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Warman-Chardon J, Breiner A, Bourque PR. Inclusion body myositis. CMAJ 2024; 196:E486. [PMID: 38621777 PMCID: PMC11019609 DOI: 10.1503/cmaj.231815] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Affiliation(s)
- Jodi Warman-Chardon
- Ottawa Hospital Research Institute (Warman-Chardon, Breiner, Bourque); Department of Medicine, Neurology (Warman-Chardon, Breiner, Bourque), The Ottawa Hospital, Ottawa, Ont
| | - Ari Breiner
- Ottawa Hospital Research Institute (Warman-Chardon, Breiner, Bourque); Department of Medicine, Neurology (Warman-Chardon, Breiner, Bourque), The Ottawa Hospital, Ottawa, Ont
| | - Pierre R Bourque
- Ottawa Hospital Research Institute (Warman-Chardon, Breiner, Bourque); Department of Medicine, Neurology (Warman-Chardon, Breiner, Bourque), The Ottawa Hospital, Ottawa, Ont.
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Smith IC, Chakraborty S, Bourque PR, Sampaio ML, Melkus G, Lochmüller H, Woulfe J, Parks RJ, Brais B, Warman-Chardon J. Emerging and established biomarkers of oculopharyngeal muscular dystrophy. Neuromuscul Disord 2023; 33:824-834. [PMID: 37926637 DOI: 10.1016/j.nmd.2023.09.010] [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: 07/28/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 11/07/2023]
Abstract
Oculopharyngeal muscular dystrophy (OPMD) is a rare, primarily autosomal dominant, late onset muscular dystrophy commonly presenting with ptosis, dysphagia, and subsequent weakness of proximal muscles. Although OPMD diagnosis can be confirmed with high confidence by genetic testing, the slow progression of OPMD poses a significant challenge to clinical monitoring and a barrier to assessing the efficacy of treatments during clinical trials. Accordingly, there is a pressing need for more sensitive measures of OPMD progression, particularly those which do not require a muscle biopsy. This review provides an overview of progress in OPMD biomarkers from clinical assessment, quantitative imaging, histological assessments, and genomics, as well as hypothesis-generating "omics" approaches. The ongoing search for biomarkers relevant to OPMD progression needs an integrative, longitudinal approach combining validated and experimental approaches which may include clinical, imaging, demographic, and biochemical assessment methods. A multi-omics approach to biochemical biomarker discovery could help provide context for differences found between individuals with varying levels of disease activity and provide insight into pathomechanisms and prognosis of OPMD.
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Affiliation(s)
- Ian C Smith
- The Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada
| | | | - Pierre R Bourque
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; Department of Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, ON K1H 8L6, Canada; Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, ON K1Y 4E9, Canada
| | - Marcos L Sampaio
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, ON K1Y 4E9, Canada; Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario K1Y 4E9, Canada; Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Gerd Melkus
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, ON K1Y 4E9, Canada; Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario K1Y 4E9, Canada; Department of Physics, Carleton University, Ottawa, ON K1S 5B6, Canada
| | - Hanns Lochmüller
- The Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; Department of Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, ON K1H 8L6, Canada; Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, ON K1Y 4E9, Canada; Genetics, Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada
| | - John Woulfe
- The Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada; Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, ON K1Y 4E9, Canada; Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada
| | - Robin J Parks
- The Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada; Department of Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, ON K1H 8L6, Canada; Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, ON K1Y 4E9, Canada
| | - Bernard Brais
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec H3A 2B4, Canada
| | - Jodi Warman-Chardon
- The Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; Department of Medicine, The Ottawa Hospital/University of Ottawa, Ottawa, ON K1H 8L6, Canada; Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, ON K1Y 4E9, Canada; Genetics, Children's Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada; Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec H3A 2B4, Canada.
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Warman-Chardon J, Hartley T, Marshall AE, McBride A, Couse M, Macdonald W, Mann MRW, Bourque PR, Breiner A, Lochmüller H, Woulfe J, Sampaio ML, Melkus G, Brais B, Dyment DA, Boycott KM, Kernohan K. Biallelic SOX8 Variants Associated With Novel Syndrome With Myopathy, Skeletal Deformities, Intellectual Disability, and Ovarian Dysfunction. Neurol Genet 2023; 9:e200088. [PMID: 38235364 PMCID: PMC10508790 DOI: 10.1212/nxg.0000000000200088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/30/2023] [Indexed: 01/19/2024]
Abstract
Background and Objectives The human genome contains ∼20,000 genes, each of which has its own set of complex regulatory systems to govern precise expression in each developmental stage and cell type. Here, we report a female patient with congenital weakness, respiratory failure, skeletal dysplasia, contractures, short stature, intellectual delay, respiratory failure, and amenorrhea who presented to Medical Genetics service with no known cause for her condition. Methods Whole-exome and whole-genome sequencing were conducted, as well as investigational functional studies to assess the effect of SOX8 variant. Results The patient was found to have biallelic SOX8 variants (NM_014587.3:c.422+5G>C; c.583dup p.(His195ProfsTer11)). SOX8 is a transcriptional regulator, which is predicted to be imprinted (expressed from only one parental allele), but this has not yet been confirmed. We provide evidence that while SOX8 was maternally expressed in adult-derived fibroblasts and lymphoblasts, it was biallelically expressed in other cell types and therefore suggest that biallelic variants are associated with this recessive condition. Functionally, we showed that the paternal variant had the capacity to affect mRNA splicing while the maternal variant resulted in low levels of a truncated protein, which showed decreased binding at and altered expression of SOX8 targets. Discussion Our findings associate SOX8 variants with this novel condition, highlight how complex genome regulation can complicate novel disease-gene identification, and provide insight into the molecular pathogenesis of this disease.
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Affiliation(s)
- Jodi Warman-Chardon
- From the Department of Medicine (J.W.-C., P.R.B., A.B., H.L.), The Ottawa Hospital; The Ottawa Hospital Research Institute (J.W.-C., P.R.B., H.L., J.W., M.L.S., G.M.); Faculty of Medicine (J.W.-C., P.R.B., A.B., H.L., J.W., M.L.S., D.A.D., K.M.B.); Children's Hospital of Eastern Ontario Research Institute (J.W.-C., T.H., A.E.M., A.M., H.L., D.A.D., K.M.B., K.K.), University of Ottawa; Hospital for Sick Children (M.C.), Centre for Computational Medicine, Toronto, Canada; Department of Obstetrics (W.M., M.R.W.M.), Gynaecology and Reproductive Sciences, University of Pittsburgh School of Medicine; Magee-Womens Research Institute (W.M., M.R.W.M.), Pittsburgh, PA; Department of Pathology and Laboratory Medicine (A.B., J.W.), The Ottawa Hospital; Department of Radiology (M.L.S., G.M.), Radiation Oncology and Medical Physics, University of Ottawa; Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University; and Newborn Screening Ontario (K.K.), Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Taila Hartley
- From the Department of Medicine (J.W.-C., P.R.B., A.B., H.L.), The Ottawa Hospital; The Ottawa Hospital Research Institute (J.W.-C., P.R.B., H.L., J.W., M.L.S., G.M.); Faculty of Medicine (J.W.-C., P.R.B., A.B., H.L., J.W., M.L.S., D.A.D., K.M.B.); Children's Hospital of Eastern Ontario Research Institute (J.W.-C., T.H., A.E.M., A.M., H.L., D.A.D., K.M.B., K.K.), University of Ottawa; Hospital for Sick Children (M.C.), Centre for Computational Medicine, Toronto, Canada; Department of Obstetrics (W.M., M.R.W.M.), Gynaecology and Reproductive Sciences, University of Pittsburgh School of Medicine; Magee-Womens Research Institute (W.M., M.R.W.M.), Pittsburgh, PA; Department of Pathology and Laboratory Medicine (A.B., J.W.), The Ottawa Hospital; Department of Radiology (M.L.S., G.M.), Radiation Oncology and Medical Physics, University of Ottawa; Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University; and Newborn Screening Ontario (K.K.), Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Aren Elizabeth Marshall
- From the Department of Medicine (J.W.-C., P.R.B., A.B., H.L.), The Ottawa Hospital; The Ottawa Hospital Research Institute (J.W.-C., P.R.B., H.L., J.W., M.L.S., G.M.); Faculty of Medicine (J.W.-C., P.R.B., A.B., H.L., J.W., M.L.S., D.A.D., K.M.B.); Children's Hospital of Eastern Ontario Research Institute (J.W.-C., T.H., A.E.M., A.M., H.L., D.A.D., K.M.B., K.K.), University of Ottawa; Hospital for Sick Children (M.C.), Centre for Computational Medicine, Toronto, Canada; Department of Obstetrics (W.M., M.R.W.M.), Gynaecology and Reproductive Sciences, University of Pittsburgh School of Medicine; Magee-Womens Research Institute (W.M., M.R.W.M.), Pittsburgh, PA; Department of Pathology and Laboratory Medicine (A.B., J.W.), The Ottawa Hospital; Department of Radiology (M.L.S., G.M.), Radiation Oncology and Medical Physics, University of Ottawa; Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University; and Newborn Screening Ontario (K.K.), Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Arran McBride
- From the Department of Medicine (J.W.-C., P.R.B., A.B., H.L.), The Ottawa Hospital; The Ottawa Hospital Research Institute (J.W.-C., P.R.B., H.L., J.W., M.L.S., G.M.); Faculty of Medicine (J.W.-C., P.R.B., A.B., H.L., J.W., M.L.S., D.A.D., K.M.B.); Children's Hospital of Eastern Ontario Research Institute (J.W.-C., T.H., A.E.M., A.M., H.L., D.A.D., K.M.B., K.K.), University of Ottawa; Hospital for Sick Children (M.C.), Centre for Computational Medicine, Toronto, Canada; Department of Obstetrics (W.M., M.R.W.M.), Gynaecology and Reproductive Sciences, University of Pittsburgh School of Medicine; Magee-Womens Research Institute (W.M., M.R.W.M.), Pittsburgh, PA; Department of Pathology and Laboratory Medicine (A.B., J.W.), The Ottawa Hospital; Department of Radiology (M.L.S., G.M.), Radiation Oncology and Medical Physics, University of Ottawa; Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University; and Newborn Screening Ontario (K.K.), Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Madeline Couse
- From the Department of Medicine (J.W.-C., P.R.B., A.B., H.L.), The Ottawa Hospital; The Ottawa Hospital Research Institute (J.W.-C., P.R.B., H.L., J.W., M.L.S., G.M.); Faculty of Medicine (J.W.-C., P.R.B., A.B., H.L., J.W., M.L.S., D.A.D., K.M.B.); Children's Hospital of Eastern Ontario Research Institute (J.W.-C., T.H., A.E.M., A.M., H.L., D.A.D., K.M.B., K.K.), University of Ottawa; Hospital for Sick Children (M.C.), Centre for Computational Medicine, Toronto, Canada; Department of Obstetrics (W.M., M.R.W.M.), Gynaecology and Reproductive Sciences, University of Pittsburgh School of Medicine; Magee-Womens Research Institute (W.M., M.R.W.M.), Pittsburgh, PA; Department of Pathology and Laboratory Medicine (A.B., J.W.), The Ottawa Hospital; Department of Radiology (M.L.S., G.M.), Radiation Oncology and Medical Physics, University of Ottawa; Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University; and Newborn Screening Ontario (K.K.), Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - William Macdonald
- From the Department of Medicine (J.W.-C., P.R.B., A.B., H.L.), The Ottawa Hospital; The Ottawa Hospital Research Institute (J.W.-C., P.R.B., H.L., J.W., M.L.S., G.M.); Faculty of Medicine (J.W.-C., P.R.B., A.B., H.L., J.W., M.L.S., D.A.D., K.M.B.); Children's Hospital of Eastern Ontario Research Institute (J.W.-C., T.H., A.E.M., A.M., H.L., D.A.D., K.M.B., K.K.), University of Ottawa; Hospital for Sick Children (M.C.), Centre for Computational Medicine, Toronto, Canada; Department of Obstetrics (W.M., M.R.W.M.), Gynaecology and Reproductive Sciences, University of Pittsburgh School of Medicine; Magee-Womens Research Institute (W.M., M.R.W.M.), Pittsburgh, PA; Department of Pathology and Laboratory Medicine (A.B., J.W.), The Ottawa Hospital; Department of Radiology (M.L.S., G.M.), Radiation Oncology and Medical Physics, University of Ottawa; Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University; and Newborn Screening Ontario (K.K.), Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Mellissa R W Mann
- From the Department of Medicine (J.W.-C., P.R.B., A.B., H.L.), The Ottawa Hospital; The Ottawa Hospital Research Institute (J.W.-C., P.R.B., H.L., J.W., M.L.S., G.M.); Faculty of Medicine (J.W.-C., P.R.B., A.B., H.L., J.W., M.L.S., D.A.D., K.M.B.); Children's Hospital of Eastern Ontario Research Institute (J.W.-C., T.H., A.E.M., A.M., H.L., D.A.D., K.M.B., K.K.), University of Ottawa; Hospital for Sick Children (M.C.), Centre for Computational Medicine, Toronto, Canada; Department of Obstetrics (W.M., M.R.W.M.), Gynaecology and Reproductive Sciences, University of Pittsburgh School of Medicine; Magee-Womens Research Institute (W.M., M.R.W.M.), Pittsburgh, PA; Department of Pathology and Laboratory Medicine (A.B., J.W.), The Ottawa Hospital; Department of Radiology (M.L.S., G.M.), Radiation Oncology and Medical Physics, University of Ottawa; Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University; and Newborn Screening Ontario (K.K.), Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Pierre R Bourque
