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Otto LA, Froeling M, van Eijk RP, Wadman RI, Cuppen I, van der Woude DR, Bartels B, Asselman FL, Hendrikse J, van der Pol WL. Monitoring Nusinersen Treatment Effects in Children with Spinal Muscular Atrophy with Quantitative Muscle MRI. J Neuromuscul Dis 2024; 11:91-101. [PMID: 38073395 PMCID: PMC10789331 DOI: 10.3233/jnd-221671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Spinal muscular atrophy (SMA) is caused by deficiency of survival motor neuron (SMN) protein. Intrathecal nusinersen treatment increases SMN protein in motor neurons and has been shown to improve motor function in symptomatic children with SMA. OBJECTIVE We used quantitative MRI to gain insight in microstructure and fat content of muscle during treatment and to explore its use as biomarker for treatment effect. METHODS We used a quantitative MRI protocol before start of treatment and following the 4th and 6th injection of nusinersen in 8 children with SMA type 2 and 3 during the first year of treatment. The MR protocol allowed DIXON, T2 mapping and diffusion tensor imaging acquisitions. We also assessed muscle strength and motor function scores. RESULTS Fat fraction of all thigh muscles with the exception of the m. adductor longus increased in all patients during treatment (+3.2%, p = 0.02). WaterT2 showed no significant changes over time (-0.7 ms, p = 0.3). DTI parameters MD and AD demonstrate a significant decrease in the hamstrings towards values observed in healthy muscle. CONCLUSIONS Thigh muscles of children with SMA treated with nusinersen showed ongoing fatty infiltration and possible normalization of thigh muscle microstructure during the first year of nusinersen treatment. Quantitative muscle MRI shows potential as biomarker for the effects of SMA treatment strategies.
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Affiliation(s)
- Louise A.M. Otto
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - M. Froeling
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ruben P.A. van Eijk
- Biostatistics & Research Support, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Renske I. Wadman
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Inge Cuppen
- Department of Neurology and Child Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Danny R. van der Woude
- Department of Child Development and Exercise Center, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Bart Bartels
- Department of Child Development and Exercise Center, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Fay-Lynn Asselman
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - W. Ludo van der Pol
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Scheijmans FEV, Cuppen I, van Eijk RPA, Wijngaarde CA, Schoenmakers MAGC, van der Woude DR, Bartels B, Veldhoen ES, Oude Lansink ILB, Groen EJN, Asselman FL, Wadman RI, van der Pol WL. Population-based assessment of nusinersen efficacy in children with spinal muscular atrophy: a 3-year follow-up study. Brain Commun 2022; 4:fcac269. [PMID: 36382221 PMCID: PMC9651026 DOI: 10.1093/braincomms/fcac269] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 08/17/2022] [Accepted: 10/27/2022] [Indexed: 11/13/2022] Open
Abstract
Nusinersen (Spinraza®) improves survival of infants with hereditary proximal spinal muscular atrophy and motor function in children up to 12 years. Population-based assessments of treatment efficacy are limited and confined to select cohorts of patients. We performed a nationwide, population-based, single-centre cohort study in children with spinal muscular atrophy younger than 9.5 years at start of treatment in line with reimbursement criteria in the Netherlands. We assessed age-relevant motor function scores, the need for tube feeding, hours of ventilatory support and documented adverse events. We used linear mixed modelling to assess treatment effects. We compared motor function during treatment with natural history data and to individual trajectories of muscle strength and motor function before the start of treatment. We included 71 out of 72 Dutch children who were treated (median age 54 months; range 0–117) and followed them for a median of 38 months (range 5–52). We observed improvement of motor function in 72% and stabilization in another 18% of the symptomatic children, which differed from the natural disease course in a matched cohort of which we had previously collected natural history data. Longitudinal analysis showed that motor function improved up to a median of 24 months (range 12–30) of treatment after which it stabilized. Shorter disease duration at start of treatment resulted in better treatment efficacy (P < 0.01). Sixteen children (23%) achieved new motor milestones. Bulbar and respiratory function did not improve significantly during treatment. In 15 patients from whom treatment-naïve data were available, the pre-treatment trajectory of motor function decline changed to stabilization or improvement after the start of treatment. We documented 82 adverse events after 934 injections (9%) in 45 patients. None of the adverse events led to treatment discontinuation. Intrathecal nusinersen treatment is safe and improves or stabilizes motor function in 90% of young children with spinal muscular atrophy types 1c–3a. We did not observe improvement of respiratory and bulbar functions.
