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Shieh P, Kuntz N, Dowling J, Müller-Felber W, Blaschek A, Bönnemann C, Foley R, Saade D, Seferian A, Servais L, Lawlor M, Noursalehi M, Prasad S, Rico S, Miller W. CLINICAL TRIAL HIGHLIGHTS. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.018] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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2
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Shieh P, Kuntz N, Bönnemann C, Müller-Felber W, Lawlor M, Servais L, Smith B, Noursalehi M, Prasad S, Dowling J. MUSCLE FUNCTION & HOMEOSTASIS / MOLECULAR THERAPEUTIC APPROACHES. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.070] [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: 11/25/2022]
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3
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Pechmann A, Bernert G, Hagenacker T, Müller-Felber W, Schara U, Schwersenz I, Walter M, Lochmüller H, Kirschner J. SMA: REGISTRIES, BIOMARKERS & OUTCOME MEASURES. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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4
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Vill K, Sehri M, Müller C, Hannibal I, Huf V, Idriess M, Gerstl L, Bonfert MV, Tacke M, Schroeder AS, Landgraf MN, Müller-Felber W, Blaschek A. Qualitative and quantitative muscle ultrasound in patients with Duchenne muscular dystrophy: Where do sonographic changes begin? Eur J Paediatr Neurol 2020; 28:142-150. [PMID: 32758414 DOI: 10.1016/j.ejpn.2020.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 05/19/2020] [Accepted: 06/04/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The number of studies investigating and understanding the disease mechanisms of Duchenne muscular dystrophy (DMD) in human clinical trials have increased substantially over the last decade. Suitable clinical instruments for the measurement of disease progress and drug efficiency are mandatory, but currently not available, especially in the youngest patients. The aim of this study was to detect a reproducible pattern of muscle involvement in early stages potentially preceding evidence of motor regression. MATERIAL AND METHODS A cohort of 25 DMD patients aged 1-6 years at the first presentation were examined at multiple timepoints and compared with age-matched healthy controls. Muscle ultrasound was quantified using computer-analyzed gray scale levels (GSL) and blinded visual rating, using a modified Heckmatt scale. RESULTS Changes in muscle echogenicity in DMD patients occurred very early, clearly preceding motor regression and in some cases, even before the motor plateau phase was reached. Visual rating and GSL identified the earliest changes in the proximal adductor magnus muscle. CONCLUSION Muscle ultrasound can be used as an additional method to assess the disease progression and for decision-making in paucisymptomatic DMD patients. Sonographic changes in the ad-ductor magnus muscle seem to be the first detectable changes with a recognisable pattern.
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Affiliation(s)
- K Vill
- LMU Munich, University Hospital, Dr. von Hauner Children's Hospital, Department of Pediatrics, Disvision of Pediatric Neurology and Developmental Medicine, Munich, Germany.
| | - M Sehri
- LMU Munich, University Hospital, Dr. von Hauner Children's Hospital, Department of Pediatrics, Disvision of Pediatric Neurology and Developmental Medicine, Munich, Germany
| | - C Müller
- LMU Munich, University Hospital, Dr. von Hauner Children's Hospital, Department of Pediatrics, Disvision of Pediatric Neurology and Developmental Medicine, Munich, Germany
| | - I Hannibal
- LMU Munich, University Hospital, Dr. von Hauner Children's Hospital, Department of Pediatrics, Disvision of Pediatric Neurology and Developmental Medicine, Munich, Germany
| | - V Huf
- Department of Radiology, University Medical Center Regensburg, Germany.