- From the Department of Medicine (J.W.-C., P.R.B., A.B., H.L.), The Ottawa Hospital; The Ottawa Hospital Research Institute (J.W.-C., P.R.B., H.L., J.W., M.L.S., G.M.); Faculty of Medicine (J.W.-C., P.R.B., A.B., H.L., J.W., M.L.S., D.A.D., K.M.B.); Children's Hospital of Eastern Ontario Research Institute (J.W.-C., T.H., A.E.M., A.M., H.L., D.A.D., K.M.B., K.K.), University of Ottawa; Hospital for Sick Children (M.C.), Centre for Computational Medicine, Toronto, Canada; Department of Obstetrics (W.M., M.R.W.M.), Gynaecology and Reproductive Sciences, University of Pittsburgh School of Medicine; Magee-Womens Research Institute (W.M., M.R.W.M.), Pittsburgh, PA; Department of Pathology and Laboratory Medicine (A.B., J.W.), The Ottawa Hospital; Department of Radiology (M.L.S., G.M.), Radiation Oncology and Medical Physics, University of Ottawa; Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University; and Newborn Screening Ontario (K.K.), Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Ari Breiner
- From the Department of Medicine (J.W.-C., P.R.B., A.B., H.L.), The Ottawa Hospital; The Ottawa Hospital Research Institute (J.W.-C., P.R.B., H.L., J.W., M.L.S., G.M.); Faculty of Medicine (J.W.-C., P.R.B., A.B., H.L., J.W., M.L.S., D.A.D., K.M.B.); Children's Hospital of Eastern Ontario Research Institute (J.W.-C., T.H., A.E.M., A.M., H.L., D.A.D., K.M.B., K.K.), University of Ottawa; Hospital for Sick Children (M.C.), Centre for Computational Medicine, Toronto, Canada; Department of Obstetrics (W.M., M.R.W.M.), Gynaecology and Reproductive Sciences, University of Pittsburgh School of Medicine; Magee-Womens Research Institute (W.M., M.R.W.M.), Pittsburgh, PA; Department of Pathology and Laboratory Medicine (A.B., J.W.), The Ottawa Hospital; Department of Radiology (M.L.S., G.M.), Radiation Oncology and Medical Physics, University of Ottawa; Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University; and Newborn Screening Ontario (K.K.), Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Hanns Lochmüller
- From the Department of Medicine (J.W.-C., P.R.B., A.B., H.L.), The Ottawa Hospital; The Ottawa Hospital Research Institute (J.W.-C., P.R.B., H.L., J.W., M.L.S., G.M.); Faculty of Medicine (J.W.-C., P.R.B., A.B., H.L., J.W., M.L.S., D.A.D., K.M.B.); Children's Hospital of Eastern Ontario Research Institute (J.W.-C., T.H., A.E.M., A.M., H.L., D.A.D., K.M.B., K.K.), University of Ottawa; Hospital for Sick Children (M.C.), Centre for Computational Medicine, Toronto, Canada; Department of Obstetrics (W.M., M.R.W.M.), Gynaecology and Reproductive Sciences, University of Pittsburgh School of Medicine; Magee-Womens Research Institute (W.M., M.R.W.M.), Pittsburgh, PA; Department of Pathology and Laboratory Medicine (A.B., J.W.), The Ottawa Hospital; Department of Radiology (M.L.S., G.M.), Radiation Oncology and Medical Physics, University of Ottawa; Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University; and Newborn Screening Ontario (K.K.), Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - John Woulfe
- From the Department of Medicine (J.W.-C., P.R.B., A.B., H.L.), The Ottawa Hospital; The Ottawa Hospital Research Institute (J.W.-C., P.R.B., H.L., J.W., M.L.S., G.M.); Faculty of Medicine (J.W.-C., P.R.B., A.B., H.L., J.W., M.L.S., D.A.D., K.M.B.); Children's Hospital of Eastern Ontario Research Institute (J.W.-C., T.H., A.E.M., A.M., H.L., D.A.D., K.M.B., K.K.), University of Ottawa; Hospital for Sick Children (M.C.), Centre for Computational Medicine, Toronto, Canada; Department of Obstetrics (W.M., M.R.W.M.), Gynaecology and Reproductive Sciences, University of Pittsburgh School of Medicine; Magee-Womens Research Institute (W.M., M.R.W.M.), Pittsburgh, PA; Department of Pathology and Laboratory Medicine (A.B., J.W.), The Ottawa Hospital; Department of Radiology (M.L.S., G.M.), Radiation Oncology and Medical Physics, University of Ottawa; Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University; and Newborn Screening Ontario (K.K.), Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Marcos Loreto Sampaio
- From the Department of Medicine (J.W.-C., P.R.B., A.B., H.L.), The Ottawa Hospital; The Ottawa Hospital Research Institute (J.W.-C., P.R.B., H.L., J.W., M.L.S., G.M.); Faculty of Medicine (J.W.-C., P.R.B., A.B., H.L., J.W., M.L.S., D.A.D., K.M.B.); Children's Hospital of Eastern Ontario Research Institute (J.W.-C., T.H., A.E.M., A.M., H.L., D.A.D., K.M.B., K.K.), University of Ottawa; Hospital for Sick Children (M.C.), Centre for Computational Medicine, Toronto, Canada; Department of Obstetrics (W.M., M.R.W.M.), Gynaecology and Reproductive Sciences, University of Pittsburgh School of Medicine; Magee-Womens Research Institute (W.M., M.R.W.M.), Pittsburgh, PA; Department of Pathology and Laboratory Medicine (A.B., J.W.), The Ottawa Hospital; Department of Radiology (M.L.S., G.M.), Radiation Oncology and Medical Physics, University of Ottawa; Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University; and Newborn Screening Ontario (K.K.), Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Gerd Melkus
- From the Department of Medicine (J.W.-C., P.R.B., A.B., H.L.), The Ottawa Hospital; The Ottawa Hospital Research Institute (J.W.-C., P.R.B., H.L., J.W., M.L.S., G.M.); Faculty of Medicine (J.W.-C., P.R.B., A.B., H.L., J.W., M.L.S., D.A.D., K.M.B.); Children's Hospital of Eastern Ontario Research Institute (J.W.-C., T.H., A.E.M., A.M., H.L., D.A.D., K.M.B., K.K.), University of Ottawa; Hospital for Sick Children (M.C.), Centre for Computational Medicine, Toronto, Canada; Department of Obstetrics (W.M., M.R.W.M.), Gynaecology and Reproductive Sciences, University of Pittsburgh School of Medicine; Magee-Womens Research Institute (W.M., M.R.W.M.), Pittsburgh, PA; Department of Pathology and Laboratory Medicine (A.B., J.W.), The Ottawa Hospital; Department of Radiology (M.L.S., G.M.), Radiation Oncology and Medical Physics, University of Ottawa; Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University; and Newborn Screening Ontario (K.K.), Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Bernard Brais
- From the Department of Medicine (J.W.-C., P.R.B., A.B., H.L.), The Ottawa Hospital; The Ottawa Hospital Research Institute (J.W.-C., P.R.B., H.L., J.W., M.L.S., G.M.); Faculty of Medicine (J.W.-C., P.R.B., A.B., H.L., J.W., M.L.S., D.A.D., K.M.B.); Children's Hospital of Eastern Ontario Research Institute (J.W.-C., T.H., A.E.M., A.M., H.L., D.A.D., K.M.B., K.K.), University of Ottawa; Hospital for Sick Children (M.C.), Centre for Computational Medicine, Toronto, Canada; Department of Obstetrics (W.M., M.R.W.M.), Gynaecology and Reproductive Sciences, University of Pittsburgh School of Medicine; Magee-Womens Research Institute (W.M., M.R.W.M.), Pittsburgh, PA; Department of Pathology and Laboratory Medicine (A.B., J.W.), The Ottawa Hospital; Department of Radiology (M.L.S., G.M.), Radiation Oncology and Medical Physics, University of Ottawa; Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University; and Newborn Screening Ontario (K.K.), Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - David A Dyment
- From the Department of Medicine (J.W.-C., P.R.B., A.B., H.L.), The Ottawa Hospital; The Ottawa Hospital Research Institute (J.W.-C., P.R.B., H.L., J.W., M.L.S., G.M.); Faculty of Medicine (J.W.-C., P.R.B., A.B., H.L., J.W., M.L.S., D.A.D., K.M.B.); Children's Hospital of Eastern Ontario Research Institute (J.W.-C., T.H., A.E.M., A.M., H.L., D.A.D., K.M.B., K.K.), University of Ottawa; Hospital for Sick Children (M.C.), Centre for Computational Medicine, Toronto, Canada; Department of Obstetrics (W.M., M.R.W.M.), Gynaecology and Reproductive Sciences, University of Pittsburgh School of Medicine; Magee-Womens Research Institute (W.M., M.R.W.M.), Pittsburgh, PA; Department of Pathology and Laboratory Medicine (A.B., J.W.), The Ottawa Hospital; Department of Radiology (M.L.S., G.M.), Radiation Oncology and Medical Physics, University of Ottawa; Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University; and Newborn Screening Ontario (K.K.), Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Kym M Boycott
- From the Department of Medicine (J.W.-C., P.R.B., A.B., H.L.), The Ottawa Hospital; The Ottawa Hospital Research Institute (J.W.-C., P.R.B., H.L., J.W., M.L.S., G.M.); Faculty of Medicine (J.W.-C., P.R.B., A.B., H.L., J.W., M.L.S., D.A.D., K.M.B.); Children's Hospital of Eastern Ontario Research Institute (J.W.-C., T.H., A.E.M., A.M., H.L., D.A.D., K.M.B., K.K.), University of Ottawa; Hospital for Sick Children (M.C.), Centre for Computational Medicine, Toronto, Canada; Department of Obstetrics (W.M., M.R.W.M.), Gynaecology and Reproductive Sciences, University of Pittsburgh School of Medicine; Magee-Womens Research Institute (W.M., M.R.W.M.), Pittsburgh, PA; Department of Pathology and Laboratory Medicine (A.B., J.W.), The Ottawa Hospital; Department of Radiology (M.L.S., G.M.), Radiation Oncology and Medical Physics, University of Ottawa; Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University; and Newborn Screening Ontario (K.K.), Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Kristin Kernohan
- From the Department of Medicine (J.W.-C., P.R.B., A.B., H.L.), The Ottawa Hospital; The Ottawa Hospital Research Institute (J.W.-C., P.R.B., H.L., J.W., M.L.S., G.M.); Faculty of Medicine (J.W.-C., P.R.B., A.B., H.L., J.W., M.L.S., D.A.D., K.M.B.); Children's Hospital of Eastern Ontario Research Institute (J.W.-C., T.H., A.E.M., A.M., H.L., D.A.D., K.M.B., K.K.), University of Ottawa; Hospital for Sick Children (M.C.), Centre for Computational Medicine, Toronto, Canada; Department of Obstetrics (W.M., M.R.W.M.), Gynaecology and Reproductive Sciences, University of Pittsburgh School of Medicine; Magee-Womens Research Institute (W.M., M.R.W.M.), Pittsburgh, PA; Department of Pathology and Laboratory Medicine (A.B., J.W.), The Ottawa Hospital; Department of Radiology (M.L.S., G.M.), Radiation Oncology and Medical Physics, University of Ottawa; Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University; and Newborn Screening Ontario (K.K.), Children's Hospital of Eastern Ontario, Ottawa, Canada
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Al Towairqi W, Torres C, O'Donnell H, Bourque PR. MRI Findings in Transient Headache and Neurologic Deficits with Cerebrospinal Lymphocytosis Syndrome. Can J Neurol Sci 2023; 50:764-765. [PMID: 35929372 DOI: 10.1017/cjn.2022.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Wed Al Towairqi
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Carlos Torres
- Division of Neuroradiology, Department of Radiology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Hailey O'Donnell
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Pierre R Bourque
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada
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Smith IC, Pileggi CA, Wang Y, Kernohan K, Hartley T, McMillan HJ, Sampaio ML, Melkus G, Woulfe J, Parmar G, Bourque PR, Breiner A, Zwicker J, Pringle CE, Jarinova O, Lochmüller H, Dyment DA, Brais B, Boycott KM, Hekimi S, Harper ME, Warman-Chardon J. Novel Homozygous Variant in COQ7in Siblings With Hereditary Motor Neuropathy. Neurol Genet 2023; 9:e200048. [PMID: 37077559 PMCID: PMC10108386 DOI: 10.1212/nxg.0000000000200048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/19/2022] [Indexed: 01/26/2023]
Abstract
Background and ObjectivesCoenzyme Q10(CoQ10) is an important electron carrier and antioxidant. The COQ7 enzyme catalyzes the hydroxylation of 5-demethoxyubiquinone-10 (DMQ10), the second-to-last step in the CoQ10biosynthesis pathway. We report a consanguineous family presenting with a hereditary motor neuropathy associated with a homozygous c.1A > G p.? variant ofCOQ7with abnormal CoQ10biosynthesis.MethodsAffected family members underwent clinical assessments that included nerve conduction testing, histologic analysis, and MRI. Pathogenicity of theCOQ7variant was assessed in cultured fibroblasts and skeletal muscle using a combination of immunoblots, respirometry, and quinone analysis.ResultsThree affected siblings, ranging from 12 to 24 years of age, presented with a severe length-dependent motor neuropathy with marked symmetric distal weakness and atrophy with normal sensation. Muscle biopsy of the quadriceps revealed chronic denervation pattern. An MRI examination identified moderate to severe fat infiltration in distal muscles. Exome sequencing demonstrated the homozygousCOQ7c.1A > G p.? variant that is expected to bypass the first 38 amino acid residues at the n-terminus, initiating instead with methionine at position 39. This is predicted to cause the loss of the cleavable mitochondrial targeting sequence and 2 additional amino acids, thereby preventing the incorporation and subsequent folding of COQ7 into the inner mitochondrial membrane. Pathogenicity of theCOQ7variant was demonstrated by diminished COQ7 and CoQ10levels in muscle and fibroblast samples of affected siblings but not in the father, unaffected sibling, or unrelated controls. In addition, fibroblasts from affected siblings had substantial accumulation of DMQ10, and maximal mitochondrial respiration was impaired in both fibroblasts and muscle.DiscussionThis report describes a new neurologic phenotype ofCOQ7-related primary CoQ10deficiency. Novel aspects of the phenotype presented by this family include pure distal motor neuropathy involvement, as well as the lack of upper motor neuron features, cognitive delay, or sensory involvement in comparison with cases ofCOQ7-related CoQ10deficiency previously reported in the literature.
