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Tawil R, Wagner KR, Hamel JI, Leung DG, Statland JM, Wang LH, Genge A, Sacconi S, Lochmüller H, Reyes-Leiva D, Diaz-Manera J, Alonso-Perez J, Muelas N, Vilchez JJ, Pestronk A, Gibson S, Goyal NA, Hayward LJ, Johnson N, LoRusso S, Freimer M, Shieh PB, Subramony SH, van Engelen B, Kools J, Leinhard OD, Widholm P, Morabito C, Moxham CM, Cadavid D, Mellion ML, Odueyungbo A, Tracewell WG, Accorsi A, Ronco L, Gould RJ, Shoskes J, Rojas LA, Jiang JG. Safety and efficacy of losmapimod in facioscapulohumeral muscular dystrophy (ReDUX4): a randomised, double-blind, placebo-controlled phase 2b trial. Lancet Neurol 2024; 23:477-486. [PMID: 38631764 DOI: 10.1016/s1474-4422(24)00073-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Facioscapulohumeral muscular dystrophy is a hereditary progressive myopathy caused by aberrant expression of the transcription factor DUX4 in skeletal muscle. No approved disease-modifying treatments are available for this disorder. We aimed to assess the safety and efficacy of losmapimod (a small molecule that inhibits p38α MAPK, a regulator of DUX4 expression, and p38β MAPK) for the treatment of facioscapulohumeral muscular dystrophy. METHODS We did a randomised, double-blind, placebo-controlled phase 2b trial at 17 neurology centres in Canada, France, Spain, and the USA. We included adults aged 18-65 years with type 1 facioscapulohumeral muscular dystrophy (ie, with loss of repression of DUX4 expression, as ascertained by genotyping), a Ricci clinical severity score of 2-4, and at least one skeletal muscle judged using MRI to be suitable for biopsy. Participants were randomly allocated (1:1) to either oral losmapimod (15 mg twice a day) or matching placebo for 48 weeks, via an interactive response technology system. The investigator, study staff, participants, sponsor, primary outcome assessors, and study monitor were masked to the treatment allocation until study closure. The primary endpoint was change from baseline to either week 16 or 36 in DUX4-driven gene expression in skeletal muscle biopsy samples, as measured by quantitative RT-PCR. The primary efficacy analysis was done in all participants who were randomly assigned and who had available data for assessment, according to the modified intention-to-treat principle. Safety and tolerability were assessed as secondary endpoints. This study is registered at ClinicalTrials.gov, number NCT04003974. The phase 2b trial is complete; an open-label extension is ongoing. FINDINGS Between Aug 27, 2019, and Feb 27, 2020, 80 people were enrolled. 40 were randomly allocated to losmapimod and 40 to placebo. 54 (68%) participants were male and 26 (33%) were female, 70 (88%) were White, and mean age was 45·7 (SD 12·5) years. Least squares mean changes from baseline in DUX4-driven gene expression did not differ significantly between the losmapimod (0·83 [SE 0·61]) and placebo (0·40 [0·65]) groups (difference 0·43 [SE 0·56; 95% CI -1·04 to 1·89]; p=0·56). Losmapimod was well tolerated. 29 treatment-emergent adverse events (nine drug-related) were reported in the losmapimod group compared with 23 (two drug-related) in the placebo group. Two participants in the losmapimod group had serious adverse events that were deemed unrelated to losmapimod by the investigators (alcohol poisoning and suicide attempt; postoperative wound infection) compared with none in the placebo group. No treatment discontinuations due to adverse events occurred and no participants died during the study. INTERPRETATION Although losmapimod did not significantly change DUX4-driven gene expression, it was associated with potential improvements in prespecified structural outcomes (muscle fat infiltration), functional outcomes (reachable workspace, a measure of shoulder girdle function), and patient-reported global impression of change compared with placebo. These findings have informed the design and choice of efficacy endpoints for a phase 3 study of losmapimod in adults with facioscapulohumeral muscular dystrophy. FUNDING Fulcrum Therapeutics.
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Affiliation(s)
- Rabi Tawil
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Kathryn R Wagner
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Johanna I Hamel
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Doris G Leung
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Leo H Wang
- University of Washington, Seattle, WA, USA
| | - Angela Genge
- Montreal Neurological Institute and Hospital, Montreal, QC, Canada
| | - Sabrina Sacconi
- Peripheral Nervous System and Muscle Department, Nice University Hospital and University of Côte d'Azur, Nice, France
| | - Hanns Lochmüller
- Children's Hospital of Eastern Ontario Research Institute, Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada; Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - David Reyes-Leiva
- Institut de Recerca IIB Sant Pau, Hospital Universitari Santa Creu i Sant Pau, Barcelona, Spain
| | - Jordi Diaz-Manera
- Institut de Recerca IIB Sant Pau, Hospital Universitari Santa Creu i Sant Pau, Barcelona, Spain; John Walton Muscular Dystrophy Research Center, Newcastle University, Newcastle, UK
| | - Jorge Alonso-Perez
- Neuromuscular Diseases Unit, Neurology Department, Hospital Universitario Nuestra Señora de Candelaria, Fundación Canaria Instituto de Investigación Sanitaria de Canarias, Santa Cruz de Tenerife, Tenerife, Spain; Neuromuscular Diseases Unit, Neurology Department, Institut d'Investigació Biomèdica Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Nuria Muelas
- Neuromuscular Diseases Unit, Neurology Department, Hospital Universitari i Politecnic La Fe and Neuromuscular Reference Centre, Valencia, Spain; Neuromuscular and Ataxias Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras, Barcelona, Spain; Department of Medicine, University of Valencia, Valencia, Spain
| | - Juan J Vilchez
- Neuromuscular and Ataxias Research Group, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Alan Pestronk
- Washington University in St Louis, St Louis, MO, USA
| | | | | | | | | | | | - Miriam Freimer
- Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Perry B Shieh
- University of California at Los Angeles, Los Angeles, CA, USA
| | - S H Subramony
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Baziel van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Joost Kools
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Olof Dahlqvist Leinhard
- AMRA Medical, Linköping, Sweden; Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Per Widholm
- AMRA Medical, Linköping, Sweden; Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden; Department of Radiology, Linköping University, Linköping, Sweden
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Wong CJ, Friedman SD, Snider L, Bennett SR, Jones TI, Jones PL, Shaw DWW, Blemker SS, Riem L, DuCharme O, Lemmers RJFL, van der Maarel SM, Wang LH, Tawil R, Statland JM, Tapscott SJ. Regional and bilateral MRI and gene signatures in facioscapulohumeral dystrophy: implications for clinical trial design and mechanisms of disease progression. Hum Mol Genet 2024; 33:698-708. [PMID: 38268317 PMCID: PMC11000661 DOI: 10.1093/hmg/ddae007] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/11/2023] [Accepted: 01/02/2024] [Indexed: 01/26/2024] Open
Abstract
Identifying the aberrant expression of DUX4 in skeletal muscle as the cause of facioscapulohumeral dystrophy (FSHD) has led to rational therapeutic development and clinical trials. Several studies support the use of MRI characteristics and the expression of DUX4-regulated genes in muscle biopsies as biomarkers of FSHD disease activity and progression. We performed lower-extremity MRI and muscle biopsies in the mid-portion of the tibialis anterior (TA) muscles bilaterally in FSHD subjects and validated our prior reports of the strong association between MRI characteristics and expression of genes regulated by DUX4 and other gene categories associated with FSHD disease activity. We further show that measurements of normalized fat content in the entire TA muscle strongly predict molecular signatures in the mid-portion of the TA, indicating that regional biopsies can accurately measure progression in the whole muscle and providing a strong basis for inclusion of MRI and molecular biomarkers in clinical trial design. An unanticipated finding was the strong correlations of molecular signatures in the bilateral comparisons, including markers of B-cells and other immune cell populations, suggesting that a systemic immune cell infiltration of skeletal muscle might have a role in disease progression.
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Affiliation(s)
- Chao-Jen Wong
- Division of Human Biology, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA 98109, United States
| | - Seth D Friedman
- Department of Radiology, Seattle Children’s Hospital, 4540 Sandpoint Way, Seattle, WA 98105, United States
| | - Lauren Snider
- Division of Human Biology, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA 98109, United States
| | - Sean R Bennett
- Division of Human Biology, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA 98109, United States
| | - Takako I Jones
- Department of Pharmacology, University of Nevada, Reno School of Medicine, 1664 North Virginia Street, Reno, NV 89557, United States
| | - Peter L Jones
- Department of Pharmacology, University of Nevada, Reno School of Medicine, 1664 North Virginia Street, Reno, NV 89557, United States
| | - Dennis W W Shaw
- Department of Radiology, Seattle Children’s Hospital, 4540 Sandpoint Way, Seattle, WA 98105, United States
| | - Silvia S Blemker
- Springbok Analytics, 100 W South St, Charlottesville, VA 22902, United States
| | - Lara Riem
- Springbok Analytics, 100 W South St, Charlottesville, VA 22902, United States
| | - Olivia DuCharme
- Springbok Analytics, 100 W South St, Charlottesville, VA 22902, United States
| | - Richard J F L Lemmers
- Department of Human Genetics, Leiden University Medical Center, Einthovenweg 20, 2333 ZC Leiden, The Netherlands
| | - Silvère M van der Maarel
- Department of Human Genetics, Leiden University Medical Center, Einthovenweg 20, 2333 ZC Leiden, The Netherlands
| | - Leo H Wang
- Department of Neurology, University of Washington, 1959 NE Pacific St, Seattle, WA 98105, United States
| | - Rabi Tawil
- Department of Neurology, University of Rochester Medical Center, 601 Elm St, Rochester, NY 14642, United States
| | - Jeffrey M Statland
- Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KA 66160, United States
| | - Stephen J Tapscott
- Division of Human Biology, Fred Hutchinson Cancer Center, 1100 Fairview Ave N, Seattle, WA 98109, United States
- Department of Neurology, University of Washington, 1959 NE Pacific St, Seattle, WA 98105, United States
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Attarian S, Young P, Brannagan TH, Adams D, Van Damme P, Thomas FP, Casanovas C, Kafaie J, Tard C, Walter MC, Péréon Y, Walk D, Stino A, de Visser M, Verhamme C, Amato A, Carter G, Magy L, Statland JM, Felice K. Correction to: A double-blind, placebo-controlled, randomized trial of PXT3003 for the treatment of Charcot-Marie-Tooth type 1A. Orphanet J Rare Dis 2024; 19:142. [PMID: 38561848 PMCID: PMC10985943 DOI: 10.1186/s13023-024-03110-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Affiliation(s)
- Shahram Attarian
- Reference Center for Neuromuscular Disorders and ALS, CHU La Timone, Marseille, France.
| | - Peter Young
- Department of Neurology, Medical Park Bad Feilnbach, Bad Feilnbach, Germany
| | - Thomas H Brannagan
- Columbia University Medical Center, The Neurological Institute, New York, USA
| | - David Adams
- French Reference Center for Rare Peripheral Neuropathies, Service de Neurologie Adulte, APHP, CHU Bicêtre, Le Kremlin Bicêtre, France
| | - Philip Van Damme
- Department of Neurology, University Hospitals Leuven, KU, Leuven, Belgium
- Center for Brain & Disease Research, VIB, Leuven, Belgium
| | - Florian P Thomas
- Department of Neurology, Hackensack University Medical Center, Hackensack, USA
- Department of Neurology, Saint Louis University School of Medicine, St. Louis, USA
| | - Carlos Casanovas
- Neuromuscular Unit, Neurology Department, Bellvitge University Hospital, Barcelona, Spain
- Neurometabolic Diseases Group, Bellvitge Research Institute (IDIBELL) and CIBERER, Barcelona, Spain
| | - Jafar Kafaie
- Department of Neurology, Saint Louis University School of Medicine, St. Louis, USA
| | - Céline Tard
- U1171, Centre de référence des maladies neuromusculaires Nord Est Ile de France, Hôpital Salengro CHU de Lille, Lille, France
| | - Maggie C Walter
- Department of Neurology, Friedrich-Baur-Institute, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Yann Péréon
- Centre de Référence Maladies Neuromusculaires AOC, Filnemus, Euro-NMD, CHU Nantes, Hôtel-Dieu, Nantes, France
| | - David Walk
- Clinical Neuroscience Research Unit, University of Minnesota, Minneapolis, USA
| | - Amro Stino
- University of Michigan Health System, Ann Arbor, MI, USA
| | - Marianne de Visser
- Department of Neurology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Camiel Verhamme
- Department of Neurology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Anthony Amato
- Department of Neurology, Brigham and Women's Hospital, Boston, USA
| | - Gregory Carter
- St. Luke's Rehabilitation Institute, Physical Medicine and Rehabilitation, Spokane, USA
| | | | | | - Kevin Felice
- Department of Neuromuscular Medicine, Hospital for Special Care, New Britain, USA
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4
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Witzel S, Statland JM, Steinacker P, Otto M, Dorst J, Schuster J, Barohn RJ, Ludolph AC. Longitudinal course of neurofilament light chain levels in amyotrophic lateral sclerosis-insights from a completed randomized controlled trial with rasagiline. Eur J Neurol 2024; 31:e16154. [PMID: 37975796 DOI: 10.1111/ene.16154] [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] [Received: 08/04/2023] [Revised: 10/17/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND AND PURPOSE Rasagiline might be disease modifying in patients with amyotrophic lateral sclerosis (ALS). The aim was to evaluate the effect of rasagiline 2 mg/day on neurofilament light chain (NfL), a prognostic biomarker in ALS. METHODS In 65 patients with ALS randomized in a 3:1 ratio to rasagiline 2 mg/day (n = 48) or placebo (n = 17) in a completed randomized controlled multicentre trial, NfL levels in plasma were measured at baseline, month 6 and month 12. Longitudinal changes in NfL levels were evaluated regarding treatment and clinical parameters. RESULTS Baseline NfL levels did not differ between the study arms and correlated with disease progression rates both pre-baseline (r = 0.64, p < 0.001) and during the study (r = 0.61, p < 0.001). NfL measured at months 6 and 12 did not change significantly from baseline in both arms, with a median individual NfL change of +1.4 pg/mL (interquartile range [IQR] -5.6, 14.2) across all follow-up time points. However, a significant difference in NfL change at month 12 was observed between patients with high and low NfL baseline levels treated with rasagiline (high [n = 13], -6.9 pg/mL, IQR -20.4, 6.0; low [n = 18], +5.9 pg/mL, IQR -1.4, 19.7; p = 0.025). Additionally, generally higher longitudinal NfL variability was observed in patients with high baseline levels, whereas disease progression rates and disease duration at baseline had no impact on the longitudinal NfL course. CONCLUSION Post hoc NfL measurements in completed clinical trials are helpful in interpreting NfL data from ongoing and future interventional trials and could provide hypothesis-generating complementary insights. Further studies are warranted to ultimately differentiate NfL response to treatment from other factors.
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Affiliation(s)
- Simon Witzel
- Department of Neurology, Ulm University, Ulm, Germany
| | | | - Petra Steinacker
- Department of Neurology, University of Halle, Halle (Saale), Germany
| | - Markus Otto
- Department of Neurology, University of Halle, Halle (Saale), Germany
| | | | - Joachim Schuster
- Department of Neurology, Ulm University, Ulm, Germany
- German Center for Neurodegenerative Diseases (DZNE), Ulm, Germany
| | - Richard J Barohn
- School of Medicine, NextGen Precision Health, University of Missouri, Columbia, Missouri, USA
| | - Albert C Ludolph
- Department of Neurology, Ulm University, Ulm, Germany
- German Center for Neurodegenerative Diseases (DZNE), Ulm, Germany
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5
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Thornton CA, Moxley RT, Eichinger K, Heatwole C, Mignon L, Arnold WD, Ashizawa T, Day JW, Dent G, Tanner MK, Duong T, Greene EP, Herbelin L, Johnson NE, King W, Kissel JT, Leung DG, Lott DJ, Norris DA, Pucillo EM, Schell W, Statland JM, Stinson N, Subramony SH, Xia S, Bishop KM, Bennett CF. Antisense oligonucleotide targeting DMPK in patients with myotonic dystrophy type 1: a multicentre, randomised, dose-escalation, placebo-controlled, phase 1/2a trial. Lancet Neurol 2023; 22:218-228. [PMID: 36804094 DOI: 10.1016/s1474-4422(23)00001-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 02/17/2023]
Abstract
BACKGROUND Myotonic dystrophy type 1 results from an RNA gain-of-function mutation, in which DM1 protein kinase (DMPK) transcripts carrying expanded trinucleotide repeats exert deleterious effects. Antisense oligonucleotides (ASOs) provide a promising approach to treatment of myotonic dystrophy type 1 because they reduce toxic RNA levels. We aimed to investigate the safety of baliforsen (ISIS 598769), an ASO targeting DMPK mRNA. METHODS In this dose-escalation phase 1/2a trial, adults aged 20-55 years with myotonic dystrophy type 1 were enrolled at seven tertiary referral centres in the USA and randomly assigned via an interactive web or phone response system to subcutaneous injections of baliforsen 100 mg, 200 mg, or 300 mg, or placebo (6:2 randomisation at each dose level), or to baliforsen 400 mg or 600 mg, or placebo (10:2 randomisation at each dose level), on days 1, 3, 5, 8, 15, 22, 29, and 36. Sponsor personnel directly involved with the trial, participants, and all study personnel were masked to treatment assignments. The primary outcome measure was safety in all participants who received at least one dose of study drug up to day 134. This trial is registered with ClinicalTrials.gov (NCT02312011), and is complete. FINDINGS Between Dec 12, 2014, and Feb 22, 2016, 49 participants were enrolled and randomly assigned to baliforsen 100 mg (n=7, one patient not dosed), 200 mg (n=6), 300 mg (n=6), 400 mg (n=10), 600 mg (n=10), or placebo (n=10). The safety population comprised 48 participants who received at least one dose of study drug. Treatment-emergent adverse events were reported for 36 (95%) of 38 participants assigned to baliforsen and nine (90%) of ten participants assigned to placebo. Aside from injection-site reactions, common treatment-emergent adverse events were headache (baliforsen: ten [26%] of 38 participants; placebo: four [40%] of ten participants), contusion (baliforsen: seven [18%] of 38; placebo: one [10%] of ten), and nausea (baliforsen: six [16%] of 38; placebo: two [20%] of ten). Most adverse events (baliforsen: 425 [86%] of 494; placebo: 62 [85%] of 73) were mild in severity. One participant (baliforsen 600 mg) developed transient thrombocytopenia considered potentially treatment related. Baliforsen concentrations in skeletal muscle increased with dose. INTERPRETATION Baliforsen was generally well tolerated. However, skeletal muscle drug concentrations were below levels predicted to achieve substantial target reduction. These results support the further investigation of ASOs as a therapeutic approach for myotonic dystrophy type 1, but suggest improved drug delivery to muscle is needed. FUNDING Ionis Pharmaceuticals, Biogen.
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Affiliation(s)
| | | | | | - Chad Heatwole
- Center for Health and Technology, University of Rochester, Rochester, NY, USA
| | - Laurence Mignon
- Translational Medicine, Ionis Pharmaceuticals, Carlsbad, CA, USA
| | - W David Arnold
- Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Tetsuo Ashizawa
- Neuroscience Research Program, Houston Methodist Research Institute, Houston, TX, USA
| | - John W Day
- Neuromuscular Medicine, Stanford University, Palo Alto, CA, USA
| | - Gersham Dent
- Neurodegeneration Development Unit, Biogen, Cambridge, MA, USA
| | | | - Tina Duong
- Neuromuscular Medicine, Stanford University, Palo Alto, CA, USA
| | - Ericka P Greene
- Neuromuscular Clinic, Houston Methodist Research Institute, Houston, TX, USA
| | - Laura Herbelin
- Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Wendy King
- Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John T Kissel
- Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Doris G Leung
- Center for Genetic Muscle Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Donovan J Lott
- Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Daniel A Norris
- Pharmacokinetics and Clinical Pharmacology, Ionis Pharmaceuticals, Carlsbad, CA, USA
| | | | - Wendy Schell
- Neuromuscular Clinic, Houston Methodist Research Institute, Houston, TX, USA
| | | | - Nikia Stinson
- Center for Genetic Muscle Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Sub H Subramony
- Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Shuting Xia
- Biometrics, Ionis Pharmaceuticals, Carlsbad, CA, USA
| | - Kathie M Bishop
- Clinical Development, Ionis Pharmaceuticals, Carlsbad, CA, USA
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Wong CJ, Friedman SD, Snider L, Bennett SR, Jones TI, Jones PL, Shaw DWW, Blemker SS, Riem L, DuCharme O, Lemmers RJFL, van der Maarel SRM, Wang LH, Tawil R, Statland JM, Tapscott SJ. Validation of the association between MRI and gene signatures in facioscapulohumeral dystrophy muscle: implications for clinical trial design. bioRxiv 2023:2023.02.20.529303. [PMID: 36865168 PMCID: PMC9980042 DOI: 10.1101/2023.02.20.529303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Identifying the aberrant expression of DUX4 in skeletal muscle as the cause of facioscapulohumeral dystrophy (FSHD) has led to rational therapeutic development and clinical trials. Several studies support the use of MRI characteristics and the expression of DUX4-regulated genes in muscle biopsies as biomarkers of FSHD disease activity and progression, but reproducibility across studies needs further validation. We performed lower-extremity MRI and muscle biopsies in the mid-portion of the tibialis anterior (TA) muscles bilaterally in FSHD subjects and validated our prior reports of the strong association between MRI characteristics and expression of genes regulated by DUX4 and other gene categories associated with FSHD disease activity. We further show that measurements of normalized fat content in the entire TA muscle strongly predict molecular signatures in the mid-portion of the TA. Together with moderate-to-strong correlations of gene signatures and MRI characteristics between the TA muscles bilaterally, these results suggest a whole muscle model of disease progression and provide a strong basis for inclusion of MRI and molecular biomarkers in clinical trial design.
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7
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Pasnoor M, Bril V, Levine T, Trivedi J, Silvestri NJ, Phadnis M, Katzberg HD, Saperstein DS, Wolfe GI, Herbelin L, Higgs K, Heim AJ, Statland JM, Barohn RJ, Dimachkie MM. Phase 2 trial in acetylcholine receptor antibody-positive myasthenia gravis of transition from intravenous to subcutaneous immunoglobulin: The MGSCIg study. Eur J Neurol 2023; 30:1417-1424. [PMID: 36779862 DOI: 10.1111/ene.15745] [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] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/01/2023] [Accepted: 02/09/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND AND PURPOSE Data on maintenance therapy with subcutaneous immunoglobulin (SCIg) in myasthenia gravis (MG) are limited. We report on transitioning acetylcholine receptor (AChR) antibody-positive (Ab+) MG patients on stable intravenous immunoglobulin (IVIg) regimens as part of routine clinical care to SCIg 1:1.2. METHODS This multicenter North American open-label prospective investigator-initiated study had two components: the IVIg Stabilization Period (ISP) enrolling patients already on IVIg as part of routine clinical care (Weeks -10 to -1), followed by transition of stable MG subjects to SCIg in the Experimental Treatment Period (ETP; Weeks 0 to 12). We hypothesized that >65% of patients entering the ETP would have a stable Quantitative Myasthenia Gravis (QMG) score from Week 0 to Week 12. Secondary outcome measures included other efficacy measures, safety, tolerability, IgG levels, and treatment satisfaction. RESULTS We recruited 23 patients in the ISP, and 22 entered the ETP. A total of 12 subjects (54.5%) were female, and 18 (81.8%) were White, with mean age 51.4 ± 17 years. We obtained Week 12 ETP QMG data on 19 of 22; one subject withdrew from ETP owing to clinical deterioration, and two subjects withdrew due to dislike of needles. On primary analysis, 19 of 22 participants (86.4%, 95% confidence interval = 0.72-1.00) were treatment successes using last observation carried forward (p = 0.018). Secondary efficacy measures supported MG stability. SCIg was safe and well tolerated, and IgG levels were stable. Treatment satisfaction was comparable between ISP and ETP. CONCLUSIONS MG patients on IVIg as part of their routine clinical care remained stable on monthly IVIg dosage, and most maintained similar disease stability on SCIg.