| | - M Idriess
- LMU Munich, University Hospital, Dr. von Hauner Children's Hospital, Department of Pediatrics, Disvision of Pediatric Neurology and Developmental Medicine, Munich, Germany
| | - L Gerstl
- LMU Munich, University Hospital, Dr. von Hauner Children's Hospital, Department of Pediatrics, Disvision of Pediatric Neurology and Developmental Medicine, Munich, Germany
| | - M V Bonfert
- LMU Munich, University Hospital, Dr. von Hauner Children's Hospital, Department of Pediatrics, Disvision of Pediatric Neurology and Developmental Medicine, Munich, Germany
| | - M Tacke
- LMU Munich, University Hospital, Dr. von Hauner Children's Hospital, Department of Pediatrics, Disvision of Pediatric Neurology and Developmental Medicine, Munich, Germany
| | - A S Schroeder
- LMU Munich, University Hospital, Dr. von Hauner Children's Hospital, Department of Pediatrics, Disvision of Pediatric Neurology and Developmental Medicine, Munich, Germany
| | - M N Landgraf
- LMU Munich, University Hospital, Dr. von Hauner Children's Hospital, Department of Pediatrics, Disvision of Pediatric Neurology and Developmental Medicine, Munich, Germany
| | - W Müller-Felber
- LMU Munich, University Hospital, Dr. von Hauner Children's Hospital, Department of Pediatrics, Disvision of Pediatric Neurology and Developmental Medicine, Munich, Germany
| | - A Blaschek
- LMU Munich, University Hospital, Dr. von Hauner Children's Hospital, Department of Pediatrics, Disvision of Pediatric Neurology and Developmental Medicine, Munich, Germany
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Schüssler SC, Gerhalter T, Abicht A, Müller-Felber W, Nagel AM, Trollmann R. Rare intronic mutation between Exon 62 and 63 (c.9225-285A>G) of the dystrophin gene associated with atypical BMD phenotype. Neuromuscul Disord 2020; 30:680-684. [PMID: 32669210 DOI: 10.1016/j.nmd.2020.06.003] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 12/14/2022]
Abstract
Dystrophinopathies are predominantly caused by deletions, duplications and point mutations in the coding regions of the dystrophin gene with less than 1% of all pathogenic mutations identified within intronic sequences. We describe a 17-year-old male with a Becker muscular dystrophy diagnosis and mental disability due to an intron mutation that led to aberrant splicing and formation of an additional exon. Histopathological analysis of muscle tissue revealed signs of muscular dystrophy and reduced signal for dystrophin, alpha-sarcoglycan, and alpha-dystroglycan. Multiplex ligation-dependent probe amplification screening and total sequencing of the dystrophin gene did not identify a mutation in the coding regions. However, next generation sequencing revealed an intron mutation between exons 62 and 63 of the dystrophin gene known for pseudoexon formation and disruption of the reading frame. We report a functional consequence of this mutation as an increased intracellular-weighted sodium signal (assessed by 23Na-magnetic resonance imaging) in leg muscles.
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Affiliation(s)
- S C Schüssler
- Department of Pediatrics, Division of Neuropediatrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen (FAU), Loschgestr. 15, 91054 Erlangen, Germany
| | - T Gerhalter
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen (FAU), Erlangen, Germany
| | - A Abicht
- Medical Center of Human Genetics, Munich, Germany
| | - W Müller-Felber
- Department of Pediatric Neurology and Developmental Medicine, Dr. v. Hauner Children's Hospital, Ludwig-Maximilian-Universität Munich, Munich, Germany
| | - A M Nagel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen (FAU), Erlangen, Germany
| | - R Trollmann
- Department of Pediatrics, Division of Neuropediatrics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen (FAU), Loschgestr. 15, 91054 Erlangen, Germany.
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6
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Korinthenberg R, Trollmann R, Felderhoff-Müser U, Bernert G, Hackenberg A, Hufnagel M, Pohl M, Hahn G, Mentzel HJ, Sommer C, Lambeck J, Mecher F, Hessenauer M, Winterholler C, Kempf U, Jacobs BC, Rostasy K, Müller-Felber W. Diagnosis and treatment of Guillain-Barré Syndrome in childhood and adolescence: An evidence- and consensus-based guideline. Eur J Paediatr Neurol 2020; 25:5-16. [PMID: 31941581 DOI: 10.1016/j.ejpn.2020.01.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/27/2019] [Accepted: 01/03/2020] [Indexed: 12/22/2022]
Abstract
This evidence- and consensus-based practical guideline for the diagnosis and treatment of Guillain-Barré Syndrome (GBS) in childhood and adolescence has been developed by a group of delegates from relevant specialist societies and organisations; it is the result of an initiative by the German-Speaking Society of Neuropediatrics (GNP), and is supported by the Association of Scientific Medical Societies (AWMF, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften). A systematic analysis of the literature revealed that only a few adequately-controlled studies exist for this particular age group, while none carries a low risk of bias. For this reason, the diagnostic and therapeutic recommendations largely rely on findings in adult patients with GBS, for which there are a higher number of suitable studies available. Consensus was established using a written, multi-step Delphi process. A high level of consensus could be reached for the crucial steps in diagnosis and treatment. We recommend basing the diagnostic approach on the clinical criteria of GBS and deriving support from CSF and electrophysiological findings. Repetition of invasive procedures that yield ambiguous results is only recommended if the diagnosis cannot be ascertained from the other criteria. For severe or persistently-progressive GBS treatment with intravenous immunoglobulin (IVIG) is recommended, whereas in cases of IVIG intolerance or inefficacy we recommended treatment with plasmapheresis. Corticosteroids are ineffective for GBS but can be considered when acute onset chronic inflammatory demyelinating polyneuropathy (A-CIDP) is suspected due to a prolonged disease course. The full German version of the Guideline is available on the AWMF website (https://www.awmf.org/leitlinien/detail/ll/022-008.html).