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Affiliation(s)
- Ian C Smith
- The Ottawa Hospital Research Institute (I.C.S., M.L.S., G.M., A.B., J.Z., H.L., J.W.-C.), Ottawa; Department of Biochemistry, Microbiology and Immunology (C.A.P., G.P., M.-E.H.), Faculty of Medicine, University of Ottawa, Ontario; Ottawa Institute of Systems Biology (C.A.P., G.P., M.-E.H.), University of Ottawa, Ontario; Department of Biology (Y.W., S.H.), McGill University, Montreal, Quebec; Children's Hospital of Eastern Ontario Research Institute (K.K., T.H., O.J., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; Newborn Screening Ontario (K.K.), Ottawa; Departments of Pediatrics, Neurology, & Neurosurgery (H.J.M.), Montreal Children's Hospital, McGill University, Montreal, Quebec; Department of Radiology, Radiation Oncology and Medical Physics (M.L.S., G.M.), University of Ottawa, Ontario; Department of Laboratory Medicine (J.W.), The Ottawa Hospital, Ontario; Department of Medicine (Neurology) (P.R.B., A.B., J.Z., E.P., C.E.P., H.L., J.W.-C.), The Ottawa Hospital, Ontario; Faculty of Medicine/Brain and Mind Research Institute (A.B., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; and Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - Chantal A Pileggi
- The Ottawa Hospital Research Institute (I.C.S., M.L.S., G.M., A.B., J.Z., H.L., J.W.-C.), Ottawa; Department of Biochemistry, Microbiology and Immunology (C.A.P., G.P., M.-E.H.), Faculty of Medicine, University of Ottawa, Ontario; Ottawa Institute of Systems Biology (C.A.P., G.P., M.-E.H.), University of Ottawa, Ontario; Department of Biology (Y.W., S.H.), McGill University, Montreal, Quebec; Children's Hospital of Eastern Ontario Research Institute (K.K., T.H., O.J., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; Newborn Screening Ontario (K.K.), Ottawa; Departments of Pediatrics, Neurology, & Neurosurgery (H.J.M.), Montreal Children's Hospital, McGill University, Montreal, Quebec; Department of Radiology, Radiation Oncology and Medical Physics (M.L.S., G.M.), University of Ottawa, Ontario; Department of Laboratory Medicine (J.W.), The Ottawa Hospital, Ontario; Department of Medicine (Neurology) (P.R.B., A.B., J.Z., E.P., C.E.P., H.L., J.W.-C.), The Ottawa Hospital, Ontario; Faculty of Medicine/Brain and Mind Research Institute (A.B., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; and Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - Ying Wang
- The Ottawa Hospital Research Institute (I.C.S., M.L.S., G.M., A.B., J.Z., H.L., J.W.-C.), Ottawa; Department of Biochemistry, Microbiology and Immunology (C.A.P., G.P., M.-E.H.), Faculty of Medicine, University of Ottawa, Ontario; Ottawa Institute of Systems Biology (C.A.P., G.P., M.-E.H.), University of Ottawa, Ontario; Department of Biology (Y.W., S.H.), McGill University, Montreal, Quebec; Children's Hospital of Eastern Ontario Research Institute (K.K., T.H., O.J., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; Newborn Screening Ontario (K.K.), Ottawa; Departments of Pediatrics, Neurology, & Neurosurgery (H.J.M.), Montreal Children's Hospital, McGill University, Montreal, Quebec; Department of Radiology, Radiation Oncology and Medical Physics (M.L.S., G.M.), University of Ottawa, Ontario; Department of Laboratory Medicine (J.W.), The Ottawa Hospital, Ontario; Department of Medicine (Neurology) (P.R.B., A.B., J.Z., E.P., C.E.P., H.L., J.W.-C.), The Ottawa Hospital, Ontario; Faculty of Medicine/Brain and Mind Research Institute (A.B., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; and Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - Kristin Kernohan
- The Ottawa Hospital Research Institute (I.C.S., M.L.S., G.M., A.B., J.Z., H.L., J.W.-C.), Ottawa; Department of Biochemistry, Microbiology and Immunology (C.A.P., G.P., M.-E.H.), Faculty of Medicine, University of Ottawa, Ontario; Ottawa Institute of Systems Biology (C.A.P., G.P., M.-E.H.), University of Ottawa, Ontario; Department of Biology (Y.W., S.H.), McGill University, Montreal, Quebec; Children's Hospital of Eastern Ontario Research Institute (K.K., T.H., O.J., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; Newborn Screening Ontario (K.K.), Ottawa; Departments of Pediatrics, Neurology, & Neurosurgery (H.J.M.), Montreal Children's Hospital, McGill University, Montreal, Quebec; Department of Radiology, Radiation Oncology and Medical Physics (M.L.S., G.M.), University of Ottawa, Ontario; Department of Laboratory Medicine (J.W.), The Ottawa Hospital, Ontario; Department of Medicine (Neurology) (P.R.B., A.B., J.Z., E.P., C.E.P., H.L., J.W.-C.), The Ottawa Hospital, Ontario; Faculty of Medicine/Brain and Mind Research Institute (A.B., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; and Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - Taila Hartley
- The Ottawa Hospital Research Institute (I.C.S., M.L.S., G.M., A.B., J.Z., H.L., J.W.-C.), Ottawa; Department of Biochemistry, Microbiology and Immunology (C.A.P., G.P., M.-E.H.), Faculty of Medicine, University of Ottawa, Ontario; Ottawa Institute of Systems Biology (C.A.P., G.P., M.-E.H.), University of Ottawa, Ontario; Department of Biology (Y.W., S.H.), McGill University, Montreal, Quebec; Children's Hospital of Eastern Ontario Research Institute (K.K., T.H., O.J., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; Newborn Screening Ontario (K.K.), Ottawa; Departments of Pediatrics, Neurology, & Neurosurgery (H.J.M.), Montreal Children's Hospital, McGill University, Montreal, Quebec; Department of Radiology, Radiation Oncology and Medical Physics (M.L.S., G.M.), University of Ottawa, Ontario; Department of Laboratory Medicine (J.W.), The Ottawa Hospital, Ontario; Department of Medicine (Neurology) (P.R.B., A.B., J.Z., E.P., C.E.P., H.L., J.W.-C.), The Ottawa Hospital, Ontario; Faculty of Medicine/Brain and Mind Research Institute (A.B., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; and Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - Hugh J McMillan
- The Ottawa Hospital Research Institute (I.C.S., M.L.S., G.M., A.B., J.Z., H.L., J.W.-C.), Ottawa; Department of Biochemistry, Microbiology and Immunology (C.A.P., G.P., M.-E.H.), Faculty of Medicine, University of Ottawa, Ontario; Ottawa Institute of Systems Biology (C.A.P., G.P., M.-E.H.), University of Ottawa, Ontario; Department of Biology (Y.W., S.H.), McGill University, Montreal, Quebec; Children's Hospital of Eastern Ontario Research Institute (K.K., T.H., O.J., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; Newborn Screening Ontario (K.K.), Ottawa; Departments of Pediatrics, Neurology, & Neurosurgery (H.J.M.), Montreal Children's Hospital, McGill University, Montreal, Quebec; Department of Radiology, Radiation Oncology and Medical Physics (M.L.S., G.M.), University of Ottawa, Ontario; Department of Laboratory Medicine (J.W.), The Ottawa Hospital, Ontario; Department of Medicine (Neurology) (P.R.B., A.B., J.Z., E.P., C.E.P., H.L., J.W.-C.), The Ottawa Hospital, Ontario; Faculty of Medicine/Brain and Mind Research Institute (A.B., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; and Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - Marcos Loreto Sampaio
- The Ottawa Hospital Research Institute (I.C.S., M.L.S., G.M., A.B., J.Z., H.L., J.W.-C.), Ottawa; Department of Biochemistry, Microbiology and Immunology (C.A.P., G.P., M.-E.H.), Faculty of Medicine, University of Ottawa, Ontario; Ottawa Institute of Systems Biology (C.A.P., G.P., M.-E.H.), University of Ottawa, Ontario; Department of Biology (Y.W., S.H.), McGill University, Montreal, Quebec; Children's Hospital of Eastern Ontario Research Institute (K.K., T.H., O.J., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; Newborn Screening Ontario (K.K.), Ottawa; Departments of Pediatrics, Neurology, & Neurosurgery (H.J.M.), Montreal Children's Hospital, McGill University, Montreal, Quebec; Department of Radiology, Radiation Oncology and Medical Physics (M.L.S., G.M.), University of Ottawa, Ontario; Department of Laboratory Medicine (J.W.), The Ottawa Hospital, Ontario; Department of Medicine (Neurology) (P.R.B., A.B., J.Z., E.P., C.E.P., H.L., J.W.-C.), The Ottawa Hospital, Ontario; Faculty of Medicine/Brain and Mind Research Institute (A.B., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; and Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - Gerd Melkus
- The Ottawa Hospital Research Institute (I.C.S., M.L.S., G.M., A.B., J.Z., H.L., J.W.-C.), Ottawa; Department of Biochemistry, Microbiology and Immunology (C.A.P., G.P., M.-E.H.), Faculty of Medicine, University of Ottawa, Ontario; Ottawa Institute of Systems Biology (C.A.P., G.P., M.-E.H.), University of Ottawa, Ontario; Department of Biology (Y.W., S.H.), McGill University, Montreal, Quebec; Children's Hospital of Eastern Ontario Research Institute (K.K., T.H., O.J., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; Newborn Screening Ontario (K.K.), Ottawa; Departments of Pediatrics, Neurology, & Neurosurgery (H.J.M.), Montreal Children's Hospital, McGill University, Montreal, Quebec; Department of Radiology, Radiation Oncology and Medical Physics (M.L.S., G.M.), University of Ottawa, Ontario; Department of Laboratory Medicine (J.W.), The Ottawa Hospital, Ontario; Department of Medicine (Neurology) (P.R.B., A.B., J.Z., E.P., C.E.P., H.L., J.W.-C.), The Ottawa Hospital, Ontario; Faculty of Medicine/Brain and Mind Research Institute (A.B., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; and Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - John Woulfe
- The Ottawa Hospital Research Institute (I.C.S., M.L.S., G.M., A.B., J.Z., H.L., J.W.-C.), Ottawa; Department of Biochemistry, Microbiology and Immunology (C.A.P., G.P., M.-E.H.), Faculty of Medicine, University of Ottawa, Ontario; Ottawa Institute of Systems Biology (C.A.P., G.P., M.-E.H.), University of Ottawa, Ontario; Department of Biology (Y.W., S.H.), McGill University, Montreal, Quebec; Children's Hospital of Eastern Ontario Research Institute (K.K., T.H., O.J., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; Newborn Screening Ontario (K.K.), Ottawa; Departments of Pediatrics, Neurology, & Neurosurgery (H.J.M.), Montreal Children's Hospital, McGill University, Montreal, Quebec; Department of Radiology, Radiation Oncology and Medical Physics (M.L.S., G.M.), University of Ottawa, Ontario; Department of Laboratory Medicine (J.W.), The Ottawa Hospital, Ontario; Department of Medicine (Neurology) (P.R.B., A.B., J.Z., E.P., C.E.P., H.L., J.W.-C.), The Ottawa Hospital, Ontario; Faculty of Medicine/Brain and Mind Research Institute (A.B., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; and Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - Gaganvir Parmar
- The Ottawa Hospital Research Institute (I.C.S., M.L.S., G.M., A.B., J.Z., H.L., J.W.-C.), Ottawa; Department of Biochemistry, Microbiology and Immunology (C.A.P., G.P., M.-E.H.), Faculty of Medicine, University of Ottawa, Ontario; Ottawa Institute of Systems Biology (C.A.P., G.P., M.-E.H.), University of Ottawa, Ontario; Department of Biology (Y.W., S.H.), McGill University, Montreal, Quebec; Children's Hospital of Eastern Ontario Research Institute (K.K., T.H., O.J., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; Newborn Screening Ontario (K.K.), Ottawa; Departments of Pediatrics, Neurology, & Neurosurgery (H.J.M.), Montreal Children's Hospital, McGill University, Montreal, Quebec; Department of Radiology, Radiation Oncology and Medical Physics (M.L.S., G.M.), University of Ottawa, Ontario; Department of Laboratory Medicine (J.W.), The Ottawa Hospital, Ontario; Department of Medicine (Neurology) (P.R.B., A.B., J.Z., E.P., C.E.P., H.L., J.W.-C.), The Ottawa Hospital, Ontario; Faculty of Medicine/Brain and Mind Research Institute (A.B., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; and Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - Pierre R Bourque
- The Ottawa Hospital Research Institute (I.C.S., M.L.S., G.M., A.B., J.Z., H.L., J.W.-C.), Ottawa; Department of Biochemistry, Microbiology and Immunology (C.A.P., G.P., M.-E.H.), Faculty of Medicine, University of Ottawa, Ontario; Ottawa Institute of Systems Biology (C.A.P., G.P., M.-E.H.), University of Ottawa, Ontario; Department of Biology (Y.W., S.H.), McGill University, Montreal, Quebec; Children's Hospital of Eastern Ontario Research Institute (K.K., T.H., O.J., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; Newborn Screening Ontario (K.K.), Ottawa; Departments of Pediatrics, Neurology, & Neurosurgery (H.J.M.), Montreal Children's Hospital, McGill University, Montreal, Quebec; Department of Radiology, Radiation Oncology and Medical Physics (M.L.S., G.M.), University of Ottawa, Ontario; Department of Laboratory Medicine (J.W.), The Ottawa Hospital, Ontario; Department of Medicine (Neurology) (P.R.B., A.B., J.Z., E.P., C.E.P., H.L., J.W.-C.), The Ottawa Hospital, Ontario; Faculty of Medicine/Brain and Mind Research Institute (A.B., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; and Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - Ari Breiner
- The Ottawa Hospital Research Institute (I.C.S., M.L.S., G.M., A.B., J.Z., H.L., J.W.-C.), Ottawa; Department of Biochemistry, Microbiology and Immunology (C.A.P., G.P., M.-E.H.), Faculty of Medicine, University of Ottawa, Ontario; Ottawa Institute of Systems Biology (C.A.P., G.P., M.-E.H.), University of Ottawa, Ontario; Department of Biology (Y.W., S.H.), McGill University, Montreal, Quebec; Children's Hospital of Eastern Ontario Research Institute (K.K., T.H., O.J., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; Newborn Screening Ontario (K.K.), Ottawa; Departments of Pediatrics, Neurology, & Neurosurgery (H.J.M.), Montreal Children's Hospital, McGill University, Montreal, Quebec; Department of Radiology, Radiation Oncology and Medical Physics (M.L.S., G.M.), University of Ottawa, Ontario; Department of Laboratory Medicine (J.W.), The Ottawa Hospital, Ontario; Department of Medicine (Neurology) (P.R.B., A.B., J.Z., E.P., C.E.P., H.L., J.W.-C.), The Ottawa Hospital, Ontario; Faculty of Medicine/Brain and Mind Research Institute (A.B., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; and Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - Jocelyn Zwicker
- The Ottawa Hospital Research Institute (I.C.S., M.L.S., G.M., A.B., J.Z., H.L., J.W.-C.), Ottawa; Department of Biochemistry, Microbiology and Immunology (C.A.P., G.P., M.-E.H.), Faculty of Medicine, University of Ottawa, Ontario; Ottawa Institute of Systems Biology (C.A.P., G.P., M.-E.H.), University of Ottawa, Ontario; Department of Biology (Y.W., S.H.), McGill University, Montreal, Quebec; Children's Hospital of Eastern Ontario Research Institute (K.K., T.H., O.J., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; Newborn Screening Ontario (K.K.), Ottawa; Departments of Pediatrics, Neurology, & Neurosurgery (H.J.M.), Montreal Children's Hospital, McGill University, Montreal, Quebec; Department of Radiology, Radiation Oncology and Medical Physics (M.L.S., G.M.), University of Ottawa, Ontario; Department of Laboratory Medicine (J.W.), The Ottawa Hospital, Ontario; Department of Medicine (Neurology) (P.R.B., A.B., J.Z., E.P., C.E.P., H.L., J.W.-C.), The Ottawa Hospital, Ontario; Faculty of Medicine/Brain and Mind Research Institute (A.B., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; and Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - C Elizabeth Pringle
- The Ottawa Hospital Research Institute (I.C.S., M.L.S., G.M., A.B., J.Z., H.L., J.W.-C.), Ottawa; Department of Biochemistry, Microbiology and Immunology (C.A.P., G.P., M.-E.H.), Faculty of Medicine, University of Ottawa, Ontario; Ottawa Institute of Systems Biology (C.A.P., G.P., M.-E.H.), University of Ottawa, Ontario; Department of Biology (Y.W., S.H.), McGill University, Montreal, Quebec; Children's Hospital of Eastern Ontario Research Institute (K.K., T.H., O.J., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; Newborn Screening Ontario (K.K.), Ottawa; Departments of Pediatrics, Neurology, & Neurosurgery (H.J.M.), Montreal Children's Hospital, McGill University, Montreal, Quebec; Department of Radiology, Radiation Oncology and Medical Physics (M.L.S., G.M.), University of Ottawa, Ontario; Department of Laboratory Medicine (J.W.), The Ottawa Hospital, Ontario; Department of Medicine (Neurology) (P.R.B., A.B., J.Z., E.P., C.E.P., H.L., J.W.-C.), The Ottawa Hospital, Ontario; Faculty of Medicine/Brain and Mind Research Institute (A.B., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; and Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - Olga Jarinova
- The Ottawa Hospital Research Institute (I.C.S., M.L.S., G.M., A.B., J.Z., H.L., J.W.-C.), Ottawa; Department of Biochemistry, Microbiology and Immunology (C.A.P., G.P., M.-E.H.), Faculty of Medicine, University of Ottawa, Ontario; Ottawa Institute of Systems Biology (C.A.P., G.P., M.-E.H.), University of Ottawa, Ontario; Department of Biology (Y.W., S.H.), McGill University, Montreal, Quebec; Children's Hospital of Eastern Ontario Research Institute (K.K., T.H., O.J., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; Newborn Screening Ontario (K.K.), Ottawa; Departments of Pediatrics, Neurology, & Neurosurgery (H.J.M.), Montreal Children's Hospital, McGill University, Montreal, Quebec; Department of Radiology, Radiation Oncology and Medical Physics (M.L.S., G.M.), University of Ottawa, Ontario; Department of Laboratory Medicine (J.W.), The Ottawa Hospital, Ontario; Department of Medicine (Neurology) (P.R.B., A.B., J.Z., E.P., C.E.P., H.L., J.W.-C.), The Ottawa Hospital, Ontario; Faculty of Medicine/Brain and Mind Research Institute (A.B., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; and Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - Hanns Lochmüller
- The Ottawa Hospital Research Institute (I.C.S., M.L.S., G.M., A.B., J.Z., H.L., J.W.-C.), Ottawa; Department of Biochemistry, Microbiology and Immunology (C.A.P., G.P., M.-E.H.), Faculty of Medicine, University of Ottawa, Ontario; Ottawa Institute of Systems Biology (C.A.P., G.P., M.-E.H.), University of Ottawa, Ontario; Department of Biology (Y.W., S.H.), McGill University, Montreal, Quebec; Children's Hospital of Eastern Ontario Research Institute (K.K., T.H., O.J., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; Newborn Screening Ontario (K.K.), Ottawa; Departments of Pediatrics, Neurology, & Neurosurgery (H.J.M.), Montreal Children's Hospital, McGill University, Montreal, Quebec; Department of Radiology, Radiation Oncology and Medical Physics (M.L.S., G.M.), University of Ottawa, Ontario; Department of Laboratory Medicine (J.W.), The Ottawa Hospital, Ontario; Department of Medicine (Neurology) (P.R.B., A.B., J.Z., E.P., C.E.P., H.L., J.W.-C.), The Ottawa Hospital, Ontario; Faculty of Medicine/Brain and Mind Research Institute (A.B., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; and Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - David A Dyment