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Affiliation(s)
- Mamatha Pasnoor
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Vera Bril
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Todd Levine
- HonorHealth Neurology, Phoenix, Arizona, USA
| | - Jaya Trivedi
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Milind Phadnis
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Hans D Katzberg
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Gil I Wolfe
- Department of Neurology, University at Buffalo, Buffalo, New York, USA
| | - Laura Herbelin
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kiley Higgs
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andrew J Heim
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jeffrey M Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Mazen M Dimachkie
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
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Tihaya MS, Mul K, Balog J, de Greef JC, Tapscott SJ, Tawil R, Statland JM, van der Maarel SM. Facioscapulohumeral muscular dystrophy: the road to targeted therapies. Nat Rev Neurol 2023; 19:91-108. [PMID: 36627512 DOI: 10.1038/s41582-022-00762-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 01/11/2023]
Abstract
Advances in the molecular understanding of facioscapulohumeral muscular dystrophy (FSHD) have revealed that FSHD results from epigenetic de-repression of the DUX4 gene in skeletal muscle, which encodes a transcription factor that is active in early embryonic development but is normally silenced in almost all somatic tissues. These advances also led to the identification of targets for disease-altering therapies for FSHD, as well as an improved understanding of the molecular mechanism of the disease and factors that influence its progression. Together, these developments led the FSHD research community to shift its focus towards the development of disease-modifying treatments for FSHD. This Review presents advances in the molecular and clinical understanding of FSHD, discusses the potential targeted therapies that are currently being explored, some of which are already in clinical trials, and describes progress in the development of FSHD-specific outcome measures and assessment tools for use in future clinical trials.
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Affiliation(s)
- Mara S Tihaya
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Karlien Mul
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Judit Balog
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Jessica C de Greef
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Stephen J Tapscott
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Rabi Tawil
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Jeffrey M Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
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9
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Zizzi C, Seabury J, Rosero S, Alexandrou D, Wagner E, Weinstein JS, Varma A, Dilek N, Heatwole J, Wuu J, Caress J, Bedlack R, Granit V, Statland JM, Mehta P, Benatar M, Heatwole C. Patient reported impact of symptoms in amyotrophic lateral sclerosis (PRISM-ALS): A national, cross-sectional study. EClinicalMedicine 2023; 55:101768. [PMID: 36531982 PMCID: PMC9755057 DOI: 10.1016/j.eclinm.2022.101768] [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: 07/25/2022] [Revised: 11/06/2022] [Accepted: 11/14/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND As novel therapeutic interventions are being developed and tested in the amyotrophic lateral sclerosis (ALS) population, there is a need to better understand the symptoms and issues that have the greatest impact on the lives of individuals with ALS. We aimed to determine the frequency and relative importance of symptoms experienced by adults in a national ALS sample and to identify factors that are associated with the greatest disease burden in this population. METHODS We conducted 15 qualitative interviews of individuals with varied ALS phenotypes and analyzed 732 quotes regarding the symptomatic disease burden of ALS between August 2018 and March 2019. We subsequently conducted a national, cross-sectional study of 497 participants with ALS and ALS variants through the Centers for Disease Control and Prevention's (CDC) National ALS Registry between July 2019 and December 2019. Participants reported on the prevalence and relative importance of 189 symptomatic questions representing 17 symptomatic themes that were previously identified through qualitative interviews. Analysis was performed to determine how age, sex, education, employment, time since onset of symptoms, location of symptom onset, feeding tube status, breathing status and speech status relate to symptom and symptomatic theme prevalence. FINDINGS Symptomatic themes with the highest prevalence in our sample were an inability to do activities (93.8%), fatigue (92.6%), problems with hands or fingers (87.7%), limitations with mobility or walking (86.7%), and a decreased performance in social situations (85.7%). Participants identified inability to do activities and limitations with mobility or walking as having the greatest overall effect on their lives. INTERPRETATION Individuals with ALS experience a variety of symptoms that affect their lives. The prevalence and importance of these symptoms differ among the ALS population. The most prevalent and important symptoms offer potential targets for improvements in future therapeutic interventions. FUNDING Research funding was provided by ALS Association.
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Affiliation(s)
- Christine Zizzi
- Center for Health + Technology, 265 Crittenden Blvd, CU 420694, Rochester, NY, 14642, USA
- University of Rochester, Department of Neurology, 601 Elmwood Ave, Box 673, Rochester, NY, 14642, USA
| | - Jamison Seabury
- Center for Health + Technology, 265 Crittenden Blvd, CU 420694, Rochester, NY, 14642, USA
| | - Spencer Rosero
- Center for Health + Technology, 265 Crittenden Blvd, CU 420694, Rochester, NY, 14642, USA
| | - Danae Alexandrou
- Center for Health + Technology, 265 Crittenden Blvd, CU 420694, Rochester, NY, 14642, USA
| | - Ellen Wagner
- Center for Health + Technology, 265 Crittenden Blvd, CU 420694, Rochester, NY, 14642, USA
| | - Jennifer S. Weinstein
- Center for Health + Technology, 265 Crittenden Blvd, CU 420694, Rochester, NY, 14642, USA
| | - Anika Varma
- Center for Health + Technology, 265 Crittenden Blvd, CU 420694, Rochester, NY, 14642, USA
| | - Nuran Dilek
- University of Rochester, Department of Neurology, 601 Elmwood Ave, Box 673, Rochester, NY, 14642, USA
| | | | - Joanne Wuu
- University of Miami Miller School of Medicine, Department of Neurology, 1120 NW 14th Street, Suite 1300, Miami, FL, 33136, USA
| | - James Caress
- Wake Forest Baptist Health, Medical Center Blvd, Winston–Salem, NC, 27157, USA
| | - Richard Bedlack
- Duke University School of Medicine, Department of Neurology, 311 Research Dr, Durham, NC, 27710, USA
| | - Volkan Granit
- University of Miami Miller School of Medicine, Department of Neurology, 1120 NW 14th Street, Suite 1300, Miami, FL, 33136, USA
| | - Jeffrey M. Statland
- University of Kansas Medical Center, Department of Neurology, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Paul Mehta
- Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, National ALS Registry, 4770 Buford Highway NE, Atlanta, GA, 30341, USA
| | - Michael Benatar
- University of Miami Miller School of Medicine, Department of Neurology, 1120 NW 14th Street, Suite 1300, Miami, FL, 33136, USA
| | - Chad Heatwole
- Center for Health + Technology, 265 Crittenden Blvd, CU 420694, Rochester, NY, 14642, USA
- University of Rochester, Department of Neurology, 601 Elmwood Ave, Box 673, Rochester, NY, 14642, USA
- Corresponding author. 265 Crittenden Blvd, CU 420694, Rochester, NY 14642, USA.
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10
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Abstract
PURPOSE OF REVIEW The limb-girdle muscular dystrophies (LGMDs) are a group of inherited muscle disorders with a common feature of limb-girdle pattern of weakness, caused by over 29 individual genes. This article describes the classification scheme, common subtypes, and the management of individuals with LGMD. RECENT FINDINGS Advances in genetic testing and next-generation sequencing panels containing all of the LGMD genes have led to earlier genetic confirmation, but also to more individuals with variants of uncertain significance. The LGMDs include disorders with autosomal recessive inheritance, which are often due to loss-of-function mutations in muscle structural or repair proteins and typically have younger ages of onset and more rapidly progressive presentations, and those with autosomal dominant inheritance, which can have older ages of presentation and chronic progressive disease courses. All cause progressive disability and potential loss of ability to walk or maintain a job due to progressive muscle wasting. Certain mutations are associated with cardiac or respiratory involvement. No disease-altering therapies have been approved by the US Food and Drug Administration (FDA) for LGMDs and standard treatment uses a multidisciplinary clinic model, but recessive LGMDs are potentially amenable to systemic gene replacement therapies, which are already being tested in clinical trials for sarcoglycan and FKRP mutations. The dominant LGMDs may be amenable to RNA-based therapeutic approaches. SUMMARY International efforts are underway to better characterize LGMDs, help resolve variants of uncertain significance, provide consistent and improved standards of care, and prepare for future clinical trials.
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11
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Hoffmann HM, Malo-Juvera V, Statland JM. Self-reported reduced sleep quality and excessive daytime sleepiness in facioscapulohumeral muscular dystrophy. Muscle Nerve 2022; 66:487-494. [PMID: 35893768 PMCID: PMC9489670 DOI: 10.1002/mus.27688] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION/AIMS Facioscapulohumeral muscular dystrophy (FSHD) causes weakness and secondary associations, such as respiratory complications and pain, that can be linked to abnormal sleep patterns. Limited studies have focused on sleep in FSHD. The purpose of this study was to identify the prevalence of, and clinical features associated with, self-reported lowered sleep quality (SQ) and excessive daytime sleepiness (DS) in a large group of participants with FSHD. METHODS We conducted a prospective survey of individuals with self-reported FSHD enrolled in the FSHD Society Registry. The survey consisted of demographic and clinical characteristics, the Pittsburgh Sleep Quality Index (PSQI), and the Epworth Sleepiness Scale. Descriptive statistics were evaluated, and associations between clinical characteristics and SQ and DS were explored using one-way analysis of variance tests. Small effect size was identified as 0.01 ≥ η2 > 0.06, medium was 0.06 ≥ η2 > 0.14, and large was 0.14 ≥ η2 . RESULTS Six hundred ninety individuals responded to the survey, equally distributed between men and women, and spanning the age range from under 12 to 74 years of age or older. Sixty-six percent of the respondents showed reduced SQ (PSQI > 5) (n = 392; 95% confidence interval [CI], 62.4-70.0), and 15% showed excessive DS (>10) (n = 89; 95% CI, 12.2-17.9). There was a significant association between SQ and DS. Nocturnal pain had a large significant effect on lowering SQ (P < .001, η2 = 0.192). Factors including age and gender had minor effects on SQ. DISCUSSION Physicians should monitor sleep quality of patients with FSHD as a routine part of care, with special attention to potentially modifiable factors. Future research should address the physiological effects of pain in sleep.
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Affiliation(s)
| | | | - Jeffrey M. Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
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12
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Statland JM, Campbell C, Desai U, Karam C, Díaz-Manera J, Guptill JT, Korngut L, Genge A, Tawil RN, Elman L, Joyce NC, Wagner KR, Manousakis G, Amato AA, Butterfield RJ, Shieh PB, Wicklund M, Gamez J, Bodkin C, Pestronk A, Weihl CC, Vilchez-Padilla JJ, Johnson NE, Mathews KD, Miller B, Leneus A, Fowler M, van de Rijn M, Attie KM. Randomized phase 2 study of ACE-083, a muscle-promoting agent, in facioscapulohumeral muscular dystrophy. Muscle Nerve 2022; 66:50-62. [PMID: 35428982 PMCID: PMC9321022 DOI: 10.1002/mus.27558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 04/07/2022] [Accepted: 04/09/2022] [Indexed: 12/21/2022]
Abstract
Introduction/Aims Facioscapulohumeral muscular dystrophy (FSHD) is a slowly progressive muscular dystrophy without approved therapies. In this study we evaluated whether locally acting ACE‐083 could safely increase muscle volume and improve functional outcomes in adults with FSHD. Methods Participants were at least 18 years old and had FSHD1/FSHD2. Part 1 was open label, ascending dose, assessing safety and tolerability (primary objective). Part 2 was randomized, double‐blind for 6 months, evaluating ACE‐083240 mg/muscle vs placebo injected bilaterally every 3 weeks in the biceps brachii (BB) or tibialis anterior (TA) muscles, followed by 6 months of open label. Magnetic resonance imaging measures included total muscle volume (TMV; primary objective), fat fraction (FF), and contractile muscle volume (CMV). Functional measures included 6‐minute walk test, 10‐meter walk/run, and 4‐stair climb (TA group), and performance of upper limb midlevel/elbow score (BB group). Strength, patient‐reported outcomes (PROs), and safety were also evaluated. Results Parts 1 and 2 enrolled 37 and 58 participants, respectively. Among 55 participants evaluable in Part 2, the least‐squares mean (90% confidence interval, analysis of covariance) treatment difference for TMV was 16.4% (9.8%‐23.0%) in the BB group (P < .0001) and 9.5% (3.2%‐15.9%) in the TA group (P = .01). CMV increased significantly in the BB and TA groups and FF decreased in the TA group. There were no consistent improvements in functional or PRO measures in either group. The most common adverse events were mild or moderate injection‐site reactions. Discussion Significant increases in TMV with ACE‐083 vs placebo did not result in consistent functional or PRO improvements with up to 12 months of treatment.
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Affiliation(s)
- Jeffrey M Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Craig Campbell
- Department of Pediatrics and Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada
| | - Urvi Desai
- Carolinas MDA Care Center, Atrium Health, Charlotte, North Carolina, USA
| | - Chafic Karam
- Neuromuscular Division, Oregon Health & Science University, Portland, Oregon, USA
| | - Jordi Díaz-Manera
- Neuromuscular Diseases Unit, Neurology Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain.,John Walton Muscular Dystrophy Research Centre, Newcastle University Translational and Clinical Research Institute, Newcastle, UK
| | - Jeffrey T Guptill
- Department of Neurology, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Angela Genge
- Montreal Neurological Institute, Montreal, Quebec, Canada
| | - Rabi N Tawil
- University of Rochester School of Medicine, Rochester, New York, USA
| | - Lauren Elman
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nanette C Joyce
- University of California Davis Medical Center, Davis, California, USA
| | - Kathryn R Wagner
- Johns Hopkins School of Medicine, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Georgios Manousakis
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Russell J Butterfield
- Departments of Neurology and Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Perry B Shieh
- University of California Los Angeles, Los Angeles, California, USA
| | | | - Josep Gamez
- Department of Medicine, GMA Clinic, European Reference Network on Rare Neuromuscular Diseases (ERN EURO-NMD) and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cynthia Bodkin
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alan Pestronk
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Conrad C Weihl
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Juan J Vilchez-Padilla
- Hospital UIP La Fe, Neuromuscular Reference Centre, Valencia, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
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13
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Mellion ML, Widholm P, Karlsson M, Ahlgren A, Tawil R, Wagner KR, Statland JM, Wang L, Shieh PB, van Engelen BGM, Kools J, Ronco L, Odueyungbo A, Jiang J, Han JJ, Hatch M, Towles J, Leinhard OD, Cadavid D. Quantitative Muscle Analysis in FSHD Using Whole-Body Fat-Referenced MRI: Composite Scores for Longitudinal and Cross-Sectional Analysis. Neurology 2022; 99:e877-e889. [PMID: 35750498 DOI: 10.1212/wnl.0000000000200757] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 04/06/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Facioscapulohumeral muscular dystrophy (FSHD) is a rare, debilitating disease characterized by progressive muscle weakness. MRI is a sensitive assessment of disease severity and progression. We developed a quantitative whole-body (WB) musculoskeletal MRI (WB-MSK-MRI) protocol analyzing muscles in their entirety. This study aimed to assess WB-MSK-MRI as a potential imaging biomarker providing reliable measurements of muscle health that capture disease heterogeneity and clinically meaningful composite assessments correlating with severity and more responsive to change in clinical trials. METHODS Participants 18 to 65 years, genetically confirmed FSHD1, clinical severity 2 to 4 (Ricci's scale, range 0-5), and ≥1 short tau inversion recovery (STIR)-positive lower extremity muscle eligible for needle biopsy enrolled at 6 sites; imaged twice 4 - 12 weeks apart. Volumetric analysis of muscle fat infiltration (MFI), muscle fat fraction (MFF), and lean muscle volume (LMV) in 18 (36 total) muscles from bilateral shoulder, proximal arm, trunk, and legs was performed after automated atlas-based segmentation followed by manual verification. A WB composite score, including muscles at highest risk for progression, and functional cross-sectional composites for correlation with relevant functional outcomes including timed up and go (TUG), FSHD-TUG, and reachable workspace (RWS) were developed. RESULTS Seventeen participants;16 follow-up MRIs performed at 52 days (range 36 to 85). Functional cross-sectional composites (MFF and MFI) showed moderate to strong correlations: TUG (rho=0.71, rho=0.83), FSHD-TUG (rho=0.73, rho=0.73), and RWS (left arm: rho=-0.71, rho=-0.53; right arm: rho=-0.61, rho=-0.65). WB composite variability:LMVtot, coefficient of variation (CV) 1.9% and 3.4%; MFFtot, within-subject standard deviation (Sw) 0.5% and 1.5%; MFItot, (Sw), 0.3% and 0.4% for normal and intermediate muscles respectively. CV and Sw were higher in intermediate (MFI≥0.10; MFF<0.50) than in normal (MFI<0.10, MFF<0.50) muscles. DISCUSSION We developed a WB-MSK-MRI protocol and composite measures that capture disease heterogeneity and assess muscle involvement as it correlates with FSHD-relevant clinical endpoints. Functional composites robustly correlate with functional assessments. Stability of the WB composite shows it could be an assessment of change in therapeutic clinical trials. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that quantitative WB-MSK-MRI findings associate with FSHD1 severity measured using established functional assessments.
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Affiliation(s)
| | - Per Widholm
- AMRA Medical AB, Linköping, Sweden.,Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Centre for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | | | | | - Rabi Tawil
- University of Rochester Medical Center, Rochester, NY
| | - Kathryn R Wagner
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Leo Wang
- University of Washington, Seattle, WA
| | | | | | - Joost Kools
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | | | - Jay J Han
- University of California-Irvine, Orange, CA
| | - Maya Hatch
- University of California-Irvine, Orange, CA
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14
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Thomas FP, Brannagan TH, Butterfield RJ, Desai U, Habib AA, Herrmann DN, Eichinger KJ, Johnson NE, Karam C, Pestronk A, Quinn C, Shy ME, Statland JM, Subramony SH, Walk D, Stevens-Favorite K, Miller B, Leneus A, Fowler M, van de Rijn M, Attie KM. Randomized Phase 2 Study of ACE-083 in Patients With Charcot-Marie-Tooth Disease. Neurology 2022; 98:e2356-e2367. [PMID: 35545446 PMCID: PMC9202530 DOI: 10.1212/wnl.0000000000200325] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 02/17/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The goal of this work was to determine whether locally acting ACE-083 is safe and well tolerated and increases muscle volume, motor function, and quality of life (QoL) in adults with Charcot-Marie-Tooth disease (CMT) type 1. METHODS This phase 2 study enrolled adults with CMT1 or CMTX (N = 63). Part 1 was open label and evaluated the safety and tolerability of different dose levels of ACE-083 for use in part 2. Part 2 was a randomized, placebo-controlled, 6-month study of 240 mg/muscle ACE-083 injected bilaterally into the tibialis anterior muscle, followed by a 6-month, open-label extension in which all patients received ACE-083. Pharmacodynamic endpoints included total muscle volume (TMV; primary endpoint), contractile muscle volume (CMV), and fat fraction. Additional secondary endpoints included 6-minute walk test, 10-m walk/run, muscle strength, and QoL. Safety was assessed with treatment-emergent adverse events (TEAEs) and clinical laboratory tests. RESULTS In part 1 (n = 18), ACE-083 was generally safe and well tolerated at all dose levels, with no serious adverse events, TEAEs of grade 3 or greater, or death reported. In part 2 (n = 45 enrolled, n = 44 treated), there was significantly greater change in TMV with ACE-083 compared with placebo (least-squares mean difference 13.5%; p = 0.0096). There was significant difference between ACE-083 and placebo for CMV and change in ankle dorsiflexion strength. Fat fraction and all other functional outcomes were not significantly improved by ACE-083. Moderate to mild injection-site reactions were the most common TEAEs. DISCUSSION Despite significantly increased TMV and CMV, patients with CMT receiving ACE-083 in tibialis anterior muscles did not demonstrate greater functional improvement compared with those receiving placebo. TRIAL REGISTRATION INFORMATION Clinical Trials Registration: NCT03124459. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that intramuscular ACE-083 is safe and well tolerated and increases total muscle volume after 6 months of treatment in adults with CMT1 or CMTX.
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Affiliation(s)
- Florian P Thomas
- From Hackensack University Medical Center (F.P.T.), Hackensack Meridian School of Medicine, Nutley, NJ; Columbia University Medical Center (T.H.B.), New York, NY; University of Utah (R.J.B.), Salt Lake City; Carolinas Healthcare System Neurosciences Institute (U.D.), Charlotte, NC; University of California Irvine (A.A.H.); University of Rochester Medical Center (D.N.H., K.J.E.), NY; Virginia Commonwealth University (N.E.J.), Richmond; Oregon Health & Science University (C.K.), Portland; Washington University School of Medicine (A.P.), St. Louis, MO; University of Pennsylvania (C.Q.), Philadelphia; University of Iowa (M.E.S.), Iowa City; University of Kansas Medical Center (J.M.S.), Kansas City; University of Florida (S.H.S.), Gainesville; University of Minnesota (D.W.), Minneapolis; Cadent Medical Communications, LLC, a Syneos Health group company (K.S.-F.), New York, NY; Acceleron Pharma (B.M., A.L., M.F., M.v.d.R., K.M.A.), Cambridge, MA.
