia
| | - Miloš Brkušanin
- University of Belgrade-Faculty of Biology, Center for Human Molecular Genetics, Belgrade, Serbia
| | - Ružica Kravljanac
- Neurology Department, Institute for Mother and Child Health Care of Serbia "Dr. Vukan Cupic", Faculty of Medicine, University of Belgrade, Serbia
| | - Marina Perić
- Nephrology Department, Institute for Mother and Child Health Care of Serbia "Dr. Vukan Cupic", Faculty of Medicine, University of Belgrade, Serbia
| | - Jelena Martić
- Intensive Care Unit, Institute for Mother and Child Health Care of Serbia "Dr. Vukan Cupic", Faculty of Medicine, University of Belgrade, Serbia
| | - Katarina Pejić
- Intensive Care Unit, Institute for Mother and Child Health Care of Serbia "Dr. Vukan Cupic", Faculty of Medicine, University of Belgrade, Serbia
| | - Snežana Ristić
- Intensive Care Unit, Institute for Mother and Child Health Care of Serbia "Dr. Vukan Cupic", Faculty of Medicine, University of Belgrade, Serbia
| | - Stojan Perić
- Neurology Clinic, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Serbia
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Wu Y, Wei Q, Lin J, Shang H, Ou R. Cognitive impairment, neuroimaging abnormalities, and their correlations in myotonic dystrophy: a comprehensive review. Front Cell Neurosci 2024; 18:1369332. [PMID: 38638300 PMCID: PMC11024338 DOI: 10.3389/fncel.2024.1369332] [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: 01/26/2024] [Accepted: 03/22/2024] [Indexed: 04/20/2024] Open
Abstract
Myotonic dystrophy (DM) encompasses a spectrum of neuromuscular diseases characterized by myotonia, muscle weakness, and wasting. Recent research has led to the recognition of DM as a neurological disorder. Cognitive impairment is a central nervous system condition that has been observed in various forms of DM. Neuroimaging studies have increasingly linked DM to alterations in white matter (WM) integrity and highlighted the relationship between cognitive impairment and abnormalities in WM structure. This review aims to summarize investigations into cognitive impairment and brain abnormalities in individuals with DM and to elucidate the correlation between these factors and the potential underlying mechanisms contributing to these abnormalities.
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Affiliation(s)
| | | | | | | | - Ruwei Ou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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4
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Ahmadpour‐kacho M, Pasha YZ, Pournajaf S. A couple of the first cousins born with hypotonia and maternal polyhydramnios. Clin Case Rep 2024; 12:e8503. [PMID: 38333661 PMCID: PMC10849984 DOI: 10.1002/ccr3.8503] [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: 11/25/2023] [Revised: 01/28/2024] [Accepted: 01/30/2024] [Indexed: 02/10/2024] Open
Abstract
Congenital myotonic dystrophy should be considered in hypotonic infants with polyhydramniotic mothers with a positive history of myotonia. Abstract Congenital myotonic dystrophy (CDM) is a predominantly maternally inherited disease and results from increased numbers of cytosine, thymine, and guanine (CTG) repeats in the unstable DNA regions and presents as hypotonia in the neonatal period and myotonia in adulthood. This report aims to present two cases of CDM. A first-cousin couple was born and hospitalized due to hypotonia at birth and a maternal history of polyhydramnios during this pregnancy. The first-born baby girl was admitted to the NICU with tachypnea and hypotonia, clubfoot, and frog-like posture. The pregnancy was complicated by polyhydramnios. Interestingly, her first cousin was born the next day with a similar picture and history. Myotonia was detected in their mothers. The concurrent presence of hypotonia and polyhydramnios as well as maternal myotonia in a first cousin should be considered CDM until proven otherwise and this was confirmed by the EMG- NCV test.
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Affiliation(s)
- Mousa Ahmadpour‐kacho
- Non‐Communicable Pediatric Diseases Research Center, Department of PediatricsBabol University of Medical SciencesBabolIran
- Non‐Communicable Pediatric Diseases Research Center, Department of PediatricsClinical Research Development Unit of Rouhani Hospital Babol University of Medical SciencesBabolIran
| | - Yadollah Zahed Pasha
- Non‐Communicable Pediatric Diseases Research Center, Department of PediatricsBabol University of Medical SciencesBabolIran
- Non‐Communicable Pediatric Diseases Research Center, Department of PediatricsClinical Research Development Unit of Rouhani Hospital Babol University of Medical SciencesBabolIran
| | - Samira Pournajaf
- Non‐Communicable Pediatric Diseases Research Center, Department of PediatricsBabol University of Medical SciencesBabolIran
- Non‐Communicable Pediatric Diseases Research Center, Department of PediatricsClinical Research Development Unit of Rouhani Hospital Babol University of Medical SciencesBabolIran
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Furlong P, Dugar A, White M. Patient engagement in clinical trial design for rare neuromuscular disorders: impact on the DELIVER and ACHIEVE clinical trials. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:1. [PMID: 38167117 PMCID: PMC10759564 DOI: 10.1186/s40900-023-00535-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Engaging individuals living with disease in drug development and regulatory processes leads to more thoughtful and sensitive trial designs, drives more informative and meaningful outcomes from clinical studies, and builds trust between the public, government, and industry stakeholders. This engagement is especially important in the case of rare diseases, where affected individuals and their families face many difficulties getting information, treatment, and support. Dyne Therapeutics is developing therapeutics for people with genetically-driven muscle diseases. During the development of potential treatments for Duchenne muscular dystrophy (DMD) and myotonic dystrophy type 1 (DM1), Dyne sought the opinions of individuals living with these diseases to inform its clinical trial design and to decrease the difficulties that participants and families might experience participating in them. METHODS Dyne engaged individuals and families living with DMD and DM1 as expert partners in its clinical development programs. Dyne convened panels of affected individuals and care partners/parents of individuals living with DMD (n = 8) or DM1 (n = 18). Workshops focused on how affected individuals and their families evaluate and select clinical trials for participation, the importance, quality, and burden associated with individual trial design elements, participation considerations such as site location and the study visit design, patient privacy, the suitability and scope of travel and participant support programs, and the accessibility of content in the informed consent (or assent) forms. Dyne also engaged the DMD Community Advisory Board (CAB) to collect feedback and advice on designing optimal and meaningful clinical trials and measuring relevant outcomes. RESULTS The issues most important to individuals living with DM1 and DMD regarding clinical trials were the ability to participate/access to the trial, perceptions of benefit and risk of trials and potential treatments, the flexibility of participation, clear communication from the sponsor, availability of information from trusted sources, and patient enrollment. In response to the patient advisory workshops and CAB feedback, Dyne refined clinical trial inclusion/exclusion criteria and clinic visit design, developed a travel service program to address the burden of clinical trial travel and enable long-distance and cross-border participation, planned for home visits when feasible, and allowed for adequate rest before clinic visit initiation and between assessments. Additionally, Dyne developed and implemented a transparent and consistent communications plan (including age-appropriate content) for trial participants and community members, and assessed and adjusted procedures to provide maximum participant comfort and lower anxiety, particularly with younger participants. CONCLUSIONS Ongoing communication with the Duchenne CAB and with DMD and DM1 patient advisory committee members allows Dyne to stay current with disease community perspectives and feedback on the needs and preferences of those affected and has provided valuable insights into the participant experience thereby helping Dyne initiate clinical trials that better meet the needs of affected individuals and their families.
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Affiliation(s)
- Patricia Furlong
- Parent Project Muscular Dystrophy, 1012 14th NW, Suite 500, Washington, DC, 20005, USA.
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Cascais I, Garrido C, Morais L, Amorim R, Lima R, Mansilha HF, Correia T, Oliveira A, Santos M. Myotonic dystrophy type 1 (Steinert disease): 29 years of experience at a tertiary pediatric hospital. Eur J Paediatr Neurol 2024; 48:85-90. [PMID: 38088012 DOI: 10.1016/j.ejpn.2023.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/19/2023] [Accepted: 12/03/2023] [Indexed: 03/23/2024]
Abstract
BACKGROUND Myotonic dystrophy type 1 (DM1) is a multisystemic disorder caused by the expansion of a noncoding triplet repeat. METHODS A cross-sectional study was performed to characterize pediatric patients with DM1 followed in a tertiary hospital over the last 29 years, comparing the congenital and the childhood/juvenile-onset forms. RESULTS Thirty-seven patients (59.5 % male) were included, with a median age at the latest assessment of 16.8 years and a median follow-up of 7.7 years. Eleven patients were lost to follow-up, and two died. Twenty-five had congenital DM1 (CDM1), and this form had significantly higher triplet repeat length, history of polyhydramnios, lower median age at diagnosis, and first and last assessment. Common symptoms included distal skeletal muscle weakness (75.7 %) and facial involvement (94.6 %), along with dysphonia/dysarthria (73.0 %) and myotonia (73.0 %). Delayed independent ambulation frequency was significantly higher for CDM1 cases. Skeletal deformities affected 54.1 %, with talipes equinovarus and scoliosis occurring exclusively in CDM1 patients. Cognitive deficit was present in 75.7 % of cases. Polysomnograms revealed seven cases of obstructive sleep apnea and two of hypoventilation. Noninvasive ventilation was used in nine cases, and three had recurrent respiratory infections. The cardiovascular system was affected in 21.6 % of cases. Gastrointestinal issues included constipation (24.3 %), feeding difficulties (16.2 %), and cholelithiasis (5.4 %). Cataracts, epilepsy, and diabetes mellitus were reported in two cases each. CONCLUSION Our study highlights the diverse spectrum of severity and multiorgan involvement of DM1 in pediatric patients. It underscores the importance of establishing a pediatric-specific standard of care to enhance health outcomes through comprehensive multidisciplinary management.