- The Ottawa Hospital Research Institute (I.C.S., M.L.S., G.M., A.B., J.Z., H.L., J.W.-C.), Ottawa; Department of Biochemistry, Microbiology and Immunology (C.A.P., G.P., M.-E.H.), Faculty of Medicine, University of Ottawa, Ontario; Ottawa Institute of Systems Biology (C.A.P., G.P., M.-E.H.), University of Ottawa, Ontario; Department of Biology (Y.W., S.H.), McGill University, Montreal, Quebec; Children's Hospital of Eastern Ontario Research Institute (K.K., T.H., O.J., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; Newborn Screening Ontario (K.K.), Ottawa; Departments of Pediatrics, Neurology, & Neurosurgery (H.J.M.), Montreal Children's Hospital, McGill University, Montreal, Quebec; Department of Radiology, Radiation Oncology and Medical Physics (M.L.S., G.M.), University of Ottawa, Ontario; Department of Laboratory Medicine (J.W.), The Ottawa Hospital, Ontario; Department of Medicine (Neurology) (P.R.B., A.B., J.Z., E.P., C.E.P., H.L., J.W.-C.), The Ottawa Hospital, Ontario; Faculty of Medicine/Brain and Mind Research Institute (A.B., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; and Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - Bernard Brais
- The Ottawa Hospital Research Institute (I.C.S., M.L.S., G.M., A.B., J.Z., H.L., J.W.-C.), Ottawa; Department of Biochemistry, Microbiology and Immunology (C.A.P., G.P., M.-E.H.), Faculty of Medicine, University of Ottawa, Ontario; Ottawa Institute of Systems Biology (C.A.P., G.P., M.-E.H.), University of Ottawa, Ontario; Department of Biology (Y.W., S.H.), McGill University, Montreal, Quebec; Children's Hospital of Eastern Ontario Research Institute (K.K., T.H., O.J., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; Newborn Screening Ontario (K.K.), Ottawa; Departments of Pediatrics, Neurology, & Neurosurgery (H.J.M.), Montreal Children's Hospital, McGill University, Montreal, Quebec; Department of Radiology, Radiation Oncology and Medical Physics (M.L.S., G.M.), University of Ottawa, Ontario; Department of Laboratory Medicine (J.W.), The Ottawa Hospital, Ontario; Department of Medicine (Neurology) (P.R.B., A.B., J.Z., E.P., C.E.P., H.L., J.W.-C.), The Ottawa Hospital, Ontario; Faculty of Medicine/Brain and Mind Research Institute (A.B., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; and Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - Kym M Boycott
- The Ottawa Hospital Research Institute (I.C.S., M.L.S., G.M., A.B., J.Z., H.L., J.W.-C.), Ottawa; Department of Biochemistry, Microbiology and Immunology (C.A.P., G.P., M.-E.H.), Faculty of Medicine, University of Ottawa, Ontario; Ottawa Institute of Systems Biology (C.A.P., G.P., M.-E.H.), University of Ottawa, Ontario; Department of Biology (Y.W., S.H.), McGill University, Montreal, Quebec; Children's Hospital of Eastern Ontario Research Institute (K.K., T.H., O.J., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; Newborn Screening Ontario (K.K.), Ottawa; Departments of Pediatrics, Neurology, & Neurosurgery (H.J.M.), Montreal Children's Hospital, McGill University, Montreal, Quebec; Department of Radiology, Radiation Oncology and Medical Physics (M.L.S., G.M.), University of Ottawa, Ontario; Department of Laboratory Medicine (J.W.), The Ottawa Hospital, Ontario; Department of Medicine (Neurology) (P.R.B., A.B., J.Z., E.P., C.E.P., H.L., J.W.-C.), The Ottawa Hospital, Ontario; Faculty of Medicine/Brain and Mind Research Institute (A.B., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; and Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - Siegfried Hekimi
- The Ottawa Hospital Research Institute (I.C.S., M.L.S., G.M., A.B., J.Z., H.L., J.W.-C.), Ottawa; Department of Biochemistry, Microbiology and Immunology (C.A.P., G.P., M.-E.H.), Faculty of Medicine, University of Ottawa, Ontario; Ottawa Institute of Systems Biology (C.A.P., G.P., M.-E.H.), University of Ottawa, Ontario; Department of Biology (Y.W., S.H.), McGill University, Montreal, Quebec; Children's Hospital of Eastern Ontario Research Institute (K.K., T.H., O.J., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; Newborn Screening Ontario (K.K.), Ottawa; Departments of Pediatrics, Neurology, & Neurosurgery (H.J.M.), Montreal Children's Hospital, McGill University, Montreal, Quebec; Department of Radiology, Radiation Oncology and Medical Physics (M.L.S., G.M.), University of Ottawa, Ontario; Department of Laboratory Medicine (J.W.), The Ottawa Hospital, Ontario; Department of Medicine (Neurology) (P.R.B., A.B., J.Z., E.P., C.E.P., H.L., J.W.-C.), The Ottawa Hospital, Ontario; Faculty of Medicine/Brain and Mind Research Institute (A.B., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; and Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - Mary-Ellen Harper
- The Ottawa Hospital Research Institute (I.C.S., M.L.S., G.M., A.B., J.Z., H.L., J.W.-C.), Ottawa; Department of Biochemistry, Microbiology and Immunology (C.A.P., G.P., M.-E.H.), Faculty of Medicine, University of Ottawa, Ontario; Ottawa Institute of Systems Biology (C.A.P., G.P., M.-E.H.), University of Ottawa, Ontario; Department of Biology (Y.W., S.H.), McGill University, Montreal, Quebec; Children's Hospital of Eastern Ontario Research Institute (K.K., T.H., O.J., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; Newborn Screening Ontario (K.K.), Ottawa; Departments of Pediatrics, Neurology, & Neurosurgery (H.J.M.), Montreal Children's Hospital, McGill University, Montreal, Quebec; Department of Radiology, Radiation Oncology and Medical Physics (M.L.S., G.M.), University of Ottawa, Ontario; Department of Laboratory Medicine (J.W.), The Ottawa Hospital, Ontario; Department of Medicine (Neurology) (P.R.B., A.B., J.Z., E.P., C.E.P., H.L., J.W.-C.), The Ottawa Hospital, Ontario; Faculty of Medicine/Brain and Mind Research Institute (A.B., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; and Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
| | - Jodi Warman-Chardon
- The Ottawa Hospital Research Institute (I.C.S., M.L.S., G.M., A.B., J.Z., H.L., J.W.-C.), Ottawa; Department of Biochemistry, Microbiology and Immunology (C.A.P., G.P., M.-E.H.), Faculty of Medicine, University of Ottawa, Ontario; Ottawa Institute of Systems Biology (C.A.P., G.P., M.-E.H.), University of Ottawa, Ontario; Department of Biology (Y.W., S.H.), McGill University, Montreal, Quebec; Children's Hospital of Eastern Ontario Research Institute (K.K., T.H., O.J., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; Newborn Screening Ontario (K.K.), Ottawa; Departments of Pediatrics, Neurology, & Neurosurgery (H.J.M.), Montreal Children's Hospital, McGill University, Montreal, Quebec; Department of Radiology, Radiation Oncology and Medical Physics (M.L.S., G.M.), University of Ottawa, Ontario; Department of Laboratory Medicine (J.W.), The Ottawa Hospital, Ontario; Department of Medicine (Neurology) (P.R.B., A.B., J.Z., E.P., C.E.P., H.L., J.W.-C.), The Ottawa Hospital, Ontario; Faculty of Medicine/Brain and Mind Research Institute (A.B., H.L., D.A.D., K.M.B., J.W.-C.), University of Ottawa, Ontario; and Department of Neurology and Neurosurgery (B.B.), Montreal Neurological Institute and Hospital, McGill University, Quebec, Canada
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6
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Breiner A, Bourque PR. Vaccination against COVID-19 does not lead to exacerbation in patients with myasthenia gravis. Muscle Nerve 2023; 67:1-2. [PMID: 36321578 PMCID: PMC9878044 DOI: 10.1002/mus.27747] [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: 10/14/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022]
Abstract
See article on pages 558‐561 in volume 66, Issue 5, November issue.
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Affiliation(s)
- Ari Breiner
- Department of Medicine (Neurology)The Ottawa Hospital, and Ottawa Hospital Research InstituteOttawaCanada,Eric Poulin Centre for Neuromuscular DiseaseUniversity of OttawaOttawaCanada
| | - Pierre R. Bourque
- Department of Medicine (Neurology)The Ottawa Hospital, and Ottawa Hospital Research InstituteOttawaCanada,Eric Poulin Centre for Neuromuscular DiseaseUniversity of OttawaOttawaCanada
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7
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Melkus G, Sampaio ML, Smith IC, Rakhra KS, Bourque PR, Breiner A, Zwicker J, Lochmüller H, Brais B, Warman-Chardon J. Quantitative vs qualitative muscle MRI: Imaging biomarker in patients with Oculopharyngeal Muscular Dystrophy (OPMD). Neuromuscul Disord 2023; 33:24-31. [PMID: 36462961 DOI: 10.1016/j.nmd.2022.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 05/20/2022] [Revised: 08/19/2022] [Accepted: 09/30/2022] [Indexed: 01/28/2023]
Abstract
Oculopharyngeal muscular dystrophy (OPMD) is a genetic muscle disease causing ptosis, severe swallowing difficulties and progressive limb weakness, although atypical presentations may be difficult to diagnose. Sensitive biomarkers of disease progression in OPMD are needed to enable more effective clinical trials. This study was designed to test the feasibility of using MRI to aid OPMD diagnosis and monitor OPMD progression. Twenty-five subjects with Dixon whole-body muscle MRI were enrolled: 10 patients with genetically confirmed OPMD, 10 patients with non-OPMD muscular dystrophies, and 5 controls. Using the MRI Dixon technique, muscle fat replacement was evaluated in the tongue, serratus anterior, lumbar paraspinal, adductor magnus, and soleus muscles using quantitative and semi-quantitative rating methods. Changes were compared with muscle strength testing, dysphagia severity, use of gait aids, and presence of dysarthria. Quantitative MRI scores of muscle fat replacement in the tongue could differentiate OPMD from other muscular dystrophies and from controls. Moreover, fat fraction in the tongue correlated with clinical severity of dysphagia. This study provides preliminary support for the use of Dixon-based quantitative MRI images as outcome measures for monitoring disease progression in clinical trials and provides rationale for future prospective studies aimed at methodological refinement and covariate identification.
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Affiliation(s)
- Gerd Melkus
- Department of Radiology, Radiation Oncology and Medical Physics, University of, Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Physics, Carleton University, Ottawa, ON, Canada
| | - Marcos L Sampaio
- Department of Radiology, Radiation Oncology and Medical Physics, University of, Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Faculty of Medicine /Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, ON, Canada
| | - Ian C Smith
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Kawan S Rakhra
- Department of Radiology, Radiation Oncology and Medical Physics, University of, Ottawa, Ottawa, ON, Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Faculty of Medicine /Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, ON, Canada
| | - Pierre R Bourque
- Ottawa Hospital Research Institute, Ottawa, ON, Canada; Faculty of Medicine /Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, ON, Canada; Department of Medicine (Neurology), The Ottawa Hospital/The University of Ottawa
| | - Ari Breiner
- Ottawa Hospital Research Institute, Ottawa, ON, Canada; Faculty of Medicine /Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, ON, Canada; Department of Medicine (Neurology), The Ottawa Hospital/The University of Ottawa
| | - Jocelyn Zwicker
- Faculty of Medicine /Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, ON, Canada; Department of Medicine (Neurology), The Ottawa Hospital/The University of Ottawa
| | - Hanns Lochmüller
- Ottawa Hospital Research Institute, Ottawa, ON, Canada; Faculty of Medicine /Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, ON, Canada; Department of Medicine (Neurology), The Ottawa Hospital/The University of Ottawa; Genetics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Bernard Brais
- Montreal Neurological Institute and Hospital, Genetics, McGill University, Montreal, Quebec, Canada
| | - Jodi Warman-Chardon
- Ottawa Hospital Research Institute, Ottawa, ON, Canada; Faculty of Medicine /Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, ON, Canada; Department of Medicine (Neurology), The Ottawa Hospital/The University of Ottawa; Genetics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
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8
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Muacevic A, Adler JR, O'Connell K, Miller WD, Bourque PR. Isolated Internuclear Ophthalmoplegia as an Embolic Complication of Transcatheter Aortic Valve Implantation. Cureus 2022; 14:e32292. [PMID: 36514705 PMCID: PMC9733954 DOI: 10.7759/cureus.32292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 12/12/2022] Open
Abstract
An 83-year-old male developed horizontal diplopia immediately following elective transfemoral transcatheter aortic valve implantation (TAVI). On right gaze, left eye adduction was impaired while there was horizontal nystagmus of the abducting right eye, representative of internuclear ophthalmoplegia (INO). The remainder of the neurological examination was normal. Computer tomography (CT) imaging of the brain and CT angiogram of the head and neck were normal. Magnetic resonance imaging (MRI) of the brain showed five small foci of restricted diffusion affecting both the anterior and posterior circulation bilaterally. One such tiny infarct was seen in the left parasagittal upper pontine tegmentum and was attributed to his presentation. While all symptoms rapidly improved, minimal residual signs of INO were still detectable at the six-month follow-up. Isolated intra-nuclear ophthalmoplegia is a rare stroke syndrome and an unusual cardio-embolic complication of minimally invasive cardiac procedures. TAVI is an increasingly popular technique, although has been associated with a higher incidence of micro-embolic cerebrovascular events evident on MRI than surgical repairs. While the use of embolic protection devices has high-quality evidence in reducing the burden of these usually silent cerebrovascular events, their role in preventing long-term neurocognitive sequala has not been demonstrated.
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9
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Besant G, Bourque PR, Smith IC, Chih S, Lamacie MM, Breiner A, Zwicker J, Lochmüller H, Warman-Chardon J. Case Report: Severe Peripartum Cardiac Disease in Myotonic Dystrophy Type 1. Front Cardiovasc Med 2022; 9:899606. [PMID: 35722118 PMCID: PMC9203732 DOI: 10.3389/fcvm.2022.899606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background Myotonic dystrophy type 1 (DM1) is a hereditary muscular dystrophy affecting ∼2.1–14.3/100,000 adults. Cardiac manifestations of DM1 include conduction disorders and rarely cardiomyopathies. DM1 increases the risk of obstetric complications, however, little is known about the relationship between pregnancy and cardiomyopathy in DM1 due to disease rarity. Case A 23-year-old with DM1 developed cardiomyopathy during pregnancy. Despite initial medical stabilization, she subsequently developed multiple spontaneous coronary artery dissections postpartum, worsening cardiomyopathy and multiorgan failure. She died 5 months postpartum. Conclusion Though cardiomyopathy and arterial dissection are both known complications of pregnancy, this case suggests individuals with myotonic dystrophy type 1 may be at heightened risk for cardiac disease during the peripartum period. Physicians caring for women with suspected or proven DM1 should offer counseling and be alerted to the risk of cardiac complications with pregnancy and in the peripartum period. Pregnant and peripartum women with DM1 are likely to benefit from more frequent assessments of cardiac function including echocardiograms and early institution of heart failure management protocols when symptoms of cardiomyopathy present.
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Affiliation(s)
- Georgia Besant
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Pierre R. Bourque
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Ian C. Smith
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Sharon Chih
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Mariana M. Lamacie
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Ari Breiner
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Jocelyn Zwicker
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Hanns Lochmüller
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Jodi Warman-Chardon
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- *Correspondence: Jodi Warman-Chardon,
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10
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Gotesman RD, Lalonde E, McKim DA, Bourque PR, Warman-Chardon J, Zwicker J, Breiner A. Laryngospasm in amyotrophic lateral sclerosis. Muscle Nerve 2021; 65:400-404. [PMID: 34817079 DOI: 10.1002/mus.27466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Laryngospasm is an involuntary, sustained closure of sphincter musculature that leads to an unpleasant subjective experience of dyspnea and choking. It is an underreported symptom in amyotrophic lateral sclerosis (ALS). In this study we aimed to better characterize the prevalence and clinical characteristics of laryngospasm in ALS patients. METHODS The medical records of 571 patients with ALS followed between 2008 and 2018 were searched for evidence of laryngospasm. A total of 23 patients with laryngospasm were identified and the data related to patient and laryngospasm characteristics were extracted. RESULTS Laryngospasm was reported in 4% of ALS patients. Females comprised 57% of patients and their mean age was 63.4 years. Laryngospasm frequently manifested in patients with moderate bulbar dysfunction and seemed independent of respiratory function. Among laryngospasm patients, 26% were cigarette smokers and 13% had a history of gastroesophageal reflux. The most common reported trigger was excessive saliva irritating the vocal cords (35%) followed by eating a meal (17%). There was significant variation in laryngospasm frequency (up to 5 per hour) and duration (seconds to minutes). Most patients could not identify an effective coping mechanism, although 13% reported that drinking water was effective. DISCUSSION Despite its low prevalence in ALS, laryngospasm should be included in the symptom inquiry. The present findings may improve patient care through increased recognition of the clinical features of laryngospasm in ALS patients, identifying a link between laryngospasm and moderate bulbar dysfunction, and highlighting trigger avoidance as a management strategy. Additional research is required to understand the pathophysiology and optimal treatment.
