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Selge C, Kümpfel T, Havla J, Schöberl F, Danek A, Reilich P. [Seronegative myasthenic syndrome?]. Nervenarzt 2020; 91:150-152. [PMID: 31535177 DOI: 10.1007/s00115-019-00810-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- C Selge
- Medizinische Fakultät, Ludwig-Maximilians-Universität München, München, Deutschland.
| | - T Kümpfel
- Medizinische Fakultät, Ludwig-Maximilians-Universität München, München, Deutschland
| | - J Havla
- Medizinische Fakultät, Ludwig-Maximilians-Universität München, München, Deutschland
| | - F Schöberl
- Medizinische Fakultät, Ludwig-Maximilians-Universität München, München, Deutschland
| | - A Danek
- Medizinische Fakultät, Ludwig-Maximilians-Universität München, München, Deutschland
| | - P Reilich
- Medizinische Fakultät, Ludwig-Maximilians-Universität München, München, Deutschland
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Walter M, Reilich P, Krause S, Abicht A, Schoser B. Congenital centronuclear myopathy and epidermolysis bullosa due to two novel mutations in the plectin gene. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Schorling E, Schreiber-Katz O, Kaiser K, Thiele S, Klug C, Reilich P, Walter MC, Nagels K. Subjektives Erkrankungsempfinden bei Charcot-Marie-Tooth (CMT)-Neuropathien: Ergebnisse einer qualitativen Vorstudie. Gesundheitswesen 2015. [DOI: 10.1055/s-0035-1563300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Schreiber O, Klug C, Thiele S, Schorling E, Zowe J, Reilich P, Nagels K, Walter M. G.P.166. Neuromuscul Disord 2014. [DOI: 10.1016/j.nmd.2014.06.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schreiber O, Klug C, Thiele S, Herrmann C, Zowe J, Reilich P, Nagels K, Walter M. P541: The impact of spinal muscular atrophies with regard to patients’ quality of life: a socio-economic analysis of a German patient cohort. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50639-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Schreiber O, Klug C, Thiele S, Herrmann C, Zowe J, Reilich P, Nagels K, Walter M. Evaluation of Cost Of Illness (COI) and health care burden in Spinal Muscular Atrophies (SMA). J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.1559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Schroeder AS, Huss K, Blaschek A, Koerte IK, Zeycan B, Roser T, Langhagen T, Schwerin A, Berweck S, Reilich P, Schaefer J, Straube A, Heinen F. Ten-year follow-up in a case series of integrative botulinum toxin intervention in adolescents with chronic daily headache and associated muscle pain. Neuropediatrics 2012; 43:339-45. [PMID: 23129438 DOI: 10.1055/s-0032-1329612] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION A total of 83% of children report headache during a 6-month period. The estimated 1-year prevalence of chronic daily headache (CDH) in children is at least 1 to 2%. Muscle pain is associated with headache severity and chronicity. Muscle pain can be associated with active muscular trigger points, a functional concept still remaining a controversy. An integrated approach including bio-behavioral management is accepted as standard treatment but does not provide sufficient pain relief in all patients. OBJECTIVE We report the individual clinical course of five adolescents with treatment-refractory CDH associated with focal muscle pain. We describe a concept of short-term integrative intervention including botulinum toxin (StiBo) in a personalized "follow the referred pain pattern" injection regimen with the focus on long-term follow-up. RESULTS StiBo showed short-term efficacy on headache frequency and severity. In the long-term follow-up, CDH was not existent in any of the patients. CONCLUSION The treatment may have enabled the patients to draw attention away from a repeated circle of muscle-triggered pain and withdrawal of daily activities toward self-driven activities, thereby potentially preventing the development of further chronification. To prove this hypothesis, a prospective, placebo-controlled study in young adolescents with CDH should be initiated including objective outcome parameters on muscular level.