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Affiliation(s)
- Inês Cascais
- Department of Pediatrics, Centro Materno Infantil Do Norte (CMIN), Centro Hospitalar Universitário de Santo António (CHUdSA), Porto, Portugal.
| | - Cristina Garrido
- Multidisciplinary Pediatric Neuromuscular Diseases Team, CMIN, CHUdSA, European Reference Network for Rare Neuromuscular Diseases (EURO-NMD) Center, Porto, Portugal
| | - Lurdes Morais
- Multidisciplinary Pediatric Neuromuscular Diseases Team, CMIN, CHUdSA, European Reference Network for Rare Neuromuscular Diseases (EURO-NMD) Center, Porto, Portugal
| | - Rosa Amorim
- Multidisciplinary Pediatric Neuromuscular Diseases Team, CMIN, CHUdSA, European Reference Network for Rare Neuromuscular Diseases (EURO-NMD) Center, Porto, Portugal
| | - Rosa Lima
- Multidisciplinary Pediatric Neuromuscular Diseases Team, CMIN, CHUdSA, European Reference Network for Rare Neuromuscular Diseases (EURO-NMD) Center, Porto, Portugal
| | - Helena Ferreira Mansilha
- Multidisciplinary Pediatric Neuromuscular Diseases Team, CMIN, CHUdSA, European Reference Network for Rare Neuromuscular Diseases (EURO-NMD) Center, Porto, Portugal
| | - Teresa Correia
- Multidisciplinary Pediatric Neuromuscular Diseases Team, CMIN, CHUdSA, European Reference Network for Rare Neuromuscular Diseases (EURO-NMD) Center, Porto, Portugal
| | - António Oliveira
- Multidisciplinary Pediatric Neuromuscular Diseases Team, CMIN, CHUdSA, European Reference Network for Rare Neuromuscular Diseases (EURO-NMD) Center, Porto, Portugal
| | - Manuela Santos
- Multidisciplinary Pediatric Neuromuscular Diseases Team, CMIN, CHUdSA, European Reference Network for Rare Neuromuscular Diseases (EURO-NMD) Center, Porto, Portugal
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Pascoe JE, Zygmunt A, Ehsan Z, Gurbani N. Sleep in pediatric neuromuscular disorders. Semin Pediatr Neurol 2023; 48:101092. [PMID: 38065635 DOI: 10.1016/j.spen.2023.101092] [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: 08/14/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 12/18/2023]
Abstract
Sleep disordered breathing (SDB) is prevalent among children with neuromuscular disorders (NMD). The combination of respiratory muscle weakness, altered drive, and chest wall distortion due to scoliosis make sleep a stressful state in this population. Symptomatology can range from absent to snoring, nocturnal awakenings, morning headaches, and excessive daytime sleepiness. Sequelae of untreated SDB includes cardiovascular effects, metabolic derangements, and neurocognitive concerns which can be compounded by those innate to the NMD. The clinician should have a low threshold for obtaining polysomnography and recognize the nuances of individual disorders due to disproportionately impacted muscle groups such as hypoventilation in ambulating patients from diaphragm weakness. Non-invasive or invasive ventilation are the mainstay of treatment. In this review we explore the diagnosis and treatment of SDB in children with various NMD.
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Affiliation(s)
- John E Pascoe
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
| | - Alexander Zygmunt
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Zarmina Ehsan
- Division of Pulmonary and Sleep Medicine, Children's Mercy-Kansas City, Kansas City, MO, United States; Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States
| | - Neepa Gurbani
- Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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Chidambaram AG, Jhawar S, McDonald CM, Nandalike K. Sleep Disordered Breathing in Children with Neuromuscular Disease. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1675. [PMID: 37892338 PMCID: PMC10605855 DOI: 10.3390/children10101675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 10/29/2023]
Abstract
Sleep disordered breathing (SDB) in children with neuromuscular disease (NMD) is more prevalent compared to the general population, and often manifests as sleep-related hypoventilation, sleep-related hypoxemia, obstructive sleep apnea, central sleep apnea, and/or disordered control of breathing. Other sleep problems include, sleep fragmentation, abnormal sleep architecture, and nocturnal seizures in certain neuromuscular diseases. The manifestation of sleep disordered breathing in children depends on the extent, type, and progression of neuromuscular weakness, and in some instances, may be the first sign of a neuromuscular weakness leading to diagnosis of an NMD. In-lab diagnostic polysomnography (PSG) remains the gold standard for the diagnosis of sleep disordered breathing in children, but poses several challenges, including access to many children with neuromuscular disease who are non-ambulatory. If SDB is untreated, it can result in significant morbidity and mortality. Hence, we aimed to perform a comprehensive review of the literature of SDB in children with NMD. This review includes pathophysiological changes during sleep, clinical evaluation, diagnosis, challenges in interpreting PSG data using American Academy of Sleep (AASM) diagnostic criteria, management of SDB, and suggests areas for future research.
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Affiliation(s)
- Ambika G. Chidambaram
- Division of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, University of California, Davis, CA 95817, USA
| | - Sanjay Jhawar
- Division of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, University of California, Davis, CA 95817, USA
| | - Craig M. McDonald
- Department of Physical Medicine and Rehabilitation, University of California, Davis, CA 95817, USA
| | - Kiran Nandalike
- Division of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, University of California, Davis, CA 95817, USA
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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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Respiratory phenotypes of neuromuscular diseases: A challenging issue for pediatricians. Pediatr Neonatol 2023; 64:109-118. [PMID: 36682912 DOI: 10.1016/j.pedneo.2022.09.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 08/25/2022] [Accepted: 09/21/2022] [Indexed: 01/05/2023] Open
Abstract
Neuromuscular disease (NMDs) encompass a heterogeneous group of genetic disorders, with respiratory problems of variable intensity and progression described at any pediatric age, from infancy to adolescence, and they are largely associated with significant lifelong morbidity and high mortality. Restriction of breathing, impaired gas exchange, decline of lung function and sleep disordered breathing progressively develop because of muscular weakness and culminate in respiratory failure. Depending on the disease progression, airways manifestations can take weeks to months or even years to evolve, thus depicting two major respiratory phenotypes, characterized by rapid or slow progression to respiratory failure. Assessing type and age at onset of airways problems and their evolution over time can support pediatricians in the diagnostic assessment of NMD. In addition, knowing the characteristics of patients' respiratory phenotype can increase the level of awareness among neonatologists, geneticists, neurologists, pulmonologists, nutritionists, and chest therapists, supporting them in the challenging task of the multidisciplinary medical care of patients. In this review we examine the issues related to the pediatric respiratory phenotypes of NMD and present a novel algorithm that can act as a guide for the diagnostic agenda and the key preventive or therapeutic interventions of airways manifestations. With prolonged survival of children with NMD, the advent of neuromuscular respiratory medicine, including accurate assessment of the respiratory phenotype, will help physicians to determine patients' prognoses and to design studies for the evaluation of new therapies.
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11
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Ricci FS, Vacchetti M, Brusa C, D'Alessandro R, La Rosa P, Martone G, Davico C, Vitiello B, Mongini TE. Cognitive, neuropsychological and emotional-behavioural functioning in a sample of children with myotonic dystrophy type 1. Eur J Paediatr Neurol 2022; 39:59-64. [PMID: 35679764 DOI: 10.1016/j.ejpn.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/05/2021] [Accepted: 05/27/2022] [Indexed: 10/18/2022]
Abstract
AIM An observational longitudinal study to evaluate the feasibility of assessing cognitive, neuropsychological and emotional-behavioural functioning in children with myotonic dystrophy type 1 (DM1), and to estimate prospectively changes in functioning over time. METHOD Ten DM1 patients, aged 1.5-16 years (mean 9.1), 5 with congenital DM1, and 5 with childhood DM1, were assessed with standardized measures of intellectual, neuropsychological, and emotional-behavioural functioning. For 6 patients, assessments were repeated 2 years later. RESULTS At baseline, intellectual disability was found both in the congenital and the childhood group. A clear-cut reduction of the mean and individual developmental/intelligence quotient after 2 years was demonstrated in re-tested patients. As regards to the neuropsychological aspects, the baseline evaluation identified impairments in visuospatial skills and attentional functions, with no clear trend observed after two years. In executive functions, no significant profile was identified even though impairments were detected in a few patients. At the emotional-behavioural assessment, scores in clinical range were found, but they remained heterogeneous and no trends could be recognized. CONCLUSION Several aspects of CNS functions in DM1 children deserve better definition and a longitudinal assessment. A comprehensive protocol should include cognitive, neuropsychological, emotional and behavioural assessment but larger longitudinal studies are needed to better evaluate the trajectories over time and inform practice.
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Affiliation(s)
- Federica S Ricci
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Italy.
| | - Martina Vacchetti
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Italy
| | - Chiara Brusa
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Italy
| | - Rossella D'Alessandro
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Italy
| | - Paola La Rosa
- Section of Child and Adolescent Neuropsychiatry, Health District TO3, Turin, Italy
| | - Gianluca Martone
- Department of Public Health and Pediatric Sciences, Section of Pediatric, University of Turin, Italy
| | - Chiara Davico
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Italy
| | - Benedetto Vitiello
- Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Italy
| | - Tiziana E Mongini
- Department of Neuroscience, Section of Neurology 1, University of Turin, Italy
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12
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Braun M, Shoshani S, Teixeira J, Mellul Shtern A, Miller M, Granot Z, Fischer SE, Garcia SMA, Tabach Y. Asymmetric inheritance of RNA toxicity in C. elegans expressing CTG repeats. iScience 2022; 25:104246. [PMID: 35494247 PMCID: PMC9051633 DOI: 10.1016/j.isci.2022.104246] [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] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/01/2022] [Accepted: 04/07/2022] [Indexed: 11/18/2022] Open
Abstract
Nucleotide repeat expansions are a hallmark of over 40 neurodegenerative diseases and cause RNA toxicity and multisystemic symptoms that worsen with age. Through an unclear mechanism, RNA toxicity can trigger severe disease manifestation in infants if the repeats are inherited from their mother. Here we use Caenorhabditis elegans bearing expanded CUG repeats to show that this asymmetric intergenerational inheritance of toxicity contributes to disease pathogenesis. In addition, we show that this mechanism is dependent on small RNA pathways with maternal repeat-derived small RNAs causing transcriptomic changes in the offspring, reduced motility, and shortened lifespan. We rescued the toxicity phenotypes in the offspring by perturbing the RNAi machinery in the affected hermaphrodites. This points to a novel mechanism linking maternal bias and the RNAi machinery and suggests that toxic RNA is transmitted to offspring, causing disease phenotypes through intergenerational epigenetic inheritance. Maternal origin of expanded CUG repeats induces RNA toxicity in Caenorhabditis elegans offspring Offspring of affected hermaphrodites show molecular and phenotypic disease phenotypes The RNAi machinery is directly related to the maternal inheritance of RNA toxicity Altering the RNAi machinery in affected hermaphrodites rescues toxicity in offspring
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Affiliation(s)
- Maya Braun
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Shachar Shoshani
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Joana Teixeira
- Institute of Biotechnology, HiLIFE, University of Helsinki, Helsinki 00790 Finland
| | - Anna Mellul Shtern
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Maya Miller
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Zvi Granot
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Sylvia E.J. Fischer
- Division of Infectious Diseases, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Susana M.D. A. Garcia
- Institute of Biotechnology, HiLIFE, University of Helsinki, Helsinki 00790 Finland
- Corresponding author
| | - Yuval Tabach
- Department of Developmental Biology and Cancer Research, Institute for Medical Research Israel-Canada, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
- Corresponding author
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13
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Thomas MT, Shah S, Popat H, Hanna B, Jani P. Hypoglycaemia and myotonic dystrophy. J Paediatr Child Health 2022; 58:713-714. [PMID: 34184806 DOI: 10.1111/jpc.15633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/09/2021] [Accepted: 06/13/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Meryl T Thomas
- Neonatal Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia
| | - Swapnil Shah
- Neonatal intensive care unit, Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Himanshu Popat
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Grace Centre for Newborn Care, The Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Bernadette Hanna
- Clinical Genetics, The Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Pranav Jani
- Neonatal intensive care unit, Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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14
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Cellular Senescence and Aging in Myotonic Dystrophy. Int J Mol Sci 2022; 23:ijms23042339. [PMID: 35216455 PMCID: PMC8877951 DOI: 10.3390/ijms23042339] [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] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/06/2022] [Accepted: 02/12/2022] [Indexed: 01/10/2023] Open
Abstract
Myotonic dystrophy (DM) is a dominantly inherited multisystemic disorder affecting various organs, such as skeletal muscle, heart, the nervous system, and the eye. Myotonic dystrophy type 1 (DM1) and type 2 (DM2) are caused by expanded CTG and CCTG repeats, respectively. In both forms, the mutant transcripts containing expanded repeats aggregate as nuclear foci and sequester several RNA-binding proteins, resulting in alternative splicing dysregulation. Although certain alternative splicing events are linked to the clinical DM phenotypes, the molecular mechanisms underlying multiple DM symptoms remain unclear. Interestingly, multi-systemic DM manifestations, including muscle weakness, cognitive impairment, cataract, and frontal baldness, resemble premature aging. Furthermore, cellular senescence, a critical contributor to aging, is suggested to play a key role in DM cellular pathophysiology. In particular, several senescence inducers including telomere shortening, mitochondrial dysfunction, and oxidative stress and senescence biomarkers such as cell cycle inhibitors, senescence-associated secretory phenotype, chromatin reorganization, and microRNA have been implicated in DM pathogenesis. In this review, we focus on the clinical similarities between DM and aging, and summarize the involvement of cellular senescence in DM and the potential application of anti-aging DM therapies.