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Affiliation(s)
- Ryan D Gotesman
- Department of Medicine (Neurology), The Ottawa Hospital, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, Ontario, Canada
| | - Emilie Lalonde
- Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, Ontario, Canada
| | - Douglas A McKim
- Division of Respiratory Medicine, CANVent Respiratory Rehabilitation Services, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Pierre R Bourque
- Department of Medicine (Neurology), The Ottawa Hospital, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, Ontario, Canada
| | - Jodi Warman-Chardon
- Department of Medicine (Neurology), The Ottawa Hospital, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, Ontario, Canada
| | - Jocelyn Zwicker
- Department of Medicine (Neurology), The Ottawa Hospital, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, Ontario, Canada
| | - Ari Breiner
- Department of Medicine (Neurology), The Ottawa Hospital, and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Eric Poulin Centre for Neuromuscular Disease, University of Ottawa, Ottawa, Ontario, Canada
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11
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Bourque PR, Rakhra KS, Zwicker J, Pringle CE, Warman-Chardon J. Pseudohypertrophy of the extensor digitorum brevis in diabetic polyneuropathy. Muscle Nerve 2021; 64:E20-E22. [PMID: 34296440 DOI: 10.1002/mus.27377] [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] [Received: 02/27/2021] [Revised: 07/09/2021] [Accepted: 07/18/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Pierre R Bourque
- The Ottawa Hospital and Neuromuscular Centre, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kawan S Rakhra
- Department of Medical Imaging, The Ottawa Hospital, Ottawa, Ontario, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jocelyn Zwicker
- The Ottawa Hospital and Neuromuscular Centre, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Catherine E Pringle
- The Ottawa Hospital and Neuromuscular Centre, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jodi Warman-Chardon
- The Ottawa Hospital and Neuromuscular Centre, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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12
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Breiner A, Nguyen TB, Purgina B, Bourque PR. Vertebral Ischemic Necrosis in Diabetic Lumbosacral Radiculoplexus Neuropathy. Diabetes Care 2021; 44:e53-e54. [PMID: 33479158 DOI: 10.2337/dc20-2787] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 12/11/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Ari Breiner
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada .,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Thanh B Nguyen
- Division of Neuroradiology, Department of Radiology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Bibianna Purgina
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Pierre R Bourque
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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13
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Hodgkinson V, Lounsberry J, M'Dahoma S, Russell A, Jewett G, Benstead T, Brais B, Campbell C, Johnston W, Lochmüller H, McCormick A, Nguyen CT, O'Ferrall E, Oskoui M, Abrahao A, Briemberg H, Bourque PR, Botez S, Cashman N, Chapman K, Chrestian N, Crone M, Dobrowolski P, Dojeiji S, Dowling JJ, Dupré N, Genge A, Gonorazky H, Grant I, Hasal S, Izenberg A, Kalra S, Katzberg H, Krieger C, Leung E, Linassi G, Mackenzie A, Mah JK, Marrero A, Massie R, Matte G, McAdam L, McMillan H, Melanson M, Mezei MM, O'Connell C, Pfeffer G, Phan C, Plamondon S, Poulin C, Rodrigue X, Schellenberg K, Selby K, Sheriko J, Shoesmith C, Smith RG, Taillon M, Taylor S, Venance S, Warman-Chardon J, Worley S, Zinman L, Korngut L. The Canadian Neuromuscular Disease Registry 2010-2019: A Decade of Facilitating Clinical Research Througha Nationwide, Pan-NeuromuscularDisease Registry. J Neuromuscul Dis 2021; 8:53-61. [PMID: 32925088 PMCID: PMC7902956 DOI: 10.3233/jnd-200538] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We report the recruitment activities and outcomes of a multi-disease neuromuscular patient registry in Canada. The Canadian Neuromuscular Disease Registry (CNDR) registers individuals across Canada with a confirmed diagnosis of a neuromuscular disease. Diagnosis and contact information are collected across all diseases and detailed prospective data is collected for 5 specific diseases: Amyotrophic Lateral Sclerosis (ALS), Duchenne Muscular Dystrophy (DMD), Myotonic Dystrophy (DM), Limb Girdle Muscular Dystrophy (LGMD), and Spinal Muscular Atrophy (SMA). Since 2010, the CNDR has registered 4306 patients (1154 pediatric and 3148 adult) with 91 different neuromuscular diagnoses and has facilitated 125 projects (73 academic, 3 not-for-profit, 3 government, and 46 commercial) using registry data. In conclusion, the CNDR is an effective and productive pan-neuromuscular registry that has successfully facilitated a substantial number of studies over the past 10 years.
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Affiliation(s)
- V Hodgkinson
- Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - J Lounsberry
- Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - S M'Dahoma
- Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - A Russell
- Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - G Jewett
- Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - T Benstead
- Division of Neurology, Dalhousie University, Halifax, Canada
| | - B Brais
- Montreal Neurological Institute and Hospital, Montreal, Canada
| | - C Campbell
- Department of Pediatrics, Children's Health Research Institute, London Health Sciences Centre, Western University, London, Canada
| | - W Johnston
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - H Lochmüller
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada.,Department of Medicine, The Ottawa Hospital and Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada
| | - A McCormick
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - C T Nguyen
- CHU Sainte-Justine, Université de Montréal, Montréal, Canada
| | - E O'Ferrall
- Montreal Neurological Institute and Hospital, Montreal, Canada.,Department of Neurosciences, McGill University, Montréal, Canada
| | - M Oskoui
- Department of Neurosciences, McGill University, Montréal, Canada.,Departments of Pediatrics, Montreal Children's Hospital, McGill University, Montréal, Canada
| | - A Abrahao
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - H Briemberg
- GF Strong Rehabilitation Centre, University of British Columbia, Vancouver, Canada.,Division of Neurology, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - P R Bourque
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - S Botez
- Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, Canada
| | - N Cashman
- GF Strong Rehabilitation Centre, University of British Columbia, Vancouver, Canada.,Division of Neurology, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - K Chapman
- Division of Neurology, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - N Chrestian
- Department of Medicine, Université Laval, Quebec City, Canada, Neuroscience axis, CHU de Québec-Université Laval
| | - M Crone
- Division of Pediatric Neurology, Department of Neurology, University of Saskatchewan, Saskatoon, Canada
| | - P Dobrowolski
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - S Dojeiji
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Ottawa, Ottawa, Canada
| | - J J Dowling
- Department of Pediatrics, Sick Kids Hospital, University of Toronto, Toronto, Canada
| | - N Dupré
- Department of Medicine, Laval University, Québec City, Canada
| | - A Genge
- Department of Neurosciences, McGill University, Montréal, Canada
| | - H Gonorazky
- Department of Pediatrics, Sick Kids Hospital, University of Toronto, Toronto, Canada
| | - I Grant
- Division of Neurology, Dalhousie University, Halifax, Canada
| | - S Hasal
- Division of Pediatric Neurology, Department of Neurology, University of Saskatchewan, Saskatoon, Canada
| | - A Izenberg
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - S Kalra
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - H Katzberg
- University Health Network, University of Toronto, Toronto, Canada
| | - C Krieger
- GF Strong Rehabilitation Centre, University of British Columbia, Vancouver, Canada.,Division of Neurology, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - E Leung
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - G Linassi
- Department of Physical Medicine and Rehabilitation University of Saskatchewan, Saskatoon, Canada
| | - A Mackenzie
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - J K Mah
- Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Department of Pediatrics, University of Calgary, Calgary, Canada
| | - A Marrero
- CHU Dr. Georges-L-Dumont, Université de Sherbrooke, Moncton, Canada
| | - R Massie
- Montreal Neurological Institute and Hospital, Montreal, Canada.,Department of Neurosciences, McGill University, Montréal, Canada
| | - G Matte
- Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, Canada
| | - L McAdam
- Department of Pediatrics, Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, University of Toronto, Toronto, Canada
| | - H McMillan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - M Melanson
- Department of Physical Medicine and Rehabilitation, Queen's University, Kingston, Canada
| | - M M Mezei
- Division of Neurology, Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - C O'Connell
- Stan Cassidy Centre for Rehabilitation, Fredericton, Canada.,Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - G Pfeffer
- Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.,Department of Medical Genetics, and Alberta Child Health Research Institute, University of Calgary, Calgary, Canada
| | - C Phan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - S Plamondon
- Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - C Poulin
- Departments of Pediatrics, Montreal Children's Hospital, McGill University, Montréal, Canada
| | - X Rodrigue
- Department of Medicine, Laval University, Québec City, Canada
| | - K Schellenberg
- Department of Physical Medicine and Rehabilitation University of Saskatchewan, Saskatoon, Canada
| | - K Selby
- Division of Neurology, Department of Pediatrics, BC Children's Hospital, University of Vancouver, Vancouver, Canada
| | - J Sheriko
- Division of Neurology, Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - C Shoesmith
- Division of Neurology, Clinical Neurological Sciences, Western University, London, Canada
| | - R G Smith
- Department of Pediatrics, KidsInclusive Centre for Child & Youth Development, Hotel Dieu Hospital, Queen's University, Kingston, Canada
| | - M Taillon
- Stan Cassidy Centre for Rehabilitation, Fredericton, Canada.,Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - S Taylor
- Division of Neurology, Dalhousie University, Halifax, Canada
| | - S Venance
- Division of Neurology, Clinical Neurological Sciences, Western University, London, Canada
| | - J Warman-Chardon
- Department of Medicine, The Ottawa Hospital and Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada
| | - S Worley
- Stan Cassidy Centre for Rehabilitation, Fredericton, Canada.,Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - L Zinman
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - L Korngut
- Department of Clinical Neurosciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
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Bourque PR, Masson-Roy J, Warman-Chardon J, Massie R, Melanson M, Brooks J, Breiner A. Temporal evolution of nerve conduction study abnormalities in anti-myelin-associated glycoprotein neuropathy. Muscle Nerve 2020; 63:401-404. [PMID: 33290607 DOI: 10.1002/mus.27134] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 08/04/2020] [Revised: 11/27/2020] [Accepted: 12/06/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND A distal-predominant demyelinating symmetric pattern is most frequent in patients with neuropathy associated with anti-myelin-associated glycoprotein (MAG) antibodies. The literature however lacks longitudinal data to describe whether this is consistent over time. METHODS From the Ottawa Neuromuscular Center database, we identified 23 patients with both immunoglobulin M gammopathy and anti-MAG antibodies. For median, ulnar and fibular motor conduction studies, we analyzed distal latency and amplitude, negative peak duration, terminal latency index (TLI), and conduction velocity. For median, ulnar, sural, and superficial fibular sensory conduction studies, we analyzed distal latency and amplitude. Results were compared for the earliest and the latest data sets. RESULTS The mean time interval between the two assessment points was 6.5 years. Median and ulnar motor nerve conduction studies did not show a significant change for any of the parameters tested. There was disproportionate prolongation of median distal motor latency and reduction in TLI, compared to the ulnar nerve. Deep fibular motor conduction studies showed a marked reduction in amplitudes over time. Sensory potentials were recordable in the upper limb in less than 50% at the first study and less than 25% on the most recent study. There was an even larger attrition of recordable sural and superficial fibular sensory potentials. CONCLUSIONS Our results highlight the stability of median and ulnar motor conduction study results over a mean observation period of 6.5 years. In contrast, lower limb motor and all sensory potentials show a marked trend toward becoming unrecordable.
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Affiliation(s)
- Pierre R Bourque
- The Ottawa Hospital and Neuromuscular Centre, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, Ontario, K1Y 4E9, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Josée Masson-Roy
- The Ottawa Hospital and Neuromuscular Centre, Ottawa, Ontario, Canada
| | - Jodi Warman-Chardon
- The Ottawa Hospital and Neuromuscular Centre, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, Ontario, K1Y 4E9, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Rami Massie
- Department of Neurology, McGill University, Montreal, Québec, Canada
| | - Michel Melanson
- Division of Neurology, Queen's University, Kingston, Ontario, Canada
| | - John Brooks
- The Ottawa Hospital and Neuromuscular Centre, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, Ontario, K1Y 4E9, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ari Breiner
- The Ottawa Hospital and Neuromuscular Centre, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, Ontario, K1Y 4E9, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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15
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Bourque PR, Brooks J, Mobach T, Gammon B, Papp S, Warman-Chardon J. Correction: Systematic prospective electrophysiological studies of the median nerve after simple distal radius fracture. PLoS One 2020; 15:e0243490. [PMID: 33270775 PMCID: PMC7714225 DOI: 10.1371/journal.pone.0243490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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16
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Affiliation(s)
- Ari Breiner
- Division of Neurology (Breiner, Bourque), Department of Medicine, The Ottawa Hospital and University of Ottawa; Ottawa Hospital Research Institute (Breiner, Bourque), Ottawa, Ont.; Sunnybrook Research Institute (Zinman), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre; Division of Neurology (Zinman), Department of Medicine, University of Toronto, Toronto, Ont.
| | - Lorne Zinman
- Division of Neurology (Breiner, Bourque), Department of Medicine, The Ottawa Hospital and University of Ottawa; Ottawa Hospital Research Institute (Breiner, Bourque), Ottawa, Ont.; Sunnybrook Research Institute (Zinman), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre; Division of Neurology (Zinman), Department of Medicine, University of Toronto, Toronto, Ont
| | - Pierre R Bourque
- Division of Neurology (Breiner, Bourque), Department of Medicine, The Ottawa Hospital and University of Ottawa; Ottawa Hospital Research Institute (Breiner, Bourque), Ottawa, Ont.; Sunnybrook Research Institute (Zinman), Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre; Division of Neurology (Zinman), Department of Medicine, University of Toronto, Toronto, Ont
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17
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Abstract
A 76-year-old man with a 5-year history of gait difficulties was suspected to have length-dependent sensorimotor polyneuropathy. Electrodiagnostic results pointed to a foot drop of neurogenic etiology, except for the prominence of myotonic discharges on needle EMG. Tests for acquired and genetic causes of polyneuropathy were unrevealing. The patient's first-degree cousin, with a much different clinical phenotype had been diagnosed with myofibrillar myopathy. Our patient was eventually found to carry the same myotilin c.179C>T p.Ser60Phe mutation. Muscle MRI was helpful in delineating clinically unsuspected involvement of paraspinal and pelvi-femoral muscles, as well as showing marked myopathic fatty infiltration of distal leg muscles. The association of neuropathy and myopathy is a recognized feature of myofibrillar myopathy. In some patients with unexplained foot drop, whole-body muscle MRI and a dedicated genetic mutation testing strategy may help reveal a diagnosis of genetic myopathy.