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Affiliation(s)
- A S Schroeder
- Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, Ludwig-Maximilians University of Munich, Munich, Bavaria, Germany
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Horvath R, Reilich P, Krause S, Turnbull D, Trenell M, Hollingsworth K, Gorman G, Czermin B, Holinski-Feder E, Walter M, Schoser B, Lochmüller H. P64 Neutral lipid storage myopathy due to PNPLA2 mutations may respond to beta-adrenergic treatment. Neuromuscul Disord 2011. [DOI: 10.1016/s0960-8966(11)70083-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sarkozy A, Hicks P, Miller J, Walter M, Reilich P, Radunovic A, Vaidya S, Lochmüller H, Bushby K, Straub V. P75 Muscle MRI findings in LGMD2L. Neuromuscul Disord 2011. [DOI: 10.1016/s0960-8966(11)70094-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Schessl J, Schuberth M, Reilich P, Schneiderat P, Strigl-Pill N, Walter MC, Schlotter-Weigel B, Schoser B. Long-term efficiency of intravenously administered immunoglobulin in anti-Yo syndrome with paraneoplastic cerebellar degeneration. J Neurol 2010; 258:946-7. [PMID: 21174114 DOI: 10.1007/s00415-010-5859-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 11/27/2010] [Accepted: 11/30/2010] [Indexed: 11/28/2022]
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Reilich P. Myofasziale Schmerzsyndrome. AKTUEL RHEUMATOL 2009. [DOI: 10.1055/s-0029-1234085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Schneiderat P, Reilich P, Krause S, Strigl-Pill N, Schoser B, Walter M. Rituximab als Therapie-Alternative beim Jo-1-Syndrom. Akt Neurol 2008. [DOI: 10.1055/s-0028-1086541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Schramm N, Born C, Weckbach S, Reilich P, Walter MC, Reiser M. Nachweis unterschiedlicher Verteilungsmuster bei Patienten mit Myotilinopathie und Desminopathie durch ein Ganzkörper-MRT-Protokoll. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Krause S, Göhringer T, Walter MC, Schoser BGH, Reilich P, Linn J, Pöpperl GE, Frölich L, Hentschel F, Lochmüller H, Danek A. Brain imaging and neuropsychology in late-onset dementia due to a novel mutation (R93C) of valosin-containing protein. Clin Neuropathol 2007; 26:232-40. [PMID: 17907600 DOI: 10.5414/npp26232] [Citation(s) in RCA: 17] [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] [Indexed: 11/18/2022] Open
Abstract
Inclusion body myopathy with Paget disease of bone and frontotemporal dementia (IBMPFD, MIM 167320) is a recently identified autosomal dominant disorder due to mutations in the valosin-containing protein (VCP) that affects muscle, bone and brain. Brain involvement and neuropsychological findings of IBMPFD have not been described in detail. A patient carried a novel heterozygous base pair change, 47832C>T, in the VCP gene that resulted in substitution of an arginine residue by cysteine at position 93 (R93C). He presented first with myopathy while bone involvement remained subclinical. The patient developed behavioral abnormalities in his 60s and showed frank personality change with fluent empty speech at the age of 74 years. This syndrome was best classified as semantic dementia. Magnetic resonance imaging disclosed slight but progressive cerebral atrophy with prominent callosal and frontal white matter loss. Positron emission tomography demonstrated glucose hypometabolism of the frontal and temporal lobes disproportionate to their structural involvement. This first comprehensive clinical and neuroimaging study in IBMPFD may raise the awareness among clinicians as well as basic scientists for this exemplary genetic model of dementia.