| | - Thomas H Brannagan
- From Hackensack University Medical Center (F.P.T.), Hackensack Meridian School of Medicine, Nutley, NJ; Columbia University Medical Center (T.H.B.), New York, NY; University of Utah (R.J.B.), Salt Lake City; Carolinas Healthcare System Neurosciences Institute (U.D.), Charlotte, NC; University of California Irvine (A.A.H.); University of Rochester Medical Center (D.N.H., K.J.E.), NY; Virginia Commonwealth University (N.E.J.), Richmond; Oregon Health & Science University (C.K.), Portland; Washington University School of Medicine (A.P.), St. Louis, MO; University of Pennsylvania (C.Q.), Philadelphia; University of Iowa (M.E.S.), Iowa City; University of Kansas Medical Center (J.M.S.), Kansas City; University of Florida (S.H.S.), Gainesville; University of Minnesota (D.W.), Minneapolis; Cadent Medical Communications, LLC, a Syneos Health group company (K.S.-F.), New York, NY; Acceleron Pharma (B.M., A.L., M.F., M.v.d.R., K.M.A.), Cambridge, MA
| | - Russell J Butterfield
- From Hackensack University Medical Center (F.P.T.), Hackensack Meridian School of Medicine, Nutley, NJ; Columbia University Medical Center (T.H.B.), New York, NY; University of Utah (R.J.B.), Salt Lake City; Carolinas Healthcare System Neurosciences Institute (U.D.), Charlotte, NC; University of California Irvine (A.A.H.); University of Rochester Medical Center (D.N.H., K.J.E.), NY; Virginia Commonwealth University (N.E.J.), Richmond; Oregon Health & Science University (C.K.), Portland; Washington University School of Medicine (A.P.), St. Louis, MO; University of Pennsylvania (C.Q.), Philadelphia; University of Iowa (M.E.S.), Iowa City; University of Kansas Medical Center (J.M.S.), Kansas City; University of Florida (S.H.S.), Gainesville; University of Minnesota (D.W.), Minneapolis; Cadent Medical Communications, LLC, a Syneos Health group company (K.S.-F.), New York, NY; Acceleron Pharma (B.M., A.L., M.F., M.v.d.R., K.M.A.), Cambridge, MA
| | - Urvi Desai
- From Hackensack University Medical Center (F.P.T.), Hackensack Meridian School of Medicine, Nutley, NJ; Columbia University Medical Center (T.H.B.), New York, NY; University of Utah (R.J.B.), Salt Lake City; Carolinas Healthcare System Neurosciences Institute (U.D.), Charlotte, NC; University of California Irvine (A.A.H.); University of Rochester Medical Center (D.N.H., K.J.E.), NY; Virginia Commonwealth University (N.E.J.), Richmond; Oregon Health & Science University (C.K.), Portland; Washington University School of Medicine (A.P.), St. Louis, MO; University of Pennsylvania (C.Q.), Philadelphia; University of Iowa (M.E.S.), Iowa City; University of Kansas Medical Center (J.M.S.), Kansas City; University of Florida (S.H.S.), Gainesville; University of Minnesota (D.W.), Minneapolis; Cadent Medical Communications, LLC, a Syneos Health group company (K.S.-F.), New York, NY; Acceleron Pharma (B.M., A.L., M.F., M.v.d.R., K.M.A.), Cambridge, MA
| | - Ali A Habib
- From Hackensack University Medical Center (F.P.T.), Hackensack Meridian School of Medicine, Nutley, NJ; Columbia University Medical Center (T.H.B.), New York, NY; University of Utah (R.J.B.), Salt Lake City; Carolinas Healthcare System Neurosciences Institute (U.D.), Charlotte, NC; University of California Irvine (A.A.H.); University of Rochester Medical Center (D.N.H., K.J.E.), NY; Virginia Commonwealth University (N.E.J.), Richmond; Oregon Health & Science University (C.K.), Portland; Washington University School of Medicine (A.P.), St. Louis, MO; University of Pennsylvania (C.Q.), Philadelphia; University of Iowa (M.E.S.), Iowa City; University of Kansas Medical Center (J.M.S.), Kansas City; University of Florida (S.H.S.), Gainesville; University of Minnesota (D.W.), Minneapolis; Cadent Medical Communications, LLC, a Syneos Health group company (K.S.-F.), New York, NY; Acceleron Pharma (B.M., A.L., M.F., M.v.d.R., K.M.A.), Cambridge, MA
| | - David N Herrmann
- From Hackensack University Medical Center (F.P.T.), Hackensack Meridian School of Medicine, Nutley, NJ; Columbia University Medical Center (T.H.B.), New York, NY; University of Utah (R.J.B.), Salt Lake City; Carolinas Healthcare System Neurosciences Institute (U.D.), Charlotte, NC; University of California Irvine (A.A.H.); University of Rochester Medical Center (D.N.H., K.J.E.), NY; Virginia Commonwealth University (N.E.J.), Richmond; Oregon Health & Science University (C.K.), Portland; Washington University School of Medicine (A.P.), St. Louis, MO; University of Pennsylvania (C.Q.), Philadelphia; University of Iowa (M.E.S.), Iowa City; University of Kansas Medical Center (J.M.S.), Kansas City; University of Florida (S.H.S.), Gainesville; University of Minnesota (D.W.), Minneapolis; Cadent Medical Communications, LLC, a Syneos Health group company (K.S.-F.), New York, NY; Acceleron Pharma (B.M., A.L., M.F., M.v.d.R., K.M.A.), Cambridge, MA
| | - Katy J Eichinger
- From Hackensack University Medical Center (F.P.T.), Hackensack Meridian School of Medicine, Nutley, NJ; Columbia University Medical Center (T.H.B.), New York, NY; University of Utah (R.J.B.), Salt Lake City; Carolinas Healthcare System Neurosciences Institute (U.D.), Charlotte, NC; University of California Irvine (A.A.H.); University of Rochester Medical Center (D.N.H., K.J.E.), NY; Virginia Commonwealth University (N.E.J.), Richmond; Oregon Health & Science University (C.K.), Portland; Washington University School of Medicine (A.P.), St. Louis, MO; University of Pennsylvania (C.Q.), Philadelphia; University of Iowa (M.E.S.), Iowa City; University of Kansas Medical Center (J.M.S.), Kansas City; University of Florida (S.H.S.), Gainesville; University of Minnesota (D.W.), Minneapolis; Cadent Medical Communications, LLC, a Syneos Health group company (K.S.-F.), New York, NY; Acceleron Pharma (B.M., A.L., M.F., M.v.d.R., K.M.A.), Cambridge, MA
| | - Nicholas E Johnson
- From Hackensack University Medical Center (F.P.T.), Hackensack Meridian School of Medicine, Nutley, NJ; Columbia University Medical Center (T.H.B.), New York, NY; University of Utah (R.J.B.), Salt Lake City; Carolinas Healthcare System Neurosciences Institute (U.D.), Charlotte, NC; University of California Irvine (A.A.H.); University of Rochester Medical Center (D.N.H., K.J.E.), NY; Virginia Commonwealth University (N.E.J.), Richmond; Oregon Health & Science University (C.K.), Portland; Washington University School of Medicine (A.P.), St. Louis, MO; University of Pennsylvania (C.Q.), Philadelphia; University of Iowa (M.E.S.), Iowa City; University of Kansas Medical Center (J.M.S.), Kansas City; University of Florida (S.H.S.), Gainesville; University of Minnesota (D.W.), Minneapolis; Cadent Medical Communications, LLC, a Syneos Health group company (K.S.-F.), New York, NY; Acceleron Pharma (B.M., A.L., M.F., M.v.d.R., K.M.A.), Cambridge, MA
| | - Chafic Karam
- From Hackensack University Medical Center (F.P.T.), Hackensack Meridian School of Medicine, Nutley, NJ; Columbia University Medical Center (T.H.B.), New York, NY; University of Utah (R.J.B.), Salt Lake City; Carolinas Healthcare System Neurosciences Institute (U.D.), Charlotte, NC; University of California Irvine (A.A.H.); University of Rochester Medical Center (D.N.H., K.J.E.), NY; Virginia Commonwealth University (N.E.J.), Richmond; Oregon Health & Science University (C.K.), Portland; Washington University School of Medicine (A.P.), St. Louis, MO; University of Pennsylvania (C.Q.), Philadelphia; University of Iowa (M.E.S.), Iowa City; University of Kansas Medical Center (J.M.S.), Kansas City; University of Florida (S.H.S.), Gainesville; University of Minnesota (D.W.), Minneapolis; Cadent Medical Communications, LLC, a Syneos Health group company (K.S.-F.), New York, NY; Acceleron Pharma (B.M., A.L., M.F., M.v.d.R., K.M.A.), Cambridge, MA
| | - Alan Pestronk
- From Hackensack University Medical Center (F.P.T.), Hackensack Meridian School of Medicine, Nutley, NJ; Columbia University Medical Center (T.H.B.), New York, NY; University of Utah (R.J.B.), Salt Lake City; Carolinas Healthcare System Neurosciences Institute (U.D.), Charlotte, NC; University of California Irvine (A.A.H.); University of Rochester Medical Center (D.N.H., K.J.E.), NY; Virginia Commonwealth University (N.E.J.), Richmond; Oregon Health & Science University (C.K.), Portland; Washington University School of Medicine (A.P.), St. Louis, MO; University of Pennsylvania (C.Q.), Philadelphia; University of Iowa (M.E.S.), Iowa City; University of Kansas Medical Center (J.M.S.), Kansas City; University of Florida (S.H.S.), Gainesville; University of Minnesota (D.W.), Minneapolis; Cadent Medical Communications, LLC, a Syneos Health group company (K.S.-F.), New York, NY; Acceleron Pharma (B.M., A.L., M.F., M.v.d.R., K.M.A.), Cambridge, MA
| | - Colin Quinn
- From Hackensack University Medical Center (F.P.T.), Hackensack Meridian School of Medicine, Nutley, NJ; Columbia University Medical Center (T.H.B.), New York, NY; University of Utah (R.J.B.), Salt Lake City; Carolinas Healthcare System Neurosciences Institute (U.D.), Charlotte, NC; University of California Irvine (A.A.H.); University of Rochester Medical Center (D.N.H., K.J.E.), NY; Virginia Commonwealth University (N.E.J.), Richmond; Oregon Health & Science University (C.K.), Portland; Washington University School of Medicine (A.P.), St. Louis, MO; University of Pennsylvania (C.Q.), Philadelphia; University of Iowa (M.E.S.), Iowa City; University of Kansas Medical Center (J.M.S.), Kansas City; University of Florida (S.H.S.), Gainesville; University of Minnesota (D.W.), Minneapolis; Cadent Medical Communications, LLC, a Syneos Health group company (K.S.-F.), New York, NY; Acceleron Pharma (B.M., A.L., M.F., M.v.d.R., K.M.A.), Cambridge, MA
| | - Michael E Shy
- From Hackensack University Medical Center (F.P.T.), Hackensack Meridian School of Medicine, Nutley, NJ; Columbia University Medical Center (T.H.B.), New York, NY; University of Utah (R.J.B.), Salt Lake City; Carolinas Healthcare System Neurosciences Institute (U.D.), Charlotte, NC; University of California Irvine (A.A.H.); University of Rochester Medical Center (D.N.H., K.J.E.), NY; Virginia Commonwealth University (N.E.J.), Richmond; Oregon Health & Science University (C.K.), Portland; Washington University School of Medicine (A.P.), St. Louis, MO; University of Pennsylvania (C.Q.), Philadelphia; University of Iowa (M.E.S.), Iowa City; University of Kansas Medical Center (J.M.S.), Kansas City; University of Florida (S.H.S.), Gainesville; University of Minnesota (D.W.), Minneapolis; Cadent Medical Communications, LLC, a Syneos Health group company (K.S.-F.), New York, NY; Acceleron Pharma (B.M., A.L., M.F., M.v.d.R., K.M.A.), Cambridge, MA
| | - Jeffrey M Statland
- From Hackensack University Medical Center (F.P.T.), Hackensack Meridian School of Medicine, Nutley, NJ; Columbia University Medical Center (T.H.B.), New York, NY; University of Utah (R.J.B.), Salt Lake City; Carolinas Healthcare System Neurosciences Institute (U.D.), Charlotte, NC; University of California Irvine (A.A.H.); University of Rochester Medical Center (D.N.H., K.J.E.), NY; Virginia Commonwealth University (N.E.J.), Richmond; Oregon Health & Science University (C.K.), Portland; Washington University School of Medicine (A.P.), St. Louis, MO; University of Pennsylvania (C.Q.), Philadelphia; University of Iowa (M.E.S.), Iowa City; University of Kansas Medical Center (J.M.S.), Kansas City; University of Florida (S.H.S.), Gainesville; University of Minnesota (D.W.), Minneapolis; Cadent Medical Communications, LLC, a Syneos Health group company (K.S.-F.), New York, NY; Acceleron Pharma (B.M., A.L., M.F., M.v.d.R., K.M.A.), Cambridge, MA
| | - Sub H Subramony
- From Hackensack University Medical Center (F.P.T.), Hackensack Meridian School of Medicine, Nutley, NJ; Columbia University Medical Center (T.H.B.), New York, NY; University of Utah (R.J.B.), Salt Lake City; Carolinas Healthcare System Neurosciences Institute (U.D.), Charlotte, NC; University of California Irvine (A.A.H.); University of Rochester Medical Center (D.N.H., K.J.E.), NY; Virginia Commonwealth University (N.E.J.), Richmond; Oregon Health & Science University (C.K.), Portland; Washington University School of Medicine (A.P.), St. Louis, MO; University of Pennsylvania (C.Q.), Philadelphia; University of Iowa (M.E.S.), Iowa City; University of Kansas Medical Center (J.M.S.), Kansas City; University of Florida (S.H.S.), Gainesville; University of Minnesota (D.W.), Minneapolis; Cadent Medical Communications, LLC, a Syneos Health group company (K.S.-F.), New York, NY; Acceleron Pharma (B.M., A.L., M.F., M.v.d.R., K.M.A.), Cambridge, MA
| | - David Walk
- From Hackensack University Medical Center (F.P.T.), Hackensack Meridian School of Medicine, Nutley, NJ; Columbia University Medical Center (T.H.B.), New York, NY; University of Utah (R.J.B.), Salt Lake City; Carolinas Healthcare System Neurosciences Institute (U.D.), Charlotte, NC; University of California Irvine (A.A.H.); University of Rochester Medical Center (D.N.H., K.J.E.), NY; Virginia Commonwealth University (N.E.J.), Richmond; Oregon Health & Science University (C.K.), Portland; Washington University School of Medicine (A.P.), St. Louis, MO; University of Pennsylvania (C.Q.), Philadelphia; University of Iowa (M.E.S.), Iowa City; University of Kansas Medical Center (J.M.S.), Kansas City; University of Florida (S.H.S.), Gainesville; University of Minnesota (D.W.), Minneapolis; Cadent Medical Communications, LLC, a Syneos Health group company (K.S.-F.), New York, NY; Acceleron Pharma (B.M., A.L., M.F., M.v.d.R., K.M.A.), Cambridge, MA
| | - Katherine Stevens-Favorite
- From Hackensack University Medical Center (F.P.T.), Hackensack Meridian School of Medicine, Nutley, NJ; Columbia University Medical Center (T.H.B.), New York, NY; University of Utah (R.J.B.), Salt Lake City; Carolinas Healthcare System Neurosciences Institute (U.D.), Charlotte, NC; University of California Irvine (A.A.H.); University of Rochester Medical Center (D.N.H., K.J.E.), NY; Virginia Commonwealth University (N.E.J.), Richmond; Oregon Health & Science University (C.K.), Portland; Washington University School of Medicine (A.P.), St. Louis, MO; University of Pennsylvania (C.Q.), Philadelphia; University of Iowa (M.E.S.), Iowa City; University of Kansas Medical Center (J.M.S.), Kansas City; University of Florida (S.H.S.), Gainesville; University of Minnesota (D.W.), Minneapolis; Cadent Medical Communications, LLC, a Syneos Health group company (K.S.-F.), New York, NY; Acceleron Pharma (B.M., A.L., M.F., M.v.d.R., K.M.A.), Cambridge, MA
| | - Barry Miller
- From Hackensack University Medical Center (F.P.T.), Hackensack Meridian School of Medicine, Nutley, NJ; Columbia University Medical Center (T.H.B.), New York, NY; University of Utah (R.J.B.), Salt Lake City; Carolinas Healthcare System Neurosciences Institute (U.D.), Charlotte, NC; University of California Irvine (A.A.H.); University of Rochester Medical Center (D.N.H., K.J.E.), NY; Virginia Commonwealth University (N.E.J.), Richmond; Oregon Health & Science University (C.K.), Portland; Washington University School of Medicine (A.P.), St. Louis, MO; University of Pennsylvania (C.Q.), Philadelphia; University of Iowa (M.E.S.), Iowa City; University of Kansas Medical Center (J.M.S.), Kansas City; University of Florida (S.H.S.), Gainesville; University of Minnesota (D.W.), Minneapolis; Cadent Medical Communications, LLC, a Syneos Health group company (K.S.-F.), New York, NY; Acceleron Pharma (B.M., A.L., M.F., M.v.d.R., K.M.A.), Cambridge, MA
| | - Ashley Leneus
- From Hackensack University Medical Center (F.P.T.), Hackensack Meridian School of Medicine, Nutley, NJ; Columbia University Medical Center (T.H.B.), New York, NY; University of Utah (R.J.B.), Salt Lake City; Carolinas Healthcare System Neurosciences Institute (U.D.), Charlotte, NC; University of California Irvine (A.A.H.); University of Rochester Medical Center (D.N.H., K.J.E.), NY; Virginia Commonwealth University (N.E.J.), Richmond; Oregon Health & Science University (C.K.), Portland; Washington University School of Medicine (A.P.), St. Louis, MO; University of Pennsylvania (C.Q.), Philadelphia; University of Iowa (M.E.S.), Iowa City; University of Kansas Medical Center (J.M.S.), Kansas City; University of Florida (S.H.S.), Gainesville; University of Minnesota (D.W.), Minneapolis; Cadent Medical Communications, LLC, a Syneos Health group company (K.S.-F.), New York, NY; Acceleron Pharma (B.M., A.L., M.F., M.v.d.R., K.M.A.), Cambridge, MA
| | - Marcie Fowler
- From Hackensack University Medical Center (F.P.T.), Hackensack Meridian School of Medicine, Nutley, NJ; Columbia University Medical Center (T.H.B.), New York, NY; University of Utah (R.J.B.), Salt Lake City; Carolinas Healthcare System Neurosciences Institute (U.D.), Charlotte, NC; University of California Irvine (A.A.H.); University of Rochester Medical Center (D.N.H., K.J.E.), NY; Virginia Commonwealth University (N.E.J.), Richmond; Oregon Health & Science University (C.K.), Portland; Washington University School of Medicine (A.P.), St. Louis, MO; University of Pennsylvania (C.Q.), Philadelphia; University of Iowa (M.E.S.), Iowa City; University of Kansas Medical Center (J.M.S.), Kansas City; University of Florida (S.H.S.), Gainesville; University of Minnesota (D.W.), Minneapolis; Cadent Medical Communications, LLC, a Syneos Health group company (K.S.-F.), New York, NY; Acceleron Pharma (B.M., A.L., M.F., M.v.d.R., K.M.A.), Cambridge, MA
| | - Marc van de Rijn
- From Hackensack University Medical Center (F.P.T.), Hackensack Meridian School of Medicine, Nutley, NJ; Columbia University Medical Center (T.H.B.), New York, NY; University of Utah (R.J.B.), Salt Lake City; Carolinas Healthcare System Neurosciences Institute (U.D.), Charlotte, NC; University of California Irvine (A.A.H.); University of Rochester Medical Center (D.N.H., K.J.E.), NY; Virginia Commonwealth University (N.E.J.), Richmond; Oregon Health & Science University (C.K.), Portland; Washington University School of Medicine (A.P.), St. Louis, MO; University of Pennsylvania (C.Q.), Philadelphia; University of Iowa (M.E.S.), Iowa City; University of Kansas Medical Center (J.M.S.), Kansas City; University of Florida (S.H.S.), Gainesville; University of Minnesota (D.W.), Minneapolis; Cadent Medical Communications, LLC, a Syneos Health group company (K.S.-F.), New York, NY; Acceleron Pharma (B.M., A.L., M.F., M.v.d.R., K.M.A.), Cambridge, MA
| | - Kenneth M Attie
- From Hackensack University Medical Center (F.P.T.), Hackensack Meridian School of Medicine, Nutley, NJ; Columbia University Medical Center (T.H.B.), New York, NY; University of Utah (R.J.B.), Salt Lake City; Carolinas Healthcare System Neurosciences Institute (U.D.), Charlotte, NC; University of California Irvine (A.A.H.); University of Rochester Medical Center (D.N.H., K.J.E.), NY; Virginia Commonwealth University (N.E.J.), Richmond; Oregon Health & Science University (C.K.), Portland; Washington University School of Medicine (A.P.), St. Louis, MO; University of Pennsylvania (C.Q.), Philadelphia; University of Iowa (M.E.S.), Iowa City; University of Kansas Medical Center (J.M.S.), Kansas City; University of Florida (S.H.S.), Gainesville; University of Minnesota (D.W.), Minneapolis; Cadent Medical Communications, LLC, a Syneos Health group company (K.S.-F.), New York, NY; Acceleron Pharma (B.M., A.L., M.F., M.v.d.R., K.M.A.), Cambridge, MA
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15
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Wong CJ, Wang L, Holers VM, Frazer-Abel A, van der Maarel SM, Tawil R, Statland JM, Tapscott SJ. Elevated plasma complement components in facioscapulohumeral dystrophy. Hum Mol Genet 2022; 31:1821-1829. [PMID: 34919696 PMCID: PMC9169453 DOI: 10.1093/hmg/ddab364] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/07/2021] [Accepted: 12/14/2021] [Indexed: 11/12/2022] Open
Abstract
Advances in understanding the pathophysiology of facioscapulohumeral dystrophy (FSHD) have led to several therapeutic approaches entering clinical trials and an increased need to develop biomarkers of disease activity and progression. Multiple prior studies have shown early elevation of RNAs encoding components of the complement pathways and relatively widespread activated complement complexes by immunodetection in FSHD muscle. The current study tested plasma from two independent cohorts of FSHD and control subjects and found elevated complement components in both FSHD cohorts. Combining subjects from both cohorts identified complement factors that best distinguished FSHD and controls. Within the FSHD group, a subset of subjects showed elevation in multiple complement components. Together these findings suggest the need for future studies to determine whether measurements of complement activation can be used as a non-invasive measurement of FSHD disease activity, progression and/or response to therapies. In addition, with the ongoing expansion of complement therapeutic approaches, consideration for precision-based targeting of this pathway is appropriate.
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Affiliation(s)
- Chao-Jen Wong
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Leo Wang
- Department of Neurology, University of Washington, Seattle, WA 98105, USA
| | - V Michael Holers
- Division of Rheumatology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Ashley Frazer-Abel
- Exsera BioLabs, Division of Rheumatalogy, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | | | - Rabi Tawil
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Jeffrey M Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, KA 66160, USA
| | - Stephen J Tapscott
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
- Department of Neurology, University of Washington, Seattle, WA 98105, USA
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16
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Fullam TR, Chandrashekhar S, Farmakidis C, Jawdat O, Pasnoor M, Dimachkie MM, Statland JM. Non-dystrophic myotonia: 2-year clinical and patient reported outcomes. Muscle Nerve 2022; 66:148-158. [PMID: 35644941 PMCID: PMC9308727 DOI: 10.1002/mus.27649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION/AIMS Consistency of differences between non-dystrophic myotonias over time measured by standardized clinical/patient-reported outcomes is lacking. Evaluation of longitudinal data could establish clinically relevant endpoints for future research. METHODS Data from prospective observational study of 95 definite/clinically suspected non-dystrophic myotonia participants (six sites in the United States, United Kingdom, and Canada) between March 2006 and March 2009 were analyzed. Outcomes included: standardized symptom interview/exam, Short Form-36, Individualized Neuromuscular Quality of Life (INQoL), electrophysiological short/prolonged exercise tests, manual muscle testing, quantitative grip strength, modified get-up-and-go test. Patterns were assigned as described by Fournier et al. Comparisons were restricted to confirmed sodium channelopathies (SCN4A, baseline, year 1, year 2: n = 34, 19, 13), chloride channelopathies (CLCN1, n = 32, 26, 18), and myotonic dystrophy type 2 (DM2, n = 9, 6, 2). RESULTS Muscle stiffness was the most frequent symptom over time (54.7%-64.7%). Eyelid myotonia and paradoxical handgrip/eyelid myotonia were more frequent in SCN4A. Grip strength and combined manual muscle testing remained stable. Modified get-up-and-go showed less warm up in SCN4A but remained stable. Median post short exercise decrement was stable, except for SCN4A (baseline to year 2 decrement difference 16.6% [Q1, Q3: 9.5, 39.2]). Fournier patterns type 2 (CLCN1) and 1 (SCN4A) were most specific; 40.4% of participants had a change in pattern over time. INQoL showed higher impact for SCN4A and DM2 with scores stable over time. DISCUSSION Symptom frequency and clinical outcome assessments were stable with defined variability in myotonia measures supporting trial designs like cross over or combined n-of-1 as important for rare disorders.
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Affiliation(s)
- Timothy R Fullam
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA.,Department of Neurology, Brooke Army Medical Center, JBSA-Fort Sam, Houston, Texas, USA
| | - Swathy Chandrashekhar
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Omar Jawdat
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mamatha Pasnoor
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mazen M Dimachkie
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jeffrey M Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
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17
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Widholm P, Ahlgren A, Karlsson M, Romu T, Tawil R, Wagner KR, Statland JM, Wang LH, Shieh PB, van Engelen BGM, Cadavid D, Ronco L, Odueyungbo AO, Jiang JG, Mellion ML, Dahlqvist Leinhard O. Quantitative muscle analysis in facioscapulohumeral muscular dystrophy using whole-body fat-referenced MRI: Protocol development, multicenter feasibility, and repeatability. Muscle Nerve 2022; 66:183-192. [PMID: 35585766 DOI: 10.1002/mus.27638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION/AIMS Functional performance tests are the gold standard to assess disease progression and treatment effects in neuromuscular disorders. These tests can be confounded by motivation, pain, fatigue, and learning effects, increasing variability and decreasing sensitivity to disease progression, limiting efficacy assessment in clinical trials with small sample sizes. We aimed to develop and validate a quantitative and objective method to measure skeletal muscle volume and fat content based on whole-body fat-referenced magnetic resonance imaging (MRI) for use in multisite clinical trials. METHODS Subjects aged 18 to 65 years, genetically confirmed facioscapulohumeral muscular dystrophy 1 (FSHD1), clinical severity 2 to 4 (Ricci's scale, range 0-5), were enrolled at six sites and imaged twice 4-12 weeks apart with T1-weighted two-point Dixon MRI covering the torso and upper and lower extremities. Thirty-six muscles were volumetrically segmented using semi-automatic multi-atlas-based segmentation. Muscle fat fraction (MFF), muscle fat infiltration (MFI), and lean muscle volume (LMV) were quantified for each muscle using fat-referenced quantification. RESULTS Seventeen patients (mean age ± SD, 49.4 years ±13.02; 12 men) were enrolled. Within-patient SD ranged from 1.00% to 3.51% for MFF and 0.40% to 1.48% for MFI in individual muscles. For LMV, coefficients of variation ranged from 2.7% to 11.7%. For the composite score average of all muscles, observed SDs were 0.70% and 0.32% for MFF and MFI, respectively; composite LMV coefficient of variation was 2.0%. DISCUSSION We developed and validated a method for measuring skeletal muscle volume and fat content for use in multisite clinical trials of neuromuscular disorders.