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Affiliation(s)
- R Korinthenberg
- Division of Neuropediatrics and Muscular Disorders, Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, University Medical Center (UMC), University of Freiburg, Germany.
| | - R Trollmann
- Department of Neuropediatrics, UMC, Friedrich- Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | | | - G Bernert
- Department of Pediatrics, Kaiser-Franz-Joseph-Hospital with Preyer's Childrens Hospital, Vienna, Austria
| | - A Hackenberg
- Department of Pediatric Neurology, University Children's Hospital, Zürich, Switzerland
| | - M Hufnagel
- Division of Pediatric Infectious Diseases and Rheumatology, Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, UMC, University of Freiburg, Germany
| | - M Pohl
- Section Pediatric Nephrology, Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, UMC, University of Freiburg, Germany
| | - G Hahn
- Department of Radiological Diagnostics, UMC, University of Dresden, Germany
| | - H J Mentzel
- Section Pediatric Radiology, Institute of Diagnostic and Interventional Radiology, Universitätsklinikum Jena, Germany
| | - C Sommer
- Department of Neurology, UMC, University of Wuerzburg, Germany
| | - J Lambeck
- Department of Neurology and Neurophysiology, UMC, University of Freiburg, Germany
| | - F Mecher
- Physio Deutschland, German Federal Association for Physiotherapy, Germany
| | - M Hessenauer
- Centre for Pediatric Neurology, Neurorehabilitation and Epileptology, Schoen Clinic Vogtareuth, Germany
| | - C Winterholler
- German Federal Association of Logopedics (dbl e.V. Deutscher Bundesverband für Logopädie e.v), Germany
| | - U Kempf
- Mother of a GBS PPatient, Kraichtal-Neuenbürg, Germany
| | - B C Jacobs
- Departments of Neurology and Immunology, Erasmus MC, UMC Rotterdam, the Netherlands
| | - K Rostasy
- Department of Neuropediatrics, Children´s Hospital Datteln, University Witten/Herdecke, Germany
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Servais L, Shieh P, Dowling J, Kuntz N, Müller-Felber W, Smith B, Bönnemann C, Muntoni F, Bilder D, Duong T, Graham R, Jain M, Lawlor M, MacBean V, Noursalehi M, Pitts T, Rafferty G, Rico S, Prasad S. P.105INCEPTUS pre-phase 1, prospective, non-interventional, natural history run-in study to evaluate subjects aged 4 years and younger with X-linked myotubular myopathy (XLMTM). Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Vill K, Blaschek A, Gläser D, Kuhn M, Haack T, Alhaddad B, Wagner M, Kovacs-Nagy R, Tacke M, Gerstl L, Schroeder AS, Borggraefe I, Mueller C, Schlotter-Weigel B, Schoser B, Walter MC, Müller-Felber W. Early-Onset Myopathies: Clinical Findings, Prevalence of Subgroups and Diagnostic Approach in a Single Neuromuscular Referral Center in Germany. J Neuromuscul Dis 2019; 4:315-325. [PMID: 29172004 DOI: 10.3233/jnd-170231] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Early-onset myopathies are a heterogeneous group of neuromuscular diseases with broad clinical, genetic and histopathological overlap. The diagnostic approach has considerably changed since high throughput genetic methods (next generation sequencing, NGS) became available. OBJECTIVE We present diagnostic subgroups in a single neuromuscular referral center and describe an algorithm for the diagnostic work-up. METHODS The diagnostic approach of 98 index patients was retrospectively analysed. In 56 cases targeted sequencing of a known gene was performed, in 44 patients NGS was performed using large muscle specific panels, and in 12 individuals whole exome sequencing (WES) was undertaken. One patient was diagnosed via array CGH. Clinical features of all patients are provided. RESULTS The final diagnosis could be found in 63 out of 98 patients (64%) with molecular genetic analysis. In 55% targeted gene sequencing could establish the genetic diagnosis. However, this rate largely depended on the presence of distinct histological or clinical features. NGS (large myopathy-related panels and WES) revealed genetic diagnosis in 58.5% (52% and 67%, respectively). The genes detected by WES in our cohort of patients were all covered by the panels. Based on our findings we propose an algorithm for a practical diagnostic approach.Prevalences:MTM1- and LAMA2-patients are the two biggest subgroups, followed by SEPN1-, RYR1- and Collagen VI-related diseases. 31% of genetically confirmed cases represents a group with overlap between "congenital myopathies (CM)" and "congenital muscular dystrophies (CMD)". In 36% of the patients a specific genetic diagnosis could not be assigned. CONCLUSIONS A final diagnosis can be confirmed by high throughput genetic analysis in 58.5% of the cases, which is a higher rate than reported in the literature for muscle biopsy and should in many cases be considered as a first diagnostic tool. NGS cannot replace neuromuscular expertise and a close discussion with the geneticists on NGS is mandatory. Targeted candidate gene sequencing still plays a role in selected cases with highly suspicious clinical or histological features. There is a relevant clinical and genetic overlap between the entities CM and CMD.