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15
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Rogers R, Moyer K, Moise KJ. Congenital Myotonic Dystrophy: An Overlooked Diagnosis Not Amenable to Detection by Sequencing. Prenat Diagn 2022; 42:233-235. [PMID: 35083764 DOI: 10.1002/pd.6105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To increase the clinical awareness of the need for genetic evaluation for congenital myotonic dystrophy in cases of fetal akinesia sequence and idiopathic polyhydramnios. METHODS Retrospective case review. RESULT A 27 y.o. G1P0 with no significant family history presented for ultrasound at 25 weeks gestation. Notable findings included lack of extension of the fetal arms and legs with bilateral talipes consistent with fetal akinesia sequence. Polyhydramnios with an amniotic fluid index of 32.2cm was also present. Amniotic fluid obtained by amniocentesis revealed normal results for a chromosomal microarray and a next generation sequencing panel for arthrogryposis. The patient underwent serial amnioreductions for recurrent severe polyhydramnios with removal of a total of 9.3 L. Further amniotic fluid testing for CDM1 identified >200 repeats in one copy of the fetal DMPK gene, consistent with a diagnosis of congenital myotonic dystrophy type 1. The patient was delivered at 35 weeks gestation and neonatal demise occurred on the second day of life. CONCLUSION Congenital myotonic dystrophy should be a consideration for cases of severe polyhydramnios identified on ultrasound. Myotonic dystrophy is detected using PCR and southern blot and is not typically included on next generation sequencing panels that test for similar conditions. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Rosemary Rogers
- From the Department of Women's Health, Dell Medical School - UT Health Austin, and the Comprehensive Fetal Center, Dell Children's Medical Center, Austin, Texas
| | - Kelly Moyer
- From the Department of Women's Health, Dell Medical School - UT Health Austin, and the Comprehensive Fetal Center, Dell Children's Medical Center, Austin, Texas
| | - Kenneth J Moise
- From the Department of Women's Health, Dell Medical School - UT Health Austin, and the Comprehensive Fetal Center, Dell Children's Medical Center, Austin, Texas
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16
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Ait Benichou S, Jauvin D, De Serres-Bérard T, Pierre M, Ling KK, Bennett CF, Rigo F, Gourdon G, Chahine M, Puymirat J. Antisense oligonucleotides as a potential treatment for brain deficits observed in myotonic dystrophy type 1. Gene Ther 2022; 29:698-709. [PMID: 35075265 PMCID: PMC9750879 DOI: 10.1038/s41434-022-00316-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/05/2022] [Accepted: 01/12/2022] [Indexed: 01/09/2023]
Abstract
Myotonic dystrophy, or dystrophia myotonica type 1 (DM1), is a multi-systemic disorder and is the most common adult form of muscular dystrophy. It affects not only muscles but also many organs, including the brain. Cerebral impairments include cognitive deficits, daytime sleepiness, and loss of visuospatial and memory functions. The expression of mutated transcripts with CUG repeats results in a gain of toxic mRNA function. The antisense oligonucleotide (ASO) strategy to treat DM1 brain deficits is limited by the fact that ASOs do not cross the blood-brain barrier after systemic administration, indicating that other methods of delivery should be considered. ASO technology has emerged as a powerful tool for developing potential new therapies for a wide variety of human diseases, and its potential has been proven in a recent clinical trial. Targeting DMPK mRNA in neural cells derived from human induced pluripotent stem cells obtained from a DM1 patient with the IONIS 486178 ASO abolished CUG-expanded foci, enabled nuclear redistribution of MBNL1/2, and corrected aberrant splicing. Intracerebroventricular injection of the IONIS 486178 ASO in DMSXL mice decreased the levels of mutant DMPK mRNAs by up to 70% throughout different brain regions. It also reversed behavioral abnormalities following neonatal administration. The present study indicated that the IONIS 486178 ASO targets mutant DMPK mRNAs in the brain and strongly supports the feasibility of a therapy for DM1 patients based on the intrathecal injection of an ASO.
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Affiliation(s)
- Siham Ait Benichou
- grid.23856.3a0000 0004 1936 8390LOEX, CHU de Québec-Université Laval Research Center, Quebec City, QC Canada
| | - Dominic Jauvin
- grid.23856.3a0000 0004 1936 8390LOEX, CHU de Québec-Université Laval Research Center, Quebec City, QC Canada ,grid.420732.00000 0001 0621 4067CERVO Research Center, Institut universitaire en santé mentale de Québec, Quebec City, QC Canada
| | - Thiéry De Serres-Bérard
- grid.23856.3a0000 0004 1936 8390LOEX, CHU de Québec-Université Laval Research Center, Quebec City, QC Canada ,grid.420732.00000 0001 0621 4067CERVO Research Center, Institut universitaire en santé mentale de Québec, Quebec City, QC Canada
| | - Marion Pierre
- grid.420732.00000 0001 0621 4067CERVO Research Center, Institut universitaire en santé mentale de Québec, Quebec City, QC Canada
| | - Karen K. Ling
- grid.282569.20000 0004 5879 2987Ionis Pharmaceuticals Inc., Carlsbad, CA USA
| | - C. Frank Bennett
- grid.282569.20000 0004 5879 2987Ionis Pharmaceuticals Inc., Carlsbad, CA USA
| | - Frank Rigo
- grid.282569.20000 0004 5879 2987Ionis Pharmaceuticals Inc., Carlsbad, CA USA
| | - Genevieve Gourdon
- grid.418250.a0000 0001 0308 8843Sorbonne Université, Inserm, Association Institut de Myologie, Centre de recherche en Myologie, Paris, France
| | - Mohamed Chahine
- grid.420732.00000 0001 0621 4067CERVO Research Center, Institut universitaire en santé mentale de Québec, Quebec City, QC Canada ,grid.23856.3a0000 0004 1936 8390Department of Medicine, Faculty of Medicine, Université Laval, Quebec City, QC Canada
| | - Jack Puymirat
- grid.23856.3a0000 0004 1936 8390LOEX, CHU de Québec-Université Laval Research Center, Quebec City, QC Canada ,grid.23856.3a0000 0004 1936 8390Department of Medicine, Faculty of Medicine, Université Laval, Quebec City, QC Canada
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17
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Brunet Garcia L, Hajra A, Field E, Wacher J, Walsh H, Norrish G, Manzur A, Muntoni F, Munot P, Robb S, Quinlivan R, Scoto M, Baranello G, Sarkozy A, Starling L, Kaski JP, Cervi E. Cardiac Manifestations of Myotonic Dystrophy in a Pediatric Cohort. Front Pediatr 2022; 10:910660. [PMID: 35757141 PMCID: PMC9218560 DOI: 10.3389/fped.2022.910660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED Myotonic dystrophy type 1 (DM1) is the most prevalent inherited neuromuscular dystrophy in adults. It is a multisystem disease with cardiac manifestations. Whilst these are well-defined in adults, there are scarce published data in the pediatric population. This study aimed to investigate the yield and progression of cardiac disease in pediatric DM1 patients, focusing on congenital DM1 (cDM1). METHODS A retrospective observational study of all pediatric DM1 patients referred to our center (December 2000-November 2020) was conducted. Patients were classified into DM1 forms according to age of symptom onset and disease severity. Patients underwent clinical and cardiac evaluation with 12-lead ECG, transthoracic echocardiography and 24-h ECG Holter monitoring. RESULTS 67 DM1 pediatric patients were included: 56 (83.6%) cDM1 and 11 (16.4%) non-cDM1. Median follow-up time of cDM1 patients was 8.0 [3.25-11.0] years. 49 (87.5%) cDM1 patients had baseline 12-lead ECG and 44 (78.6%) had a follow-up 12-lead-ECG, with a median follow-up time from diagnosis to baseline ECG of 2.8 [1.0-8.5] years and to follow-up ECG of 10.9 [5.7-14.2] years. Overall, 43 (87.8%) presented ECG abnormalities, most commonly in the form of asymptomatic conduction disease (n = 23, 46.9%), of which 21 (42.9%) had first degree atrioventricular block (1st AVB). There was an increase of prevalence from baseline to follow-up ECG in low QRS voltage (16.7%), poor R wave progression (13.9%), abnormal repolarisation (11.9%) and 1st AVB (7.6%). one patient (1.8%) underwent pacemaker implantation for syncope in the context of progressive conduction disease. No patients developed left ventricular systolic dysfunction. 4 (7.1%) cDM1 patients died during follow up, including three who died suddenly with no clear cause of death. CONCLUSIONS This study is the first to analyse the prevalence and progression of ECG abnormalities in cDM1 pediatric patients. The high prevalence of abnormal findings, progressive changes and number of potentially associated events (1 pacemaker implantation and 3 unexplained sudden deaths) stresses the importance of systematic and continued cardiac evaluation of these patients.