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Affiliation(s)
- S Krause
- Neurologische Klinik, Ludwig-Maximilians-Universität München, Germany
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Walter MC, Reilich P, Huebner A, Fischer D, Schröder R, Vorgerd M, Kress W, Born C, Schoser BG, Krause KH, Klutzny U, Bulst S, Frey JR, Lochmüller H. Scapuloperoneal syndrome type Kaeser and a wide phenotypic spectrum of adult-onset, dominant myopathies are associated with the desmin mutation R350P. Brain 2007; 130:1485-96. [PMID: 17439987 DOI: 10.1093/brain/awm039] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In 1965, an adult-onset, autosomal dominant disorder with a peculiar scapuloperoneal distribution of weakness and atrophy was described in a large, multi-generation kindred and named 'scapuloperoneal syndrome type Kaeser' (OMIM #181400). By genetic analysis of the original kindred, we discovered a heterozygous missense mutation of the desmin gene (R350P) cosegregating with the disorder. Moreover, we detected DES R350P in four unrelated German families allowing for genotype-phenotype correlations in a total of 15 patients carrying the same mutation. Large clinical variability was recognized, even within the same family, ranging from scapuloperoneal (n = 2, 12%), limb girdle (n = 10, 60%) and distal phenotypes (n = 3, 18%) with variable cardiac (n = 7, 41%) or respiratory involvement (n = 7, 41%). Facial weakness, dysphagia and gynaecomastia were frequent additional symptoms. Overall and within each family, affected men seemingly bear a higher risk of sudden, cardiac death as compared to affected women. Moreover, histological and immunohistochemical examination of muscle biopsy specimens revealed a wide spectrum of findings ranging from near normal or unspecific pathology to typical, myofibrillar changes with accumulation of desmin. This study reveals that the clinical and pathological variability generally observed in desminopathies may not be attributed to the nature of the DES mutation alone, but may be influenced by additional genetic and epigenetic factors such as gender. In addition, mutations of the desmin gene should be considered early in the diagnostic work-up of any adult-onset, dominant myopathy, even if specific myofibrillar pathology is absent.
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Affiliation(s)
- M C Walter
- Friedrich Baur Institute, Ludwig Maximilians University of Munich, Department of Neurology , Munich, Germany
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Walter MC, Reilich P, Huebner A, Fischer D, Vorgerd M, Born C, Schoser BG, Klutzny U, Frey J, Kaeser HE, Lochmüller H. Identification of a desmin gene mutation in scapuloperoneal syndrome. KLIN NEUROPHYSIOL 2007. [DOI: 10.1055/s-2007-976371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Reilich P, Krause S, Lochmüller H, Walter MC. Facio-scapulo-humeral muscular dystrophy (FSHD) presenting as vacuolar myopathy. KLIN NEUROPHYSIOL 2007. [DOI: 10.1055/s-2007-976372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Walter M, Reilich P, Huebner A, Fischer D, Vorgerd M, Born C, Frey J, Kaeser H, Lochmüller H. G.P.8 08 Identification of a desmin gene mutation in scapuloperoneal syndrome type Kaeser. Neuromuscul Disord 2006. [DOI: 10.1016/j.nmd.2006.05.210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Reilich P, Petersen JA, Vielhaber S, Mawrin C, Schneider-Gold C, Sommer C, Reiners K, Deschauer M, Pongratz D, Lochmüller H, Walter MC. LGMD 2I due to the common mutation 826C>A in the FKRP gene presenting as myopathy with vacuoles and paired-helical filaments. Acta Myol 2006; 25:73-76. [PMID: 18593008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We report on two unrelated patients clinically presenting with late-onset progressive limb girdle weakness; cardiomyopathy was seen in one patient. Muscle biopsy revealed a necrotic myopathy with numerous rimmed vacuoles, ultrastructurally typical paired-helical filaments, and reduced immunohistochemical staining for alpha-dystroglycan. Quadriceps sparing hereditary inclusion body myopathy due to mutations in GNE gene, and OPMD due to PABPN1 mutations were excluded, genetically. We detected a homozygous mutation of the FKRP gene (826C>A) in both patients. Mutations of FKRP have been reported in congenital muscular dystrophies, LGMD2I, cardiomyopathy and hyperCKemia, but not in myopathies with vacuoles and paired-helical filaments. Therefore, our findings further extend the morphological variability of muscular dystrophies due to FKRP mutations.