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Affiliation(s)
- K Vill
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Center for Neuromuscular Disorders in Childhood. Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
| | - A Blaschek
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Center for Neuromuscular Disorders in Childhood. Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
| | - D Gläser
- genetikum® Center for Human Genetics, Neu-Ulm, Germany
| | - M Kuhn
- genetikum® Center for Human Genetics, Neu-Ulm, Germany
| | - T Haack
- Institute of Human Genetics, Technische Universität München, Munich, Germany.,Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany.,Institute of Human Genetics, University of Tübingen, Germany
| | - B Alhaddad
- Institute of Human Genetics, Technische Universität München, Munich, Germany.,Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - M Wagner
- Institute of Human Genetics, Technische Universität München, Munich, Germany.,Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany.,Institute für Neurogenomik, Helmholtz Zentrum München, Neuherberg, Germany
| | - R Kovacs-Nagy
- Institute of Human Genetics, Technische Universität München, Munich, Germany
| | - M Tacke
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Center for Neuromuscular Disorders in Childhood. Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
| | - L Gerstl
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Center for Neuromuscular Disorders in Childhood. Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
| | - A S Schroeder
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Center for Neuromuscular Disorders in Childhood. Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
| | - I Borggraefe
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Center for Neuromuscular Disorders in Childhood. Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
| | - C Mueller
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Center for Neuromuscular Disorders in Childhood. Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
| | - B Schlotter-Weigel
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-Universität, München, Munich, Germany
| | - B Schoser
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-Universität, München, Munich, Germany
| | - M C Walter
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-Universität, München, Munich, Germany
| | - W Müller-Felber
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Center for Neuromuscular Disorders in Childhood. Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
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9
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Müller-Felber W, Wilichowski E. Aktuelle therapeutische Möglichkeiten bei Muskeldystrophien. Monatsschr Kinderheilkd 2019. [DOI: 10.1007/s00112-019-0675-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Vill K, Blaschek A, Schara U, Kölbel H, Hohenfellner K, Harms E, Olgemöller B, Walter MC, Müller-Felber W. [Spinal muscular atrophy : Time for newborn screening?]. Nervenarzt 2019; 88:1358-1366. [PMID: 29101527 DOI: 10.1007/s00115-017-0447-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The most common neurodegenerative disease in childhood is spinal muscular atrophy (SMA). The severe infantile type 1 (Werdnig-Hoffman disease) makes 60% of SMA in total. These children usually die within 18 months without ventilation. New therapeutic approaches have led from the theoretical concept to randomized controlled clinical trials in patients. For the first time, a pharmacological treatment of SMA has been approved. The early detection of the disease is decisive for the success of therapy. All previous data suggest starting treatment early and when possible prior to the onset of symptoms considerably improves the outcome in comparison to a delayed start. The goal must be the presymptomatic diagnosis in order to initiate treatment before motor neuron degeneration. Technical and ethical prerequisites for a molecular genetic newborn screening are given.
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Affiliation(s)
- K Vill
- Abteilung für Neuropädiatrie, Entwicklungsneurologie und Sozialpädiatrie, Zentrum für neuromuskuläre Erkrankungen und Neuroimmunologie im Kindesalter, LMU Zentrum - iSPZ Hauner, Kinderklinik und Kinderpoliklinik, Dr. von Haunersches Kinderspital der Universität München, Lindwurmstraße 4, 80337, München, Deutschland.