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Affiliation(s)
- Laia Brunet Garcia
- Hospital de Mataró, Barcelona, Spain.,Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Ankita Hajra
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Ella Field
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Joseph Wacher
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Helen Walsh
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Gabrielle Norrish
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Adnan Manzur
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Francesco Muntoni
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Pinki Munot
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Stephanie Robb
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | | | | | | | - Anna Sarkozy
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Luke Starling
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Juan Pablo Kaski
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
| | - Elena Cervi
- Great Ormond Street Hospital Children's Charity, London, United Kingdom
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18
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Chiou FK, Rizvi H, Quinlivan R, Gupte GL. Congenital Myotonic Dystrophy with Combined Heterozygous ATP8B1/ABCB4 Mutation Leading to Progressive Cholestasis and Liver Failure. JPGN REPORTS 2021; 2:e121. [PMID: 37206451 PMCID: PMC10191590 DOI: 10.1097/pg9.0000000000000121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/30/2021] [Indexed: 05/21/2023]
Abstract
Myotonic dystrophy (MyoD) is an inherited genetic disorder caused by the expansion of a CTG trinucleotide repeat in the dystrophia myotonica protein kinase gene. It manifests as a multisystem disease affecting not only skeletal muscles, but also heart, lung, eye, gastrointestinal tract, central nervous system, and endocrine system. However, MyoD is rarely associated with a progressive liver disorder. We report a case of congenital MyoD with combined heterozygous ATP8B1/ABCB4 mutation who developed chronic, progressive low gamma-glutamyltransferase cholestatic liver disease at early infancy, and eventually underwent successful liver transplantation.
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Affiliation(s)
- Fang Kuan Chiou
- From the Liver Unit (including small bowel transplantation), Birmingham Women’s and Children’s Hospital NHS Foundation Trust, Birmingham, UK
- Gastroenterology, Hepatology & Nutrition Service, Paediatric Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Hina Rizvi
- From the Liver Unit (including small bowel transplantation), Birmingham Women’s and Children’s Hospital NHS Foundation Trust, Birmingham, UK
| | - Ros Quinlivan
- MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK
| | - Girish L. Gupte
- From the Liver Unit (including small bowel transplantation), Birmingham Women’s and Children’s Hospital NHS Foundation Trust, Birmingham, UK
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19
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Myocardial and Arrhythmic Spectrum of Neuromuscular Disorders in Children. Biomolecules 2021; 11:biom11111578. [PMID: 34827576 PMCID: PMC8615674 DOI: 10.3390/biom11111578] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/02/2021] [Accepted: 10/14/2021] [Indexed: 12/30/2022] Open
Abstract
Neuromuscular disorders (NMDs) are highly heterogenous from both an etiological and clinical point of view. Their signs and symptoms are often multisystemic, with frequent cardiac involvement. In fact, childhood onset forms can predispose a person to various progressive cardiac abnormalities including cardiomyopathies (CMPs), valvulopathies, atrioventricular conduction defects (AVCD), supraventricular tachycardia (SVT) and ventricular arrhythmias (VA). In this review, we selected and described five specific NMDs: Friedreich’s Ataxia (FRDA), congenital and childhood forms of Myotonic Dystrophy type 1 (DM1), Kearns Sayre Syndrome (KSS), Ryanodine receptor type 1-related myopathies (RYR1-RM) and Laminopathies. These changes are widely investigated in adults but less researched in children. We focused on these specific topics due their relative frequency and their potential unexpected cardiac manifestations in children. Moreover these conditions present different inheritance patterns and mechanisms of action. We decided not to discuss Duchenne and Becker muscular dystrophies due to extensive work regarding the cardiac aspects in children. For each described NMD, we focused on the possible cardiac manifestations such as different types of CMPs (dilated-DCM, hypertrophic-HCM, restrictive-RCM or left ventricular non compaction-LVNC), structural heart abnormalities (including valvulopathies), and progressive heart rhythm changes (AVCD, SVT, VA). We describe the current management strategies for these conditions. We underline the importance, especially for children, of a serial multidisciplinary personalized approach and the need for periodic surveillance by a dedicated heart team. This is largely due to the fact that in children, the diagnosis of certain NMDs might be overlooked and the cardiac aspect can provide signs of their presence even prior to overt neurological diagnosis.
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20
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De Serres-Bérard T, Pierre M, Chahine M, Puymirat J. Deciphering the mechanisms underlying brain alterations and cognitive impairment in congenital myotonic dystrophy. Neurobiol Dis 2021; 160:105532. [PMID: 34655747 DOI: 10.1016/j.nbd.2021.105532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/24/2021] [Accepted: 10/11/2021] [Indexed: 12/13/2022] Open
Abstract
Myotonic dystrophy type 1 (DM1) is a multisystemic and heterogeneous disorder caused by the expansion of CTG repeats in the 3' UTR of the myotonic dystrophy protein kinase (DMPK) gene. There is a congenital form (CDM1) of the disease characterized by severe hypotonia, respiratory insufficiency as well as developmental delays and intellectual disabilities. CDM1 infants manifest important brain structure abnormalities present from birth while, in contrast, older patients with adult-onset DM1 often present neurodegenerative features and milder progressive cognitive deficits. Promising therapies targeting central molecular mechanisms contributing to the symptoms of adult-onset DM1 are currently in development, but their relevance for treating cognitive impairment in CDM1, which seems to be a partially distinct neurodevelopmental disorder, remain to be elucidated. Here, we provide an update on the clinical presentation of CDM1 and review recent in vitro and in vivo models that have provided meaningful insights on its consequences in development, with a particular focus on the brain. We discuss how enhanced toxic gain-of-function of the mutated DMPK transcripts with larger CUG repeats and the resulting dysregulation of RNA-binding proteins may affect the developing cortex in utero. Because the methylation of CpG islets flanking the trinucleotide repeats has emerged as a strong biomarker of CDM1, we highlight the need to investigate the tissue-specific impacts of these chromatin modifications in the brain. Finally, we outline promising potential therapeutic treatments for CDM1 and propose future in vitro and in vivo models with great potential to shed light on this disease.
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Affiliation(s)
- Thiéry De Serres-Bérard
- LOEX, CHU de Québec-Université Laval Research Center, Quebec City, Canada; CERVO Brain Research Center, Institut universitaire en santé mentale de Québec, Quebec City, Canada
| | - Marion Pierre
- CERVO Brain Research Center, Institut universitaire en santé mentale de Québec, Quebec City, Canada
| | - Mohamed Chahine
- CERVO Brain Research Center, Institut universitaire en santé mentale de Québec, Quebec City, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada.
| | - Jack Puymirat
- LOEX, CHU de Québec-Université Laval Research Center, Quebec City, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada
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21
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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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22
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Fujikawa H, Hayashi D, Saito M. Myotonic dystrophy type 1 presenting with grip myotonia and functional improvement after rehabilitation. BMJ Case Rep 2021; 14:e241552. [PMID: 33849876 PMCID: PMC8051416 DOI: 10.1136/bcr-2021-241552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Hirohisa Fujikawa
- Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- Department of Internal Medicine, Suwa Central Hospital, Chino, Nagano, Japan
| | - Daigo Hayashi
- Department of Internal Medicine, Suwa Central Hospital, Chino, Nagano, Japan
| | - Minoru Saito
- Department of Internal Medicine, Suwa Central Hospital, Chino, Nagano, Japan
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23
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Johnson C, Langbehn KE, Long JD, Moser D, Cross S, Gutmann L, Nopoulos PC, van der Plas E. Encoding of facial expressions in individuals with adult-onset myotonic dystrophy type 1. J Clin Exp Neuropsychol 2020; 42:932-940. [PMID: 33028165 DOI: 10.1080/13803395.2020.1826410] [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: 10/23/2022]
Abstract
Introduction: Emotional issues are often reported among individuals with myotonic dystrophy type 1 (DM1) and some studies have suggested that deficits in ability to quickly encode emotions may contribute to these problems. However, poor performance on emotion encoding tasks could also be explained by a more general cognitive deficit (Full Scale IQ [FSIQ]), rather than a specific deficit in emotional processing. Since individuals with DM1 are known to exhibit difficulties in general cognitive abilities, it is important to account for FSIQ when evaluating emotion encoding. The aim of this study was to compare emotion encoding abilities between individuals with and without DM1, while adjusting for the impact of general cognitive abilities (FSIQ). Methods: The sample included 35 individuals with adult-onset DM1 and 54 unaffected adults who completed assessments of emotion encoding abilities (Ekman faces test) and general cognitive abilities (Wechsler Adult Intelligence Scale-IV). Performance on the emotion encoding task was operationalized as proportion correct and response time. Group differences in proportion correct were evaluated with generalized linear regression, while linear regression models were used to determine the effect of group on response time. Models were adjusted for age, sex, and FSIQ. The false discovery rate (FDR) was applied to control false positives due to multiple comparisons (pfdr ). Results: No significant group differences were observed for emotion encoding abilities (all pfdr > 0.13). FSIQ was significantly associated with proportion correct and with response time (all pfdr < 0.05). Conclusions: Emotion encoding appears intact in individuals with DM1 and variation in the ability to encode facial expressions was associated with FSIQ. Further research is required to address the relationship between general cognitive abilities and emotion encoding abilities among DM1 patients.
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Affiliation(s)
- Claire Johnson
- Department of Psychiatry, University of Iowa Hospitals & Clinics , Iowa City, IA, USA
| | - Kathleen E Langbehn
- Department of Psychiatry, University of Iowa Hospitals & Clinics , Iowa City, IA, USA
| | - Jeffrey D Long
- Department of Psychiatry, University of Iowa Hospitals & Clinics , Iowa City, IA, USA.,Department of NeurologDepartment of Biostatistics, University of Iowa
| | - David Moser
- Department of Psychiatry, University of Iowa Hospitals & Clinics , Iowa City, IA, USA
| | - Stephen Cross
- Department of Psychiatry, University of Iowa Hospitals & Clinics , Iowa City, IA, USA
| | - Laurie Gutmann
- Department of Neurology, University of Iowa Hospitals & Clinics , Iowa City, IA, USA
| | - Peggy C Nopoulos
- Department of Psychiatry, University of Iowa Hospitals & Clinics , Iowa City, IA, USA
| | - Ellen van der Plas
- Department of Psychiatry, University of Iowa Hospitals & Clinics , Iowa City, IA, USA
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Mystery of Expansion: DNA Metabolism and Unstable Repeats. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1241:101-124. [PMID: 32383118 DOI: 10.1007/978-3-030-41283-8_7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The mammalian genome mostly contains repeated sequences. Some of these repeats are in the regulatory elements of genes, and their instability, particularly the propensity to change the repeat unit number, is responsible for 36 well-known neurodegenerative human disorders. The mechanism of repeat expansion has been an unsolved question for more than 20 years. There are a few hypotheses describing models of mutation development. Every hypothesis is based on assumptions about unusual secondary structures that violate DNA metabolism processes in the cell. Some models are based on replication errors, and other models are based on mismatch repair or base excision repair errors. Additionally, it has been shown that epigenetic regulation of gene expression can influence the probability and frequency of expansion. In this review, we consider the molecular bases of repeat expansion disorders and discuss possible mechanisms of repeat expansion during cell metabolism.