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Affiliation(s)
- P Reilich
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians University of Munich, Munich, Germany
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Walter MC, Petersen JA, Stucka R, Fischer D, Schröder R, Vorgerd M, Schroers A, Schreiber H, Hanemann CO, Knirsch U, Rosenbohm A, Huebner A, Barisic N, Horvath R, Komoly S, Reilich P, Müller-Felber W, Pongratz D, Müller JS, Auerswald EA, Lochmüller H. FKRP (826C>A) frequently causes limb-girdle muscular dystrophy in German patients. J Med Genet 2004; 41:e50. [PMID: 15060126 PMCID: PMC1735747 DOI: 10.1136/jmg.2003.013953] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- M C Walter
- Gene Center, Friedrich-Baur-Institute, and Department of Neurology, Ludwig-Maximilians-University of Munich, Germany
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Reilich P, Fheodoroff K, Kern U, Mense S, Seddigh S, Wissel J, Pongratz D. Consensus statement: botulinum toxin in myofascial [corrected] pain. J Neurol 2004; 251 Suppl 1:I36-8. [PMID: 14991342 DOI: 10.1007/s00415-004-1109-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- P Reilich
- Friedrich-Baur-Institut an der Neurologischen Klinik und Poliklinik, Klinikum der Universität München, Ziemssenstr. 1a, 80336 München, Germany.
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Walter MC, Dekomien G, Schlotter-Weigel B, Reilich P, Pongratz D, Müller-Felber W, Epplen JT, Huebner A, Lochmüller H. Respiratory insufficiency as a presenting symptom of LGMD2D in adulthood. Acta Myol 2004; 23:1-5. [PMID: 15298081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Several forms of recessive limb girdle muscular dystrophy (LGMD2C-F) are due to mutations in genes coding for sarcoglycans. Clinically, most sarcoglycanopathies present in childhood with skeletal muscle wasting and early loss of ambulation; respiratory insufficiency is rare. However, some cases of LGMD2D with a late onset and a milder course have been reported. In this study, two adult brothers, compound heterozygous for two missense mutations of the SGCA gene (Arg77Cys, Val247Met), presented with respiratory insufficiency while they were still ambulatory.
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Affiliation(s)
- M C Walter
- Friedrich-Baur-Institute, Department of Neurology, Gene Center, Ludwig-Maximilians-University of Munich, Germany
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Reilich P. Effekt von Botulinumtoxin auf Triggerpunkte. KLIN NEUROPHYSIOL 2003. [DOI: 10.1055/s-2003-816515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Durling HJ, Reilich P, Müller-Höcker J, Mendel B, Pongratz D, Wallgren-Pettersson C, Gunning P, Lochmüller H, Laing NG. De novo missense mutation in a constitutively expressed exon of the slow alpha-tropomyosin gene TPM3 associated with an atypical, sporadic case of nemaline myopathy. Neuromuscul Disord 2002; 12:947-51. [PMID: 12467750 DOI: 10.1016/s0960-8966(02)00182-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We describe an atypical case of nemaline myopathy with an unusual distribution of muscle weakness who presented at 14 years of age with kyphoscoliosis. In this patient, we demonstrate heterozygosity for a de novo CGT-CAT (Arg167His) mutation in a constitutively expressed exon (exon 5) of slow alpha-tropomyosin (TPM3). This is the first mutation identified in a constitutively expressed exon of TPM3 in a nemaline myopathy patient, but is similar to recently described mutations in beta-tropomyosin (TPM2) associated with nemaline myopathy and mutations in fast alpha-tropomyosin (TPM1) which cause hypertrophic cardiomyopathy.
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Affiliation(s)
- H J Durling
- Neurogenetics Laboratory, Royal Perth Hospital, Western Australia, Perth, Australia
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Walter MC, Lochmüller H, Schlotter B, Reilich P, Müller-Felber W, Pongratz D. [New insights in pathogenesis and therapy of sporadic inclusion body myositis (s-IBM)]. Nervenarzt 2001; 72:117-21. [PMID: 11256145 DOI: 10.1007/s001150050723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sporadic inclusion body myositis (s-IBM) is a chronic progressive inflammatory myopathy which occurs preferentially in older patients. Histologic hallmarks are rimmed vacuoles and eosinophilic cytoplasmatic inclusions. The etiology is still unknown, but different pathogenetic mechanisms such as slow virus infection, autoimmunopathogenesis, myonuclear alterations, and mitochondrial defects have been implicated. A relation to neurodegenerative disorders and prion diseases has also been suggested. There is a poor response if any to immunosuppressive therapy. Stabilization of disease progression was shown only by intravenous immunoglobulin (IVIG) therapy. Future findings in the field of s-IBM pathogenesis may result in better therapeutic options.