| | - A Blaschek
- Abteilung für Neuropädiatrie, Entwicklungsneurologie und Sozialpädiatrie, Zentrum für neuromuskuläre Erkrankungen und Neuroimmunologie im Kindesalter, LMU Zentrum - iSPZ Hauner, Kinderklinik und Kinderpoliklinik, Dr. von Haunersches Kinderspital der Universität München, Lindwurmstraße 4, 80337, München, Deutschland
| | - U Schara
- Abteilung für neuromuskuläre Erkrankungen im Kindesalter, Universitätsklinikum Essen, Essen, Deutschland
| | - H Kölbel
- Abteilung für neuromuskuläre Erkrankungen im Kindesalter, Universitätsklinikum Essen, Essen, Deutschland
| | - K Hohenfellner
- Abteilung für Kindernephrologie, Klinik für Kinder- und Jugendmedizin, Klinikum Traunstein, Traunstein, Deutschland
| | - E Harms
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Münster, Münster, Deutschland
| | - B Olgemöller
- Labor Becker, Olgemöller und Kollegen, Neugeborenen-Screening, München, Deutschland
| | - Maggie C Walter
- Neurologische Klinik und Poliklinik, Friedrich-Bau-Institut, Klinikum der Universität München, München, Deutschland
| | - W Müller-Felber
- Abteilung für Neuropädiatrie, Entwicklungsneurologie und Sozialpädiatrie, Zentrum für neuromuskuläre Erkrankungen und Neuroimmunologie im Kindesalter, LMU Zentrum - iSPZ Hauner, Kinderklinik und Kinderpoliklinik, Dr. von Haunersches Kinderspital der Universität München, Lindwurmstraße 4, 80337, München, Deutschland
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Landgraf MN, Heinen F, Kammer B, Seubert C, Olivieri M, Schön C, Hoffmann F, Reiter K, Well T, Müller-Felber W. Schütteltrauma bei einem jungen Säugling. Rechtsmedizin (Berl) 2018. [DOI: 10.1007/s00194-018-0281-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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12
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Kuntz N, Shieh P, Smith B, Bönnemann C, Dowling J, Lawlor M, Müller-Felber W, Noursalehi M, Rico S, Servais L, Prasad S. NEW THERAPEUTIC APPROACHES AND THEIR READOUT. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Laššuthová P, Vill K, Erdem-Ozdamar S, Schröder JM, Topaloglu H, Horvath R, Müller-Felber W, Bansagi B, Schlotter-Weigel B, Gläser D, Neupauerová J, Sedláčková L, Staněk D, Mazanec R, Weis J, Seeman P, Senderek J. Novel SBF2 mutations and clinical spectrum of Charcot-Marie-Tooth neuropathy type 4B2. Clin Genet 2018; 94:467-472. [PMID: 30028002 DOI: 10.1111/cge.13417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 05/14/2018] [Revised: 07/04/2018] [Accepted: 07/17/2018] [Indexed: 12/27/2022]
Abstract
Biallelic SBF2 mutations cause Charcot-Marie-Tooth disease type 4B2 (CMT4B2), a sensorimotor neuropathy with autosomal recessive inheritance and association with glaucoma. Since the discovery of the gene mutation, only few additional patients have been reported. We identified seven CMT4B2 families with nine different SBF2 mutations. Revisiting genetic and clinical data from our cohort and the literature, SBF2 variants were private mutations, including exon-deletion and de novo variants. The neuropathy typically started in the first decade after normal early motor development, was predominantly motor and had a rather moderate course. Electrophysiology and nerve biopsies indicated demyelination and excess myelin outfoldings constituted a characteristic feature. While neuropathy was >90% penetrant at age 10 years, glaucoma was absent in ~40% of cases but sometimes developed with age. Consequently, SBF2 mutation analysis should not be restricted to individuals with coincident neuropathy and glaucoma, and CMT4B2 patients without glaucoma should be followed for increased intraocular pressure. The presence of exon-deletion and de novo mutations demands comprehensive mutation scanning and family studies to ensure appropriate diagnostic approaches and genetic counseling.