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Gutiérrez Gutiérrez G, Díaz-Manera J, Almendrote M, Azriel S, Eulalio Bárcena J, Cabezudo García P, Camacho Salas A, Casanova Rodríguez C, Cobo A, Díaz Guardiola P, Fernández-Torrón R, Gallano Petit M, García Pavía P, Gómez Gallego M, Gutiérrez Martínez A, Jericó I, Kapetanovic García S, López de Munaín Arregui A, Martorell L, Morís de la Tassa G, Moreno Zabaleta R, Muñoz-Blanco J, Olivar Roldán J, Pascual Pascual S, Peinado Peinado R, Pérez H, Poza Aldea J, Rabasa M, Ramos A, Rosado Bartolomé A, Rubio Pérez M, Urtizberea J, Zapata-Wainberg G, Gutiérrez-Rivas E. Guía clínica para el diagnóstico y seguimiento de la distrofia miotónica tipo 1, DM1 o enfermedad de Steinert. Neurologia 2020; 35:185-206. [DOI: 10.1016/j.nrl.2019.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/05/2019] [Indexed: 01/18/2023] Open
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Gutiérrez Gutiérrez G, Díaz-Manera J, Almendrote M, Azriel S, Eulalio Bárcena J, Cabezudo García P, Camacho Salas A, Casanova Rodríguez C, Cobo A, Díaz Guardiola P, Fernández-Torrón R, Gallano Petit M, García Pavía P, Gómez Gallego M, Gutiérrez Martínez A, Jericó I, Kapetanovic García S, López de Munaín Arregui A, Martorell L, Morís de la Tassa G, Moreno Zabaleta R, Muñoz-Blanco J, Olivar Roldán J, Pascual Pascual S, Peinado Peinado R, Pérez H, Poza Aldea J, Rabasa M, Ramos A, Rosado Bartolomé A, Rubio Pérez M, Urtizberea J, Zapata-Wainberg G, Gutiérrez-Rivas E. Clinical guide for the diagnosis and follow-up of myotonic dystrophy type 1, MD1 or Steinert's disease. NEUROLOGÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.nrleng.2019.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Patient Input to Inform the Development of Central Nervous System Outcome Measures in Myotonic Dystrophy. Ther Innov Regul Sci 2020; 54:1010-1017. [PMID: 31970692 PMCID: PMC7458891 DOI: 10.1007/s43441-020-00117-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/06/2019] [Indexed: 11/13/2022]
Abstract
Myotonic dystrophy type 1 (DM1) and myotonic dystrophy type 2 (DM2) are multisystem, genetic disorders caused by repeat expansions on chromosome 19 (DM1) and chromosome 3 (DM2). Although the effects of DM on the skeletal, cardiac, and smooth muscles, as well as the endocrine and central nervous systems, can be disabling, there are no disease-modifying therapies for the disorder. Following a process established by the US Food and Drug Administration (FDA) in 2012 known as the Patient-Focused Drug Development (PFDD) Initiative, Myotonic (formerly the Myotonic Dystrophy Foundation) has been conducting patient- and caregiver-inclusive sessions to explore disease burden as defined by patients and caregivers, and what affected individuals want most from potential new therapies. In September 2017, at Myotonic’s annual conference, a session titled “Bringing the Patient Voice to CNS-Targeting Drug Development in Myotonic Dystrophy” attracted some 350 members of the DM community. During the session, patients and caregivers described CNS disease symptoms, their impact on quality of life, and potential CNS-related targets that they considered important for drug development consideration. These included fatigue and daytime sleepiness; dysregulated sleep; cognitive deficits such as “brain fog,” memory and focus impairment, learning and attention difficulties, and time management challenges; emotional/psychological/behavioral difficulties, including impulsivity, apathy, antisocial behavior, personality changes, and depression; social difficulties, including disconnection, lack of awareness, and feelings of isolation; and general anxieties about the future and potential loss of independence. Improvements in memory and lessening of “brain fog” were considered particularly important.
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Gupta K, Kennelly MR, Siddappa AM. Congenital Myotonic Dystrophy and Brugada Syndrome: A Report of Two Cases. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e919867. [PMID: 31915326 PMCID: PMC6977606 DOI: 10.12659/ajcr.919867] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND Congenital myotonic dystrophy is a subtype of type 1 myotonic dystrophy presenting in the neonatal period. Cardiac involvement is commonly seen in patients with type 1 myotonic dystrophy beyond the neonatal period. Brugada syndrome is a conduction abnormality associated with a mutation in the sodium voltage-gated channel alpha subunit 5 (SCN5A) gene and has been described in adult patients with type 1 myotonic dystrophy. Two cases are presented of type 1 myotonic dystrophy in neonates, one who had family members with a confirmed diagnosis of Brugada syndrome. CASE REPORT Case 1: A female infant at 40 weeks gestational age, birth weight of 3,395 grams was born to a 40-year-old gravida 4, para 3 (G4P3) mother. The mother had previously been diagnosed with Brugada syndrome. Multiple family members were identified and diagnosed with type 1 myotonic dystrophy and Brugada syndrome. The infant is being monitored closely with a plan to perform genetic testing for Brugada syndrome if she develops cardiac conduction abnormalities. Case 2: A male infant at 37 weeks gestational age, with a birth weight of 2,900 grams, was born to a 24-year-old gravida 2, para 1 (G2P1) mother. He was admitted to the neonatal intensive care unit (NICU) secondary to poor respiratory effort and generalized hypotonia. Severe polyhydramnios was diagnosed during pregnancy. The mother had previously been diagnosed with type 1 myotonic dystrophy. CONCLUSIONS Infants with congenital myotonic dystrophy should be carefully monitored for both structural and conduction abnormalities of the heart, supported by genetic testing.
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Affiliation(s)
- Kunal Gupta
- Division of Neonatology, Department of Pediatrics, Hennepin County Medical Center (HCMC), Minneapolis, MN, USA
| | - Marie R Kennelly
- Department of Maternal-Fetal Medicine, Hennepin County Medical Center (HCMC), Minneapolis, MN, USA
| | - Ashajyothi M Siddappa
- Division of Neonatology, Department of Pediatrics, Hennepin County Medical Center (HCMC), Minneapolis, MN, USA
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Look at the cognitive deficits in patients with myotonic dystrophy type 1: an exploratory research on the effects of virtual reality. Int J Rehabil Res 2019; 43:90-94. [PMID: 31851022 DOI: 10.1097/mrr.0000000000000384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Myotonic dystrophy type 1 is a neuromuscular disease, characterized by a progressive loss of strength, muscle stiffness, and difficulty in relaxation. Myotonic dystrophy type 1 patients can present several neuropsychological deficits, as well as anxiety and mood disorders. Aim of this study is to evaluate the feasibility and the effect of virtual reality in the cognitive and behavioral recovery of myotonic dystrophy type 1 patients. Eleven patients (8 female and 3 male) underwent a specific cognitive rehabilitation program including a conventional neuropsychological treatment followed by a virtual reality neurorehabilitation training using the Virtual Reality Rehabilitation System (Khymeia, Italy). Virtual reality improved many cognitive domains, including executive function, attention, verbal and visuo-spatial abilities, as well as mood and coping strategies. Due to the high prevalence of neuropsychological symptoms in patients with myotonic dystrophy type 1, cognitive rehabilitation should enter into the framework of these patients to potentially boost cognitive and behavioral function and improve quality of life.
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Dosage effect of multiple genes accounts for multisystem disorder of myotonic dystrophy type 1. Cell Res 2019; 30:133-145. [PMID: 31853004 PMCID: PMC7015062 DOI: 10.1038/s41422-019-0264-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 11/09/2019] [Indexed: 12/19/2022] Open
Abstract
Multisystem manifestations in myotonic dystrophy type 1 (DM1) may be due to dosage reduction in multiple genes induced by aberrant expansion of CTG repeats in DMPK, including DMPK, its neighboring genes (SIX5 or DMWD) and downstream MBNL1. However, direct evidence is lacking. Here, we develop a new strategy to generate mice carrying multigene heterozygous mutations to mimic dosage reduction in one step by injection of haploid embryonic stem cells with mutant Dmpk, Six5 and Mbnl1 into oocytes. The triple heterozygous mutant mice exhibit adult-onset DM1 phenotypes. With the additional mutation in Dmwd, the quadruple heterozygous mutant mice recapitulate many major manifestations in congenital DM1. Moreover, muscle stem cells in both models display reduced stemness, providing a unique model for screening small molecules for treatment of DM1. Our results suggest that the complex symptoms of DM1 result from the reduced dosage of multiple genes.
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Recovery in the Myogenic Program of Congenital Myotonic Dystrophy Myoblasts after Excision of the Expanded (CTG) n Repeat. Int J Mol Sci 2019; 20:ijms20225685. [PMID: 31766224 PMCID: PMC6888582 DOI: 10.3390/ijms20225685] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 11/11/2019] [Indexed: 12/12/2022] Open
Abstract
The congenital form of myotonic dystrophy type 1 (cDM) is caused by the large-scale expansion of a (CTG•CAG)n repeat in DMPK and DM1-AS. The production of toxic transcripts with long trinucleotide tracts from these genes results in impairment of the myogenic differentiation capacity as cDM’s most prominent morpho-phenotypic hallmark. In the current in vitro study, we compared the early differentiation programs of isogenic cDM myoblasts with and without a (CTG)2600 repeat obtained by gene editing. We found that excision of the repeat restored the ability of cDM myoblasts to engage in myogenic fusion, preventing the ensuing myotubes from remaining immature. Although the cDM-typical epigenetic status of the DM1 locus and the expression of genes therein were not altered upon removal of the repeat, analyses at the transcriptome and proteome level revealed that early abnormalities in the temporal expression of differentiation regulators, myogenic progression markers, and alternative splicing patterns before and immediately after the onset of differentiation became normalized. Our observation that molecular and cellular features of cDM are reversible in vitro and can be corrected by repeat-directed genome editing in muscle progenitors, when already committed and poised for myogenic differentiation, is important information for the future development of gene therapy for different forms of myotonic dystrophy type 1 (DM1).