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Affiliation(s)
- Féline E V Scheijmans
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, 3584 CX, Utrecht , The Netherlands
| | - Inge Cuppen
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, 3584 CX, Utrecht , The Netherlands
| | - Ruben P A van Eijk
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, 3584 CX, Utrecht , The Netherlands
- Biostatistics and Research Support, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht , 3584 CX, Utrecht , The Netherlands
| | - Camiel A Wijngaarde
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, 3584 CX, Utrecht , The Netherlands
| | - Marja A G C Schoenmakers
- Child Development and Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, 3584 CX, Utrecht , The Netherlands
| | - Danny R van der Woude
- Child Development and Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, 3584 CX, Utrecht , The Netherlands
| | - Bart Bartels
- Child Development and Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, 3584 CX, Utrecht , The Netherlands
| | - Esther S Veldhoen
- Pediatric Intensive Care Unit, Wilhelmina Children’s Hospital , 3584 EA, Utrecht , The Netherlands
| | - Irene L B Oude Lansink
- Department of Rehabilitation, Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht , 3584 CX, Utrecht , The Netherlands
| | - Ewout J N Groen
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, 3584 CX, Utrecht , The Netherlands
| | - Fay-Lynn Asselman
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, 3584 CX, Utrecht , The Netherlands
| | - Renske I Wadman
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, 3584 CX, Utrecht , The Netherlands
| | - W Ludo van der Pol
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, 3584 CX, Utrecht , The Netherlands
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van der Woude DR, Ruyten T, Bartels B. Reliability of Muscle Strength and Muscle Power Assessments Using Isokinetic Dynamometry in Neuromuscular Diseases: A Systematic Review. Phys Ther 2022; 102:6650967. [PMID: 35899532 PMCID: PMC10071497 DOI: 10.1093/ptj/pzac099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 04/22/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to critically appraise and summarize the evidence for reliability of muscle strength and muscle power assessment in patients with neuromuscular diseases (NMDs) using isokinetic dynamometry. METHODS PubMed, CINAHL, and Embase electronic databases were searched from inception to March 8, 2022. Studies designed to evaluate reliability of muscle strength and power measurements using isokinetic dynamometry were included in this review. First, the methodological quality of the studies was assessed according to the Consensus-Based Standards for the Selection of Health Measurement Instruments guidelines. Next, the quality of measurement properties was determined. Finally, the methodological quality and quality of measurement properties of the studies were combined to obtain a best-evidence synthesis. RESULTS A best-evidence synthesis of reliability was performed in 11 studies including postpoliomyelitis syndrome (n = 5), hereditary motor and sensory neuropathy (n = 2), motor neuron diseases (n = 1), myotonic dystrophy (n = 1), and groups of pooled NMDs (n = 2). A best-evidence synthesis on measurement error could not be performed. Quality of evidence on reliability ranged from high in postpoliomyelitis syndrome to very low in hereditary motor and sensory neuropathy, motor neuron diseases, and groups of pooled NMDs. The most frequently used outcome measure was peak torque, which was reliable in all populations (intraclass correlation coefficient >0.7). CONCLUSION The quality of evidence for reliability of isokinetic dynamometry was found to vary substantially among different NMDs. High quality of evidence has been obtained only in patients with postpoliomyelitis syndrome. Further research is needed in the majority of known NMDs to determine reliability and validity of isokinetic dynamometry. IMPACT The ability of isokinetic dynamometers to capture clinically relevant changes in muscle strength and muscle power in NMDs remains unclear. Isokinetic dynamometry results in NMDs should be interpreted with caution.
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Affiliation(s)
- Danny R van der Woude
- Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Thijs Ruyten
- Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bart Bartels
- Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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