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Affiliation(s)
- P Laššuthová
- DNA Laboratory, Department of Pediatric Neurology, Charles University and University Hospital Motol, Prague, Czech Republic
| | - K Vill
- Department of Pediatric Neurology, Dr. v. Hauner Children's Hospital, LMU Munich, Munich, Germany
| | - S Erdem-Ozdamar
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - J M Schröder
- Institute of Neuropathology, RWTH Aachen University Hospital, Aachen, Germany
| | - H Topaloglu
- Department of Pediatric Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - R Horvath
- Wellcome Centre for Mitochondrial Research, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - W Müller-Felber
- Department of Pediatric Neurology, Dr. v. Hauner Children's Hospital, LMU Munich, Munich, Germany
| | - B Bansagi
- Wellcome Centre for Mitochondrial Research, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - B Schlotter-Weigel
- Friedrich-Baur-Institute, Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - D Gläser
- Genetikum, Center for Human Genetics, Neu-Ulm, Germany
| | - J Neupauerová
- DNA Laboratory, Department of Pediatric Neurology, Charles University and University Hospital Motol, Prague, Czech Republic
| | - L Sedláčková
- DNA Laboratory, Department of Pediatric Neurology, Charles University and University Hospital Motol, Prague, Czech Republic
| | - D Staněk
- DNA Laboratory, Department of Pediatric Neurology, Charles University and University Hospital Motol, Prague, Czech Republic
| | - R Mazanec
- Department of Neurology, Charles University and University Hospital Motol, Prague, Czech Republic
| | - J Weis
- Institute of Neuropathology, RWTH Aachen University Hospital, Aachen, Germany
| | - P Seeman
- DNA Laboratory, Department of Pediatric Neurology, Charles University and University Hospital Motol, Prague, Czech Republic
| | - J Senderek
- Friedrich-Baur-Institute, Department of Neurology, University Hospital, LMU Munich, Munich, Germany
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Blaschek A, Huppke P, Kümpfel T, Müller-Felber W, Rostasy K. [Multiple sclerosis in childhood and adolescence : Complex, chronic and differentiated]. Nervenarzt 2017; 88:1377-1384. [PMID: 29038883 DOI: 10.1007/s00115-017-0422-z] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pediatric multiple sclerosis (MS) is one of the most important acquired neurological disorders in childhood and adolescence. A timely recognition, diagnosis and treatment are of utmost importance. This article highlights the current state of knowledge on the etiology, pathogenesis, diagnosis, clinical presentation and treatment in childhood. Although the rate of progression of disability in the early years is slower in younger patients compared to adults, a disease-modifying therapy should be started once MS is diagnosed.
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Affiliation(s)
- A Blaschek
- Pädiatrische Neurologie, Zentrum für neuromuskuläre Erkrankungen und Neuroimmunologie im Kindesalter, LMU Zentrum - iSPZ Hauner, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Universität München, München, Deutschland. .,Abteilung Pädiatrische Neurologie, Entwicklungsneurologie und Sozialpädiatrie, Dr. von Haunersches Kinderspital, Ludwig-Maximilians-Universität München, Lindwurmstraße 4, 80337, München, Deutschland.
| | - P Huppke
- Abteilung Neuropädiatrie, Klinik für Kinder- und Jugendmedizin, Göttingen, Deutschland
| | - T Kümpfel
- Institut für klinische Neuroimmunologie, Campus Großhadern, Klinikum der Universität München, München, Deutschland.,Biomedizinisches Centrum München, Campus Großhadern, Klinikum der Universität München, München, Deutschland
| | - W Müller-Felber
- Pädiatrische Neurologie, Zentrum für neuromuskuläre Erkrankungen und Neuroimmunologie im Kindesalter, LMU Zentrum - iSPZ Hauner, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Universität München, München, Deutschland.,Abteilung Pädiatrische Neurologie, Entwicklungsneurologie und Sozialpädiatrie, Dr. von Haunersches Kinderspital, Ludwig-Maximilians-Universität München, Lindwurmstraße 4, 80337, München, Deutschland
| | - K Rostasy
- Neuropädiatrie und Entwicklungsneurologie, Vestische Kinder- und Jugendklinik Datteln, Universität Witten/Herdecke, Witten, Deutschland
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15
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Müller-Felber W, Schoser B. In memoriam Dieter Pongratz. Z Rheumatol 2017. [DOI: 10.1007/s00393-017-0286-4] [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: 11/30/2022]
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16
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Vill K, Müller-Felber W, Teusch V, Blaschek A, Gerstl L, Huetker S, Albert MH. Proximal muscular atrophy and weakness: An unusual adverse effect of deferasirox iron chelation therapy. Neuromuscul Disord 2016; 26:322-5. [PMID: 27068298 DOI: 10.1016/j.nmd.2016.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 02/11/2016] [Accepted: 02/16/2016] [Indexed: 11/17/2022]
Abstract
Deferasirox is a standard treatment for chronic transfusional iron overload. Adverse effects of deferasirox have been reported in large prospective studies. We report two cases of monozygotic twins manifesting with proximal muscular atrophy and weakness under deferasirox. Discontinuation of deferasirox resulted in symptom improvement and ultimately in complete remission five months after successful haematopoietic stem cell transplantation. Broad diagnostic work-up could not bring evidence of another aetiology of muscular weakness. Iron overload or beta thalassemia itself as a cause is considered unlikely in our patients because the chronological coincidence of muscular symptoms was contra-directional to serum ferritin levels and significant clinical improvement was observed promptly after cessation of deferasirox even before transplantation. These observations suggest that the development of muscular weakness in patients on deferasirox should be recognised as a possible adverse effect of the drug.