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Stokes M, Varughese N, Iannaccone S, Castro D. Clinical and genetic characteristics of childhood-onset myotonic dystrophy. Muscle Nerve 2019; 60:732-738. [PMID: 31520483 DOI: 10.1002/mus.26716] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 09/10/2019] [Accepted: 09/12/2019] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Myotonic dystrophy type 1 (DM1) is caused by a CTG (cytosine-thymine-guanine) trinucleotide repeat expansion. Congenital DM (CDM) presents in the first month of life, whereas individuals with infantile and juvenile DM1 have later onset of symptoms. METHODS We performed a retrospective chart review of patients with childhood-onset DM1 seen at one of three locations in Dallas, Texas between 1990 and 2018. Symptoms, disease course, cognitive features, and family history were reviewed. RESULTS Seventy-four patients were included; CDM was diagnosed in 52 patients. There was maternal inheritance in 74% of patients. CTG repeat number ranged from 143 to 2300. Neuropsychiatric and cognitive deficits were common. Over half of the patients had GI disturbances, and orthopedic complications were common. DISCUSSION Myotonic dystrophy type 1 in children requires a multidisciplinary approach to management. Presenting symptoms vary, and repeat expansion size does not necessarily directly relate to severity of symptoms. A consensus for outcome measures is required.
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Affiliation(s)
- Mathew Stokes
- Department of Pediatrics & Neurology, Division of Pediatric Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas.,Children's Medical Center Dallas, Dallas, Texas
| | - Natasha Varughese
- Department of Pediatrics & Neurology, Division of Pediatric Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas.,Children's Medical Center Dallas, Dallas, Texas
| | - Susan Iannaccone
- Department of Pediatrics & Neurology, Division of Pediatric Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas.,Children's Medical Center Dallas, Dallas, Texas
| | - Diana Castro
- Department of Pediatrics & Neurology, Division of Pediatric Neurology, The University of Texas Southwestern Medical Center, Dallas, Texas.,Children's Medical Center Dallas, Dallas, Texas
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Lanni S, Pearson CE. Molecular genetics of congenital myotonic dystrophy. Neurobiol Dis 2019; 132:104533. [PMID: 31326502 DOI: 10.1016/j.nbd.2019.104533] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/29/2019] [Accepted: 07/11/2019] [Indexed: 12/26/2022] Open
Abstract
Myotonic Dystrophy type 1 (DM1) is a neuromuscular disease showing strong genetic anticipation, and is caused by the expansion of a CTG repeat tract in the 3'-UTR of the DMPK gene. Congenital Myotonic Dystrophy (CDM1) represents the most severe form of the disease, with prenatal onset, symptoms distinct from adult onset DM1, and a high rate of perinatal mortality. CDM1 is usually associated with very large CTG expansions, but this correlation is not absolute and cannot explain the distinct clinical features and the strong bias for maternal transmission. This review focuses upon the molecular and epigenetic factors that modulate disease severity and might be responsible for CDM1. Changes in the epigenetic status of the DM1 locus and in gene expression have recently been observed. Increasing evidence supports a role of a CTCF binding motif as a cis-element, upstream of the DMPK CTG tract, whereby CpG methylation of this site regulates the interaction of the insulator protein CTCF as a modulating trans-factor responsible for the inheritance and expression of CDM1.
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Affiliation(s)
- Stella Lanni
- Program of Genetics & Genome Biology, The Hospital for Sick Children, The Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto M5G 0A4, Ontario, Canada
| | - Christopher E Pearson
- Program of Genetics & Genome Biology, The Hospital for Sick Children, The Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto M5G 0A4, Ontario, Canada; University of Toronto, Program of Molecular Genetics, Canada.
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Guía clínica para el diagnóstico y seguimiento de la distrofia miotónica tipo 1, DM1 o enfermedad de Steinert. Med Clin (Barc) 2019; 153:82.e1-82.e17. [DOI: 10.1016/j.medcli.2018.10.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/15/2018] [Accepted: 10/18/2018] [Indexed: 01/19/2023]
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Berggren KN, Hung M, Dixon MM, Bounsanga J, Crockett B, Foye MD, Gu Y, Campbell C, Butterfield RJ, Johnson NE. Orofacial strength, dysarthria, and dysphagia in congenital myotonic dystrophy. Muscle Nerve 2019; 58:413-417. [PMID: 29901230 PMCID: PMC6131032 DOI: 10.1002/mus.26176] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 04/24/2018] [Accepted: 05/21/2018] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Herein we present an exploratory study of orofacial function in children with congenital myotonic dystrophy (CDM) vs. healthy controls. METHODS We evaluated 41 children with CDM and 29 healthy controls for speech and swallow function and for lingual and labial strength. RESULTS The Iowa Oral Performance Instrument (IOPI), measuring tongue strength, and a lip force meter (LFM), measuring lip strength, had excellent interrater reliability with intraclass correlation coefficients (ICCs) of 0.75 (n = 19, P < 0.001) and 0.96 (n = 20, P < 0.001), respectively. Mean overall lingual strength was 3.5-fold less and labial strength was about 7-fold less in CDM patients than in healthy controls. Eighteen of 24 children with CDM demonstrated dysarthria and an additional 11 participants were nonverbal. Dysarthria correlated moderately with lingual strength, age, and dysphagia. Strength measures correlated moderately with dysphagia. DISCUSSION Children with CDM have impaired orofacial functioning that affects communication and swallowing. Reliability of strength measures may be useful for future therapeutic trials. Muscle Nerve 58: 413-417, 2018.
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Affiliation(s)
- Kiera N Berggren
- Department of Neurology, University of Utah, 15 North 2030 East, EIHG 2260, Salt Lake City, Utah, 84112, USA
| | - Man Hung
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Melissa M Dixon
- Department of Neurology, University of Utah, 15 North 2030 East, EIHG 2260, Salt Lake City, Utah, 84112, USA
| | - Jerry Bounsanga
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Becky Crockett
- Department of Neurology, University of Utah, 15 North 2030 East, EIHG 2260, Salt Lake City, Utah, 84112, USA
| | - Mary D Foye
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, Utah, USA
| | - Yushan Gu
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, USA
| | - Craig Campbell
- Children's Health Research Institute, University of Western Ontario, London, Ontario, Canada
| | - Russell J Butterfield
- Department of Neurology, University of Utah, 15 North 2030 East, EIHG 2260, Salt Lake City, Utah, 84112, USA.,Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Nicholas E Johnson
- Department of Neurology, University of Utah, 15 North 2030 East, EIHG 2260, Salt Lake City, Utah, 84112, USA
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D’Amico A, Bertini E. Neonatal Hypotonia. Neurology 2019. [DOI: 10.1016/b978-0-323-54392-7.00013-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Activation of the interferon type I response rather than autophagy contributes to myogenesis inhibition in congenital DM1 myoblasts. Cell Death Dis 2018; 9:1071. [PMID: 30341284 PMCID: PMC6195593 DOI: 10.1038/s41419-018-1080-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 12/16/2022]
Abstract
Congenital myotonic dystrophy type 1 (CDM1) is characterized by severe symptoms that affect patients from birth, with 40% mortality in the neonatal period and impaired skeletal muscle development. In this paper, we examined the relationship between autophagy and abnormal myogenic differentiation of CDM1 myoblasts. We investigated these pathological features at both ultrastructural and molecular levels, utilizing two CDM1 foetal myoblasts, CDM13 and CDM15, with 1800 and 3200 repeats, respectively. The congenital nature of these CDM1 myoblasts was confirmed by the high methylation level at the DMPK locus. Our results indicated that abnormal autophagy was independent of myogenic differentiation, as CDM13 myoblasts differentiated as well as control myoblasts but underwent autophagy like CDM15, displaying impaired differentiation. miRNA expression profiles revealed that CDM15 myoblasts failed to upregulate the complex network of myo-miRNAs under MYOD and MEF2A control, while this network was upregulated in CDM13 myoblasts. Interestingly, the abnormal differentiation of CDM15 myoblasts was associated with cellular stress accompanied by the induction of the interferon type 1 pathway (innate immune response). Indeed, inhibition of the interferon (IFN) type I pathway restores myogenic differentiation of CDM15 myoblasts, suggesting that the inappropriate activation of the innate immune response might contribute to impaired myogenic differentiation and severe muscle symptoms observed in some CDM1 patients. These findings open up the possibility of new therapeutic approaches to treat CDM1.
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Abstract
Myotonic dystrophy is an autosomal dominant muscular dystrophy not only associated with muscle weakness, atrophy, and myotonia but also prominent multisystem involvement. There are 2 similar, but distinct, forms of myotonic dystrophy; type 1 is caused by a CTG repeat expansion in the DMPK gene, and type 2 is caused by a CCTG repeat expansion in the CNBP gene. Type 1 is associated with distal limb, neck flexor, and bulbar weakness and results in different phenotypic subtypes with variable onset from congenital to very late-onset as well as variable signs and symptoms. The classically described adult-onset form is the most common. In contrast, myotonic dystrophy type 2 is adult-onset or late-onset, has proximal predominant muscle weakness, and generally has less severe multisystem involvement. In both forms of myotonic dystrophy, the best characterized disease mechanism is a RNA toxic gain-of-function during which RNA repeats form nuclear foci resulting in sequestration of RNA-binding proteins and, therefore, dysregulated splicing of premessenger RNA. There are currently no disease-modifying therapies, but clinical surveillance, preventative measures, and supportive treatments are used to reduce the impact of muscular impairment and other systemic involvement including cataracts, cardiac conduction abnormalities, fatigue, central nervous system dysfunction, respiratory weakness, dysphagia, and endocrine dysfunction. Exciting preclinical progress has been made in identifying a number of potential strategies including genome editing, small molecule therapeutics, and antisense oligonucleotide-based therapies to target the pathogenesis of type 1 and type 2 myotonic dystrophies at the DNA, RNA, or downstream target level.
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Affiliation(s)
- Samantha LoRusso
- Department of Neurology, The Ohio State University, 395 West 12th Avenue, Columbus, OH, 43210, USA
| | - Benjamin Weiner
- The Ohio State University College of Medicine, The Ohio State University, 370 West 9th Avenue, Columbus, OH, 43210, USA
| | - W David Arnold
- Department of Neurology, The Ohio State University, 395 West 12th Avenue, Columbus, OH, 43210, USA.