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Affiliation(s)
- Per Widholm
- AMRA Medical AB, Linköping, Sweden.,Department of Radiology, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Centre for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | | | | | | | - Rabi Tawil
- University of Rochester Medical Center, Rochester, New York, USA
| | - Kathryn R Wagner
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Leo H Wang
- University of Washington, Seattle, Washington, USA
| | - Perry B Shieh
- University of California, Los Angeles, California, USA
| | - Baziel G M van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | | | - John G Jiang
- Fulcrum Therapeutics, Cambridge, Massachusetts, USA
| | | | - Olof Dahlqvist Leinhard
- AMRA Medical AB, Linköping, Sweden.,Centre for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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18
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Deutsch GK, Hagerman KA, Sampson J, Dent G, Dekdebrun J, Parker DM, Thornton CA, Heatwole CR, Subramony SH, Mankodi AK, Ashizawa T, Statland JM, Arnold WD, Moxley RT, Day JW. Brief assessment of cognitive function in myotonic dystrophy: multicenter longitudinal study using computer-assisted evaluation. Muscle Nerve 2022; 65:560-567. [PMID: 35179228 PMCID: PMC9102286 DOI: 10.1002/mus.27520] [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] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 02/09/2022] [Accepted: 02/12/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION/AIMS Myotonic dystrophy type 1 (DM1) is known to affect cognitive function, but the best methods to assess CNS involvement in multicenter studies have not been determined. This study's primary aim was to evaluate the potential of computerized cognitive tests to assess cognition in DM1. METHODS We conducted a prospective, longitudinal, observational study of 113 adults with DM1 at 6 sites. Psychomotor speed, attention, working memory, and executive functioning were assessed at baseline, 3-months and 12-months using computerized cognitive tests. Results were compared with assessments of muscle function and patient reported outcomes (PROs), including the Myotonic Dystrophy Health Index (MDHI) and EQ-5D-5L. RESULTS Based on intra-class correlation coefficients (ICCs), computerized cognitive tests had moderate to good reliability for psychomotor speed (0.76), attention (0.82), working memory speed (0.79), working memory accuracy (0.65), and executive functioning (0.87). Performance at baseline was lowest for working memory accuracy (p < 0.0001). Executive function performance improved from baseline to 3-months (p < 0.0001), without further changes over one year. There was a moderate correlation between poorer executive function and larger CTG repeat size (r = -0.433). There were some weak associations between PROs and cognitive performance. DISCUSSION Computerized tests of cognition are feasible in multicenter studies of DM1. Poor performance was exhibited in working memory, which may be a useful variable in clinical trials. Learning effects may have contributed to the improvement in executive functioning. The relationship between PROs and cognitive impairment in DM1 requires further study. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Gayle K Deutsch
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, United States
| | - Katharine A Hagerman
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, United States
| | - Jacinda Sampson
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, United States
| | | | - Jeanne Dekdebrun
- The University of Rochester Medical Center, Rochester, New York, United States
| | - Dana M Parker
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, United States
| | - Charles A Thornton
- The University of Rochester Medical Center, Rochester, New York, United States
| | - Chad R Heatwole
- The University of Rochester Medical Center, Rochester, New York, United States
| | - Sub H Subramony
- University of Florida McKnight Brain Institute, Gainesville, Florida, United States
| | - Ami K Mankodi
- National Institute of Neurological Disorders and Stroke, Rockville, Maryland, United States
| | | | | | - W David Arnold
- The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Richard T Moxley
- The University of Rochester Medical Center, Rochester, New York, United States
| | - John W Day
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, United States
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Attarian S, Young P, Brannagan TH, Adams D, Van Damme P, Thomas FP, Casanovas C, Kafaie J, Tard C, Walter MC, Péréon Y, Walk D, Stino A, de Visser M, Verhamme C, Amato A, Carter G, Magy L, Statland JM, Felice K. A double-blind, placebo-controlled, randomized trial of PXT3003 for the treatment of Charcot-Marie-Tooth type 1A. Orphanet J Rare Dis 2021; 16:433. [PMID: 34656144 PMCID: PMC8520617 DOI: 10.1186/s13023-021-02040-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Charcot-Marie-Tooth disease type 1A (CMT1A) is a rare, orphan, hereditary neuromuscular disorder with no cure and for which only symptomatic treatment is currently available. A previous phase 2 trial has shown preliminary evidence of efficacy for PXT3003 in treating CMT1A. This phase 3, international, randomized, double-blind, placebo-controlled study further investigated the efficacy and safety of high- or low-dose PXT3003 (baclofen/naltrexone/D-sorbitol [mg]: 6/0.70/210 or 3/0.35/105) in treating subjects with mild to moderate CMT1A. METHODS In this study, 323 subjects with mild-to-moderate CMT1A were randomly assigned in a 1:1:1 ratio to receive 5 mL of high- or low-dose PXT3003, or placebo, orally twice daily for up to 15 months. Efficacy was assessed using the change in Overall Neuropathy Limitations Scale total score from baseline to months 12 and 15 (primary endpoint). Secondary endpoints included the 10-m walk test and other assessments. The high-dose group was discontinued early due to unexpected crystal formation in the high-dose formulation, which resulted in an unanticipated high discontinuation rate, overall and especially in the high-dose group. The statistical analysis plan was adapted to account for the large amount of missing data before database lock, and a modified full analysis set was used in the main analyses. Two sensitivity analyses were performed to check the interpretation based on the use of the modified full analysis set. RESULTS High-dose PXT3003 demonstrated significant improvement in the Overall Neuropathy Limitations Scale total score vs placebo (mean difference: - 0.37 points; 97.5% CI [- 0.68 to - 0.06]; p = 0.008), and consistent treatment effects were shown in the sensitivity analyses. Both PXT3003 doses were safe and well-tolerated. CONCLUSION The high-dose group demonstrated a statistically significant improvement in the primary endpoint and a good safety profile. Overall, high-dose PXT3003 is a promising treatment option for patients with Charcot-Marie-Tooth disease type 1A.
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Affiliation(s)
- Shahram Attarian
- Reference Center for Neuromuscular Disorders and ALS, CHU La Timone, Marseille, France.
| | - Peter Young
- Department of Neurology, Medical Park Bad Feilnbach, Bad Feilnbach, Germany
| | - Thomas H Brannagan
- Columbia University Medical Center, The Neurological Institute, New York, USA
| | - David Adams
- French Reference Center for Rare Peripheral Neuropathies, Service de Neurologie Adulte, APHP, CHU Bicêtre, Le Kremlin Bicêtre, France
| | - Philip Van Damme
- Department of Neurology, University Hospitals Leuven, KU, Leuven, Belgium
- Center for Brain & Disease Research, VIB, Leuven, Belgium
| | - Florian P Thomas
- Department of Neurology, Hackensack University Medical Center, Hackensack, USA
- Department of Neurology, Saint Louis University School of Medicine, St. Louis, USA
| | - Carlos Casanovas
- Neuromuscular Unit, Neurology Department, Bellvitge University Hospital, Barcelona, Spain
- Neurometabolic Diseases Group, Bellvitge Research Institute (IDIBELL) and CIBERER, Barcelona, Spain
| | - Jafar Kafaie
- Department of Neurology, Saint Louis University School of Medicine, St. Louis, USA
| | - Céline Tard
- U1171, Centre de référence des maladies neuromusculaires Nord Est Ile de France, Hôpital Salengro CHU de Lille, Lille, France
| | - Maggie C Walter
- Department of Neurology, Friedrich-Baur-Institute, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Yann Péréon
- Centre de Référence Maladies Neuromusculaires AOC, Filnemus, Euro-NMD, CHU Nantes, Hôtel-Dieu, Nantes, France
| | - David Walk
- Clinical Neuroscience Research Unit, University of Minnesota, Minneapolis, USA
| | - Amro Stino
- University of Michigan Health System, Ann Arbor, MI, USA
| | - Marianne de Visser
- Department of Neurology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Camiel Verhamme
- Department of Neurology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Anthony Amato
- Department of Neurology, Brigham and Women's Hospital, Boston, USA
| | - Gregory Carter
- St. Luke's Rehabilitation Institute, Physical Medicine and Rehabilitation, Spokane, USA
| | | | | | - Kevin Felice
- Department of Neuromuscular Medicine, Hospital for Special Care, New Britain, USA
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20
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LoRusso S, Eichinger K, Higgs K, Lewis L, Walker M, Albert J, Langer M, Tawil R, Statland JM, Kimminau KS. A Roadmap to Patient Engagement: Facioscapulohumeral Muscular Dystrophy and the ReSolve Clinical Trial. Neurol Clin Pract 2021; 11:e722-e726. [PMID: 34840889 PMCID: PMC8610524 DOI: 10.1212/cpj.0000000000001074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/08/2021] [Indexed: 11/15/2022]
Abstract
We describe our efforts to overcome barriers to patient engagement in facioscapulohumeral muscular dystrophy (FSHD) and offer a roadmap that can be replicated in other rare neurologic disorders. We implemented an engagement plan during Clinical Trial Readiness to Solve Barriers to Drug Development for FSHD (ReSolve), an 18-month, multisite, observational study of individuals with FSHD. Elements of our engagement plan included conducting focus groups during protocol development, patient involvement on the ReSolve external advisory committee, creation of a patient advisory committee, and collaboration with patient advocacy groups. Patient feedback led to adaptations in the study protocol and to changes in recruitment and retention methods. Patient engagement ensures that the patient voice contributes to multiple aspects of trial design and implementation. Our engagement efforts exemplify how collaboration with patients and families can be accomplished in FSHD and the resultant roadmap process may be replicable in other rare neurologic diseases.
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Affiliation(s)
- Samantha LoRusso
- Department of Neurology (SL), Ohio State University Medical Center, Columbus, Ohio; Department of Neurology (KE. LL, RT), Strong Memorial Hospital, University of Rochester, Rochester, New York; Department of Neurology (KH, MW, JMS), University of Kansas Medical Center, Kansas City, Kansas; University of Missouri School of Medicine (KSK), Columbia, Missouri
| | - Katy Eichinger
- Department of Neurology (SL), Ohio State University Medical Center, Columbus, Ohio; Department of Neurology (KE. LL, RT), Strong Memorial Hospital, University of Rochester, Rochester, New York; Department of Neurology (KH, MW, JMS), University of Kansas Medical Center, Kansas City, Kansas; University of Missouri School of Medicine (KSK), Columbia, Missouri
| | - Kiley Higgs
- Department of Neurology (SL), Ohio State University Medical Center, Columbus, Ohio; Department of Neurology (KE. LL, RT), Strong Memorial Hospital, University of Rochester, Rochester, New York; Department of Neurology (KH, MW, JMS), University of Kansas Medical Center, Kansas City, Kansas; University of Missouri School of Medicine (KSK), Columbia, Missouri
| | - Leann Lewis
- Department of Neurology (SL), Ohio State University Medical Center, Columbus, Ohio; Department of Neurology (KE. LL, RT), Strong Memorial Hospital, University of Rochester, Rochester, New York; Department of Neurology (KH, MW, JMS), University of Kansas Medical Center, Kansas City, Kansas; University of Missouri School of Medicine (KSK), Columbia, Missouri
| | - Michaela Walker
- Department of Neurology (SL), Ohio State University Medical Center, Columbus, Ohio; Department of Neurology (KE. LL, RT), Strong Memorial Hospital, University of Rochester, Rochester, New York; Department of Neurology (KH, MW, JMS), University of Kansas Medical Center, Kansas City, Kansas; University of Missouri School of Medicine (KSK), Columbia, Missouri
| | - James Albert
- Department of Neurology (SL), Ohio State University Medical Center, Columbus, Ohio; Department of Neurology (KE. LL, RT), Strong Memorial Hospital, University of Rochester, Rochester, New York; Department of Neurology (KH, MW, JMS), University of Kansas Medical Center, Kansas City, Kansas; University of Missouri School of Medicine (KSK), Columbia, Missouri
| | - Michele Langer
- Department of Neurology (SL), Ohio State University Medical Center, Columbus, Ohio; Department of Neurology (KE. LL, RT), Strong Memorial Hospital, University of Rochester, Rochester, New York; Department of Neurology (KH, MW, JMS), University of Kansas Medical Center, Kansas City, Kansas; University of Missouri School of Medicine (KSK), Columbia, Missouri
| | - Rabi Tawil
- Department of Neurology (SL), Ohio State University Medical Center, Columbus, Ohio; Department of Neurology (KE. LL, RT), Strong Memorial Hospital, University of Rochester, Rochester, New York; Department of Neurology (KH, MW, JMS), University of Kansas Medical Center, Kansas City, Kansas; University of Missouri School of Medicine (KSK), Columbia, Missouri
| | - Jeffrey M Statland
- Department of Neurology (SL), Ohio State University Medical Center, Columbus, Ohio; Department of Neurology (KE. LL, RT), Strong Memorial Hospital, University of Rochester, Rochester, New York; Department of Neurology (KH, MW, JMS), University of Kansas Medical Center, Kansas City, Kansas; University of Missouri School of Medicine (KSK), Columbia, Missouri
| | - Kim S Kimminau
- Department of Neurology (SL), Ohio State University Medical Center, Columbus, Ohio; Department of Neurology (KE. LL, RT), Strong Memorial Hospital, University of Rochester, Rochester, New York; Department of Neurology (KH, MW, JMS), University of Kansas Medical Center, Kansas City, Kansas; University of Missouri School of Medicine (KSK), Columbia, Missouri
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21
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Katz NK, Hogan J, Delbango R, Cernik C, Tawil R, Statland JM. Predictors of functional outcomes in patients with facioscapulohumeral muscular dystrophy. Brain 2021; 144:3451-3460. [PMID: 34542603 DOI: 10.1093/brain/awab326] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/15/2021] [Accepted: 07/30/2021] [Indexed: 11/13/2022] Open
Abstract
Facioscapulohumeral muscular dystrophy (FSHD) is one of the most prevalent muscular dystrophies characterized by considerable variability in severity, rates of progression and functional outcomes. Few studies follow FSHD cohorts long enough to understand predictors of disease progression and functional outcomes, creating gaps in our understanding which impacts clinical care and the design of clinical trials. Efforts to identify molecularly targeted therapies create a need to better understand disease characteristics with predictive value to help refine clinical trial strategies and understand trial outcomes. Here we analyzed a prospective cohort from a large, longitudinally-followed registry of patients with FSHD in the United States to determine predictors of outcomes such as need for wheelchair use. This study analyzed de-identified data from 578 individuals with confirmed FSHD type 1 enrolled in the United States National Registry for FSHD Patients and Family members. Data were collected from January 2002 to September 2019 and included an average of nine years (range 0 to 18) of follow up surveys. Data were analyzed using descriptive epidemiological techniques, and risk of wheelchair use was determined using cox proportional hazards models. Supervised machine learning analysis was completed using Random Forest modeling and included all 189 unique features collected from registry questionnaires. A separate medications-only model was created that included 359 unique medications reported by participants. Here we show that smaller allele sizes were predictive of earlier age at onset, diagnosis and likelihood of wheelchair use. Additionally, we show that women were more likely overall to progress to wheelchair use and at a faster rate as compared to men, independent of genetics. Use of machine learning models that included all reported clinical features showed that the effect of allele size on progression to wheelchair use is small compared to disease duration, which may be important to consider in trial design. Medical comorbidities and medication use add to the risk for need for wheelchair dependence, raising the possibility for better medical management impacting outcomes in FSHD. The findings in this study will require further validation in additional, larger datasets but could have implications for clinical care, and inclusion criteria for future clinical trials in FSHD.
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Affiliation(s)
- Natalie K Katz
- Department of Neurology, Children's Mercy Hospital, Kansas City, MO 64108, USA
| | - John Hogan
- Department of Artificial Intelligence, AIbytes, LLC, Hurley, NY 12443, USA
| | - Ryan Delbango
- Department of Artificial Intelligence, AIbytes, LLC, Hurley, NY 12443, USA
| | - Colin Cernik
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Rabi Tawil
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Jeffrey M Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS 66160, USA
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22
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Barohn RJ, Fink JK, Heiman-Patterson T, Huey ED, Murphy J, Statland JM, Turner MR, Elman L. The clinical spectrum of primary lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2021; 21:3-10. [PMID: 33602013 DOI: 10.1080/21678421.2020.1837178] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Primary lateral sclerosis is a distinct entity that has recently been classified as a "restricted phenotype" of ALS. It is characterized by a pattern of isolated upper motor neuron involvement that often begins in the legs and spreads diffusely. Distinction from other conditions requires careful consideration of clinical presentation and time course of disease. Mills' Syndrome is a rare unilateral variant of primary lateral sclerosis. Cognitive and behavioral involvement may occur.
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Affiliation(s)
- Richard J Barohn
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - John K Fink
- Department of Neurology, Ann Arbor Veterans Affairs Medical Center, University of Michigan, Ann Arbor, MI, USA
| | - Terry Heiman-Patterson
- Department of Neurology, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Edward D Huey
- College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Jennifer Murphy
- Department of Neurology, University of California at San Francisco, San Francisco, CA, USA
| | - Jeffrey M Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Martin R Turner
- Nuffield Department of Neurosciences, University of Oxford, Oxford, UK
| | - Lauren Elman
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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23
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Sansone VA, Johnson NE, Hanna MG, Ciafaloni E, Statland JM, Shieh PB, Cohen F, Griggs RC. Long-term efficacy and safety of dichlorphenamide for treatment of primary periodic paralysis. Muscle Nerve 2021; 64:342-346. [PMID: 34129236 PMCID: PMC9290603 DOI: 10.1002/mus.27354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 06/04/2021] [Accepted: 06/13/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION/AIM Long-term efficacy and safety of dichlorphenamide (DCP) were characterized in patients with primary periodic paralysis (PPP). METHODS Patients with PPP in a double-blind, placebo-controlled study were randomly assigned to receive DCP 50 mg twice daily or placebo for 9 weeks, followed by a 52-week open-label DCP treatment phase (DCP/DCP and placebo/DCP populations). Efficacy (attack rate, severity-weighted attack rate) and safety were assessed in patients completing the study (61 weeks). In this post hoc analysis, efficacy and safety data were pooled from hyperkalemic and hypokalemic substudies. RESULTS Sixty-three adults (age, 19-76 years) completed the double-blind phase; 47 (74.6%) of these patients completed 61 weeks. There were median decreases in weekly attack and severity-weighted attack rates from baseline to week 61 (DCP/DCP [n = 25], -1.00 [P < .0001]; placebo/DCP [n = 20], -0.63 [P = .01] and DCP/DCP, -2.25 [P < .0001]; placebo/DCP, -1.69 [P = .01]). Relatively smaller median decreases in weekly attack and severity-weighted attack rates occurred from weeks 9 to 61 among patients receiving DCP continuously (n = 26; -0.14 [P = .1] and -0.24 [P = .09]) than among those switching from placebo to DCP after 9 weeks (n = 16; -1.04 [P = .049] and -2.72 [P = .08]). Common adverse events (AEs) were paresthesia and cognition-related events, which typically first occurred within 1 month of blinded treatment initiation and in rare cases led to treatment discontinuation. Dose reductions were frequently associated with common AE resolution. DISCUSSION One-year open-label DCP treatment after a 9-week randomized, controlled study confirmed long-term DCP remains safe and effective for chronic use. Tolerability issues (paresthesia, cognition-related AEs) were manageable in most patients.
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Affiliation(s)
- Valeria A Sansone
- Neuromuscular Omnicentre, Neurorehabilitation Unit, University of Milan, Niguarda Hospital, Milan, Italy
| | - Nicholas E Johnson
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Michael G Hanna
- MRC Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, UCL Institute of Neurology, London, UK
| | - Emma Ciafaloni
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Jeffrey M Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Perry B Shieh
- Department of Neurology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA
| | | | - Robert C Griggs
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
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24
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Wong CJ, Wang LH, Friedman SD, Shaw D, Campbell AE, Budech CB, Lewis LM, Lemmers RJFL, Statland JM, van der Maarel SM, Tawil RN, Tapscott SJ. Longitudinal measures of RNA expression and disease activity in FSHD muscle biopsies. Hum Mol Genet 2021; 29:1030-1043. [PMID: 32083293 DOI: 10.1093/hmg/ddaa031] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/20/2020] [Accepted: 02/13/2020] [Indexed: 11/13/2022] Open
Abstract
Advances in understanding the pathophysiology of facioscapulohumeral dystrophy (FSHD) have led to the discovery of candidate therapeutics, and it is important to identify markers of disease activity to inform clinical trial design. For drugs that inhibit DUX4 expression, measuring DUX4 or DUX4-target gene expression might be an interim measure of drug activity; however, only a subset of FHSD muscle biopsies shows evidence of DUX4 expression. Our prior study showed that MRI T2-STIR-positive muscles had a higher probability of showing DUX4 expression than muscles with normal MRI characteristics. In the current study, we performed a 1-year follow-up assessment of the same muscle with repeat MRI and muscle biopsy. There was little change in MRI characteristics over the 1-year period and, similar to the initial evaluation, MRI T2-STIR-postive muscles had a higher expression of DUX4-regulated genes, as well as genes associated with inflammation, extracellular matrix and cell cycle. Compared to the initial evaluation, overall the level of expression in these gene categories remained stable over the 1-year period; however, there was some variability for each individual muscle biopsied. The pooled data from both the initial and 1-year follow-up evaluations identified several FSHD subgroups based on gene expression, as well as a set of genes-composed of DUX4-target genes, inflammatory and immune genes and cell cycle control genes-that distinguished all of the FSHD samples from the controls. These candidate markers of disease activity need to be replicated in independent datasets and, if validated, may provide useful measures of disease progression and response to therapy.
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Affiliation(s)
- Chao-Jen Wong
- Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Leo H Wang
- Department of Neurology, University of Washington, Seattle, WA 98105, USA
| | - Seth D Friedman
- Department of Radiology, Seattle Children's Hospital, Seattle, WA 98105, USA
| | - Dennis Shaw
- Department of Radiology, Seattle Children's Hospital, Seattle, WA 98105, USA.,Department of Radiology, University of Washington, Seattle, WA 98105, USA
| | - Amy E Campbell
- Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Chris B Budech
- Department of Radiology, Seattle Children's Hospital, Seattle, WA 98105, USA
| | - Leann M Lewis
- Department of Neurology, University of Rochester Medical Center, Rochester, NY 14642, USA
| | - Richard J F L Lemmers
- Department of Human Genetics, Leiden University Medical Center, 2333, Leiden, The Netherlands
| | - Jeffrey M Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, KA 66160, USA
| | | | - Rabi N Tawil
- Department of Human Genetics, Leiden University Medical Center, 2333, Leiden, The Netherlands
| | - Stephen J Tapscott
- Human Biology Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.,Department of Neurology, University of Washington, Seattle, WA 98105, USA
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25
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Mul K, Hamadeh T, Horlings CGC, Tawil R, Statland JM, Sacconi S, Corbett AJ, Voermans NC, Faber CG, van Engelen BGM, Merkies ISJ. The facioscapulohumeral muscular dystrophy Rasch-built overall disability scale (FSHD-RODS). Eur J Neurol 2021; 28:2339-2348. [PMID: 33838063 PMCID: PMC8251612 DOI: 10.1111/ene.14863] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/30/2021] [Accepted: 04/07/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Facioscapulohumeral muscular dystrophy (FHSD) is a debilitating inherited muscle disease for which various therapeutic strategies are being investigated. Thus far, little attention has been given in FSHD to the development of scientifically sound outcome measures fulfilling regulatory authority requirements. The aim of this study was to design a patient-reported Rasch-built interval scale on activity and participation for FSHD. METHODS A pre-phase FSHD-Rasch-built overall disability scale (pre-FSHD-RODS; consisting of 159 activity/participation items), based on the World Health Organization international classification of disease-related functional consequences was completed by 762 FSHD patients (Netherlands: n = 171; UK: n = 287; United States: n = 221; France: n = 52; Australia: n = 32). A proportion of the patient cohort completed it twice (n = 230; interval 2-4 weeks; reliability studies). The pre-FSHD-RODS was subjected to Rasch analyses to create a model fulfilling its requirements. Validity studies were performed through correlation with the motor function measure. RESULTS The pre-FSHD-RODS did not meet the Rasch model expectations. Based on determinants such as misfit statistics and misfit residuals, differential item functioning, and local dependency, we systematically removed items until a final 38-inquiry (originating from 32 items; six items split) FSHD-RODS was constructed achieving Rasch model expectations. Adequate test-retest reliability and (cross-cultural and external) validity scores were obtained. CONCLUSIONS The FSHD-RODS is a disease-specific interval measure suitable for detecting activity and participation restrictions in patients with FSHD with good item/person reliability and validity scores. The use of this scale is recommended in the near future, to determine the functional deterioration slope in FSHD per year as a preparation for the upcoming clinical intervention trials in FSHD.