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Affiliation(s)
- K Vill
- Department of Pediatric Neurology and Developmental Medicine, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany.
| | - W Müller-Felber
- Department of Pediatric Neurology and Developmental Medicine, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - V Teusch
- Department of Pediatric Radiology, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - A Blaschek
- Department of Pediatric Neurology and Developmental Medicine, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - L Gerstl
- Department of Pediatric Neurology and Developmental Medicine, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - S Huetker
- Department of Pediatric Hematology and Oncology, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - M H Albert
- Department of Pediatric Hematology and Oncology, Dr. v. Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
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Rudnik-Schöneborn S, Tölle D, Senderek J, Eggermann K, Elbracht M, Kornak U, von der Hagen M, Kirschner J, Leube B, Müller-Felber W, Schara U, von Au K, Wieczorek D, Bußmann C, Zerres K. Diagnostic algorithms in Charcot-Marie-Tooth neuropathies: experiences from a German genetic laboratory on the basis of 1206 index patients. Clin Genet 2015; 89:34-43. [PMID: 25850958 DOI: 10.1111/cge.12594] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [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: 02/17/2015] [Revised: 03/18/2015] [Accepted: 04/02/2015] [Indexed: 11/30/2022]
Abstract
We present clinical features and genetic results of 1206 index patients and 124 affected relatives who were referred for genetic testing of Charcot-Marie-Tooth (CMT) neuropathy at the laboratory in Aachen between 2001 and 2012. Genetic detection rates were 56% in demyelinating CMT (71% of autosomal dominant (AD) CMT1/CMTX), and 17% in axonal CMT (24% of AD CMT2/CMTX). Three genetic defects (PMP22 duplication/deletion, GJB1/Cx32 or MPZ/P0 mutation) were responsible for 89.3% of demyelinating CMT index patients in whom a genetic diagnosis was achieved, and the diagnostic yield of the three main genetic defects in axonal CMT (GJB1/Cx32, MFN2, MPZ/P0 mutations) was 84.2%. De novo mutations were detected in 1.3% of PMP22 duplication, 25% of MPZ/P0, and none in GJB1/Cx32. Motor nerve conduction velocity was uniformly <38 m/s in median or ulnar nerves in PMP22 duplication, >40 m/s in MFN2, and more variable in GJB1/Cx32, MPZ/P0 mutations. Patients with CMT2A showed a broad clinical severity regardless of the type or position of the MFN2 mutation. Out of 75 patients, 8 patients (11%) with PMP22 deletions were categorized as CMT1 or CMT2. Diagnostic algorithms are still useful for cost-efficient mutation detection and for the interpretation of large-scale genetic data made available by next generation sequencing strategies.
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Affiliation(s)
- S Rudnik-Schöneborn
- Institute of Human Genetics, RWTH Aachen University Hospital, Aachen, Germany
| | - D Tölle
- Institute of Human Genetics, RWTH Aachen University Hospital, Aachen, Germany
| | - J Senderek
- Institute of Human Genetics, RWTH Aachen University Hospital, Aachen, Germany.,Friedrich-Baur-Institute, LMU Munich, Munich, Germany
| | - K Eggermann
- Institute of Human Genetics, RWTH Aachen University Hospital, Aachen, Germany
| | - M Elbracht
- Institute of Human Genetics, RWTH Aachen University Hospital, Aachen, Germany
| | - U Kornak
- Institute of Medical Genetics and Human Genetics, Charité-University Berlin, Berlin, Germany
| | - M von der Hagen
- Abteilung Neuropädiatrie, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - J Kirschner
- Department of Neuropediatrics, University Hospital Freiburg, Freiburg, Germany
| | - B Leube
- Medical Faculty, Institute of Human Genetics and Anthropology, Heinrich-Heine University, Düsseldorf, Germany
| | - W Müller-Felber
- Dr. v. Hauner Childrens Hospital, University of Munich, Munich, Germany
| | - U Schara
- Department of Neuropediatrics, Developmental Neurology and Social Pediatrics, University Essen, Essen, Germany
| | - K von Au
- SPZ Pediatric Neurology, Charité University Berlin, Berlin, Germany
| | - D Wieczorek
- Institute of Human Genetics, University Essen, Essen, Germany
| | - C Bußmann
- Center for Children and Adolescent Medicine, University Clinic Heidelberg, Heidelberg, Germany
| | - K Zerres
- Institute of Human Genetics, RWTH Aachen University Hospital, Aachen, Germany