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SMFM Consult Series #46: Evaluation and management of polyhydramnios. Am J Obstet Gynecol 2018; 219:B2-B8. [PMID: 30048635 DOI: 10.1016/j.ajog.2018.07.016] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 07/17/2018] [Indexed: 12/21/2022]
Abstract
Polyhydramnios, or hydramnios, is an abnormal increase in the volume of amniotic fluid. Identification of polyhydramnios should prompt a search for an underlying etiology. Although most cases of mild polyhydramnios are idiopathic, the 2 most common pathologic causes are maternal diabetes mellitus and fetal anomalies, some of which are associated with genetic syndromes. Other causes of polyhydramnios include congenital infection and alloimmunization. The purpose of this document is to provide guidance on the evaluation and management of polyhydramnios. The following are Society for Maternal-Fetal Medicine recommendations: (1) we suggest that polyhydramnios in singleton pregnancies be defined as either a deepest vertical pocket of ≥8 cm or an amniotic fluid index of ≥24 cm (GRADE 2C); (2) we recommend that amnioreduction be considered only for the indication of severe maternal discomfort, dyspnea, or both in the setting of severe polyhydramnios (GRADE 1C); (3) we recommend that indomethacin should not be used for the sole purpose of decreasing amniotic fluid in the setting of polyhydramnios (GRADE 1B); (4) we suggest that antenatal fetal surveillance is not required for the sole indication of mild idiopathic polyhydramnios (GRADE 2C); (5) we recommend that labor should be allowed to occur spontaneously at term for women with mild idiopathic polyhydramnios; that induction, if planned, should not occur at <39 weeks of gestation in the absence of other indications; and that mode of delivery should be determined based on usual obstetric indications (GRADE 1C); and (6) we recommend that women with severe polyhydramnios deliver at a tertiary center due to the significant possibility that fetal anomalies may be present (GRADE 1C).
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Hayes HA, Dibella D, Crockett R, Dixon M, Butterfield RJ, Johnson NE. Stepping Activity in Children With Congenital Myotonic Dystrophy. Pediatr Phys Ther 2018; 30:335-339. [PMID: 30277969 DOI: 10.1097/pep.0000000000000537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE The purpose of this study was to investigate the physical activity levels in children with congenital myotonic dystrophy (CDM), and to examine whether patient clinical and functional characteristics correlated to physical activity. METHODS Twenty-five children with CDM were assessed on functional measures, clinical measures, and physical activity levels. RESULTS Results support that children with CDM spend the majority of their time inactive. There was a negative correlation between inactivity and cytosine-thymine-guanine repeats, suggesting increased inactivity with increased CDM severity. Age, body mass index, and lean muscle mass may be factors influencing activity levels. CONCLUSIONS Children in this study received one-third the recommended steps per day. The number of steps per day is not correlated with clinical measures.
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Affiliation(s)
- Heather A Hayes
- Department of Physical Therapy and Athletic Training (Dr Hayes) and Department of Neurology (Mss Dibella and Crockett and Drs Dixon, Butterfield, and Johnson), University of Utah, Salt Lake City, Utah
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Wenninger S, Montagnese F, Schoser B. Core Clinical Phenotypes in Myotonic Dystrophies. Front Neurol 2018; 9:303. [PMID: 29770119 PMCID: PMC5941986 DOI: 10.3389/fneur.2018.00303] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 04/18/2018] [Indexed: 12/22/2022] Open
Abstract
Myotonic dystrophy type 1 (DM1) and type 2 (DM2) represent the most frequent multisystemic muscular dystrophies in adulthood. They are progressive, autosomal dominant diseases caused by an abnormal expansion of an unstable nucleotide repeat located in the non-coding region of their respective genes DMPK for DM1 and CNBP in DM2. Clinically, these multisystemic disorders are characterized by a high variability of muscular and extramuscular symptoms, often causing a delay in diagnosis. For both subtypes, many symptoms overlap, but some differences allow their clinical distinction. This article highlights the clinical core features of myotonic dystrophies, thus facilitating their early recognition and diagnosis. Particular attention will be given to signs and symptoms of muscular involvement, to issues related to respiratory impairment, and to the multiorgan involvement. This article is part of a Special Issue entitled “Beyond Borders: Myotonic Dystrophies—A European Perception.”
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Affiliation(s)
- Stephan Wenninger
- Friedrich-Baur-Institute, Klinikum der Universität München, Munich, Germany
| | | | - Benedikt Schoser
- Friedrich-Baur-Institute, Klinikum der Universität München, Munich, Germany
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Choudhury A, Rahyead A, Kammermeier J, Mutalib M. The Use of Pyridostigmine in a Child With Chronic Intestinal Pseudo-Obstruction. Pediatrics 2018; 141:S404-S407. [PMID: 29610160 DOI: 10.1542/peds.2017-0007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2017] [Indexed: 11/24/2022] Open
Abstract
Chronic intestinal pseudo-obstruction is a rare disorder that affects the motility of the gastrointestinal tract. It results in acute or subacute intestinal obstruction symptoms in the absence of mechanical lesion. It can lead to intestinal failure in children with significant strain on nutrition, growth, and development. There is no universally agreed protocol for management of chronic intestinal pseudo-obstruction in children, and there is wide variation in clinical practice.
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Affiliation(s)
- Ahamodur Choudhury
- Faculty of Life Sciences and Medicine, Kings College London, London, United Kingdom; and
| | - Abdul Rahyead
- Faculty of Life Sciences and Medicine, Kings College London, London, United Kingdom; and
| | - Jochen Kammermeier
- Department of Paediatric Gastroenterology, Evelina London Children's Hospital, London, United Kingdom
| | - Mohamed Mutalib
- Department of Paediatric Gastroenterology, Evelina London Children's Hospital, London, United Kingdom
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Valenzuela I, Linés M, Martínez-Sáez E, Cueto-González A, Castillo F, Tizzano E. Clinical study of a patient with congenital myotonic dystrophy reveals chylothorax as neonatal presentation of the disease. CASE REPORTS IN PERINATAL MEDICINE 2018. [DOI: 10.1515/crpm-2017-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Congenital myotonic dystrophy type 1 presents with severe generalized weakness, hypotonia and respiratory involvement after birth with high mortality and poor outcome among survivors. We report on a patient that prenatally showed polyhydramnios and arthrogypotic attitude. Postnatal examination was compatible with the diagnosis of congenital myopathy. A rare finding associated with the patient was chylothorax. Genetic testing confirmed the diagnosis of myotonic dystrophy. Few prenatal and neonatal cases of congenital myotonic dystrophy associated with chylothorax have been reported in the literature. We reviewed all cases reported to date showing congenital myopathic weakness in association with chylothorax to delineate the clinical manifestations that allow an early diagnosis and management of this syndrome. Possible mechanisms to explain the association between myopathy and chylothorax are also discussed.
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Affiliation(s)
- Irene Valenzuela
- Department of Clinical and Molecular Genetics and Rare Disease Unit , Hospital Vall d’Hebron , Passeig Vall d’Hebrón 119-129 , 08035 Barcelona , Spain
| | - Marcos Linés
- Neonatal Intensive Care Unit, Hospital Vall d’Hebron , Passeig Vall d’Hebrón 119-129 , 08035 Barcelona , Spain
| | - Elena Martínez-Sáez
- Anatomo-Pathology Department , Hospital Vall d’Hebron , Passeig Vall d’Hebrón 119-129 , 08035 Barcelona , Spain
| | - Ana Cueto-González
- Department of Clinical and Molecular Genetics and Rare Disease Unit , Hospital Vall d’Hebron , Passeig Vall d’Hebrón 119-129 , 08035 Barcelona , Spain
| | - Félix Castillo
- Neonatal Intensive Care Unit, Hospital Vall d’Hebron , Passeig Vall d’Hebrón 119-129 , 08035 Barcelona , Spain
| | - Eduardo Tizzano
- Department of Clinical and Molecular Genetics and Rare Disease Unit , Hospital Vall d’Hebron , Passeig Vall d’Hebrón 119-129, 08035 Barcelona Hospital Vall d’Hebron , Barcelona , Spain , Tel.: +34934893141
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Thomas JD, Oliveira R, Sznajder ŁJ, Swanson MS. Myotonic Dystrophy and Developmental Regulation of RNA Processing. Compr Physiol 2018; 8:509-553. [PMID: 29687899 DOI: 10.1002/cphy.c170002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Myotonic dystrophy (DM) is a multisystemic disorder caused by microsatellite expansion mutations in two unrelated genes leading to similar, yet distinct, diseases. DM disease presentation is highly variable and distinguished by differences in age-of-onset and symptom severity. In the most severe form, DM presents with congenital onset and profound developmental defects. At the molecular level, DM pathogenesis is characterized by a toxic RNA gain-of-function mechanism that involves the transcription of noncoding microsatellite expansions. These mutant RNAs disrupt key cellular pathways, including RNA processing, localization, and translation. In DM, these toxic RNA effects are predominantly mediated through the modulation of the muscleblind-like and CUGBP and ETR-3-like factor families of RNA binding proteins (RBPs). Dysfunction of these RBPs results in widespread RNA processing defects culminating in the expression of developmentally inappropriate protein isoforms in adult tissues. The tissue that is the focus of this review, skeletal muscle, is particularly sensitive to mutant RNA-responsive perturbations, as patients display a variety of developmental, structural, and functional defects in muscle. Here, we provide a comprehensive overview of DM1 and DM2 clinical presentation and pathology as well as the underlying cellular and molecular defects associated with DM disease onset and progression. Additionally, fundamental aspects of skeletal muscle development altered in DM are highlighted together with ongoing and potential therapeutic avenues to treat this muscular dystrophy. © 2018 American Physiological Society. Compr Physiol 8:509-553, 2018.
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Affiliation(s)
- James D Thomas
- Department of Molecular Genetics and Microbiology, Center for NeuroGenetics and the Genetics Institute, University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Ruan Oliveira
- Department of Molecular Genetics and Microbiology, Center for NeuroGenetics and the Genetics Institute, University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Łukasz J Sznajder
- Department of Molecular Genetics and Microbiology, Center for NeuroGenetics and the Genetics Institute, University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Maurice S Swanson
- Department of Molecular Genetics and Microbiology, Center for NeuroGenetics and the Genetics Institute, University of Florida, College of Medicine, Gainesville, Florida, USA
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Management of anesthesia in a pediatric patient with myotonic dystrophy type 1. Case report. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2018. [DOI: 10.1097/cj9.0000000000000013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Thomas JD, Sznajder ŁJ, Bardhi O, Aslam FN, Anastasiadis ZP, Scotti MM, Nishino I, Nakamori M, Wang ET, Swanson MS. Disrupted prenatal RNA processing and myogenesis in congenital myotonic dystrophy. Genes Dev 2017; 31:1122-1133. [PMID: 28698297 PMCID: PMC5538435 DOI: 10.1101/gad.300590.117] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 05/26/2017] [Indexed: 02/06/2023]
Abstract
Thomas et al. demonstrate that RNA misprocessing is a major pathogenic factor in congenital myotonic dystrophy and provide novel mouse models to further examine roles for cotranscriptional/post-transcriptional gene regulation during tissue development. Myotonic dystrophy type 1 (DM1) is a CTG microsatellite expansion (CTGexp) disorder caused by expression of CUGexp RNAs. These mutant RNAs alter the activities of RNA processing factors, including MBNL proteins, leading to re-expression of fetal isoforms in adult tissues and DM1 pathology. While this pathogenesis model accounts for adult-onset disease, the molecular basis of congenital DM (CDM) is unknown. Here, we test the hypothesis that disruption of developmentally regulated RNA alternative processing pathways contributes to CDM disease. We identify prominent alternative splicing and polyadenylation abnormalities in infant CDM muscle, and, although most are also misregulated in adult-onset DM1, dysregulation is significantly more severe in CDM. Furthermore, analysis of alternative splicing during human myogenesis reveals that CDM-relevant exons undergo prenatal RNA isoform transitions and are predicted to be disrupted by CUGexp-associated mechanisms in utero. To test this possibility and the contribution of MBNLs to CDM pathogenesis, we generated mouse Mbnl double (Mbnl1; Mbnl2) and triple (Mbnl1; Mbnl2; Mbnl3) muscle-specific knockout models that recapitulate the congenital myopathy, gene expression, and spliceopathy defects characteristic of CDM. This study demonstrates that RNA misprocessing is a major pathogenic factor in CDM and provides novel mouse models to further examine roles for cotranscriptional/post-transcriptional gene regulation during development.