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Affiliation(s)
- Pierre R Bourque
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ari Breiner
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jodi Warman-Chardon
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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18
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Bourque PR, Brooks J, Mobach T, Gammon B, Papp S, Warman-Chardon J. Systematic prospective electrophysiological studies of the median nerve after simple distal radius fracture. PLoS One 2020; 15:e0231502. [PMID: 32282809 PMCID: PMC7153861 DOI: 10.1371/journal.pone.0231502] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/24/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To assess whether there is a measurable impairment of median nerve conduction study parameters with uncomplicated distal radius fracture. Methods Patients were assessed prospectively at the time of cast removal (visit 1) after a standard 6–8 week immobilization for uncomplicated distal radius fracture. Patients with prior entrapment neuropathy or polyneuropathy were excluded. Patients were asked to report sensory symptoms. Median and ulnar motor and sensory conduction studies were performed bilaterally, as well as transcarpal stimulation. All electrophysiologic studies were repeated at a follow-up visit 2, on average 7.8 weeks later. Results 39 patients were assessed at visit 1 and 30 (77%) were available for follow-up visit 2. Paresthesia in the median territory on the fractured side were reported in 20% at visit 1 and 26% at visit 2. Electrophysiological evidence of only mild carpal tunnel syndrome was found on the fractured side in 4/39 at visit 1 and 6/30 at visit 2. There were only 2 cases of moderate-marked median neuropathy, both asymptomatic and on the unfractured side. Median motor and sensory latencies and amplitudes did not show statistically significant differences between fractured and unfractured sides with the single exception of median distal motor latency at visit 1. Conclusions Median territory paresthesia at the time of cast removal following distal radius fracture are often not associated with electrophysiologic evidence of median neuropathy. Most median nerve electrophysiologic parameters do not significantly differ between the fractured and uninjured sides. Significant traumatic median neuropathy is not likely to be a frequent manifestation of uncomplicated distal radius fracture. Level of evidence Diagnostic analysis, Level III
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Affiliation(s)
- Pierre R. Bourque
- Department of Medicine (Neurology), University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
- * E-mail:
| | - John Brooks
- Department of Medicine (Neurology), University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Theo Mobach
- Department of Medicine (Neurology), University of Ottawa, Ottawa, Canada
| | - Brendan Gammon
- Ottawa Hospital Research Institute, Ottawa, Canada
- Division of Orthopedic Surgery, University of Ottawa, Ottawa, Canada
| | - Steven Papp
- Ottawa Hospital Research Institute, Ottawa, Canada
- Division of Orthopedic Surgery, University of Ottawa, Ottawa, Canada
| | - Jodi Warman-Chardon
- Department of Medicine (Neurology), University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
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19
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Bourque PR, Sampaio ML, Warman-Chardon J, Samaan S, Torres C. Neurolymphomatosis of the lumbosacral plexus and its branches: case series and literature review. BMC Cancer 2019; 19:1149. [PMID: 31775683 PMCID: PMC6882218 DOI: 10.1186/s12885-019-6365-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 08/19/2019] [Accepted: 11/15/2019] [Indexed: 12/12/2022] Open
Abstract
Background Neurolymphomatosis (NL) is a direct process of invasion of peripheral nerves by lymphoma. It occurs in roughly 5% of patients with lymphoma and represents a particularly difficult diagnostic dilemma when it is the presenting focal manifestation of occult lymphoma. Case presentation We present 3 examples of invasion of the lumbosacral plexus and its branches. These cases demonstrate a protean clinical picture with regards to the time relationship to the clinical course of lymphoma and the neuroanatomical extent of lumbosacral plexus invasion. We demonstrate the complementary role of different imaging modalities. A review of the literature summarizes 23 reports where lumbosacral plexus invasion was the index manifestation, at the time of first diagnosis or recurrence of lymphoma. This series confirms the strong preponderance of B-cell type (92%). There is a marked predilection for involvement of the sciatic nerve (74%), either focally or in a longitudinally extensive fashion, from the ischium to the popliteal fossa. There can also be restricted and discrete involvement of tibial and fibular branches. In recent years, ultrasound and CT have been given a more limited role, as screening tools or as a guide for biopsy. MRI neurography and PET-CT have become leading diagnostic modalities for diagnosis, staging and assessment of treatment response. Conclusion The diagnosis of NL may be challenging, and it was once only reached at autopsy. Improved diagnostic imaging of focal or even asymptomatic disease offers new hope for earlier diagnosis and successful targeted therapy.
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Affiliation(s)
- Pierre R Bourque
- Department of Medicine (Neurology), University of Ottawa, Ottawa, Canada.,The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Marcos Loreto Sampaio
- The Ottawa Hospital Research Institute, Ottawa, Canada. .,Department of Radiology, University of Ottawa, Ottawa, Canada.
| | - Jodi Warman-Chardon
- Department of Medicine (Neurology), University of Ottawa, Ottawa, Canada.,The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sam Samaan
- Division of Nuclear Medicine, The Ottawa Hospital, Ottawa, Canada
| | - Carlos Torres
- The Ottawa Hospital Research Institute, Ottawa, Canada.,Department of Radiology, University of Ottawa, Ottawa, Canada
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20
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Bourque PR, Brooks J, Warman-Chardon J, Breiner A. Cerebrospinal fluid total protein in Guillain-Barré syndrome variants: correlations with clinical category, severity, and electrophysiology. J Neurol 2019; 267:746-751. [PMID: 31734909 DOI: 10.1007/s00415-019-09634-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 06/12/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 01/08/2023]
Abstract
The discriminative value of CSF total protein (CSF-TP) in subtypes of Guillain-Barré syndrome has not been well documented in North-American patients. We reviewed 173 cases from a single institution, comprising the following clinical categories of neuropathy: 134 Sensorimotor (SM) GBS, 13 Motor (M) GBS, 8 Localized (L) GBS, and 18 Miller Fisher syndrome (MFS). We grouped the electrophysiological interpretation in primarily demyelinating, primarily axonal and normal / equivocal categories. Mean CSF-TP were substantially higher for SM and L-GBS, as well as cases classified as Acute-onset chronic inflammatory demyelinating polyneuropathy. They were lower for M-GBS and L-GBS. The most statistically significant correlation was found for elevated CSF-TP in GBS cases showing an electrophysiologic pattern classified as demyelinating (1.56 g/L) compared with axonal (0.68 g/L) or normal/ equivocal patterns (0.65 g/L). There was a correlation between CSF-TP and time interval between symptom onset and lumbar puncture. There was a weak correlation between CSF-TP and maximal overall-clinical severity grade, which was likely mostly determined by the electorphysiological pattern. Though CSF-TP is a sensitive test for GBS in the second week after onset, it may not be a reliable predictor of clinical severity. There is a robust association of CSF-TP elevation and a demyelinative electrophysiologic pattern and a suggestion that lower mean CSF-TP values can be expected in GBS-spectrum disorders thought to represent nodo-paranodopathies.
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Affiliation(s)
- Pierre R Bourque
- The Ottawa Hospital, University of Ottawa, 1053 Carling, Ottawa, ON, K1Y4E9, Canada. .,The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - J Brooks
- The Ottawa Hospital, University of Ottawa, 1053 Carling, Ottawa, ON, K1Y4E9, Canada.,The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - J Warman-Chardon
- The Ottawa Hospital, University of Ottawa, 1053 Carling, Ottawa, ON, K1Y4E9, Canada.,The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - A Breiner
- The Ottawa Hospital, University of Ottawa, 1053 Carling, Ottawa, ON, K1Y4E9, Canada.,The Ottawa Hospital Research Institute, Ottawa, ON, Canada
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21
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Breiner A, Basndwah A, Warman-Chardon J, Bourque PR, Mestre TA. Intermittent undulating tongue as an involuntary movement in early amyotrophic lateral sclerosis. Parkinsonism Relat Disord 2019; 67:1-2. [PMID: 31621597 DOI: 10.1016/j.parkreldis.2019.09.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/26/2019] [Accepted: 09/01/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Ari Breiner
- Division of Neurology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, University of Ottawa Brain and Research Institute, Ottawa, Ontario, Canada
| | - Ahmed Basndwah
- Parkinson's Disease and Movement Disorders Center, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Jodi Warman-Chardon
- Division of Neurology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, University of Ottawa Brain and Research Institute, Ottawa, Ontario, Canada
| | - Pierre R Bourque
- Division of Neurology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, University of Ottawa Brain and Research Institute, Ottawa, Ontario, Canada
| | - Tiago A Mestre
- Division of Neurology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada; Parkinson's Disease and Movement Disorders Center, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, University of Ottawa Brain and Research Institute, Ottawa, Ontario, Canada.
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22
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Mobach T, Brooks J, Breiner A, Warman-Chardon J, Papp S, Gammon B, Nandedkar SD, Bourque PR. Impact of disuse muscular atrophy on the compound muscle action potential. Muscle Nerve 2019; 61:58-62. [PMID: 31588576 DOI: 10.1002/mus.26730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 06/13/2019] [Revised: 09/18/2019] [Accepted: 09/23/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Disuse atrophy from immobilization is the result of decreased neural activity and muscle unloading. METHODS We studied the impact of disuse on hand intrinsic compound muscle action potentials (CMAPs) in a cohort of 39 patients with unilateral 6-week immobilization of the hand in a cast, after distal radius fracture. We excluded patients with nerve injury. We compared side-to-side CMAP characteristics at the time of cast removal and at a subsequent follow-up visit, after a mean interval of 7.8 weeks. RESULTS Statistically significant reductions in CMAP amplitude were noted for the abductor pollicis brevis (29.2%), abductor digiti minimi (19.0%), and first dorsal interosseus (24.9%). There was partial repair of the relative CMAP reduction at the follow-up visit (20.1%, 10.7%, and 8.7%, respectively). There was no significant change in CMAP duration. CONCLUSIONS These results provide a framework for quantifying the degree of hand intrinsic CMAP amplitude reduction attributed to disuse.
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Affiliation(s)
- Theo Mobach
- Division of Neurology (Medicine), University of Ottawa, The Ottawa Hospital, Ottawa, Canada
| | - John Brooks
- Division of Neurology (Medicine), University of Ottawa, The Ottawa Hospital, Ottawa, Canada.,The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Ari Breiner
- Division of Neurology (Medicine), University of Ottawa, The Ottawa Hospital, Ottawa, Canada.,The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jodi Warman-Chardon
- Division of Neurology (Medicine), University of Ottawa, The Ottawa Hospital, Ottawa, Canada.,The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Steven Papp
- Division of Orthopedic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Canada
| | - Braden Gammon
- Division of Orthopedic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Canada
| | | | - Pierre R Bourque
- Division of Neurology (Medicine), University of Ottawa, The Ottawa Hospital, Ottawa, Canada.,The Ottawa Hospital Research Institute, Ottawa, Canada
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23
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Bourque PR, Breiner A. Cerebrospinal Fluid in Posterior Reversible Encephalopathy Syndrome. Neurohospitalist 2019; 9:125. [PMID: 31244966 DOI: 10.1177/1941874419847364] [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: 11/16/2022] Open
Affiliation(s)
- Pierre R Bourque
- Department of Medicine (Neurology), University of Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ari Breiner
- Department of Medicine (Neurology), University of Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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24
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Bourque PR, Brooks J, Warman-Chardon J, Hegen H, Deisenhammer F, McCudden CR, Breiner A. Dataset for worldwide survey of cerebrospinal total protein upper reference values. Data Brief 2019; 23:103760. [PMID: 31193022 PMCID: PMC6514267 DOI: 10.1016/j.dib.2019.103760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 02/06/2019] [Accepted: 02/08/2019] [Indexed: 11/01/2022] Open
Abstract
This article reports data pertaining to a worldwide web-based survey referenced in the publication "Adult CSF Total Protein: Higher upper reference limits should be considered worldwide " (P.R. Bourque, et al., 2019). This survey was distributed to corresponding authors of the journal Neurology and the Journal of neurological sciences for the period of Jan-Dec 2017. The response rate was 36.9%. Additional results were collated through networking and national associations. There were 473 unique responses from clinical hospital laboratories in 69 countries: North America 178, South America 26, Europe 139, Africa 20, Asia 102 and Oceania 8. The upper reference limit for cerebrospinal fluid total protein ranged from 0.2 g/L to 0.8 g/L. 86.8% of the survey responses were 0.45 g/L or less. Data is presented separately for tertiary/academic and non-university/community centers.
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Affiliation(s)
- Pierre R Bourque
- Division of Neurology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - John Brooks
- Division of Neurology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Jodi Warman-Chardon
- Division of Neurology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Harald Hegen
- Department of Neurology, Neuroimmunology Laboratory, Medical University of Innsbruck, Innsbruck, Austria
| | - Florian Deisenhammer
- Department of Neurology, Neuroimmunology Laboratory, Medical University of Innsbruck, Innsbruck, Austria
| | - Chris R McCudden
- Department of Pathology & Laboratory Medicine, The Ottawa Hospital and University of Ottawa, Ontario, Canada
| | - Ari Breiner
- Division of Neurology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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25
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Bourque PR, Brooks J, McCudden CR, Warman-Chardon J, Breiner A. Age matters: Impact of data-driven CSF protein upper reference limits in Guillain-Barré syndrome. Neurol Neuroimmunol Neuroinflamm 2019; 6:e576. [PMID: 31355312 PMCID: PMC6624106 DOI: 10.1212/nxi.0000000000000576] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/28/2019] [Indexed: 11/17/2022]
Abstract
Objective We conducted a retrospective review of patients with a diagnosis of Guillain-Barré syndrome (GBS) to assess the diagnostic impact of applying age-adjusted upper limits for CSF total protein (CSF-TP) supported by a systematic literature review. Methods Cases coded as GBS or inflammatory neuropathy for the period 2001–2016 at The Ottawa Hospital were reviewed. Cases were included if they met the Brighton criteria for GBS with a diagnostic certainty level 1 or 2 and had contemporaneous CSF-TP data. We excluded cases with CSF pleocytosis >50 and cases with Miller-Fisher syndrome. Age-adjusted reference limits were compared with conventional 0.45 and 0.6 g/L upper limits. Results One hundred thirty-eight cases met the study criteria, with a mean age of 47 years. The mean interval from symptom onset to lumbar puncture was 7.9 days, and mean CSF-TP was 1.23 g/L. There was a strong correlation between rising CSF-TP and time to lumbar puncture. Age-adjusted CSF-TP had a significantly lower sensitivity of only 45% in the first week (32% in the first 3 days) compared with 70% in the first week for the 0.45 g/L limit. All upper limits gained high sensitivity after the first week. Conclusions The low sensitivity of CSF-TP for the diagnosis of GBS is exacerbated by age-adjusted upper limits. The main role of lumbar puncture in GBS in the first week may be to help exclude other inflammatory or neoplastic etiologies of acute neuropathy. After the first week, the magnitude of the CSF-TP rise reduces the effect of different upper reference limits.
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Affiliation(s)
- Pierre R Bourque
- The Ottawa Hospital (P.R.B., J.B., J.W.-C., A.B.), University of Ottawa; The Ottawa Hospital Research Institute (P.R.B., C.R.M., J.W.-C., A.B.); and Department of Pathology and Laboratory Medicine (C.R.M.), The Ottawa Hospital, Ottawa, Canada
| | - John Brooks
- The Ottawa Hospital (P.R.B., J.B., J.W.-C., A.B.), University of Ottawa; The Ottawa Hospital Research Institute (P.R.B., C.R.M., J.W.-C., A.B.); and Department of Pathology and Laboratory Medicine (C.R.M.), The Ottawa Hospital, Ottawa, Canada
| | - Christopher R McCudden
- The Ottawa Hospital (P.R.B., J.B., J.W.-C., A.B.), University of Ottawa; The Ottawa Hospital Research Institute (P.R.B., C.R.M., J.W.-C., A.B.); and Department of Pathology and Laboratory Medicine (C.R.M.), The Ottawa Hospital, Ottawa, Canada
| | - Jodi Warman-Chardon
- The Ottawa Hospital (P.R.B., J.B., J.W.-C., A.B.), University of Ottawa; The Ottawa Hospital Research Institute (P.R.B., C.R.M., J.W.-C., A.B.); and Department of Pathology and Laboratory Medicine (C.R.M.), The Ottawa Hospital, Ottawa, Canada
| | - Ari Breiner
- The Ottawa Hospital (P.R.B., J.B., J.W.-C., A.B.), University of Ottawa; The Ottawa Hospital Research Institute (P.R.B., C.R.M., J.W.-C., A.B.); and Department of Pathology and Laboratory Medicine (C.R.M.), The Ottawa Hospital, Ottawa, Canada
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Breiner A, Bourque PR, Allen JA. Updated cerebrospinal fluid total protein reference values improve chronic inflammatory demyelinating polyneuropathy diagnosis. Muscle Nerve 2019; 60:180-183. [DOI: 10.1002/mus.26488] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/11/2019] [Accepted: 04/12/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Ari Breiner
- Department of Medicine, Division of NeurologyThe Ottawa Hospital, University of Ottawa 1053 Carling Ave, Room ES‐08, Ottawa M5G 2C4 Ontario Canada
- Ottawa Hospital Research Institute Ottawa Ontario Canada
| | - Pierre R. Bourque
- Department of Medicine, Division of NeurologyThe Ottawa Hospital, University of Ottawa 1053 Carling Ave, Room ES‐08, Ottawa M5G 2C4 Ontario Canada
- Ottawa Hospital Research Institute Ottawa Ontario Canada
| | - Jeffrey A. Allen
- Department of NeurologyNorthwestern University Chicago Illinois USA
- Department of NeurologyUniversity of Minnesota Minneapolis Minnesota USA
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Brooks JA, McCudden C, Breiner A, Bourque PR. Causes of albuminocytological dissociation and the impact of age-adjusted cerebrospinal fluid protein reference intervals: a retrospective chart review of 2627 samples collected at tertiary care centre. BMJ Open 2019; 9:e025348. [PMID: 30765408 PMCID: PMC6398735 DOI: 10.1136/bmjopen-2018-025348] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE We set out to test the discriminative power of an age-adjusted upper reference limit for cerebrospinal fluid total protein (CSF-TP) in identifying clinically relevant causes of albuminocytological dissociation (ACD). METHODS We reviewed the charts of 2627 patients who underwent a lumbar puncture at a tertiary care centre over a 20-year period. Samples with CSF-TP above 45 mg/dL (0.45 g/L) were included. Samples with white cell count >5×109/L, red cell count >50×109/L and glucose <2.5 mmol/L (45 mg/dL) were excluded as were samples with incomplete data and those taken from paediatric patients (ie, age <18 years old). Patients with CSF-TP elevated above 45 mg/dL were considered to have 'pseudo' ACD unless their CSF-TP was in excess of age-adjusted norms in which case they were considered to have 'true' ACD. Adjustment for sex was not applied to the age-adjusted norms although the importance of gender has been previously described. RESULTS The presence of ACD was associated with a broad range of neurological diagnoses. Among all 2627 patients with ACD, a clinical diagnosis explaining CSF-TP elevation was identified in 57% of cases. 'True' ACD was associated with a suitable diagnosis in 75% of cases, whereas patients with 'pseudo' ACD showed an appropriate diagnosis in only 51% of cases. Use of an age-adjusted upper reference limit favoured the detection of polyneuropathy patients (13.5% proportionate increase) and excluded a larger number of patients with isolated headache (10.7% proportionate decrease; p<0.0001). CONCLUSIONS Elevated CSF-TP is a common finding, with a range of underlying causes. Use of an age-adjusted upper reference limit for the CSF-TP value improves diagnostic specificity and helps to avoid overdiagnosis of ACD.