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Affiliation(s)
- Karlien Mul
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tatiana Hamadeh
- Department of Neurology, Curaçao Medical Center, Willemstad, Curaçao
| | - Corinne G C Horlings
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rabi Tawil
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Jeffrey M Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Sabrina Sacconi
- Centre de référence des Maladies Neuromusculaires, Nice, France
| | - Alastair J Corbett
- Department of Neurology, Concord Hospital Medical Center, Concord, NSW, Australia
| | - Nicol C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Catharina G Faber
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Baziel G M van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ingemar S J Merkies
- Department of Neurology, Curaçao Medical Center, Willemstad, Curaçao.,Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
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26
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Lingor P, Koch JC, Statland JM, Hussain S, Hennecke C, Wuu J, Langbein T, Ahmed R, Günther R, Ilse B, Kassubek J, Kollewe K, Kuttler J, Leha A, Lengenfeld T, Meyer T, Neuwirth C, Tostmann R, Benatar M. Challenges and opportunities for Multi-National Investigator-Initiated clinical trials for ALS: European and United States collaborations. Amyotroph Lateral Scler Frontotemporal Degener 2021; 22:419-425. [PMID: 33533663 DOI: 10.1080/21678421.2021.1879866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
An inherent challenge to clinical trials that aim to test the efficacy of experimental therapeutics for patients with amyotrophic lateral sclerosis (ALS) is the relative rarity of the disease. A promising solution to this problem is a multi-center approach that ideally includes sites distributed across a broad geographic area. In support of such an approach, the European E-RARE program and the United States National Institutes of Health (NIH) partnered to support the investigator-initiated ROCK-ALS trial (Eudra-CT-Nr.: 2017-003676-31, NCT03792490) as a multi-national collaboration between centers in Europe and North America that is led by European investigators. During the set-up of this international trial, however, a number of unanticipated legal, administrative, and financial complexities emerged that required significant adaptation of the proposed trial scheme. Here, we report our experience navigating these obstacles and describe the potential solutions that we explored. Our experience may inform future efforts to implement multi-national investigator-initiated trials that involve both European and United States centers.
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Affiliation(s)
- Paul Lingor
- Department of Neurology, School of Medicine, Technical University of Munich, Klinikum rechts der Isar, München, Germany
| | - Jan C Koch
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Jeffrey M Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Sumaira Hussain
- Department of Neurology, University of Miami, Miami, Florida, USA
| | - Christiane Hennecke
- Department for International Cooperations, University Medical Center Göttingen, Göttingen, Germany
| | - Joanne Wuu
- Department of Neurology, University of Miami, Miami, Florida, USA
| | - Thomas Langbein
- Clinical Trials Unit, University Medical Center Göttingen, Göttingen, Germany
| | - Raees Ahmed
- Department for International Cooperations, University Medical Center Göttingen, Göttingen, Germany
| | - René Günther
- Department of Neurology, Technische Universität Dresden and German Center for Neurodegenerative Diseases, Dresden, Germany
| | - Benjamin Ilse
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Jan Kassubek
- Department of Neurology, RKU, University of Ulm, Ulm, Germany
| | - Katja Kollewe
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Josua Kuttler
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Andreas Leha
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Teresa Lengenfeld
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Thomas Meyer
- Center for ALS and other Motor Neuron Disorders, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Neuwirth
- Neuromuscular Disease Unit/ALS Clinic, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Ralf Tostmann
- Department for International Cooperations, University Medical Center Göttingen, Göttingen, Germany
| | - Michael Benatar
- Department of Neurology, University of Miami, Miami, Florida, USA
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27
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Placek K, Benatar M, Wuu J, Rampersaud E, Hennessy L, Van Deerlin VM, Grossman M, Irwin DJ, Elman L, McCluskey L, Quinn C, Granit V, Statland JM, Burns TM, Ravits J, Swenson A, Katz J, Pioro EP, Jackson C, Caress J, So Y, Maiser S, Walk D, Lee EB, Trojanowski JQ, Cook P, Gee J, Sha J, Naj AC, Rademakers R, Chen W, Wu G, Paul Taylor J, McMillan CT. Machine learning suggests polygenic risk for cognitive dysfunction in amyotrophic lateral sclerosis. EMBO Mol Med 2021; 13:e12595. [PMID: 33270986 PMCID: PMC7799365 DOI: 10.15252/emmm.202012595] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 11/09/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a multi-system disease characterized primarily by progressive muscle weakness. Cognitive dysfunction is commonly observed in patients; however, factors influencing risk for cognitive dysfunction remain elusive. Using sparse canonical correlation analysis (sCCA), an unsupervised machine-learning technique, we observed that single nucleotide polymorphisms collectively associate with baseline cognitive performance in a large ALS patient cohort (N = 327) from the multicenter Clinical Research in ALS and Related Disorders for Therapeutic Development (CReATe) Consortium. We demonstrate that a polygenic risk score derived using sCCA relates to longitudinal cognitive decline in the same cohort and also to in vivo cortical thinning in the orbital frontal cortex, anterior cingulate cortex, lateral temporal cortex, premotor cortex, and hippocampus (N = 90) as well as post-mortem motor cortical neuronal loss (N = 87) in independent ALS cohorts from the University of Pennsylvania Integrated Neurodegenerative Disease Biobank. Our findings suggest that common genetic polymorphisms may exert a polygenic contribution to the risk of cortical disease vulnerability and cognitive dysfunction in ALS.
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28
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Placek K, Benatar M, Wuu J, Rampersaud E, Hennessy L, Van Deerlin VM, Grossman M, Irwin DJ, Elman L, McCluskey L, Quinn C, Granit V, Statland JM, Burns TM, Ravits J, Swenson A, Katz J, Pioro EP, Jackson C, Caress J, So Y, Maiser S, Walk D, Lee EB, Trojanowski JQ, Cook P, Gee J, Sha J, Naj AC, Rademakers R, Chen W, Wu G, Paul Taylor J, McMillan CT. Machine learning suggests polygenic risk for cognitive dysfunction in amyotrophic lateral sclerosis. EMBO Mol Med 2021. [PMID: 33270986 PMCID: PMC7799365 DOI: 10.15252/emmm.202012595|] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a multi-system disease characterized primarily by progressive muscle weakness. Cognitive dysfunction is commonly observed in patients; however, factors influencing risk for cognitive dysfunction remain elusive. Using sparse canonical correlation analysis (sCCA), an unsupervised machine-learning technique, we observed that single nucleotide polymorphisms collectively associate with baseline cognitive performance in a large ALS patient cohort (N = 327) from the multicenter Clinical Research in ALS and Related Disorders for Therapeutic Development (CReATe) Consortium. We demonstrate that a polygenic risk score derived using sCCA relates to longitudinal cognitive decline in the same cohort and also to in vivo cortical thinning in the orbital frontal cortex, anterior cingulate cortex, lateral temporal cortex, premotor cortex, and hippocampus (N = 90) as well as post-mortem motor cortical neuronal loss (N = 87) in independent ALS cohorts from the University of Pennsylvania Integrated Neurodegenerative Disease Biobank. Our findings suggest that common genetic polymorphisms may exert a polygenic contribution to the risk of cortical disease vulnerability and cognitive dysfunction in ALS.
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Affiliation(s)
- Katerina Placek
- Department of NeurologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Michael Benatar
- Department of NeurologyLeonard M. Miller School of MedicineUniversity of MiamiMiamiFLUSA
| | - Joanne Wuu
- Department of NeurologyLeonard M. Miller School of MedicineUniversity of MiamiMiamiFLUSA
| | - Evadnie Rampersaud
- Center for Applied BioinformaticsSt. Jude Children’s Research HospitalMemphisTNUSA
| | - Laura Hennessy
- Department of NeurologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Vivianna M Van Deerlin
- Department of Pathology & Laboratory MedicineUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Murray Grossman
- Department of NeurologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - David J Irwin
- Department of NeurologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Lauren Elman
- Department of NeurologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Leo McCluskey
- Department of NeurologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Colin Quinn
- Department of NeurologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Volkan Granit
- Department of NeurologyLeonard M. Miller School of MedicineUniversity of MiamiMiamiFLUSA
| | - Jeffrey M Statland
- Department of NeurologyUniversity of Kansas Medical CenterKansas CityKSUSA
| | - Ted M Burns
- Department of NeurologyUniversity of Virginia Health SystemCharlottesvilleVAUSA
| | - John Ravits
- Department of NeurosciencesUniversity of California San DiegoSan DiegoCAUSA
| | | | - Jon Katz
- Forbes Norris ALS CenterCalifornia Pacific Medical CenterSan FranciscoCAUSA
| | - Erik P Pioro
- Department of NeurologyCleveland ClinicClevelandOHUSA
| | - Carlayne Jackson
- Department of NeurologyUniversity of Texas Health Science CenterSan AntonioTXUSA
| | - James Caress
- Department of NeurologyWake Forest University School of MedicineWinston‐SalemNCUSA
| | - Yuen So
- Department of NeurologyStanford University Medical CenterSan JoseCAUSA
| | - Samuel Maiser
- Department of NeurologyUniversity of Minnesota Medical CenterMinneapolisMNUSA
| | - David Walk
- Department of NeurologyUniversity of Minnesota Medical CenterMinneapolisMNUSA
| | - Edward B Lee
- Department of Pathology & Laboratory MedicineUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - John Q Trojanowski
- Department of Pathology & Laboratory MedicineUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Philip Cook
- Penn Image Computing Science Laboratory (PICSL)Department of RadiologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - James Gee
- Penn Image Computing Science Laboratory (PICSL)Department of RadiologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Jin Sha
- Department of Biostatistics, Epidemiology, and InformaticsUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA,Penn Neurodegeneration Genomics CenterDepartment of Pathology and Laboratory MedicineUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | - Adam C Naj
- Department of Pathology & Laboratory MedicineUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA,Department of Biostatistics, Epidemiology, and InformaticsUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA,Penn Neurodegeneration Genomics CenterDepartment of Pathology and Laboratory MedicineUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
| | | | | | - Wenan Chen
- Center for Applied BioinformaticsSt. Jude Children’s Research HospitalMemphisTNUSA
| | - Gang Wu
- Center for Applied BioinformaticsSt. Jude Children’s Research HospitalMemphisTNUSA
| | - J Paul Taylor
- Center for Applied BioinformaticsSt. Jude Children’s Research HospitalMemphisTNUSA,The Howard Hughes Medical InstituteChevy ChaseMSUSA
| | - Corey T McMillan
- Department of NeurologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPAUSA
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29
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Loonen TGJ, Horlings CGC, Vincenten SCC, Beurskens CHG, Knuijt S, Padberg GWAM, Statland JM, Voermans NC, Maal TJJ, van Engelen BGM, Mul K. Characterizing the face in facioscapulohumeral muscular dystrophy. J Neurol 2020; 268:1342-1350. [PMID: 33113021 PMCID: PMC7990805 DOI: 10.1007/s00415-020-10281-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 11/30/2022]
Abstract
Objective To evaluate facial weakness in patients with FSHD to better define clinical signs, and pilot a facial weakness severity score. Methods 87 FSHD patients and 55 controls were video recorded while performing seven facial tasks. The videos were assessed by three independent examiners to compile an overview of signs of facial weakness. Next, videos were semi-quantitatively assessed using a newly developed 4-point facial weakness score (FWS). This score was evaluated and correlated to other FSHD disease characteristics. Results Patients had lower scores on the total FWS than controls (mean score 43 ± 28, range 4–118, vs 14 ± 9, range 0–35, p < 0.001) and on all seven individual facial tasks (all p < 0.001). 54% of patients had FWS scores outside the range of controls. Patients had more asymmetry between the left and right side of the face than controls. About 10% of the patients had very mild facial weakness. These were mostly males (89%) with longer D4Z4 repeat sizes of 7–9 units. More severe facial weakness correlated to more severe overall disease severity and shorter D4Z4 repeat size, but not to disease duration. Interobserver agreement for the FWS between three raters was low with a Fleiss Kappa of 0.437. Conclusion This study provides an overview of the clinical spectrum of facial weakness and its relation to other disease characteristics. The 4-point scale we introduced to grade the severity of facial weakness enables correlation of facial weakness to disease characteristics, but is not suited as clinical outcome measure for longitudinal studies.
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Affiliation(s)
- T G J Loonen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.,Radboudumc 3D-Lab, Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - C G C Horlings
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - S C C Vincenten
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - C H G Beurskens
- Department of Orthopedics, Section of Physical Therapy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S Knuijt
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - G W A M Padberg
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - J M Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - N C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - T J J Maal
- Radboudumc 3D-Lab, Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - B G M van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - K Mul
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
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Stunnenberg BC, LoRusso S, Arnold WD, Barohn RJ, Cannon SC, Fontaine B, Griggs RC, Hanna MG, Matthews E, Meola G, Sansone VA, Trivedi JR, van Engelen BG, Vicart S, Statland JM. Guidelines on clinical presentation and management of nondystrophic myotonias. Muscle Nerve 2020; 62:430-444. [PMID: 32270509 PMCID: PMC8117169 DOI: 10.1002/mus.26887] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/01/2020] [Accepted: 04/04/2020] [Indexed: 12/26/2022]
Abstract
The nondystrophic myotonias are rare muscle hyperexcitability disorders caused by gain-of-function mutations in the SCN4A gene or loss-of-function mutations in the CLCN1 gene. Clinically, they are characterized by myotonia, defined as delayed muscle relaxation after voluntary contraction, which leads to symptoms of muscle stiffness, pain, fatigue, and weakness. Diagnosis is based on history and examination findings, the presence of electrical myotonia on electromyography, and genetic confirmation. In the absence of genetic confirmation, the diagnosis is supported by detailed electrophysiological testing, exclusion of other related disorders, and analysis of a variant of uncertain significance if present. Symptomatic treatment with a sodium channel blocker, such as mexiletine, is usually the first step in management, as well as educating patients about potential anesthetic complications.
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Affiliation(s)
- Bas C. Stunnenberg
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Samantha LoRusso
- Department of Neurology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - W. David Arnold
- Department of Neurology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Richard J. Barohn
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
| | - Stephen C. Cannon
- Department of Physiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Bertrand Fontaine
- Assistance Publique-Hôpitaix de Paris, Sorbonne Université, INSERM, Service of Neuro-Myology and UMR 974, Institute of Myology, University Hospital Pitié-Salpêtrière, Paris, France
| | - Robert C. Griggs
- Department of Neurology, University of Rochester, Rochester, New York
| | - Michael G. Hanna
- MRC Centre for Neuromuscular Diseases, Department of Neuromuscular diseases, UCL Queen Square Institute of Neurology, United Kingdom
| | - Emma Matthews
- MRC Centre for Neuromuscular Diseases, Department of Neuromuscular diseases, UCL Queen Square Institute of Neurology, United Kingdom
| | - Giovanni Meola
- Department of Neurorehabilitation Sciences, Casa Cura Policlinico, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Valeria A. Sansone
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Neurorehabilitation Unit, University of Milan, NEuroMuscular Omnicentre (NEMO), Fondazione Serena Onlus, Milan, Italy
| | - Jaya R. Trivedi
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, Texas
| | | | - Savine Vicart
- Assistance Publique-Hôpitaix de Paris, Sorbonne Université, INSERM, Service of Neuro-Myology and UMR 974, Institute of Myology, University Hospital Pitié-Salpêtrière, Paris, France
| | - Jeffrey M. Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
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Ikenaga C, Findlay AR, Seiffert M, Peck A, Peck N, Johnson NE, Statland JM, Weihl CC. Phenotypic diversity in an international Cure VCP Disease registry. Orphanet J Rare Dis 2020; 15:267. [PMID: 32993728 PMCID: PMC7523394 DOI: 10.1186/s13023-020-01551-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022] Open
Abstract
Background Dominant mutations in valosin-containing protein (VCP) gene cause an adult onset inclusion body myopathy, Paget’s disease of bone, and frontotemporal dementia also termed multisystem proteinopathy (MSP). The genotype-phenotype relationships in VCP-related MSP are still being defined; in order to understand this better, we investigated the phenotypic diversity and patterns of weakness in the Cure VCP Disease Patient Registry. Methods Cure VCP Disease, Inc. was founded in 2018 for the purpose of connecting patients with VCP gene mutations and researchers to help advance treatments and cures. Cure VCP Disease Patient Registry is maintained by Coordination of Rare Diseases at Sanford. The results of two questionnaires with a 5-point Likert scale questions regarding to patients’ disease onset, symptoms, and daily life were obtained from 59 participants (28 males and 31 females) between June 2018 and May 2020. Independent of the registry, 22 patients were examined at the Cure VCP Disease annual patient conference in 2019. Results In the questionnaires of the registry, fifty-three patients (90%) reported that they were with inclusion body myopathy, 17 patients (29%) with Paget’s disease of bone, eight patients (14%) with dementia, two patients (3%) with amyotrophic lateral sclerosis, and a patient with parkinsonism. Thirteen patients (22%) reported dysphagia and 25 patients (42%) reported dyspnea on exertion. A self-reported functional rating scale for motor function identified challenges with sit to stand (72%), walking (67%), and climbing stairs (85%). Thirty-five (59%) patients in the registry answered that their quality of life is more than good. As for the weakness pattern of the 22 patients who were evaluated at the Cure VCP Disease annual conference, 50% of patients had facial weakness, 55% had scapular winging, 68% had upper proximal weakness, 41% had upper distal weakness, 77% had lower proximal, and 64% had lower distal weakness. Conclusions The Cure VCP Disease Patient Registry is useful for deepening the understanding of patient daily life, which would be a basis to develop appropriate clinical outcome measures. The registry data is consistent with previous studies evaluating VCP patients in the clinical setting. Patient advocacy groups are essential in developing and maintaining disease registries.
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Affiliation(s)
- Chiseko Ikenaga
- Department of Neurology, Washington University School of Medicine, 660 S. Euclid Avenue, Box 8111, Saint Louis, MO, 63110, USA
| | - Andrew R Findlay
- Department of Neurology, Washington University School of Medicine, 660 S. Euclid Avenue, Box 8111, Saint Louis, MO, 63110, USA
| | - Michelle Seiffert
- Department of Neurology, Washington University School of Medicine, 660 S. Euclid Avenue, Box 8111, Saint Louis, MO, 63110, USA
| | | | | | - Nicholas E Johnson
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Jeffrey M Statland
- Department of Neurology, University of Kansas, Medical Center, Kansas City, KS, USA
| | - Conrad C Weihl
- Department of Neurology, Washington University School of Medicine, 660 S. Euclid Avenue, Box 8111, Saint Louis, MO, 63110, USA.
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32
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Sage JM, Hall L, McVey A, Barohn RJ, Statland JM, Jawdat O, Dimachkie MM, Agbas A. Use of Capillary Electrophoresis Immunoassay to Search for Potential Biomarkers of Amyotrophic Lateral Sclerosis in Human Platelets. J Vis Exp 2020. [PMID: 32090995 DOI: 10.3791/60638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Capillary electrophoresis immunoassay (CEI), also known as capillary western technology, is becoming a method of choice for screening disease relevant proteins and drugs in clinical trials. Reproducibility, sensitivity, small sample volume requirement, multiplexing antibodies for multiple protein labeling in the same sample, automated high-throughput ability to analyze up to 24 individual samples, and short time requirement make CEI advantageous over the classical western blot immunoassay. There are some limitations of this method, such as the inability to utilize a gradient gel (4%-20%) matrix, high background with unrefined biological samples, and commercial unavailability of individual reagents. This paper describes an efficient method for running CEI in a multiple assay setting, optimizing protein concentration and primary antibody titration in one assay plate, and providing user-friendly templates for sample preparation. Also described are methods for measuring pan TDP-43 and phosphorylated TDP-43 derivative in platelet lysate cytosol as part of the initiative in blood-based biomarker development for neurodegenerative diseases.
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Affiliation(s)
- Jessica M Sage
- Department of Basic Sciences, Kansas City University of Medicine and Biosciences
| | | | | | | | | | | | | | - Abdulbaki Agbas
- Department of Basic Sciences, Kansas City University of Medicine and Biosciences;
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Hamel J, Lee P, Glenn MD, Burka T, Choi IY, Friedman SD, Shaw DWW, McCalley A, Herbelin L, Dimachkie MM, Lemmers R, van der Maarel SM, Barohn RJ, Tawil R, Statland JM. Magnetic resonance imaging correlates with electrical impedance myography in facioscapulohumeral muscular dystrophy. Muscle Nerve 2020; 61:644-649. [PMID: 31884698 DOI: 10.1002/mus.26792] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 12/16/2019] [Accepted: 12/21/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Electrical impedance myography (EIM) has been proposed as a noninvasive biomarker of muscle composition in facioscapulohumeral muscular dystrophy (FSHD). Here we determine the associations of EIM variables with muscle structure measured by MRI. METHODS We evaluated 20 patients with FSHD at two centers, comparing EIM measurements (resistance, reactance, and phase at 50, 100, and 211 kHZ) recorded from bilateral vastus lateralis, tibialis anterior, and medial gastrocnemius muscles to MRI skin and subcutaneous fat thickness, MRI T1-based muscle severity score (T1 muscle score), and MRI quantitative intramuscular Dixon fat fraction (FF). RESULTS While reactance and phase both correlated with FF and T1 muscle score, 50 kHz reactance was most sensitive to muscle structure alterations measured by both T1 score (ρ = -0.71, P < .001) and FF (ρ = -0.74, P < .001). DISCUSSION This study establishes the correlation of EIM with structural MRI features in FSHD and supports further evaluation of EIM as a potential biomarker in FSHD clinical trials.
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Affiliation(s)
- Johanna Hamel
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Phil Lee
- Department of Radiology, University of Kansas Medical Center, Kansas City, Kansas.,Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, Kansas
| | - Melanie D Glenn
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
| | - Tekalign Burka
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
| | - In-Young Choi
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, Kansas.,Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
| | - Seth D Friedman
- Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington
| | - Dennis W W Shaw
- Center for Clinical and Translational Research, Seattle Children's Hospital, Seattle, Washington
| | - Ayla McCalley
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
| | - Laura Herbelin
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
| | - Mazen M Dimachkie
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
| | - Richard Lemmers
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Richard J Barohn
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
| | - Rabi Tawil
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Jeffrey M Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
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Raman SV, Hor KN, Mazur W, Cardona A, He X, Halnon N, Markham L, Soslow JH, Puchalski MD, Auerbach SR, Truong U, Smart S, McCarthy B, Saeed IM, Statland JM, Kissel JT, Cripe LH. Stabilization of Early Duchenne Cardiomyopathy With Aldosterone Inhibition: Results of the Multicenter AIDMD Trial. J Am Heart Assoc 2019; 8:e013501. [PMID: 31549577 PMCID: PMC6806050 DOI: 10.1161/jaha.119.013501] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Duchenne muscular dystrophy incurs nearly universal dilated cardiomyopathy by the third decade of life, preceded by myocardial damage and impaired left ventricular strain by cardiac magnetic resonance. It has been shown that (1) mineralocorticoid receptor antagonist therapy with spironolactone attenuated damage while maintaining function when given early in a mouse model and (2) low-dose eplerenone stabilized left ventricular strain in boys with Duchenne muscular dystrophy and evident myocardial damage but preserved ejection fraction. We hypothesized that moderate-dose spironolactone versus eplerenone would provide similar cardioprotection in this first head-to-head randomized trial of available mineralocorticoid receptor antagonists, the AIDMD (Aldosterone Inhibition in Duchenne Muscular Dystrophy) trial. Methods and Results This was a multicenter, double-blind, randomized, noninferiority trial. Subjects were randomized to eplerenone, 50 mg, or spironolactone, 50 mg, orally once daily for 12 months. The primary outcome was change in left ventricular systolic strain at 12 months. Among 52 enrolled male subjects, aged 14 (interquartile range, 12-18) years, spironolactone was noninferior to eplerenone (∆strain, 0.4 [interquartile range, -0.4 to 0.6] versus 0.2 [interquartile range, -0.2 to 0.7]; P=0.542). Renal and pulmonary function remained stable in both groups, and no subjects experienced serious hyperkalemia. Infrequent adverse events included gynecomastia in one subject in the spironolactone arm and facial rash in one subject in the eplerenone arm. Conclusions In boys with Duchenne muscular dystrophy and preserved left ventricular ejection fraction, spironolactone added to background therapy is noninferior to eplerenone in preserving contractile function. These findings support early mineralocorticoid receptor antagonist therapy as effective and safe in a genetic disease with high cardiomyopathy risk. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02354352.