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Affiliation(s)
- James D Thomas
- Department of Molecular Genetics and Microbiology, Center for NeuroGenetics and the Genetics Institute, College of Medicine, University of Florida, Gainesville, Florida 32610, USA
| | - Łukasz J Sznajder
- Department of Molecular Genetics and Microbiology, Center for NeuroGenetics and the Genetics Institute, College of Medicine, University of Florida, Gainesville, Florida 32610, USA
| | - Olgert Bardhi
- Department of Molecular Genetics and Microbiology, Center for NeuroGenetics and the Genetics Institute, College of Medicine, University of Florida, Gainesville, Florida 32610, USA
| | - Faaiq N Aslam
- Department of Molecular Genetics and Microbiology, Center for NeuroGenetics and the Genetics Institute, College of Medicine, University of Florida, Gainesville, Florida 32610, USA
| | - Zacharias P Anastasiadis
- Department of Molecular Genetics and Microbiology, Center for NeuroGenetics and the Genetics Institute, College of Medicine, University of Florida, Gainesville, Florida 32610, USA
| | - Marina M Scotti
- Department of Molecular Genetics and Microbiology, Center for NeuroGenetics and the Genetics Institute, College of Medicine, University of Florida, Gainesville, Florida 32610, USA
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Center of Neurology and Psychiatry, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Masayuki Nakamori
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Eric T Wang
- Department of Molecular Genetics and Microbiology, Center for NeuroGenetics and the Genetics Institute, College of Medicine, University of Florida, Gainesville, Florida 32610, USA
| | - Maurice S Swanson
- Department of Molecular Genetics and Microbiology, Center for NeuroGenetics and the Genetics Institute, College of Medicine, University of Florida, Gainesville, Florida 32610, USA
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Lee O, Porteous M. Genetic testing and reproductive choice in neurological disorders. Pract Neurol 2017; 17:275-281. [PMID: 28512206 DOI: 10.1136/practneurol-2017-001619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2017] [Indexed: 11/04/2022]
Abstract
Genetic testing is increasingly important for investigating suspected inherited neurological conditions. A genetic diagnosis can have a huge impact on patients and also their families. It is important for neurologists to appreciate the presymptomatic and prenatal testing options available to patients and their at-risk relatives once a genetic disorder is diagnosed. Asymptomatic family members can experience considerable psychological distress from the knowledge that they might have inherited a neurodegenerative condition. They may also be concerned about the risk of their children inheriting the condition. Information on reproductive options can provide hope and reassurance. This paper reviews the principles of genetic testing in neurological practice, and how they can be applied in prenatal and preimplantation genetic diagnosis. We explain the basis for direct and exclusion testing, use case examples to illustrate the process by which families are counselled and discuss the ethical implications of reproductive technologies.
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Affiliation(s)
- Omay Lee
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, EH4 2XU, Edinburgh, Scotland, UK
| | - Mary Porteous
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, EH4 2XU, Edinburgh, Scotland, UK.,South East Scotland Genetic Service, Western General Hospital, Crewe Road South, EH4 2XU, Edinburgh, Scotland, UK
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Pucillo EM, Dibella DL, Hung M, Bounsanga J, Crockett B, Dixon M, Butterfield RJ, Campbell C, Johnson NE. Physical function and mobility in children with congenital myotonic dystrophy. Muscle Nerve 2017; 56:224-229. [PMID: 27859360 PMCID: PMC5436951 DOI: 10.1002/mus.25482] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 11/11/2016] [Accepted: 11/16/2016] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Congenital myotonic dystrophy (CDM) occurs when symptoms of myotonic dystrophy present at birth. In this study we evaluated the relationship between physical function, muscle mass, and age to provide an assessment of the disease and help prepare for therapeutic trials. METHODS CDM participants performed timed functional tests (TFTs), the first 2 minutes of 6-minute walk tests (2/6MWTs), and myometry tests, and also performed dual-energy X-ray absorption (DEXA) scans. Healthy controls (HCs) performed TFTs, 6MWTs, and myometry. RESULTS Thirty-seven children with CDM and 27 HCs (age range 3-13 years) participated in the study. There were significant differences in the 10-meter walk (11.3 seconds in CDM vs. 6.8 seconds in HC) and 2MWT (91 meters in CDM vs. 193 meters in HCs). DEXA lean mass of the right arm correlated with grip strength (r = 0.91), and lean mass of the right leg correlated with 6MWT (r = 0.62). CONCLUSION Children with CDM have significant limitations in strength and mobility. The tests performed were reliable, and lean muscle mass may serve as a useful biomarker. Muscle Nerve 56: 224-229, 2017.
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Affiliation(s)
- Evan M Pucillo
- Eccles Institute of Human Genetics, Department of Neurology, University of Utah School of Medicine, 15N 2030 East, Salt Lake City, Utah, 84112, USA
| | - Deanna L Dibella
- Eccles Institute of Human Genetics, Department of Neurology, University of Utah School of Medicine, 15N 2030 East, Salt Lake City, Utah, 84112, USA
| | - Man Hung
- Department of Orthopedics, University of Utah, Salt Lake City, Utah, USA.,Division of Public Health, University of Utah, Salt Lake City, Utah, USA
| | - Jerry Bounsanga
- Department of Orthopedics, University of Utah, Salt Lake City, Utah, USA
| | - Becky Crockett
- Eccles Institute of Human Genetics, Department of Neurology, University of Utah School of Medicine, 15N 2030 East, Salt Lake City, Utah, 84112, USA
| | - Melissa Dixon
- Eccles Institute of Human Genetics, Department of Neurology, University of Utah School of Medicine, 15N 2030 East, Salt Lake City, Utah, 84112, USA
| | | | - Craig Campbell
- Department of Pediatrics, Clinical Neurological Sciences and Epidemiology, Western University, London, Ontario, Canada
| | - Nicholas E Johnson
- Eccles Institute of Human Genetics, Department of Neurology, University of Utah School of Medicine, 15N 2030 East, Salt Lake City, Utah, 84112, USA
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Abstract
Muscular dystrophy is a group of inherited myopathies characterised by progressive skeletal muscle wasting, including of the respiratory muscles. Respiratory failure, i.e. when the respiratory system fails in its gas exchange functions, is a common feature in muscular dystrophy, being the main cause of death, and it is a consequence of lung failure, pump failure or a combination of the two. The former is due to recurrent aspiration, the latter to progressive weakness of respiratory muscles and an increase in the load against which they must contract. In fact, both the resistive and elastic components of the work of breathing increase due to airway obstruction and chest wall and lung stiffening, respectively. The respiratory disturbances in muscular dystrophy are restrictive pulmonary function, hypoventilation, altered thoracoabdominal pattern, hypercapnia, dyspnoea, impaired regulation of breathing, inefficient cough and sleep disordered breathing. They can be present at different rates according to the type of muscular dystrophy and its progression, leading to different onset of each symptom, prognosis and degree of respiratory involvement. KEY POINTS A common feature of muscular dystrophy is respiratory failure, i.e. the inability of the respiratory system to provide proper oxygenation and carbon dioxide elimination.In the lung, respiratory failure is caused by recurrent aspiration, and leads to hypoxaemia and hypercarbia.Ventilatory failure in muscular dystrophy is caused by increased respiratory load and respiratory muscles weakness.Respiratory load increases in muscular dystrophy because scoliosis makes chest wall compliance decrease, atelectasis and fibrosis make lung compliance decrease, and airway obstruction makes airway resistance increase.The consequences of respiratory pump failure are restrictive pulmonary function, hypoventilation, altered thoracoabdominal pattern, hypercapnia, dyspnoea, impaired regulation of breathing, inefficient cough and sleep disordered breathing. EDUCATIONAL AIMS To understand the mechanisms leading to respiratory disturbances in patients with muscular dystrophy.To understand the impact of respiratory disturbances in patients with muscular dystrophy.To provide a brief description of the main forms of muscular dystrophy with their respiratory implications.
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Affiliation(s)
- Antonella Lo Mauro
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
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Medication adherence in patients with myotonic dystrophy and facioscapulohumeral muscular dystrophy. J Neurol 2016; 263:2528-2537. [PMID: 27734165 DOI: 10.1007/s00415-016-8300-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/03/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
Abstract
Myotonic dystrophy (DM) and facioscapulohumeral muscular dystrophy (FSHD) are the two most common adult muscular dystrophies and have progressive and often disabling manifestations. Higher levels of medication adherence lead to better health outcomes, especially important to patients with DM and FSHD because of their multisystem manifestations and complexity of care. However, medication adherence has not previously been studied in a large cohort of DM type 1 (DM1), DM type 2 (DM2), and FSHD patients. The purpose of our study was to survey medication adherence and disease manifestations in patients enrolled in the NIH-supported National DM and FSHD Registry. The study was completed by 110 DM1, 49 DM2, and 193 FSHD patients. Notable comorbidities were hypertension in FSHD (44 %) and DM2 (37 %), gastroesophageal reflux disease in DM1 (24 %) and DM2 (31 %) and arrhythmias (29 %) and thyroid disease (20 %) in DM1. Each group reported high levels of adherence based on regimen complexity, medication costs, health literacy, side effect profile, and their beliefs about treatment. Only dysphagia in DM1 was reported to significantly impact medication adherence. Approximately 35 % of study patients reported polypharmacy (taking 6 or more medications). Of the patients with polypharmacy, the DM1 cohort was significantly younger (mean 55.0 years) compared to DM2 (59.0 years) and FSHD (63.2 years), and had shorter disease duration (mean 26 years) compared to FSHD (26.8 years) and DM2 (34.8 years). Future research is needed to assess techniques to ease pill swallowing in DM1 and to monitor polypharmacy and potential drug interactions in DM and FSHD.
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