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Affiliation(s)
- John Alexander Brooks
- Department of Medicine, Division of Neurology, University of Ottawa, Ottawa, Ontario, Canada
| | - Christopher McCudden
- Department of Pathology and Laboratory Medicine, Division of Biochemistry, University of Ottawa, Ottawa, Ontario, Canada
| | - Ari Breiner
- Department of Medicine, Division of Neurology, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Pierre R Bourque
- Department of Medicine, Division of Neurology, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Thebault S, Hanes I, Woulfe J, Bourque PR. Paraneoplastic recurrent tumefactive demyelination in a 62-year-old man with metastatic seminoma. Neurol Neuroimmunol Neuroinflamm 2018; 6:e527. [PMID: 30588483 PMCID: PMC6299676 DOI: 10.1212/nxi.0000000000000527] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/17/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Simon Thebault
- Ottawa Hospital, Division of Neurology (S.T., P.R.B.); The Children's Hospital of Eastern Ontario (I.H.); The Ottawa Hospital (J.W.), Department of Pathology and Laboratory Medicine; and The Ottawa Hospital Research Institute (P.R.B.), ON, Canada
| | - Ilana Hanes
- Ottawa Hospital, Division of Neurology (S.T., P.R.B.); The Children's Hospital of Eastern Ontario (I.H.); The Ottawa Hospital (J.W.), Department of Pathology and Laboratory Medicine; and The Ottawa Hospital Research Institute (P.R.B.), ON, Canada
| | - John Woulfe
- Ottawa Hospital, Division of Neurology (S.T., P.R.B.); The Children's Hospital of Eastern Ontario (I.H.); The Ottawa Hospital (J.W.), Department of Pathology and Laboratory Medicine; and The Ottawa Hospital Research Institute (P.R.B.), ON, Canada
| | - Pierre R Bourque
- Ottawa Hospital, Division of Neurology (S.T., P.R.B.); The Children's Hospital of Eastern Ontario (I.H.); The Ottawa Hospital (J.W.), Department of Pathology and Laboratory Medicine; and The Ottawa Hospital Research Institute (P.R.B.), ON, Canada
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Bourque PR, Breiner A, Brooks J, Warman Chardon J. Teaching Video NeuroImages: Rippling muscle disease with caveolin myopathy. Neurology 2018; 91:e1726-e1727. [PMID: 30373930 DOI: 10.1212/wnl.0000000000006427] [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: 11/15/2022] Open
Affiliation(s)
- Pierre R Bourque
- From the Department of Medicine, Division of Neurology (P.R.B., A.B., J.B., J.W.C.), The Ottawa Hospital; The Ottawa Hospital Research Institute (P.R.B., A.B., J.W.C.); and Department of Genetics (P.R.B., A.B., J.W.C.), Children's Hospital of Eastern Ontario, Ottawa, Canada.
| | - Ari Breiner
- From the Department of Medicine, Division of Neurology (P.R.B., A.B., J.B., J.W.C.), The Ottawa Hospital; The Ottawa Hospital Research Institute (P.R.B., A.B., J.W.C.); and Department of Genetics (P.R.B., A.B., J.W.C.), Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - John Brooks
- From the Department of Medicine, Division of Neurology (P.R.B., A.B., J.B., J.W.C.), The Ottawa Hospital; The Ottawa Hospital Research Institute (P.R.B., A.B., J.W.C.); and Department of Genetics (P.R.B., A.B., J.W.C.), Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Jodi Warman Chardon
- From the Department of Medicine, Division of Neurology (P.R.B., A.B., J.B., J.W.C.), The Ottawa Hospital; The Ottawa Hospital Research Institute (P.R.B., A.B., J.W.C.); and Department of Genetics (P.R.B., A.B., J.W.C.), Children's Hospital of Eastern Ontario, Ottawa, Canada
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30
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Affiliation(s)
- Pierre R Bourque
- Division of Neurology, Department of Medicine (Bourque, Breiner), The Ottawa Hospital and University of Ottawa; Ottawa Hospital Research Institute (Bourque, Breiner), Ottawa, Ont.
| | - Ari Breiner
- Division of Neurology, Department of Medicine (Bourque, Breiner), The Ottawa Hospital and University of Ottawa; Ottawa Hospital Research Institute (Bourque, Breiner), Ottawa, Ont
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Bourque PR, Warman-Chardon J, Lelli DA, LaBerge L, Kirshen C, Bradshaw SH, Hartley T, Boycott KM. Novel ELOVL4 mutation associated with erythrokeratodermia and spinocerebellar ataxia (SCA 34). Neurol Genet 2018; 4:e263. [PMID: 30065956 PMCID: PMC6066365 DOI: 10.1212/nxg.0000000000000263] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/07/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Pierre R Bourque
- Department of Medicine (Neurology) (P.R.B., J.W-C., D.A.L.), University of Ottawa; Ottawa Hospital Research Institute (P.R.B., J.W-C.); Department of Medicine (Dermatology) (L.L., C.K.), University of Ottawa; Department of Anatomical Pathology (S.H.B.), University of Ottawa; and Department of Genetics (J.W-C., T.H., K.M.B.), Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Jodi Warman-Chardon
- Department of Medicine (Neurology) (P.R.B., J.W-C., D.A.L.), University of Ottawa; Ottawa Hospital Research Institute (P.R.B., J.W-C.); Department of Medicine (Dermatology) (L.L., C.K.), University of Ottawa; Department of Anatomical Pathology (S.H.B.), University of Ottawa; and Department of Genetics (J.W-C., T.H., K.M.B.), Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Daniel A Lelli
- Department of Medicine (Neurology) (P.R.B., J.W-C., D.A.L.), University of Ottawa; Ottawa Hospital Research Institute (P.R.B., J.W-C.); Department of Medicine (Dermatology) (L.L., C.K.), University of Ottawa; Department of Anatomical Pathology (S.H.B.), University of Ottawa; and Department of Genetics (J.W-C., T.H., K.M.B.), Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Lauren LaBerge
- Department of Medicine (Neurology) (P.R.B., J.W-C., D.A.L.), University of Ottawa; Ottawa Hospital Research Institute (P.R.B., J.W-C.); Department of Medicine (Dermatology) (L.L., C.K.), University of Ottawa; Department of Anatomical Pathology (S.H.B.), University of Ottawa; and Department of Genetics (J.W-C., T.H., K.M.B.), Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Carly Kirshen
- Department of Medicine (Neurology) (P.R.B., J.W-C., D.A.L.), University of Ottawa; Ottawa Hospital Research Institute (P.R.B., J.W-C.); Department of Medicine (Dermatology) (L.L., C.K.), University of Ottawa; Department of Anatomical Pathology (S.H.B.), University of Ottawa; and Department of Genetics (J.W-C., T.H., K.M.B.), Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Scott H Bradshaw
- Department of Medicine (Neurology) (P.R.B., J.W-C., D.A.L.), University of Ottawa; Ottawa Hospital Research Institute (P.R.B., J.W-C.); Department of Medicine (Dermatology) (L.L., C.K.), University of Ottawa; Department of Anatomical Pathology (S.H.B.), University of Ottawa; and Department of Genetics (J.W-C., T.H., K.M.B.), Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Taila Hartley
- Department of Medicine (Neurology) (P.R.B., J.W-C., D.A.L.), University of Ottawa; Ottawa Hospital Research Institute (P.R.B., J.W-C.); Department of Medicine (Dermatology) (L.L., C.K.), University of Ottawa; Department of Anatomical Pathology (S.H.B.), University of Ottawa; and Department of Genetics (J.W-C., T.H., K.M.B.), Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Kym M Boycott
- Department of Medicine (Neurology) (P.R.B., J.W-C., D.A.L.), University of Ottawa; Ottawa Hospital Research Institute (P.R.B., J.W-C.); Department of Medicine (Dermatology) (L.L., C.K.), University of Ottawa; Department of Anatomical Pathology (S.H.B.), University of Ottawa; and Department of Genetics (J.W-C., T.H., K.M.B.), Children's Hospital of Eastern Ontario, Ottawa, Canada
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Hartley T, Wagner JD, Warman-Chardon J, Tétreault M, Brady L, Baker S, Tarnopolsky M, Bourque PR, Parboosingh JS, Smith C, McInnes B, Innes AM, Bernier F, Curry CJ, Yoon G, Horvath GA, Bareke E, Gillespie M, Majewski J, Bulman DE, Dyment DA, Boycott KM. Whole-exome sequencing is a valuable diagnostic tool for inherited peripheral neuropathies: Outcomes from a cohort of 50 families. Clin Genet 2017; 93:301-309. [PMID: 28708278 DOI: 10.1111/cge.13101] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [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: 04/14/2017] [Revised: 07/04/2017] [Accepted: 07/09/2017] [Indexed: 01/02/2023]
Abstract
The inherited peripheral neuropathies (IPNs) are characterized by marked clinical and genetic heterogeneity and include relatively frequent presentations such as Charcot-Marie-Tooth disease and hereditary motor neuropathy, as well as more rare conditions where peripheral neuropathy is associated with additional features. There are over 250 genes known to cause IPN-related disorders but it is estimated that in approximately 50% of affected individuals a molecular diagnosis is not achieved. In this study, we examine the diagnostic utility of whole-exome sequencing (WES) in a cohort of 50 families with 1 or more affected individuals with a molecularly undiagnosed IPN with or without additional features. Pathogenic or likely pathogenic variants in genes known to cause IPN were identified in 24% (12/50) of the families. A further 22% (11/50) of families carried sequence variants in IPN genes in which the significance remains unclear. An additional 12% (6/50) of families had variants in novel IPN candidate genes, 3 of which have been published thus far as novel discoveries (KIF1A, TBCK, and MCM3AP). This study highlights the use of WES in the molecular diagnostic approach of highly heterogeneous disorders, such as IPNs, places it in context of other published neuropathy cohorts, while further highlighting associated benefits for discovery.
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Affiliation(s)
- T Hartley
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
| | - J D Wagner
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
| | - J Warman-Chardon
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada.,Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - M Tétreault
- Department of Human Genetics, McGill University, Montréal, Canada
| | - L Brady
- Department of Pediatrics, McMaster University Medical Centre, Hamilton, Canada
| | - S Baker
- Department of Medicine, McMaster University Medical Centre, Hamilton, Canada
| | - M Tarnopolsky
- Department of Pediatrics, McMaster University Medical Centre, Hamilton, Canada
| | - P R Bourque
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - J S Parboosingh
- Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - C Smith
- Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - B McInnes
- Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - A M Innes
- Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - F Bernier
- Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - C J Curry
- Department of Pediatrics, University of California, San Francisco, California
| | - G Yoon
- Divisions of Neurology and Clinical and Metabolic Genetics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - G A Horvath
- Division of Biochemical Diseases, Department of Pediatrics, B.C. Children's Hospital, University of British Columbia, Vancouver, Canada
| | - E Bareke
- Department of Human Genetics, McGill University, Montréal, Canada
| | - M Gillespie
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
| | | | | | - J Majewski
- Department of Human Genetics, McGill University, Montréal, Canada
| | - D E Bulman
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
| | - D A Dyment
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada.,Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - K M Boycott
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada.,Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Canada
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McCudden CR, Brooks J, Figurado P, Bourque PR. Cerebrospinal Fluid Total Protein Reference Intervals Derived from 20 Years of Patient Data. Clin Chem 2017; 63:1856-1865. [DOI: 10.1373/clinchem.2017.278267] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/22/2017] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Reference intervals are vital for interpretation of laboratory results. Many existing reference intervals for cerebrospinal fluid total protein (CSF-TP) are derived from old literature because of the invasive nature of sampling. The objective of this study was to determine reference intervals for CSF-TP using available patient data.
METHODS
Twenty years of hospital database information was mined for previously reported CSF-TP results. Associated demographic, laboratory, and clinical diagnosis (International Classification of Diseases 9/10 codes) details were extracted. CSF-TP results included 3 different analytical platforms: the Siemens Vista 1500, Beckman Lx20, and Roche Hitachi 917. From an initial data set of 19591 samples, the following exclusion criteria were applied: incomplete data, white blood cells (WBCs) >5 × 106/L, red blood cells (RBCs) >50 × 106/L, and glucose <2.5 mmol/L. Patient charts were reviewed in detail to exclude 60 different conditions for which increases in CSF-TP would be expected. A total of 6068 samples were included; 63% of the samples were from females. Continuous reference intervals were determined using quantile regression. Age- and sex-partitioned intervals were established using the quantile regression equation and splitting age-groups into 5-year bins.
RESULTS
CSF-TP showed a marked age dependence, and males had significantly higher CSF-TP than females across all ages. CSF-TP results from the 3 different instruments and manufacturers showed small (approximately 0.04 g/L), but statistically significant, differences. CSF-TP showed weak, but again statistically significant, correlation with WBC and RBC but was independent of serum total protein and creatinine.
CONCLUSIONS
The age dependence of CSF-TP supports that age-partitioned reference intervals will be more accurate than a single cutoff, particularly in patients with advancing age.
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Affiliation(s)
- Christopher R McCudden
- Department of Pathology and Laboratory Medicine, Division of Biochemistry, University of Ottawa, Ottawa, Canada
| | - John Brooks
- Department of Medicine, Division of Neurology, University of Ottawa, Ottawa, Canada
| | - Priya Figurado
- Department of Medicine, Division of Neurology, University of Ottawa, Ottawa, Canada
| | - Pierre R Bourque
- Department of Medicine, Division of Neurology, University of Ottawa, Ottawa, Canada
- The Ottawa Hospital Research Institute, Ottawa, Canada
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Affiliation(s)
- Michel C Shamy
- From the Department of Medicine, Division of Neurology (M.C.S., V.Y., P.R.B.), and the Department of Diagnostic Imaging (D.I.), The Ottawa Hospital; and The Ottawa Hospital Research Institute (M.C.S., P.R.B.), Canada
| | - Vignan Yogendrakumar
- From the Department of Medicine, Division of Neurology (M.C.S., V.Y., P.R.B.), and the Department of Diagnostic Imaging (D.I.), The Ottawa Hospital; and The Ottawa Hospital Research Institute (M.C.S., P.R.B.), Canada
| | - Daniela Iancu
- From the Department of Medicine, Division of Neurology (M.C.S., V.Y., P.R.B.), and the Department of Diagnostic Imaging (D.I.), The Ottawa Hospital; and The Ottawa Hospital Research Institute (M.C.S., P.R.B.), Canada
| | - Pierre R Bourque
- From the Department of Medicine, Division of Neurology (M.C.S., V.Y., P.R.B.), and the Department of Diagnostic Imaging (D.I.), The Ottawa Hospital; and The Ottawa Hospital Research Institute (M.C.S., P.R.B.), Canada.