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Affiliation(s)
- Subha V Raman
- Ohio State University Wexner Medical Center Columbus OH
| | - Kan N Hor
- Nationwide Children's Hospital Columbus OH
| | - Wojciech Mazur
- The Christ Hospital Heart and Vascular Center Cincinnati OH
| | | | - Xin He
- Department of Epidemiology and Biostatistics University of Maryland College Park MD
| | - Nancy Halnon
- University of California, Los Angeles Los Angeles CA
| | | | | | | | | | | | - Suzanne Smart
- Ohio State University Wexner Medical Center Columbus OH
| | - Beth McCarthy
- Ohio State University Wexner Medical Center Columbus OH
| | | | | | - John T Kissel
- Department of Neurology Ohio State University Columbus OH
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35
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LoRusso S, Johnson NE, McDermott MP, Eichinger K, Butterfield RJ, Carraro E, Higgs K, Lewis L, Mul K, Sacconi S, Sansone VA, Shieh P, van Engelen B, Wagner K, Wang L, Statland JM, Tawil R. Clinical trial readiness to solve barriers to drug development in FSHD (ReSolve): protocol of a large, international, multi-center prospective study. BMC Neurol 2019; 19:224. [PMID: 31506080 PMCID: PMC6734593 DOI: 10.1186/s12883-019-1452-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/27/2019] [Indexed: 12/14/2022] Open
Abstract
Background Facioscapulohumeral muscular dystrophy (FSHD) is a dominantly-inherited progressive muscular dystrophy caused by de-repression of the DUX4 gene, which causes disease by a toxic-gain-of-function. As molecularly targeted drugs move from preclinical testing into human trials, it is essential that we validate clinical trial tools and methodology to facilitate the drug development process. Methods/design The primary goal of this study is to hasten drug development for FSHD by validating two novel clinical outcome assessments (COAs) and refining clinical trial strategies. We will perform an 18-month longitudinal study in 220 genetically confirmed and clinically affected participants using our FSHD Clinical Trial Research Network, comprised of 8 sites in the United States, and 3 collaborating sites in Europe. Visits occur at baseline and months 3, 12, and 18. At each visit we will collect: 1) a novel FSHD functional composite COA made up of 18 evaluator-administered motor tasks in the domains of shoulder/arm, hand, core/abdominal, leg, and balance function; and 2) electrical impedance myography as a novel muscle quality biomarker (US sites). Other COAs include 1) Domain 1 of the Motor Function Measure; 2) Reachable workspace; 3) orofacial strength using the Iowa Oral Performance Instrument; 4) lean muscle mass using dual-energy X-ray absorptiometry (DEXA); 5) strength as measured by quantitative myometry and manual muscle testing; and 6) the FSHD Health Index and other patient-reported outcomes. Plasma, DNA, RNA, and serum will be collected for future biomarker studies. We will use an industry standard multi-site training plan. We will evaluate the test-retest reliability, validity, and sensitivity to disease progression, and minimal clinically important changes of our new COAs. We will assess associations between demographic and genetic factors and the rate of disease progression to inform refinement of eligibility criteria for future clinical trials. Discussion To the best of our knowledge, this is the largest collaborative study of patients with FSHD performed in the US and Europe. The results of this study will enable more efficient clinical trial design. During the conduct of the study, relevant data will be made available for investigators or companies pursuing novel FSHD therapeutics. Trial registration clinicaltrials.gov NCT03458832; Date of registration: 1/11/2018 Electronic supplementary material The online version of this article (10.1186/s12883-019-1452-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Samantha LoRusso
- Department of Neurology, Ohio State University Wexner Medical Center, 395 W. 12th Ave., 7th Floor, Columbus, OH, 43210, USA
| | - Nicholas E Johnson
- Department of Neurology, Virginia Commonwealth University, 1101 East Marshall St, PO Box 980599, Richmond, VA, 23298, USA
| | - Michael P McDermott
- Department of Biostatistics and Computational Biology and Department of Neurology, University of Rochester Medical Center, 265 Crittenden Blvd., CU 420630, Rochester, NY, 14642, USA
| | - Katy Eichinger
- Department of Neurology, University of Rochester Medical Center, Box 673, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Russell J Butterfield
- Department of Pediatrics and Neurology, University of Utah, Eccles Institute of Human Genetics, Room 2260A, 15 N 2030 E, Salt Lake City, UT, 84112, USA
| | - Elena Carraro
- The NEMO Clinical Center, Neurorehabilitation Unit, University of Milan, Piazza dell'Ospedale Maggiore, 3, Milan, 20162, Italy
| | - Kiley Higgs
- Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 2012, Kansas City, KS, 66160, USA
| | - Leann Lewis
- Department of Neurology, University of Rochester Medical Center, Box 673, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Karlien Mul
- Department of Neurology, Radboud University Medical Center, Reinier Postlaan 4 (935), 6525, GC, Nijmegen, The Netherlands
| | - Sabrina Sacconi
- Université Côte d'Azur, Peripheral Nervous System, Centre Hospitalier Universitaire de Nice, Muscle & ALS Department, Pasteur 2 Hospital, 30 Voie Romaine, 06001, Nice Cedex 1, France
| | - Valeria A Sansone
- The NEMO Clinical Center, Neurorehabilitation Unit, University of Milan, Piazza dell'Ospedale Maggiore, 3, Milan, 20162, Italy
| | - Perry Shieh
- Department of Neurology, University of California, Los Angeles, 300 Medical Plaza, Suite B-200, Los Angeles, CA, 90095, USA
| | - Baziel van Engelen
- Department of Neurology, Radboud University Medical Center, Reinier Postlaan 4 (935), 6525, GC, Nijmegen, The Netherlands
| | - Kathryn Wagner
- Center for Genetic Muscle Disorders, Kennedy Krieger Institute, 707 N. Broadway, Baltimore, MD, USA
| | - Leo Wang
- Department of Neurology, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Jeffrey M Statland
- Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 2012, Kansas City, KS, 66160, USA.
| | - Rabi Tawil
- Department of Neurology, University of Rochester Medical Center, Box 673, 601 Elmwood Ave, Rochester, NY, 14642, USA
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Statland JM, Karanevich A, Bruetsch A, Huisinga J. A pilot study of the responsiveness of wireless motion analysis in facioscapulohumeral muscular dystrophy. Muscle Nerve 2019; 60:590-594. [PMID: 31443130 DOI: 10.1002/mus.26681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 08/16/2019] [Accepted: 08/20/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION We determined whether instrumenting timed functional tasks with wireless inertial motion sensors were responsive to facioscapulohumeral muscular dystrophy (FSHD) progression and movement pattern changes. METHODS Ten individuals who were clinically affected with genetically confirmed FSHD, mean age 54 years (range 42-65), performed an instrumented timed up and go (iTUG) trial at each visit, wearing six wireless inertial sensors. We determined the estimated average monthly slope of progression and 12-month change for temporal and spatial motion variables using a linear mixed effects model. RESULTS For an average of 20.6 months (range 6.1-34.5), the iTUG duration stayed constant, whereas stride length, stride velocity, and trunk sagittal range of motion changed, indicating poorer performance. Arm swing changed in a compensatory direction toward the normative mean. DISCUSSION This study provides preliminary evidence that iTUG motion variables could be sensitive to progression in FSHD, but this requires validation in a larger study.
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Affiliation(s)
- Jeffrey M Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
| | - Alex Karanevich
- EMB Biostatisticians, EMB Statistical Solutions, Overland Park, Kansas
| | - Adam Bruetsch
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Jessie Huisinga
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, Kansas
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Hunter M, Heatwole C, Wicklund M, Weihl CC, Mozaffar T, Statland JM, Johnson NE. Limb-girdle muscular dystrophy: A perspective from adult patients on what matters most. Muscle Nerve 2019; 60:419-424. [PMID: 31298728 DOI: 10.1002/mus.26636] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 07/07/2019] [Accepted: 07/09/2019] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Limb-girdle muscular dystrophy (LGMD) consists of over 30 genetic conditions with varying clinical phenotypes primarily affecting pelvic girdle, shoulder girdle, and other proximal limb muscles. Studies focusing on the physical, mental, and social effects of this disease from the patient's perspective are limited. METHODS Adults with LGMD were interviewed and asked to identify issues that have the greatest impact on their quality of life. Each interview was recorded, transcribed, coded, and analyzed. RESULTS Participants provided 1385 direct quotes. One hundred sixty-five potential symptoms of importance were identified and grouped into 15 larger themes. The most frequently reported themes included limitations with mobility, difficulty performing activities, social role limitations, and emotional distress. DISCUSSION There are multiple symptoms that alter the lives of adults with LGMD. These affect their physical, emotional, and social health, and may be amenable to medical intervention.
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Affiliation(s)
- Michael Hunter
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Chad Heatwole
- Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Matthew Wicklund
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado
| | - Conrad C Weihl
- Department of Neurology, Washington University School of Medicine, St Louis, Missouri
| | - Tahseen Mozaffar
- UC Irvine-MDA ALS and Neuromuscular Center, University of California Irvine, Orange, California
| | - Jeffrey M Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
| | - Nicholas E Johnson
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia
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Affiliation(s)
- Nicholas E Johnson
- From the Department of Neurology (N.E.J.), Virginia Commonwealth University, Richmond; and the Department of Neurology (J.M.S.), Kansas University Medical Center, Kansas City.
| | - Jeffrey M Statland
- From the Department of Neurology (N.E.J.), Virginia Commonwealth University, Richmond; and the Department of Neurology (J.M.S.), Kansas University Medical Center, Kansas City
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Mul K, Berggren KN, Sills MY, McCalley A, van Engelen BGM, Johnson NE, Statland JM. Effects of weakness of orofacial muscles on swallowing and communication in FSHD. Neurology 2019; 92:e957-e963. [PMID: 30804066 DOI: 10.1212/wnl.0000000000007013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 10/25/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study explores the use of quantitative data on strength and fatigability of orofacial muscles in patients with facioscapulohumeral muscular dystrophy (FSHD) and assesses the frequency of swallowing and communication difficulties and their relationship to orofacial muscle involvement. METHODS We included 43 patients with FSHD and 35 healthy controls and used the Iowa Oral Performance Instrument (IOPI) to obtain quantitative measurements of strength and endurance of lip compression, cheek (buccodental) compression, and tongue elevation. For the assessment of swallowing and communication difficulties, we used the dysphagia-specific quality of life (SWAL-QOL) and Communicative Participation Item Bank questionnaires. RESULTS Cheek compression strength was reduced in patients with FSHD compared to healthy controls. Dysphagia and difficulty with verbal communication were reported by 25% and 35% of patients, respectively, and correlated to cheek compression strength and endurance and to anterior tongue elevation endurance. Prolonged cheek compression or anterior tongue elevation endurance (decreased fatigability) made swallowing or speech problems less likely to occur. CONCLUSION Cheek compression strength is the most sensitive IOPI measure for orofacial weakness in FSHD. Orofacial weakness contributes to dysphagia and speech difficulties in FSHD, which are both common, though generally mild. Higher endurance of orofacial muscles was associated with a lower chance of dysphagia or speech problems. More research is required for further refinement of the pattern of facial muscle involvement in FSHD and to provide new insights for improvement of speech and language therapy.
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Affiliation(s)
- Karlien Mul
- From the Department of Neurology (K.M., M.Y.S., A.M., J.M.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (K.N.B., N.E.J.), Virginia Commonwealth University, Richmond; and Department of Neurology (K.M., B.G.M.v.E.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kiera N Berggren
- From the Department of Neurology (K.M., M.Y.S., A.M., J.M.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (K.N.B., N.E.J.), Virginia Commonwealth University, Richmond; and Department of Neurology (K.M., B.G.M.v.E.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mattie Y Sills
- From the Department of Neurology (K.M., M.Y.S., A.M., J.M.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (K.N.B., N.E.J.), Virginia Commonwealth University, Richmond; and Department of Neurology (K.M., B.G.M.v.E.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ayla McCalley
- From the Department of Neurology (K.M., M.Y.S., A.M., J.M.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (K.N.B., N.E.J.), Virginia Commonwealth University, Richmond; and Department of Neurology (K.M., B.G.M.v.E.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Baziel G M van Engelen
- From the Department of Neurology (K.M., M.Y.S., A.M., J.M.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (K.N.B., N.E.J.), Virginia Commonwealth University, Richmond; and Department of Neurology (K.M., B.G.M.v.E.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nicholas E Johnson
- From the Department of Neurology (K.M., M.Y.S., A.M., J.M.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (K.N.B., N.E.J.), Virginia Commonwealth University, Richmond; and Department of Neurology (K.M., B.G.M.v.E.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jeffrey M Statland
- From the Department of Neurology (K.M., M.Y.S., A.M., J.M.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (K.N.B., N.E.J.), Virginia Commonwealth University, Richmond; and Department of Neurology (K.M., B.G.M.v.E.), Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.
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Goselink RJM, Mul K, van Kernebeek CR, Lemmers RJLF, van der Maarel SM, Schreuder THA, Erasmus CE, Padberg GW, Statland JM, Voermans NC, van Engelen BGM. Early onset as a marker for disease severity in facioscapulohumeral muscular dystrophy. Neurology 2018; 92:e378-e385. [PMID: 30568007 DOI: 10.1212/wnl.0000000000006819] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/27/2018] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To assess the relation between age at onset and disease severity in facioscapulohumeral muscular dystrophy (FSHD). METHODS In this prospective cross-sectional study, we matched adult patients with FSHD with an early disease onset with 2 sex-matched FSHD control groups with a classic onset; the first group was age matched, and the second group was disease duration matched. Genetic characteristics, muscle performance, respiratory functioning, hearing loss, vision loss, epilepsy, educational level, and work status were compared with the 2 control groups. RESULTS Twenty-eight patients with early-onset FSHD were age (n = 28) or duration (n = 27) matched with classic-onset patients. Patients with early-onset FSHD had more severe muscle weakness (mean FSHD clinical score 11 vs 5 in the age-matched and 9 in the duration-matched group, p < 0.05) and a higher frequency of wheelchair dependency (57%, 0%, and 30%, respectively, p < 0.05). In addition, systemic features were more frequent in early-onset FSHD, most important, hearing loss, decreased respiratory function and spinal deformities. There was no difference in work status. Genetically, the shortest D4Z4 repeat arrays (2-3 units) were found exclusively in the early-onset group, and the largest repeat arrays (8-9 units) were found only in the classic-onset groups. De novo mutations were more frequent in early-onset patients (46% vs 4%). CONCLUSIONS Patients with early-onset FSHD more often have severe muscle weakness and systemic features. The disease severity is greater than in patients with classic-onset FSHD who are matched for disease duration, suggesting that the progression is faster in early-onset patients.
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Affiliation(s)
- Rianne J M Goselink
- From the Department of Neurology (R.J.M.G., K.M., C.R.v.K., T.H.A.S., C.E.E., G.W.P., N.C.V., B.G.M.v.E.), Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen; Department of Human Genetics (R.J.L.F.L., S.M.v.d.M.), Leiden University Medical Center, the Netherlands; and Department of Neurology (J.M.S.), Kansas University Medical Center, Kansas City.
| | - Karlien Mul
- From the Department of Neurology (R.J.M.G., K.M., C.R.v.K., T.H.A.S., C.E.E., G.W.P., N.C.V., B.G.M.v.E.), Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen; Department of Human Genetics (R.J.L.F.L., S.M.v.d.M.), Leiden University Medical Center, the Netherlands; and Department of Neurology (J.M.S.), Kansas University Medical Center, Kansas City
| | - Caroline R van Kernebeek
- From the Department of Neurology (R.J.M.G., K.M., C.R.v.K., T.H.A.S., C.E.E., G.W.P., N.C.V., B.G.M.v.E.), Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen; Department of Human Genetics (R.J.L.F.L., S.M.v.d.M.), Leiden University Medical Center, the Netherlands; and Department of Neurology (J.M.S.), Kansas University Medical Center, Kansas City
| | - Richard J L F Lemmers
- From the Department of Neurology (R.J.M.G., K.M., C.R.v.K., T.H.A.S., C.E.E., G.W.P., N.C.V., B.G.M.v.E.), Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen; Department of Human Genetics (R.J.L.F.L., S.M.v.d.M.), Leiden University Medical Center, the Netherlands; and Department of Neurology (J.M.S.), Kansas University Medical Center, Kansas City
| | - Silvère M van der Maarel
- From the Department of Neurology (R.J.M.G., K.M., C.R.v.K., T.H.A.S., C.E.E., G.W.P., N.C.V., B.G.M.v.E.), Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen; Department of Human Genetics (R.J.L.F.L., S.M.v.d.M.), Leiden University Medical Center, the Netherlands; and Department of Neurology (J.M.S.), Kansas University Medical Center, Kansas City
| | - Tim H A Schreuder
- From the Department of Neurology (R.J.M.G., K.M., C.R.v.K., T.H.A.S., C.E.E., G.W.P., N.C.V., B.G.M.v.E.), Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen; Department of Human Genetics (R.J.L.F.L., S.M.v.d.M.), Leiden University Medical Center, the Netherlands; and Department of Neurology (J.M.S.), Kansas University Medical Center, Kansas City
| | - Corrie E Erasmus
- From the Department of Neurology (R.J.M.G., K.M., C.R.v.K., T.H.A.S., C.E.E., G.W.P., N.C.V., B.G.M.v.E.), Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen; Department of Human Genetics (R.J.L.F.L., S.M.v.d.M.), Leiden University Medical Center, the Netherlands; and Department of Neurology (J.M.S.), Kansas University Medical Center, Kansas City
| | - George W Padberg
- From the Department of Neurology (R.J.M.G., K.M., C.R.v.K., T.H.A.S., C.E.E., G.W.P., N.C.V., B.G.M.v.E.), Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen; Department of Human Genetics (R.J.L.F.L., S.M.v.d.M.), Leiden University Medical Center, the Netherlands; and Department of Neurology (J.M.S.), Kansas University Medical Center, Kansas City
| | - Jeffrey M Statland
- From the Department of Neurology (R.J.M.G., K.M., C.R.v.K., T.H.A.S., C.E.E., G.W.P., N.C.V., B.G.M.v.E.), Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen; Department of Human Genetics (R.J.L.F.L., S.M.v.d.M.), Leiden University Medical Center, the Netherlands; and Department of Neurology (J.M.S.), Kansas University Medical Center, Kansas City
| | - Nicol C Voermans
- From the Department of Neurology (R.J.M.G., K.M., C.R.v.K., T.H.A.S., C.E.E., G.W.P., N.C.V., B.G.M.v.E.), Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen; Department of Human Genetics (R.J.L.F.L., S.M.v.d.M.), Leiden University Medical Center, the Netherlands; and Department of Neurology (J.M.S.), Kansas University Medical Center, Kansas City
| | - Baziel G M van Engelen
- From the Department of Neurology (R.J.M.G., K.M., C.R.v.K., T.H.A.S., C.E.E., G.W.P., N.C.V., B.G.M.v.E.), Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen; Department of Human Genetics (R.J.L.F.L., S.M.v.d.M.), Leiden University Medical Center, the Netherlands; and Department of Neurology (J.M.S.), Kansas University Medical Center, Kansas City
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Karanevich AG, Weisbrod LJ, Jawdat O, Barohn RJ, Gajewski BJ, He J, Statland JM. Using automated electronic medical record data extraction to model ALS survival and progression. BMC Neurol 2018; 18:205. [PMID: 30547800 PMCID: PMC6295028 DOI: 10.1186/s12883-018-1208-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 11/29/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To assess the feasibility of using automated capture of Electronic Medical Record (EMR) data to build predictive models for amyotrophic lateral sclerosis (ALS) outcomes. METHODS We used an Informatics for Integrating Biology and the Bedside search discovery tool to identify and extract data from 354 ALS patients from the University of Kansas Medical Center EMR. The completeness and integrity of the data extraction were verified by manual chart review. A linear mixed model was used to model disease progression. Cox proportional hazards models were used to investigate the effects of BMI, gender, and age on survival. RESULTS Data extracted from the EMR was sufficient to create simple models of disease progression and survival. Several key variables of interest were unavailable without including a manual chart review. The average ALS Functional Rating Scale - Revised (ALSFRS-R) baseline score at first clinical visit was 34.08, and average decline was - 0.64 per month. Median survival was 27 months after first visit. Higher baseline ALSFRS-R score and BMI were associated with improved survival, higher baseline age was associated with decreased survival. CONCLUSIONS This study serves to show that EMR-captured data can be extracted and used to track outcomes in an ALS clinic setting, potentially important for post-marketing research of new drugs, or as historical controls for future studies. However, as automated EMR-based data extraction becomes more widely used there will be a need to standardize ALS data elements and clinical forms for data capture so data can be pooled across academic centers.
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Affiliation(s)
- Alex G. Karanevich
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, USA
- EMB Statistical Solutions, LLC, Overland Park, KS 66210 USA
| | - Luke J. Weisbrod
- School of Medicine, University of Kansas Medical Center, Kansas City, USA
| | - Omar Jawdat
- Department of Neurology, University of Kansas Medical Center, Kansas City, USA
| | - Richard J. Barohn
- Department of Neurology, University of Kansas Medical Center, Kansas City, USA
| | - Byron J. Gajewski
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, USA
| | - Jianghua He
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, USA
| | - Jeffrey M. Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, USA
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Stunnenberg BC, Raaphorst J, Groenewoud HM, Statland JM, Griggs RC, Woertman W, Stegeman DF, Timmermans J, Trivedi J, Matthews E, Saris CGJ, Schouwenberg BJ, Drost G, van Engelen BGM, van der Wilt GJ. Effect of Mexiletine on Muscle Stiffness in Patients With Nondystrophic Myotonia Evaluated Using Aggregated N-of-1 Trials. JAMA 2018; 320:2344-2353. [PMID: 30535218 PMCID: PMC6583079 DOI: 10.1001/jama.2018.18020] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE In rare diseases it is difficult to achieve high-quality evidence of treatment efficacy because of small cohorts and clinical heterogeneity. With emerging treatments for rare diseases, innovative trial designs are needed. OBJECTIVE To investigate the effectiveness of mexiletine in nondystrophic myotonia using an aggregated N-of-1 trials design and compare results between this innovative design and a previously conducted RCT. DESIGN, SETTING, AND PARTICIPANTS A series of aggregated, double-blind, randomized, placebo-controlled N-of-1-trials, performed in a single academic referral center. Thirty Dutch adult patients with genetically confirmed nondystrophic myotonia (38 patients screened) were enrolled between February 2014 and June 2015. Follow-up was completed in September 2016. INTERVENTIONS Mexiletine (600 mg daily) vs placebo during multiple treatment periods of 4 weeks. MAIN OUTCOMES AND MEASURES Reduction in daily-reported muscle stiffness on a scale of 1 to 9, with higher scores indicating more impairment. A Bayesian hierarchical model aggregated individual N-of-1 trial data to determine the posterior probability of reaching a clinically meaningful effect of a greater than 0.75-point difference. RESULTS Among 30 enrolled patients (mean age, 43.4 [SD, 15.24] years; 22% men; 19 CLCN1 and 11 SCN4A genotype), 27 completed the study and 3 dropped out (1 because of a serious adverse event). In 24 of the 27 completers, a clinically meaningful treatment effect was found. In the Bayesian hierarchical model, mexiletine resulted in a 100% posterior probability of reaching a clinically meaningful reduction in self-reported muscle stiffness for the nondystrophic myotonia group overall and the CLCN1 genotype subgroup and 93% posterior probability for the SCN4A genotype subgroup. In the total nondystrophic myotonia group, the median muscle stiffness score was 6.08 (interquartile range, 4.71-6.80) at baseline and was 2.50 (95% credible interval [CrI], 1.77-3.24) during the mexiletine period and 5.56 (95% CrI, 4.73-6.39) during the placebo period; difference in symptom score reduction, 3.06 (95% CrI, 1.96-4.15; n = 27) favoring mexiletine. The most common adverse event was gastrointestinal discomfort (21 mexiletine [70%], 1 placebo [3%]). One serious adverse event occurred (1 mexiletine [3%]; allergic skin reaction). Using frequentist reanalysis, mexiletine compared with placebo resulted in a mean reduction in daily-reported muscle stiffness of 3.12 (95% CI, 2.46-3.78), consistent with the previous RCT treatment effect of 2.69 (95% CI, 2.12-3.26). CONCLUSIONS AND RELEVANCE In a series of N-of-1 trials of mexiletine vs placebo in patients with nondystrophic myotonia, there was a reduction in mean daily-reported muscle stiffness that was consistent with the treatment effect in a previous randomized clinical trial. These findings support the efficacy of mexiletine for treatment of nondystrophic myotonia as well as the feasibility of N-of-1 trials for assessing interventions in some chronic rare diseases. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02045667.