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Affiliation(s)
- M C Walter
- Friedrich-Baur-Institut, Medizinische Klink, Klinikum der Ludwig-Maximilians-Universität, Ziemssenstr. 1a, 80336 München.
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Walter MC, Lochmüller H, Reilich P, Klopstock T, Huber R, Hartard M, Hennig M, Pongratz D, Müller-Felber W. Creatine monohydrate in muscular dystrophies: A double-blind, placebo-controlled clinical study. Neurology 2000; 54:1848-50. [PMID: 10802796 DOI: 10.1212/wnl.54.9.1848] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors assessed the safety and efficacy of creatine monohydrate (Cr) in various types of muscular dystrophies in a double-blind, crossover trial. Thirty-six patients (12 patients with facioscapulohumeral dystrophy, 10 patients with Becker dystrophy, 8 patients with Duchenne dystrophy, and 6 patients with sarcoglycan-deficient limb girdle muscular dystrophy) were randomized to receive Cr or placebo for 8 weeks. There was mild but significant improvement in muscle strength and daily-life activities by Medical Research Council scales and the Neuromuscular Symptom Score. Cr was well tolerated throughout the study period.
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Affiliation(s)
- M C Walter
- Friedrich-Baur-Institute, Ludwig-Maximilians-University of Munich, Germany.
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Walter MC, Lochmüller H, Toepfer M, Schlotter B, Reilich P, Schröder M, Müller-Felber W, Pongratz D. High-dose immunoglobulin therapy in sporadic inclusion body myositis: a double-blind, placebo-controlled study. J Neurol 2000; 247:22-8. [PMID: 10701893 DOI: 10.1007/s004150050005] [Citation(s) in RCA: 154] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sporadic inclusion body myositis (s-IBM) is an acquired inflammatory muscle disease of unknown cause. In general, s-IBM presents with slowly progressive, asymmetric weakness, and atrophy of skeletal muscle. There is a mild transitory or nil responsiveness to standard immunosuppressive treatment. A controlled cross-over study of 22 s-IBM patients over 3 months showed a partial improvement in those treated with high-dose intravenous immunoglobulin therapy (IVIG) versus placebo. The present study included 22 patients aged 32-75 years and with a mean duration of disease of 5.2+/-3.6 years. They were randomized by a double-blind, placebo-controlled, cross-over design to monthly infusions of 2 g/kg bodyweight IVIG or to placebo for 6 months each, followed by the alternative treatment. After 6 and 12 months the response to treatment was evaluated, using a modified Medical Research Council scale, Neuromuscular Symptom Score (NSS), the patient's own assessment of improvement, arm outstretched time, and electromyography. No serious side effects were seen, in particular no viral infection and no major cardiac or neurological complications. Overall there was no progression of the disease in 90% of patients, unlike that which might have been expected in untreated patients. A mild and significant improvement (11%) in clinical symptoms was found using NSS, but not with other test procedures. There was a trend to mild improvement in treated patients when using other tests. Individual responses to treatment was heterogeneous. The validity of this study may be reduced by mismatch of groups with regard to age at onset and variability in disease expression. The findings of this study largely confirm those of a previous IVIG trial. Treatment with IVIG may be mildly effective in s-IBM by preventing disease progression or inducing mild improvement. Long-term studies are needed to evaluate further the benefit of IVIG therapy in s-IBM.
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Affiliation(s)
- M C Walter
- Department of Neurology, Friedrich-Baur-Institut, Medizinische Klink, University of Munich, Germany.
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