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35
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Bourque PR, Al-Hajji M, Zwicker J, Warman Chardon J. Teaching Video Neuro Images: Trapezius muscle hypertrophy in multifocal motor neuropathy. Neurology 2017; 89:e81-e82. [PMID: 28808176 DOI: 10.1212/wnl.0000000000004233] [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: 11/15/2022] Open
Affiliation(s)
- Pierre R Bourque
- From the Department of Medicine, Division of Neurology (P.R.B., M.A.-H., J.Z., J.W.C.), The Ottawa Hospital; Faculty of Medicine (P.R.B., M.A.-H., J.Z., J.W.C.), University of Ottawa; The Ottawa Hospital Research Institute (P.R.B., J.W.C.); and the Division of Genetics (J.W.C.), Children's Hospital of Eastern Ontario, Ottawa, Canada.
| | - Mahmoud Al-Hajji
- From the Department of Medicine, Division of Neurology (P.R.B., M.A.-H., J.Z., J.W.C.), The Ottawa Hospital; Faculty of Medicine (P.R.B., M.A.-H., J.Z., J.W.C.), University of Ottawa; The Ottawa Hospital Research Institute (P.R.B., J.W.C.); and the Division of Genetics (J.W.C.), Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Jocelyn Zwicker
- From the Department of Medicine, Division of Neurology (P.R.B., M.A.-H., J.Z., J.W.C.), The Ottawa Hospital; Faculty of Medicine (P.R.B., M.A.-H., J.Z., J.W.C.), University of Ottawa; The Ottawa Hospital Research Institute (P.R.B., J.W.C.); and the Division of Genetics (J.W.C.), Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Jodi Warman Chardon
- From the Department of Medicine, Division of Neurology (P.R.B., M.A.-H., J.Z., J.W.C.), The Ottawa Hospital; Faculty of Medicine (P.R.B., M.A.-H., J.Z., J.W.C.), University of Ottawa; The Ottawa Hospital Research Institute (P.R.B., J.W.C.); and the Division of Genetics (J.W.C.), Children's Hospital of Eastern Ontario, Ottawa, Canada
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36
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Kernohan KD, Frésard L, Zappala Z, Hartley T, Smith KS, Wagner J, Xu H, McBride A, Bourque PR, Consortium CRC, Bennett SAL, Dyment DA, Boycott KM, Montgomery SB, Warman Chardon J. Whole-transcriptome sequencing in blood provides a diagnosis of spinal muscular atrophy with progressive myoclonic epilepsy. Hum Mutat 2017; 38:611-614. [PMID: 28251733 DOI: 10.1002/humu.23211] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 11/23/2016] [Revised: 01/19/2017] [Accepted: 02/21/2017] [Indexed: 12/22/2022]
Abstract
At least 15% of the disease-causing mutations affect mRNA splicing. Many splicing mutations are missed in a clinical setting due to limitations of in silico prediction algorithms or their location in noncoding regions. Whole-transcriptome sequencing is a promising new tool to identify these mutations; however, it will be a challenge to obtain disease-relevant tissue for RNA. Here, we describe an individual with a sporadic atypical spinal muscular atrophy, in whom clinical DNA sequencing reported one pathogenic ASAH1 mutation (c.458A>G;p.Tyr153Cys). Transcriptome sequencing on patient leukocytes identified a highly significant and atypical ASAH1 isoform not explained by c.458A>G(p<10-16 ). Subsequent Sanger-sequencing identified the splice mutation responsible for the isoform (c.504A>C;p.Lys168Asn) and provided a molecular diagnosis of autosomal-recessive spinal muscular atrophy with progressive myoclonic epilepsy. Our findings demonstrate the utility of RNA sequencing from blood to identify splice-impacting disease mutations for nonhematological conditions, providing a diagnosis for these otherwise unsolved patients.
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Affiliation(s)
- Kristin D Kernohan
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Laure Frésard
- Department of Pathology, Stanford University, Stanford, California
| | - Zachary Zappala
- Department of Pathology, Stanford University, Stanford, California.,Department of Genetics, Stanford University, Stanford, California
| | - Taila Hartley
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin S Smith
- Department of Pathology, Stanford University, Stanford, California
| | - Justin Wagner
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Hongbin Xu
- Department of BMI, University of Ottawa, Ottawa, Ontario, Canada
| | - Arran McBride
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Pierre R Bourque
- Division of Neurology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | | | - David A Dyment
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Kym M Boycott
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Stephen B Montgomery
- Department of Pathology, Stanford University, Stanford, California.,Department of Genetics, Stanford University, Stanford, California
| | - Jodi Warman Chardon
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada.,Division of Neurology, The Ottawa Hospital, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Centre for Neuromuscular Disease (CNMD), University of Ottawa, Ottawa, Ontario, Canada
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Bourque PR, Bourque G, Miller W, Woulfe J, Warman Chardon J. Combined isolated trigeminal and facial neuropathies from perineural invasion by squamous cell carcinoma: A case series and review of the literature. J Clin Neurosci 2017; 35:5-12. [DOI: 10.1016/j.jocn.2016.09.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 09/26/2016] [Indexed: 02/01/2023]
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Affiliation(s)
- Pierre R Bourque
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Canada;; Faculty of Medicine, University of Ottawa, Ottawa, Canada;; The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jodi Warman Chardon
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Canada;; Faculty of Medicine, University of Ottawa, Ottawa, Canada;; The Ottawa Hospital Research Institute, Ottawa, Canada;; Division of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Canada
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Bourque PR, Shafi S, Jansen GH, McCurdy A, Warman Chardon J. Amyloid Neuropathy Following Domino Liver Transplantation: Response to Diflunisal. JAMA Neurol 2016; 73:477-8. [PMID: 26831189 DOI: 10.1001/jamaneurol.2015.4715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Pierre R Bourque
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Sharmi Shafi
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Gerard H Jansen
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Arleigh McCurdy
- Department of Hematology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jodi Warman Chardon
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada4Ottawa Hospital Research Institute, Ottawa, Ontario, Canada5Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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McMillan HJ, Torres C, Michaud J, Ying Y, Boyd KU, Bourque PR. Diagnosis and outcome of childhood perineurioma. Childs Nerv Syst 2016; 32:1555-60. [PMID: 27086131 DOI: 10.1007/s00381-016-3089-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 04/09/2016] [Accepted: 04/13/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Intraneural perineurioma is a rare peripheral nerve tumor of childhood and early adulthood. Patients demonstrate progressive muscle weakness and atrophy largely without sensory complaints. CASE We report two children with perineurioma affecting the radial and femoral nerves. Electromyography (EMG), ultrasound, and 3-T MR imaging were important tools for localizing perineurioma and permitting its differentiation from other nerve lesions. The first patient underwent surgical excision of the perineurioma and a traditional nerve graft. At 10 months post-operative follow-up, she demonstrated no meaningful recovery of muscle strength compared to her pre-operative assessment. EMG did confirm axonal continuity indicating that reinnervation had occurred via the nerve graft. The second patient underwent a two-staged surgical procedure that included an end-to-side nerve transfer. At 18 months post-operative follow-up, she demonstrated mild improvement in muscle strength and EMG evidence of ongoing reinnervation. CONCLUSION The surgical management of perineurioma remains controversial, and reports of clinical recovery after nerve grafts and nerve transfers vary. Nerve transfers have been reported to provide superior results to traditional nerve grafting in adults with post-traumatic plexus injuries. The modest gain in strength of our patient who underwent a nerve transfer raises the question if this may also apply to patients with perineurioma. Additional studies will be required, which must also take into consideration that features of long-standing neuropathy (i.e., limb length discrepancy) have the potential to reduce the likelihood of reinnervation and clinical recovery.
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Affiliation(s)
- Hugh J McMillan
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada.
| | - C Torres
- The Ottawa Hospital, Civic Campus, University of Ottawa, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
| | - J Michaud
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Y Ying
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - K U Boyd
- The Ottawa Hospital, Civic Campus, University of Ottawa, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
| | - P R Bourque
- The Ottawa Hospital, Civic Campus, University of Ottawa, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
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Yu YJ, Warman Chardon J, Bourque PR. Systematic analysis of clinical deficits in unilateral hypoglossal nerve palsy. Muscle Nerve 2016; 54:1055-1058. [PMID: 27429166 DOI: 10.1002/mus.25258] [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: 04/14/2016] [Revised: 07/08/2016] [Accepted: 07/15/2016] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The clinical characteristics of unilateral hypoglossal neuropathy have not been systematically analyzed. METHODS We documented subjective abnormalities of speech and swallowing, and photographed 9 specific tongue movements and positions. Objective deficits were scored independently by 2 examiners. RESULTS Eight patients were analyzed. Some degree of dysarthria and dysphagia was noticed by 7 and 8 patients, respectively, mostly resolving within a few months. In all subjects, there was contralateral deviation of the tongue at rest and ipsilateral deviation upon forward protrusion. Furthermore, 7 of 8 patients had deficits in using the tongue to indent the ipsilateral cheek and cover the upper lip. CONCLUSIONS Unilateral hypoglossal nerve palsy produces mostly subtle and transient patient symptoms, even when complete. Beyond the classic sign of ipsilateral deviation on protrusion, reliable signs are contralateral deviation at rest, paresis of ipsilateral movement inside the mouth, and paresis of elevation of the tongue tip. Muscle Nerve 54: 1055-1058, 2016.
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Affiliation(s)
- Yeyao Joe Yu
- The Ottawa Hospital, Department of Medicine, Division of Neurology, Ottawa, Ontario, Canada.,University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Jodi Warman Chardon
- The Ottawa Hospital, Department of Medicine, Division of Neurology, Ottawa, Ontario, Canada.,University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, 1053 Carling Avenue, Room 2196, Ottawa, Ontario, Canada, K1Y4E9.,Children's Hospital of Eastern Ontario, Division of Genetics, Ottawa, Ontario, Canada
| | - Pierre R Bourque
- The Ottawa Hospital, Department of Medicine, Division of Neurology, Ottawa, Ontario, Canada.,University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
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Chardon JW, Bourque PR, Geraghty MT, Boycott KM. Very late-onset Sandhoff disease presenting as Kennedy disease. Muscle Nerve 2016; 52:1135-6. [PMID: 26769462 DOI: 10.1002/mus.24775] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 07/03/2015] [Accepted: 07/15/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Jodi Warman Chardon
- Division of Neurology The Ottawa Hospital, Ottawa, Ontario, Canada.,The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Genetics, The Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Pierre R Bourque
- Division of Neurology The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Michael T Geraghty
- Division of Metabolics, The Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Kym M Boycott
- Department of Genetics, The Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
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Lapalme-Remis S, Oboudiyat C, Warman Chardon J, Bourque PR. Diffuse leukoencephalopathy with spheroids presenting as primary progressive aphasiaAuthor Response. Neurology 2016; 86:1464-1465. [DOI: 10.1212/01.wnl.0000482697.58240.eb] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Abstract
INTRODUCTION Charcot-Marie-Tooth type 4C (CMT4C) is an autosomal recessive dysmyelinating neuropathy characterized by precocious and rapidly progressive scoliosis. METHODS Patients in a French-Canadian kindred were evaluated with clinical examination, electrophysiologic study, and genomic DNA extraction. RESULTS Six of 10 siblings were clinically symptomatic with supportive electrophysiologic features. The proband presented with regional side-to-side sensorimotor asymmetry, typical pes cavus without obvious scoliosis, and unremarkable plain films of the spine. Affected siblings all share symptoms of foot deformity but have variable onset of neuropathic symptoms, degree of extremity weakness, progression of symptoms, and, most notably, evidence of scoliosis. DNA sequence analysis revealed a novel combination of 2 known recessive mutations, p.R904X and p.R954X, in the SH3TC2 gene. CONCLUSIONS A broad spectrum of phenotypes should be considered in the possible diagnosis of CMT4C. The absence of scoliosis or late-onset symptoms should not exclude SH3TC2 from the list of candidate genes under consideration. Age of onset and clinical features were variable and suggest that polygenic factors contribute to the final phenotype.
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Affiliation(s)
- Talia L Varley
- Department of Medicine, Neuromuscular Disease Clinic, McMaster University, Hamilton, HSC Room 2H22, 1200 Main Street West, Ontario, Canada, L8N 3Z5
| | - Pierre R Bourque
- Division of Neurology, University of Ottawa, Ottawa, Ontario, Canada
| | - Steven K Baker
- Department of Medicine, Neuromuscular Disease Clinic, McMaster University, Hamilton, HSC Room 2H22, 1200 Main Street West, Ontario, Canada, L8N 3Z5
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van Blitterswijk M, van Es MA, Hennekam EAM, Dooijes D, van Rheenen W, Medic J, Bourque PR, Schelhaas HJ, van der Kooi AJ, de Visser M, de Bakker PIW, Veldink JH, van den Berg LH. Evidence for an oligogenic basis of amyotrophic lateral sclerosis. Hum Mol Genet 2012; 21:3776-84. [PMID: 22645277 DOI: 10.1093/hmg/dds199] [Citation(s) in RCA: 261] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder with a substantial heritable component. In pedigrees affected by its familial form, incomplete penetrance is often observed. We hypothesized that this could be caused by a complex inheritance of risk variants in multiple genes. Therefore, we screened 111 familial ALS (FALS) patients from 97 families, and large cohorts of sporadic ALS (SALS) patients and control subjects for mutations in TAR DNA-binding protein (TARDBP), fused in sarcoma/translated in liposarcoma (FUS/TLS), superoxide dismutase-1 (SOD1), angiogenin (ANG) and chromosome 9 open reading frame 72 (C9orf72). Mutations were identified in 48% of FALS families, 8% of SALS patients and 0.5% of control subjects. In five of the FALS families, we identified multiple mutations in ALS-associated genes. We detected FUS/TLS and TARDBP mutations in combination with ANG mutations, and C9orf72 repeat expansions with TARDBP, SOD1 and FUS/TLS mutations. Statistical analysis demonstrated that the presence of multiple mutations in FALS is in excess of what is to be expected by chance (P = 1.57 × 10(-7)). The most compelling evidence for an oligogenic basis was found in individuals with a p.N352S mutation in TARDBP, detected in five FALS families and three apparently SALS patients. Genealogical and haplotype analyses revealed that these individuals shared a common ancestor. We obtained DNA of 14 patients with this TARDBP mutation, 50% of whom had an additional mutation (ANG, C9orf72 or homozygous TARDBP). Hereby, we provide evidence for an oligogenic aetiology of ALS. This may have important implications for the interpretation of whole exome/genome experiments designed to identify new ALS-associated genes and for genetic counselling, especially of unaffected family members.
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Affiliation(s)
- Marka van Blitterswijk
- Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht 3584 CX, The Netherlands
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Affiliation(s)
- Dheeraj Gandhi
- Department of Diagnostic Imaging, the Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada.
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Gandhi D, Goyal M, Bourque PR. Case 138. Radiology 2008. [DOI: 10.1148/radiol.2473020675] [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: 11/11/2022]
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Liem NR, Bourque PR, Michaud C. Acute exertional compartment syndrome in the setting of anabolic steroids: An unusual cause of bilateral footdrop. Muscle Nerve 2005; 32:113-7. [PMID: 15803485 DOI: 10.1002/mus.20314] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 11/08/2022]
Abstract
Acute exertional compartment syndrome is the result of muscle ischemia within a tight fascial compartment. We report a 22-year-old boxer, with recent intake of anabolic steroids, who developed acute exertional compartment syndrome of the lower legs following an assault from which he had to run away. He presented with bilateral footdrop. Nerve conduction studies (NCS) and electromyography (EMG) were consistent with bilateral deep and superficial peroneal neuropathies, but magnetic resonance imaging (MRI) demonstrated hemorrhagic necrosis of the pretibial muscles. This case illustrates that the differential diagnosis for footdrop includes not only central and peripheral nervous system and muscle causes, but also compartment syndromes.
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Affiliation(s)
- Nathania R Liem
- Division of Physical Medicine and Rehabilitation, University of Ottawa, Ottawa, Ontario, Canada.
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Freeman CB, Goyal M, Bourque PR. MR imaging findings in delayed reversible myelopathy from lightning strike. AJNR Am J Neuroradiol 2004; 25:851-3. [PMID: 15140734 PMCID: PMC7974502] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Delayed spinal cord injury following high-voltage electrical injury is a rare but well-documented phenomenon. The MR imaging features of this entity, however, have not been well documented. We report the MR imaging findings in a case of delayed sensory and motor deficits following a lightning strike. MR imaging revealed hyperintense signal within the cord on T2-weighted and STIR images extending from C1 to C3. Axial images localized the hyperintense signal to the posterolateral region of the spinal cord bilaterally. Follow-up MR imaging 6 weeks later demonstrated resolution of abnormal cord signal intensity.
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Affiliation(s)
- Cynthia B Freeman
- Department of Diagnostic Imaging, The Ottawa Hospital, Ontario, Canada
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