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Affiliation(s)
- Bas C. Stunnenberg
- Department of Neurology, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joost Raaphorst
- Department of Neurology, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Hans M. Groenewoud
- Department of Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Robert C. Griggs
- Department of Neurology, University of Rochester Medical Center, Rochester, New York
| | - Willem Woertman
- Department of Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Dick F. Stegeman
- Department of Neurology, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Janneke Timmermans
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Jaya Trivedi
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, Texas
| | - Emma Matthews
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Christiaan G. J. Saris
- Department of Neurology, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bas J. Schouwenberg
- Department of Pharmacology–Toxicology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gea Drost
- University of Groningen, Department of Neurology and Neurosurgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Baziel G. M. van Engelen
- Department of Neurology, Donders Institute for Brain Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gert Jan van der Wilt
- Department of Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
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Statland JM, Moore D, Wang Y, Walsh M, Mozaffar T, Elman L, Nations SP, Mitsumoto H, Fernandes JA, Saperstein D, Hayat G, Herbelin L, Karam C, Katz J, Wilkins HM, Agbas A, Swerdlow RH, Santella RM, Dimachkie MM, Barohn RJ. Rasagiline for amyotrophic lateral sclerosis: A randomized, controlled trial. Muscle Nerve 2018; 59:201-207. [PMID: 30192007 PMCID: PMC6545236 DOI: 10.1002/mus.26335] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Rasagiline is a monoamine oxidase B (MAO-B) inhibitor with possible neuroprotective effects in patients with amyotrophic lateral sclerosis (ALS). METHODS We performed a randomized, double-blind, placebo-controlled trial of 80 ALS participants with enrichment of the placebo group with historical controls (n = 177) at 10 centers in the United States. Participants were randomized in a 3:1 ratio to 2 mg/day rasagiline or placebo. The primary outcome was average slope of decline on the ALS Functional Rating Scale-Revised (ALSFRS-R). Secondary measures included slow vital capacity, survival, mitochondrial and molecular biomarkers, and adverse-event reporting. RESULTS There was no difference in the average 12-month ALSFRS-R slope between rasagiline and the mixed placebo and historical control cohorts. Rasagiline did not show signs of drug-target engagement in urine and blood biomarkers. Rasagiline was well tolerated with no serious adverse events. DISCUSSION Rasagiline did not alter disease progression compared with controls over 12 months of treatment. Muscle Nerve 59:201-207, 2019.
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Affiliation(s)
- Jeffrey M Statland
- Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 2012, Kansas City, Kansas, 66160, USA
| | - Dan Moore
- The Forbes Norris MDA/ALS Research Center, California Pacific Medical Center, San Francisco, California, USA
| | - Yunxia Wang
- Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 2012, Kansas City, Kansas, 66160, USA
| | - Maureen Walsh
- Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 2012, Kansas City, Kansas, 66160, USA
| | - Tahseen Mozaffar
- Department of Neurology, University of California, Irvine, Irvine, California, USA
| | - Lauren Elman
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennslyvania, USA
| | - Sharon P Nations
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Hiroshi Mitsumoto
- Department of Neurology, Columbia University, New York, New York, USA
| | - J Americo Fernandes
- Department of Neurology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Ghazala Hayat
- Department of Neurology, St. Louis University, St. Louis, Missouri, USA
| | - Laura Herbelin
- Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 2012, Kansas City, Kansas, 66160, USA
| | - Chafic Karam
- Department of Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Jonathan Katz
- The Forbes Norris MDA/ALS Research Center, California Pacific Medical Center, San Francisco, California, USA
| | - Heather M Wilkins
- Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 2012, Kansas City, Kansas, 66160, USA
| | - Abdulbaki Agbas
- Department of Biosciences, Kansas City University of Medicine and Bioscience, Kansas City, Missouri, USA
| | - Russell H Swerdlow
- Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 2012, Kansas City, Kansas, 66160, USA
| | - Regina M Santella
- Department of Neurology, Columbia University, New York, New York, USA
| | - Mazen M Dimachkie
- Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 2012, Kansas City, Kansas, 66160, USA
| | - Richard J Barohn
- Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 2012, Kansas City, Kansas, 66160, USA
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Mul K, Heatwole C, Eichinger K, Dilek N, Martens WB, Van Engelen BGM, Tawil R, Statland JM. Electrical impedance myography in facioscapulohumeral muscular dystrophy: A 1-year follow-up study. Muscle Nerve 2018; 58:213-218. [PMID: 29543984 DOI: 10.1002/mus.26127] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Electrical impedance myography (EIM) is a noninvasive technique for measuring muscle composition and a potential physiological biomarker for facioscapulohumeral muscular dystrophy (FSHD). METHODS Thirty-two participants with genetically confirmed and clinically affected FSHD underwent EIM in 7 muscles bilaterally. Correlations between EIM and baseline clinical measures were used to select EIM variables of interest in FSHD, and EIM and clinical measures were followed for 1 year. RESULTS There were no significant changes in the EIM variables. Although 50-kHZ reactance correlated the strongest with clinical measures at baseline, the 50-211-kHZ phase ratio demonstrated lower within-subject 12-month variability, potentially offering sample size savings for FSHD clinical trial planning. DISCUSSION EIM did not identify significant disease progression over 12 months. It is currently unclear whether this is because of limitations of the technology or the slow rate of disease progression in this cohort of FSHD patients over this period of time. Muscle Nerve 58: 213-218, 2018.
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Affiliation(s)
- Karlien Mul
- Department of Neurology, University of Kansas Medical Center, 4330 Shawnee Mission Parkway, Suite 323 Fairway, Kansas, 66205, USA.,Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Chad Heatwole
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Katy Eichinger
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Nuran Dilek
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - William B Martens
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Baziel G M Van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rabi Tawil
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Jeffrey M Statland
- Department of Neurology, University of Kansas Medical Center, 4330 Shawnee Mission Parkway, Suite 323 Fairway, Kansas, 66205, USA.,Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
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Karanevich AG, Statland JM, Gajewski BJ, He J. Using an onset-anchored Bayesian hierarchical model to improve predictions for amyotrophic lateral sclerosis disease progression. BMC Med Res Methodol 2018; 18:19. [PMID: 29409450 PMCID: PMC5801819 DOI: 10.1186/s12874-018-0479-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 01/28/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's disease, is a rare disease with extreme between-subject variability, especially with respect to rate of disease progression. This makes modelling a subject's disease progression, which is measured by the ALS Functional Rating Scale (ALSFRS), very difficult. Consider the problem of predicting a subject's ALSFRS score at 9 or 12 months after a given time-point. METHODS We obtained ALS subject data from the Pooled Resource Open-Access ALS Clinical Trials Database, a collection of data from various ALS clinical trials. Due to the typical linearity of the ALSFRS, we consider several Bayesian hierarchical linear models. These include a mixture model (to account for the two potential classes of "fast" and "slow" ALS progressors) as well as an onset-anchored model, in which an additional artificial data-point, using time of disease onset, is utilized to improve predictive performance. RESULTS The onset-anchored model had a drastically reduced posterior predictive mean-square-error distributions, when compared to the Bayesian hierarchical linear model or the mixture model under a cross-validation approach. No covariates, other than time of disease onset, consistently improved predictive performance in either the Bayesian hierarchical linear model or the onset-anchored model. CONCLUSIONS Augmenting patient data with an additional artificial data-point, or onset anchor, can drastically improve predictive modelling in ALS by reducing the variability of estimated parameters at the cost of a slight increase in bias. This onset-anchored model is extremely useful if predictions are desired directly after a single baseline measure (such as at the first day of a clinical trial), a feat that would be very difficult without the onset-anchor. This approach could be useful in modelling other diseases that have bounded progression scales (e.g. Parkinson's disease, Huntington's disease, or inclusion-body myositis). It is our hope that this model can be used by clinicians and statisticians to improve the efficacy of clinical trials and aid in finding treatments for ALS.
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Affiliation(s)
- Alex G Karanevich
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Jeffrey M Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Byron J Gajewski
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jianghua He
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
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Eichinger K, Heatwole C, Iyadurai S, King W, Baker L, Heininger S, Bartlett A, Dilek N, Martens WB, McDermott M, Kissel JT, Tawil R, Statland JM. Facioscapulohumeral muscular dystrophy functional composite outcome measure. Muscle Nerve 2018; 58:10.1002/mus.26088. [PMID: 29381807 PMCID: PMC6066464 DOI: 10.1002/mus.26088] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2018] [Indexed: 01/04/2023]
Abstract
INTRODUCTION We developed an evaluator-administered functional facioscapulohumeral muscular dystrophy composite outcome measure (FSHD-COM) comprising patient-identified areas of functional burden for future clinical trials. METHODS We performed a prospective observational study of 41 patients with FSHD at 2 sites. The FSHD-COM includes functional assessment of the legs, shoulders and arms, trunk, hands, and balance/mobility. We determined the test-retest reliability and convergent validity compared to established FSHD disease metrics. RESULTS The FSHD-COM demonstrated excellent test-retest reliability (intraclass correlation coefficient [ICC] 0.96; subscale ICC range, 0.90-0.94). Cross-sectional associations between the FSHD-COM and disease duration, clinical severity, and strength were moderate to strong (Pearson correlation coefficient range |0.51-0.92|). DISCUSSION The FSHD-COM is a disease-relevant, functional composite outcome measure suitable for future FSHD clinical trials that shows excellent test-retest reliability and cross-sectional associations to disease measures. Future directions include determining multisite reliability, sensitivity to change, and the minimal clinically important change in the FSHD-COM. Muscle Nerve, 2018.
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Affiliation(s)
- Katy Eichinger
- Department of Neurology, University of Rochester Medical Center, Rochester, NY
| | - Chad Heatwole
- Department of Neurology, University of Rochester Medical Center, Rochester, NY
| | - Stanley Iyadurai
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Wendy King
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Lindsay Baker
- Department of Neurology, University of Rochester Medical Center, Rochester, NY
| | - Susanne Heininger
- Department of Neurology, University of Rochester Medical Center, Rochester, NY
| | - Amy Bartlett
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Nuran Dilek
- Department of Neurology, University of Rochester Medical Center, Rochester, NY
| | - William B Martens
- Department of Neurology, University of Rochester Medical Center, Rochester, NY
| | - Michael McDermott
- Department of Neurology, University of Rochester Medical Center, Rochester, NY
- Department of Biostatistics, University of Rochester Medical Center, Rochester, NY
| | - John T. Kissel
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Rabi Tawil
- Department of Neurology, University of Rochester Medical Center, Rochester, NY
| | - Jeffrey M. Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS
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Statland JM, Fontaine B, Hanna MG, Johnson NE, Kissel JT, Sansone VA, Shieh PB, Tawil RN, Trivedi J, Cannon SC, Griggs RC. Review of the Diagnosis and Treatment of Periodic Paralysis. Muscle Nerve 2017; 57:522-530. [PMID: 29125635 PMCID: PMC5867231 DOI: 10.1002/mus.26009] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/24/2017] [Accepted: 11/07/2017] [Indexed: 01/16/2023]
Abstract
Periodic paralyses (PPs) are rare neuromuscular disorders caused by mutations in skeletal muscle sodium, calcium, and potassium channel genes. PPs include hypokalemic paralysis, hyperkalemic paralysis, and Andersen‐Tawil syndrome. Common features of PP include autosomal dominant inheritance, onset typically in the first or second decades, episodic attacks of flaccid weakness, which are often triggered by diet or rest after exercise. Diagnosis is based on the characteristic clinic presentation then confirmed by genetic testing. In the absence of an identified genetic mutation, documented low or high potassium levels during attacks or a decrement on long exercise testing support diagnosis. The treatment approach should include both management of acute attacks and prevention of attacks. Treatments include behavioral interventions directed at avoidance of triggers, modification of potassium levels, diuretics, and carbonic anhydrase inhibitors. Muscle Nerve57: 522–530, 2018
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Affiliation(s)
- Jeffrey M Statland
- Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, Kansas, 66160, USA
| | - Bertrand Fontaine
- Sorbonne-Université, INSERM, AP-HP, Reference Center for Channelopathies, Department of Neuology, University Hospital Pitié-Salpêtrière, Paris, France
| | - Michael G Hanna
- MRC Center for Neuromuscular Diseases, University College of London Institute of Neurology, London, England
| | - Nicholas E Johnson
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - John T Kissel
- Department of Neurology, The Ohio State University, Columbus, Ohio, USA
| | - Valeria A Sansone
- The NEMO Center, Neurorehabilitation Unit, University of Milan, Italy
| | - Perry B Shieh
- Department of Neurology, University of California at Los Angeles School of Medicine, Los Angeles, California, USA
| | - Rabi N Tawil
- Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Jaya Trivedi
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Stephen C Cannon
- Department of Physiology, University of California at Los Angeles School of Medicine, Los Angeles, California, USA
| | - Robert C Griggs
- Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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Eichinger K, Heatwole C, Heininger S, Stinson N, Matichak Stock C, Grosmann C, Wagner KR, Tawil R, Statland JM. Validity of the 6 minute walk test in facioscapulohumeral muscular dystrophy. Muscle Nerve 2016; 55:333-337. [PMID: 27421252 DOI: 10.1002/mus.25251] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2016] [Indexed: 01/09/2023]
Abstract
INTRODUCTION In preparation for future clinical trials, we determined the reliability, relationship to measures of disease severity, and consistency across sites of the 6 Minute Walk Test (6MWT) in patients with facioscapulohumeral muscular dystrophy (FSHD). METHODS Genetically defined and clinically affected FSHD participants at 2 sites performed the 6MWT, the Timed Up and Go, and the 30 foot Go/Timed 10 meter test as measures of mobility using standard procedures. RESULTS Eight-six participants representing the full range of severity performed the 6MWT. The mean 6MWT distance was 404.3 meters (SD 123.9), with no difference between sites. The 6MWT was reliable (n = 25; intraclass correlation coefficient = 0.99) and demonstrated moderate to strong correlations with lower extremity strength, functional outcomes, and FSHD Clinical Score. CONCLUSIONS The 6MWT is reliable and is associated with other measures of FSHD disease severity. Future directions include assessing its sensitivity to disease progression. Muscle Nerve 55: 333-337, 2017.
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Affiliation(s)
- Katy Eichinger
- Department of Neurology, University of Rochester Medical Center, Box 673, 601 Elmwood Avenue, Rochester, New York, 14642
| | - Chad Heatwole
- Department of Neurology, University of Rochester Medical Center, Box 673, 601 Elmwood Avenue, Rochester, New York, 14642
| | - Susanne Heininger
- Department of Neurology, University of Rochester Medical Center, Box 673, 601 Elmwood Avenue, Rochester, New York, 14642
| | - Nikia Stinson
- Center for Genetic Muscle Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Carly Matichak Stock
- Center for Genetic Muscle Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Carla Grosmann
- Center for Genetic Muscle Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA.,Rady Children's Hospital and Department of Neurosciences, UC San Diego School of Medicine, San Diego, California, USA
| | - Kathryn R Wagner
- Center for Genetic Muscle Disorders, Kennedy Krieger Institute, Baltimore, Maryland, USA.,Departments of Neurology and Neuroscience, The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Rabi Tawil
- Department of Neurology, University of Rochester Medical Center, Box 673, 601 Elmwood Avenue, Rochester, New York, 14642
| | - Jeffrey M Statland
- Department of Neurology, University of Rochester Medical Center, Box 673, 601 Elmwood Avenue, Rochester, New York, 14642.,Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
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Abstract
PURPOSE OF REVIEW This article describes the clinical characteristics, diagnosis, molecular pathogenesis, and treatment of facioscapulohumeral muscular dystrophy (FSHD). RECENT FINDINGS FSHD comprises two genetically distinct types that converge on a common downstream pathway of the expression of the toxic protein DUX4. Approximately 95% of patients have FSHD type 1 (FSHD1), in which loss of DNA repetitive elements (D4Z4 repeats) in the subtelomeric region of chromosome 4q causes decreased methylation and epigenetic derepression of DUX4, a gene contained within each D4Z4 repeat. FSHD type 2 (FSHD2) occurs through a deletion-independent mechanism but, similar to FSHD1, leads to decreased methylation and epigenetic derepression in the same region of chromosome 4q. Whereas FSHD1 is dominantly inherited, FSHD2 shows digenic inheritance, and about 80% of patients will have a mutation in the SMCHD1 gene. DUX4 lacks a polyadenylation signal, so both FSHD1 and FSHD2 only occur in the presence of permissive 4q polymorphisms, which provide a stabilizing polyadenylation sequence. FSHD is an epigenetic disease, and penetrance and severity are related to both the number of residual D4Z4 units and D4Z4 methylation. SUMMARY Recent consensus guidelines outline standards for care for FSHD, and identification of potential therapeutic targets have shifted emphasis in the research community toward drug development and clinical trial planning.
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50
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Pasnoor M, He J, Herbelin L, Burns TM, Nations S, Bril V, Wang AK, Elsheikh BH, Kissel JT, Saperstein D, Shaibani JA, Jackson C, Swenson A, Howard JF, Goyal N, David W, Wicklund M, Pulley M, Becker M, Mozaffar T, Benatar M, Pazcuzzi R, Simpson E, Rosenfeld J, Dimachkie MM, Statland JM, Barohn RJ. A randomized controlled trial of methotrexate for patients with generalized myasthenia gravis. Neurology 2016; 87:57-64. [PMID: 27306628 DOI: 10.1212/wnl.0000000000002795] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 03/17/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the steroid-sparing effect of methotrexate (MTX) in patients with symptomatic generalized myasthenia gravis (MG). METHODS We performed a 12-month multicenter, randomized, double-blind, placebo-controlled trial of MTX 20 mg orally every week vs placebo in 50 acetylcholine receptor antibody-positive patients with MG between April 2009 and August 2014. The primary outcome measure was the prednisone area under the dose-time curve (AUDTC) from months 4 to 12. Secondary outcome measures included 12-month changes of the Quantitative Myasthenia Gravis Score, the Myasthenia Gravis Composite Score, Manual Muscle Testing, the Myasthenia Gravis Quality of Life, and the Myasthenia Gravis Activities of Daily Living. RESULTS Fifty-eight patients were screened and 50 enrolled. MTX did not reduce the month 4-12 prednisone AUDTC when compared to placebo (difference MTX - placebo: -488.0 mg, 95% confidence interval -2,443.4 to 1,467.3, p = 0.26); however, the average daily prednisone dose decreased in both groups. MTX did not improve secondary measures of MG compared to placebo over 12 months. Eight participants withdrew during the course of the study (1 MTX, 7 placebo). There were no serious MTX-related adverse events. The most common adverse event was nonspecific pain (19%). CONCLUSIONS We found no steroid-sparing benefit of MTX in MG over 12 months of treatment, despite being well-tolerated. This study demonstrates the challenges of conducting clinical trials in MG, including difficulties with recruitment, participants improving on prednisone alone, and the need for a better understanding of outcome measure variability for future clinical trials. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that for patients with generalized MG MTX does not significantly reduce the prednisone AUDTC over 12 months of therapy.
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Affiliation(s)
- Mamatha Pasnoor
- From the Department of Biostatistics (J.H.), University of Kansas Medical Center (M.P., J.H., L.H., M.M.D., J.M.S., R.J.B.), Kansas City; University of Virginia (T.M.B.), Charlottesville; University of Texas Southwestern (S.N.), Dallas; University of Toronto (V.B.), Canada; University of California-Irvine (A.K.W., T.M.), Orange; Ohio State University (B.H.E., J.T.K.), Columbus; Phoenix Neurological Associates (D.S.), AZ; Nerve and Muscle Center of Texas (J.A.S.), Houston; University of Texas Health Science Center (C.J.), San Antonio; University of Iowa (A.S.), Iowa City; University of North Carolina (J.F.H.), Chapel Hill; Massachusetts General Hospital (N.G., W.D.), Boston; Penn State Hershey Medical Center (M.W.), Hershey, PA; University of Florida-Jacksonville (M.P.); Children's Mercy Hospital and Clinics (M. Becker), Kansas City, MO; University of Miami (M. Benatar), FL; Indiana University (R.P.), Indianapolis; Methodist Hospital System (E.S.), Houston, TX; and University of San Francisco (J.R.), CA.
| | - Jianghua He
- From the Department of Biostatistics (J.H.), University of Kansas Medical Center (M.P., J.H., L.H., M.M.D., J.M.S., R.J.B.), Kansas City; University of Virginia (T.M.B.), Charlottesville; University of Texas Southwestern (S.N.), Dallas; University of Toronto (V.B.), Canada; University of California-Irvine (A.K.W., T.M.), Orange; Ohio State University (B.H.E., J.T.K.), Columbus; Phoenix Neurological Associates (D.S.), AZ; Nerve and Muscle Center of Texas (J.A.S.), Houston; University of Texas Health Science Center (C.J.), San Antonio; University of Iowa (A.S.), Iowa City; University of North Carolina (J.F.H.), Chapel Hill; Massachusetts General Hospital (N.G., W.D.), Boston; Penn State Hershey Medical Center (M.W.), Hershey, PA; University of Florida-Jacksonville (M.P.); Children's Mercy Hospital and Clinics (M. Becker), Kansas City, MO; University of Miami (M. Benatar), FL; Indiana University (R.P.), Indianapolis; Methodist Hospital System (E.S.), Houston, TX; and University of San Francisco (J.R.), CA
| | - Laura Herbelin
- From the Department of Biostatistics (J.H.), University of Kansas Medical Center (M.P., J.H., L.H., M.M.D., J.M.S., R.J.B.), Kansas City; University of Virginia (T.M.B.), Charlottesville; University of Texas Southwestern (S.N.), Dallas; University of Toronto (V.B.), Canada; University of California-Irvine (A.K.W., T.M.), Orange; Ohio State University (B.H.E., J.T.K.), Columbus; Phoenix Neurological Associates (D.S.), AZ; Nerve and Muscle Center of Texas (J.A.S.), Houston; University of Texas Health Science Center (C.J.), San Antonio; University of Iowa (A.S.), Iowa City; University of North Carolina (J.F.H.), Chapel Hill; Massachusetts General Hospital (N.G., W.D.), Boston; Penn State Hershey Medical Center (M.W.), Hershey, PA; University of Florida-Jacksonville (M.P.); Children's Mercy Hospital and Clinics (M. Becker), Kansas City, MO; University of Miami (M. Benatar), FL; Indiana University (R.P.), Indianapolis; Methodist Hospital System (E.S.), Houston, TX; and University of San Francisco (J.R.), CA
| | - Ted M Burns
- From the Department of Biostatistics (J.H.), University of Kansas Medical Center (M.P., J.H., L.H., M.M.D., J.M.S., R.J.B.), Kansas City; University of Virginia (T.M.B.), Charlottesville; University of Texas Southwestern (S.N.), Dallas; University of Toronto (V.B.), Canada; University of California-Irvine (A.K.W., T.M.), Orange; Ohio State University (B.H.E., J.T.K.), Columbus; Phoenix Neurological Associates (D.S.), AZ; Nerve and Muscle Center of Texas (J.A.S.), Houston; University of Texas Health Science Center (C.J.), San Antonio; University of Iowa (A.S.), Iowa City; University of North Carolina (J.F.H.), Chapel Hill; Massachusetts General Hospital (N.G., W.D.), Boston; Penn State Hershey Medical Center (M.W.), Hershey, PA; University of Florida-Jacksonville (M.P.); Children's Mercy Hospital and Clinics (M. Becker), Kansas City, MO; University of Miami (M. Benatar), FL; Indiana University (R.P.), Indianapolis; Methodist Hospital System (E.S.), Houston, TX; and University of San Francisco (J.R.), CA
| | - Sharon Nations
- From the Department of Biostatistics (J.H.), University of Kansas Medical Center (M.P., J.H., L.H., M.M.D., J.M.S., R.J.B.), Kansas City; University of Virginia (T.M.B.), Charlottesville; University of Texas Southwestern (S.N.), Dallas; University of Toronto (V.B.), Canada; University of California-Irvine (A.K.W., T.M.), Orange; Ohio State University (B.H.E., J.T.K.), Columbus; Phoenix Neurological Associates (D.S.), AZ; Nerve and Muscle Center of Texas (J.A.S.), Houston; University of Texas Health Science Center (C.J.), San Antonio; University of Iowa (A.S.), Iowa City; University of North Carolina (J.F.H.), Chapel Hill; Massachusetts General Hospital (N.G., W.D.), Boston; Penn State Hershey Medical Center (M.W.), Hershey, PA; University of Florida-Jacksonville (M.P.); Children's Mercy Hospital and Clinics (M. Becker), Kansas City, MO; University of Miami (M. Benatar), FL; Indiana University (R.P.), Indianapolis; Methodist Hospital System (E.S.), Houston, TX; and University of San Francisco (J.R.), CA
| | - Vera Bril
- From the Department of Biostatistics (J.H.), University of Kansas Medical Center (M.P., J.H., L.H., M.M.D., J.M.S., R.J.B.), Kansas City; University of Virginia (T.M.B.), Charlottesville; University of Texas Southwestern (S.N.), Dallas; University of Toronto (V.B.), Canada; University of California-Irvine (A.K.W., T.M.), Orange; Ohio State University (B.H.E., J.T.K.), Columbus; Phoenix Neurological Associates (D.S.), AZ; Nerve and Muscle Center of Texas (J.A.S.), Houston; University of Texas Health Science Center (C.J.), San Antonio; University of Iowa (A.S.), Iowa City; University of North Carolina (J.F.H.), Chapel Hill; Massachusetts General Hospital (N.G., W.D.), Boston; Penn State Hershey Medical Center (M.W.), Hershey, PA; University of Florida-Jacksonville (M.P.); Children's Mercy Hospital and Clinics (M. Becker), Kansas City, MO; University of Miami (M. Benatar), FL; Indiana University (R.P.), Indianapolis; Methodist Hospital System (E.S.), Houston, TX; and University of San Francisco (J.R.), CA
| | - Annabel K Wang
- From the Department of Biostatistics (J.H.), University of Kansas Medical Center (M.P., J.H., L.H., M.M.D., J.M.S., R.J.B.), Kansas City; University of Virginia (T.M.B.), Charlottesville; University of Texas Southwestern (S.N.), Dallas; University of Toronto (V.B.), Canada; University of California-Irvine (A.K.W., T.M.), Orange; Ohio State University (B.H.E., J.T.K.), Columbus; Phoenix Neurological Associates (D.S.), AZ; Nerve and Muscle Center of Texas (J.A.S.), Houston; University of Texas Health Science Center (C.J.), San Antonio; University of Iowa (A.S.), Iowa City; University of North Carolina (J.F.H.), Chapel Hill; Massachusetts General Hospital (N.G., W.D.), Boston; Penn State Hershey Medical Center (M.W.), Hershey, PA; University of Florida-Jacksonville (M.P.); Children's Mercy Hospital and Clinics (M. Becker), Kansas City, MO; University of Miami (M. Benatar), FL; Indiana University (R.P.), Indianapolis; Methodist Hospital System (E.S.), Houston, TX; and University of San Francisco (J.R.), CA
| | - Bakri H Elsheikh
- From the Department of Biostatistics (J.H.), University of Kansas Medical Center (M.P., J.H., L.H., M.M.D., J.M.S., R.J.B.), Kansas City; University of Virginia (T.M.B.), Charlottesville; University of Texas Southwestern (S.N.), Dallas; University of Toronto (V.B.), Canada; University of California-Irvine (A.K.W., T.M.), Orange; Ohio State University (B.H.E., J.T.K.), Columbus; Phoenix Neurological Associates (D.S.), AZ; Nerve and Muscle Center of Texas (J.A.S.), Houston; University of Texas Health Science Center (C.J.), San Antonio; University of Iowa (A.S.), Iowa City; University of North Carolina (J.F.H.), Chapel Hill; Massachusetts General Hospital (N.G., W.D.), Boston; Penn State Hershey Medical Center (M.W.), Hershey, PA; University of Florida-Jacksonville (M.P.); Children's Mercy Hospital and Clinics (M. Becker), Kansas City, MO; University of Miami (M. Benatar), FL; Indiana University (R.P.), Indianapolis; Methodist Hospital System (E.S.), Houston, TX; and University of San Francisco (J.R.), CA
| | - John T Kissel
- From the Department of Biostatistics (J.H.), University of Kansas Medical Center (M.P., J.H., L.H., M.M.D., J.M.S., R.J.B.), Kansas City; University of Virginia (T.M.B.), Charlottesville; University of Texas Southwestern (S.N.), Dallas; University of Toronto (V.B.), Canada; University of California-Irvine (A.K.W., T.M.), Orange; Ohio State University (B.H.E., J.T.K.), Columbus; Phoenix Neurological Associates (D.S.), AZ; Nerve and Muscle Center of Texas (J.A.S.), Houston; University of Texas Health Science Center (C.J.), San Antonio; University of Iowa (A.S.), Iowa City; University of North Carolina (J.F.H.), Chapel Hill; Massachusetts General Hospital (N.G., W.D.), Boston; Penn State Hershey Medical Center (M.W.), Hershey, PA; University of Florida-Jacksonville (M.P.); Children's Mercy Hospital and Clinics (M. Becker), Kansas City, MO; University of Miami (M. Benatar), FL; Indiana University (R.P.), Indianapolis; Methodist Hospital System (E.S.), Houston, TX; and University of San Francisco (J.R.), CA
| | - David Saperstein
- From the Department of Biostatistics (J.H.), University of Kansas Medical Center (M.P., J.H., L.H., M.M.D., J.M.S., R.J.B.), Kansas City; University of Virginia (T.M.B.), Charlottesville; University of Texas Southwestern (S.N.), Dallas; University of Toronto (V.B.), Canada; University of California-Irvine (A.K.W., T.M.), Orange; Ohio State University (B.H.E., J.T.K.), Columbus; Phoenix Neurological Associates (D.S.), AZ; Nerve and Muscle Center of Texas (J.A.S.), Houston; University of Texas Health Science Center (C.J.), San Antonio; University of Iowa (A.S.), Iowa City; University of North Carolina (J.F.H.), Chapel Hill; Massachusetts General Hospital (N.G., W.D.), Boston; Penn State Hershey Medical Center (M.W.), Hershey, PA; University of Florida-Jacksonville (M.P.); Children's Mercy Hospital and Clinics (M. Becker), Kansas City, MO; University of Miami (M. Benatar), FL; Indiana University (R.P.), Indianapolis; Methodist Hospital System (E.S.), Houston, TX; and University of San Francisco (J.R.), CA
| | - J Aziz Shaibani
- From the Department of Biostatistics (J.H.), University of Kansas Medical Center (M.P., J.H., L.H., M.M.D., J.M.S., R.J.B.), Kansas City; University of Virginia (T.M.B.), Charlottesville; University of Texas Southwestern (S.N.), Dallas; University of Toronto (V.B.), Canada; University of California-Irvine (A.K.W., T.M.), Orange; Ohio State University (B.H.E., J.T.K.), Columbus; Phoenix Neurological Associates (D.S.), AZ; Nerve and Muscle Center of Texas (J.A.S.), Houston; University of Texas Health Science Center (C.J.), San Antonio; University of Iowa (A.S.), Iowa City; University of North Carolina (J.F.H.), Chapel Hill; Massachusetts General Hospital (N.G., W.D.), Boston; Penn State Hershey Medical Center (M.W.), Hershey, PA; University of Florida-Jacksonville (M.P.); Children's Mercy Hospital and Clinics (M. Becker), Kansas City, MO; University of Miami (M. Benatar), FL; Indiana University (R.P.), Indianapolis; Methodist Hospital System (E.S.), Houston, TX; and University of San Francisco (J.R.), CA
| | - Carlayne Jackson
- From the Department of Biostatistics (J.H.), University of Kansas Medical Center (M.P., J.H., L.H., M.M.D., J.M.S., R.J.B.), Kansas City; University of Virginia (T.M.B.), Charlottesville; University of Texas Southwestern (S.N.), Dallas; University of Toronto (V.B.), Canada; University of California-Irvine (A.K.W., T.M.), Orange; Ohio State University (B.H.E., J.T.K.), Columbus; Phoenix Neurological Associates (D.S.), AZ; Nerve and Muscle Center of Texas (J.A.S.), Houston; University of Texas Health Science Center (C.J.), San Antonio; University of Iowa (A.S.), Iowa City; University of North Carolina (J.F.H.), Chapel Hill; Massachusetts General Hospital (N.G., W.D.), Boston; Penn State Hershey Medical Center (M.W.), Hershey, PA; University of Florida-Jacksonville (M.P.); Children's Mercy Hospital and Clinics (M. Becker), Kansas City, MO; University of Miami (M. Benatar), FL; Indiana University (R.P.), Indianapolis; Methodist Hospital System (E.S.), Houston, TX; and University of San Francisco (J.R.), CA
| | - Andrea Swenson
- From the Department of Biostatistics (J.H.), University of Kansas Medical Center (M.P., J.H., L.H., M.M.D., J.M.S., R.J.B.), Kansas City; University of Virginia (T.M.B.), Charlottesville; University of Texas Southwestern (S.N.), Dallas; University of Toronto (V.B.), Canada; University of California-Irvine (A.K.W., T.M.), Orange; Ohio State University (B.H.E., J.T.K.), Columbus; Phoenix Neurological Associates (D.S.), AZ; Nerve and Muscle Center of Texas (J.A.S.), Houston; University of Texas Health Science Center (C.J.), San Antonio; University of Iowa (A.S.), Iowa City; University of North Carolina (J.F.H.), Chapel Hill; Massachusetts General Hospital (N.G., W.D.), Boston; Penn State Hershey Medical Center (M.W.), Hershey, PA; University of Florida-Jacksonville (M.P.); Children's Mercy Hospital and Clinics (M. Becker), Kansas City, MO; University of Miami (M. Benatar), FL; Indiana University (R.P.), Indianapolis; Methodist Hospital System (E.S.), Houston, TX; and University of San Francisco (J.R.), CA
| | - James F Howard
- From the Department of Biostatistics (J.H.), University of Kansas Medical Center (M.P., J.H., L.H., M.M.D., J.M.S., R.J.B.), Kansas City; University of Virginia (T.M.B.), Charlottesville; University of Texas Southwestern (S.N.), Dallas; University of Toronto (V.B.), Canada; University of California-Irvine (A.K.W., T.M.), Orange; Ohio State University (B.H.E., J.T.K.), Columbus; Phoenix Neurological Associates (D.S.), AZ; Nerve and Muscle Center of Texas (J.A.S.), Houston; University of Texas Health Science Center (C.J.), San Antonio; University of Iowa (A.S.), Iowa City; University of North Carolina (J.F.H.), Chapel Hill; Massachusetts General Hospital (N.G., W.D.), Boston; Penn State Hershey Medical Center (M.W.), Hershey, PA; University of Florida-Jacksonville (M.P.); Children's Mercy Hospital and Clinics (M. Becker), Kansas City, MO; University of Miami (M. Benatar), FL; Indiana University (R.P.), Indianapolis; Methodist Hospital System (E.S.), Houston, TX; and University of San Francisco (J.R.), CA
| | - Namita Goyal
- From the Department of Biostatistics (J.H.), University of Kansas Medical Center (M.P., J.H., L.H., M.M.D., J.M.S., R.J.B.), Kansas City; University of Virginia (T.M.B.), Charlottesville; University of Texas Southwestern (S.N.), Dallas; University of Toronto (V.B.), Canada; University of California-Irvine (A.K.W., T.M.), Orange; Ohio State University (B.H.E., J.T.K.), Columbus; Phoenix Neurological Associates (D.S.), AZ; Nerve and Muscle Center of Texas (J.A.S.), Houston; University of Texas Health Science Center (C.J.), San Antonio; University of Iowa (A.S.), Iowa City; University of North Carolina (J.F.H.), Chapel Hill; Massachusetts General Hospital (N.G., W.D.), Boston; Penn State Hershey Medical Center (M.W.), Hershey, PA; University of Florida-Jacksonville (M.P.); Children's Mercy Hospital and Clinics (M. Becker), Kansas City, MO; University of Miami (M. Benatar), FL; Indiana University (R.P.), Indianapolis; Methodist Hospital System (E.S.), Houston, TX; and University of San Francisco (J.R.), CA
| | - William David
- From the Department of Biostatistics (J.H.), University of Kansas Medical Center (M.P., J.H., L.H., M.M.D., J.M.S., R.J.B.), Kansas City; University of Virginia (T.M.B.), Charlottesville; University of Texas Southwestern (S.N.), Dallas; University of Toronto (V.B.), Canada; University of California-Irvine (A.K.W., T.M.), Orange; Ohio State University (B.H.E., J.T.K.), Columbus; Phoenix Neurological Associates (D.S.), AZ; Nerve and Muscle Center of Texas (J.A.S.), Houston; University of Texas Health Science Center (C.J.), San Antonio; University of Iowa (A.S.), Iowa City; University of North Carolina (J.F.H.), Chapel Hill; Massachusetts General Hospital (N.G., W.D.), Boston; Penn State Hershey Medical Center (M.W.), Hershey, PA; University of Florida-Jacksonville (M.P.); Children's Mercy Hospital and Clinics (M. Becker), Kansas City, MO; University of Miami (M. Benatar), FL; Indiana University (R.P.), Indianapolis; Methodist Hospital System (E.S.), Houston, TX; and University of San Francisco (J.R.), CA
| | - Matthew Wicklund
- From the Department of Biostatistics (J.H.), University of Kansas Medical Center (M.P., J.H., L.H., M.M.D., J.M.S., R.J.B.), Kansas City; University of Virginia (T.M.B.), Charlottesville; University of Texas Southwestern (S.N.), Dallas; University of Toronto (V.B.), Canada; University of California-Irvine (A.K.W., T.M.), Orange; Ohio State University (B.H.E., J.T.K.), Columbus; Phoenix Neurological Associates (D.S.), AZ; Nerve and Muscle Center of Texas (J.A.S.), Houston; University of Texas Health Science Center (C.J.), San Antonio; University of Iowa (A.S.), Iowa City; University of North Carolina (J.F.H.), Chapel Hill; Massachusetts General Hospital (N.G., W.D.), Boston; Penn State Hershey Medical Center (M.W.), Hershey, PA; University of Florida-Jacksonville (M.P.); Children's Mercy Hospital and Clinics (M. Becker), Kansas City, MO; University of Miami (M. Benatar), FL; Indiana University (R.P.), Indianapolis; Methodist Hospital System (E.S.), Houston, TX; and University of San Francisco (J.R.), CA
| | - Michael Pulley
- From the Department of Biostatistics (J.H.), University of Kansas Medical Center (M.P., J.H., L.H., M.M.D., J.M.S., R.J.B.), Kansas City; University of Virginia (T.M.B.), Charlottesville; University of Texas Southwestern (S.N.), Dallas; University of Toronto (V.B.), Canada; University of California-Irvine (A.K.W., T.M.), Orange; Ohio State University (B.H.E., J.T.K.), Columbus; Phoenix Neurological Associates (D.S.), AZ; Nerve and Muscle Center of Texas (J.A.S.), Houston; University of Texas Health Science Center (C.J.), San Antonio; University of Iowa (A.S.), Iowa City; University of North Carolina (J.F.H.), Chapel Hill; Massachusetts General Hospital (N.G., W.D.), Boston; Penn State Hershey Medical Center (M.W.), Hershey, PA; University of Florida-Jacksonville (M.P.); Children's Mercy Hospital and Clinics (M. Becker), Kansas City, MO; University of Miami (M. Benatar), FL; Indiana University (R.P.), Indianapolis; Methodist Hospital System (E.S.), Houston, TX; and University of San Francisco (J.R.), CA
| | - Mara Becker
- From the Department of Biostatistics (J.H.), University of Kansas Medical Center (M.P., J.H., L.H., M.M.D., J.M.S., R.J.B.), Kansas City; University of Virginia (T.M.B.), Charlottesville; University of Texas Southwestern (S.N.), Dallas; University of Toronto (V.B.), Canada; University of California-Irvine (A.K.W., T.M.), Orange; Ohio State University (B.H.E., J.T.K.), Columbus; Phoenix Neurological Associates (D.S.), AZ; Nerve and Muscle Center of Texas (J.A.S.), Houston; University of Texas Health Science Center (C.J.), San Antonio; University of Iowa (A.S.), Iowa City; University of North Carolina (J.F.H.), Chapel Hill; Massachusetts General Hospital (N.G., W.D.), Boston; Penn State Hershey Medical Center (M.W.), Hershey, PA; University of Florida-Jacksonville (M.P.); Children's Mercy Hospital and Clinics (M. Becker), Kansas City, MO; University of Miami (M. Benatar), FL; Indiana University (R.P.), Indianapolis; Methodist Hospital System (E.S.), Houston, TX; and University of San Francisco (J.R.), CA
| | - Tahseen Mozaffar
- From the Department of Biostatistics (J.H.), University of Kansas Medical Center (M.P., J.H., L.H., M.M.D., J.M.S., R.J.B.), Kansas City; University of Virginia (T.M.B.), Charlottesville; University of Texas Southwestern (S.N.), Dallas; University of Toronto (V.B.), Canada; University of California-Irvine (A.K.W., T.M.), Orange; Ohio State University (B.H.E., J.T.K.), Columbus; Phoenix Neurological Associates (D.S.), AZ; Nerve and Muscle Center of Texas (J.A.S.), Houston; University of Texas Health Science Center (C.J.), San Antonio; University of Iowa (A.S.), Iowa City; University of North Carolina (J.F.H.), Chapel Hill; Massachusetts General Hospital (N.G., W.D.), Boston; Penn State Hershey Medical Center (M.W.), Hershey, PA; University of Florida-Jacksonville (M.P.); Children's Mercy Hospital and Clinics (M. Becker), Kansas City, MO; University of Miami (M. Benatar), FL; Indiana University (R.P.), Indianapolis; Methodist Hospital System (E.S.), Houston, TX; and University of San Francisco (J.R.), CA
| | - Michael Benatar
- From the Department of Biostatistics (J.H.), University of Kansas Medical Center (M.P., J.H., L.H., M.M.D., J.M.S., R.J.B.), Kansas City; University of Virginia (T.M.B.), Charlottesville; University of Texas Southwestern (S.N.), Dallas; University of Toronto (V.B.), Canada; University of California-Irvine (A.K.W., T.M.), Orange; Ohio State University (B.H.E., J.T.K.), Columbus; Phoenix Neurological Associates (D.S.), AZ; Nerve and Muscle Center of Texas (J.A.S.), Houston; University of Texas Health Science Center (C.J.), San Antonio; University of Iowa (A.S.), Iowa City; University of North Carolina (J.F.H.), Chapel Hill; Massachusetts General Hospital (N.G., W.D.), Boston; Penn State Hershey Medical Center (M.W.), Hershey, PA; University of Florida-Jacksonville (M.P.); Children's Mercy Hospital and Clinics (M. Becker), Kansas City, MO; University of Miami (M. Benatar), FL; Indiana University (R.P.), Indianapolis; Methodist Hospital System (E.S.), Houston, TX; and University of San Francisco (J.R.), CA
| | - Robert Pazcuzzi
- From the Department of Biostatistics (J.H.), University of Kansas Medical Center (M.P., J.H., L.H., M.M.D., J.M.S., R.J.B.), Kansas City; University of Virginia (T.M.B.), Charlottesville; University of Texas Southwestern (S.N.), Dallas; University of Toronto (V.B.), Canada; University of California-Irvine (A.K.W., T.M.), Orange; Ohio State University (B.H.E., J.T.K.), Columbus; Phoenix Neurological Associates (D.S.), AZ; Nerve and Muscle Center of Texas (J.A.S.), Houston; University of Texas Health Science Center (C.J.), San Antonio; University of Iowa (A.S.), Iowa City; University of North Carolina (J.F.H.), Chapel Hill; Massachusetts General Hospital (N.G., W.D.), Boston; Penn State Hershey Medical Center (M.W.), Hershey, PA; University of Florida-Jacksonville (M.P.); Children's Mercy Hospital and Clinics (M. Becker), Kansas City, MO; University of Miami (M. Benatar), FL; Indiana University (R.P.), Indianapolis; Methodist Hospital System (E.S.), Houston, TX; and University of San Francisco (J.R.), CA
| | - Ericka Simpson
- From the Department of Biostatistics (J.H.), University of Kansas Medical Center (M.P., J.H., L.H., M.M.D., J.M.S., R.J.B.), Kansas City; University of Virginia (T.M.B.), Charlottesville; University of Texas Southwestern (S.N.), Dallas; University of Toronto (V.B.), Canada; University of California-Irvine (A.K.W., T.M.), Orange; Ohio State University (B.H.E., J.T.K.), Columbus; Phoenix Neurological Associates (D.S.), AZ; Nerve and Muscle Center of Texas (J.A.S.), Houston; University of Texas Health Science Center (C.J.), San Antonio; University of Iowa (A.S.), Iowa City; University of North Carolina (J.F.H.), Chapel Hill; Massachusetts General Hospital (N.G., W.D.), Boston; Penn State Hershey Medical Center (M.W.), Hershey, PA; University of Florida-Jacksonville (M.P.); Children's Mercy Hospital and Clinics (M. Becker), Kansas City, MO; University of Miami (M. Benatar), FL; Indiana University (R.P.), Indianapolis; Methodist Hospital System (E.S.), Houston, TX; and University of San Francisco (J.R.), CA
| | - Jeffrey Rosenfeld
- From the Department of Biostatistics (J.H.), University of Kansas Medical Center (M.P., J.H., L.H., M.M.D., J.M.S., R.J.B.), Kansas City; University of Virginia (T.M.B.), Charlottesville; University of Texas Southwestern (S.N.), Dallas; University of Toronto (V.B.), Canada; University of California-Irvine (A.K.W., T.M.), Orange; Ohio State University (B.H.E., J.T.K.), Columbus; Phoenix Neurological Associates (D.S.), AZ; Nerve and Muscle Center of Texas (J.A.S.), Houston; University of Texas Health Science Center (C.J.), San Antonio; University of Iowa (A.S.), Iowa City; University of North Carolina (J.F.H.), Chapel Hill; Massachusetts General Hospital (N.G., W.D.), Boston; Penn State Hershey Medical Center (M.W.), Hershey, PA; University of Florida-Jacksonville (M.P.); Children's Mercy Hospital and Clinics (M. Becker), Kansas City, MO; University of Miami (M. Benatar), FL; Indiana University (R.P.), Indianapolis; Methodist Hospital System (E.S.), Houston, TX; and University of San Francisco (J.R.), CA
| | - Mazen M Dimachkie
- From the Department of Biostatistics (J.H.), University of Kansas Medical Center (M.P., J.H., L.H., M.M.D., J.M.S., R.J.B.), Kansas City; University of Virginia (T.M.B.), Charlottesville; University of Texas Southwestern (S.N.), Dallas; University of Toronto (V.B.), Canada; University of California-Irvine (A.K.W., T.M.), Orange; Ohio State University (B.H.E., J.T.K.), Columbus; Phoenix Neurological Associates (D.S.), AZ; Nerve and Muscle Center of Texas (J.A.S.), Houston; University of Texas Health Science Center (C.J.), San Antonio; University of Iowa (A.S.), Iowa City; University of North Carolina (J.F.H.), Chapel Hill; Massachusetts General Hospital (N.G., W.D.), Boston; Penn State Hershey Medical Center (M.W.), Hershey, PA; University of Florida-Jacksonville (M.P.); Children's Mercy Hospital and Clinics (M. Becker), Kansas City, MO; University of Miami (M. Benatar), FL; Indiana University (R.P.), Indianapolis; Methodist Hospital System (E.S.), Houston, TX; and University of San Francisco (J.R.), CA
| | - Jeffrey M Statland
- From the Department of Biostatistics (J.H.), University of Kansas Medical Center (M.P., J.H., L.H., M.M.D., J.M.S., R.J.B.), Kansas City; University of Virginia (T.M.B.), Charlottesville; University of Texas Southwestern (S.N.), Dallas; University of Toronto (V.B.), Canada; University of California-Irvine (A.K.W., T.M.), Orange; Ohio State University (B.H.E., J.T.K.), Columbus; Phoenix Neurological Associates (D.S.), AZ; Nerve and Muscle Center of Texas (J.A.S.), Houston; University of Texas Health Science Center (C.J.), San Antonio; University of Iowa (A.S.), Iowa City; University of North Carolina (J.F.H.), Chapel Hill; Massachusetts General Hospital (N.G., W.D.), Boston; Penn State Hershey Medical Center (M.W.), Hershey, PA; University of Florida-Jacksonville (M.P.); Children's Mercy Hospital and Clinics (M. Becker), Kansas City, MO; University of Miami (M. Benatar), FL; Indiana University (R.P.), Indianapolis; Methodist Hospital System (E.S.), Houston, TX; and University of San Francisco (J.R.), CA
| | - Richard J Barohn
- From the Department of Biostatistics (J.H.), University of Kansas Medical Center (M.P., J.H., L.H., M.M.D., J.M.S., R.J.B.), Kansas City; University of Virginia (T.M.B.), Charlottesville; University of Texas Southwestern (S.N.), Dallas; University of Toronto (V.B.), Canada; University of California-Irvine (A.K.W., T.M.), Orange; Ohio State University (B.H.E., J.T.K.), Columbus; Phoenix Neurological Associates (D.S.), AZ; Nerve and Muscle Center of Texas (J.A.S.), Houston; University of Texas Health Science Center (C.J.), San Antonio; University of Iowa (A.S.), Iowa City; University of North Carolina (J.F.H.), Chapel Hill; Massachusetts General Hospital (N.G., W.D.), Boston; Penn State Hershey Medical Center (M.W.), Hershey, PA; University of Florida-Jacksonville (M.P.); Children's Mercy Hospital and Clinics (M. Becker), Kansas City, MO; University of Miami (M. Benatar), FL; Indiana University (R.P.), Indianapolis; Methodist Hospital System (E.S.), Houston, TX; and University of San Francisco (J.R.), CA
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