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Vill K, Schessl J, Teusch V, Schroeder S, Blaschek A, Schoser B, Müller-Felber W. Muscle ultrasound in classic infantile and adult Pompe disease: A useful screening tool in adults but not in infants. Neuromuscul Disord 2015; 25:120-6. [DOI: 10.1016/j.nmd.2014.09.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 09/29/2014] [Indexed: 12/14/2022]
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Kirschner J, Schorling D, Hauschke D, Rensing-Zimmermann C, Wein U, Grieben U, Schottmann G, Schara U, Konrad K, Müller-Felber W, Thiele S, Wilichowski E, Hobbiebrunken E, Stettner GM, Korinthenberg R. Somatropin treatment of spinal muscular atrophy: a placebo-controlled, double-blind crossover pilot study. Neuromuscul Disord 2013; 24:134-42. [PMID: 24300782 DOI: 10.1016/j.nmd.2013.10.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 10/24/2013] [Accepted: 10/31/2013] [Indexed: 11/25/2022]
Abstract
In preclinical studies growth hormone and its primary mediator IGF-1 have shown potential to increase muscle mass and strength. A single patient with spinal muscular atrophy reported benefit after compassionate use of growth hormone. Therefore we evaluated the efficacy and safety of growth hormone treatment for spinal muscular atrophy in a multicenter, randomised, double-blind, placebo-controlled, crossover pilot trial. Patients (n = 19) with type II/III spinal muscular atrophy were randomised to receive either somatropin (0.03 mg/kg/day) or placebo subcutaneously for 3 months, followed by a 2-month wash-out phase before 3 months of treatment with the contrary remedy. Changes in upper limb muscle strength (megascore for elbow flexion and hand-grip in Newton) were assessed by hand-held myometry as the primary measure of outcome. Secondary outcome measures included lower limb muscle strength, motor function using the Hammersmith Functional Motor Scale and other functional tests for motor function and pulmonary function. Somatropin treatment did not significantly affect upper limb muscle strength (point estimate mean: 0.08 N, 95% confidence interval (CI:-3.79;3.95, p = 0.965), lower limb muscle strength (point estimate mean: 2.23 N, CI:-2.19;6.63, p = 0.302) or muscle and pulmonary function. Side effects occurring during somatropin treatment corresponded with well-known side effects of growth hormone substitution in patients with growth hormone deficiency. In this pilot study, growth hormone treatment did not improve muscle strength or function in patients with spinal muscular atrophy type II/III.
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Affiliation(s)
- J Kirschner
- Department of Neuropaediatrics and Muscle Disorders, University Medical Center, Freiburg, Germany.
| | - D Schorling
- Department of Neuropaediatrics and Muscle Disorders, University Medical Center, Freiburg, Germany
| | - D Hauschke
- Institute of Medical Biometry and Medical Informatics, University of Freiburg, Germany
| | - C Rensing-Zimmermann
- Department of Neuropaediatrics and Muscle Disorders, University Medical Center, Freiburg, Germany
| | - U Wein
- Department of Neuropaediatrics and Muscle Disorders, University Medical Center, Freiburg, Germany
| | - U Grieben
- Department of Neuropaediatrics, Charité University Medical School, Berlin, Germany
| | - G Schottmann
- Department of Neuropaediatrics, Charité University Medical School, Berlin, Germany
| | - U Schara
- Department of Paediatric Neurology, University Hospital Essen, Germany
| | - K Konrad
- Department of Paediatric Endocinology, University Hospital Essen, Germany
| | - W Müller-Felber
- Department of Paediatric Neurology and Developmental Medicine, Dr. Von Hauner Children's Hospital, München, Germany
| | - S Thiele
- Department of Paediatric Neurology and Developmental Medicine, Dr. Von Hauner Children's Hospital, München, Germany
| | - E Wilichowski
- Department of Paediatrics and Paediatric Neurology, Georg August University, Göttingen, Germany
| | - E Hobbiebrunken
- Department of Paediatrics and Paediatric Neurology, Georg August University, Göttingen, Germany
| | - G M Stettner
- Department of Paediatrics and Paediatric Neurology, Georg August University, Göttingen, Germany
| | - R Korinthenberg
- Department of Neuropaediatrics and Muscle Disorders, University Medical Center, Freiburg, Germany
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20
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Holdenried M, Schenck TL, Akpaloo J, Müller-Felber W, Holzbach T, Giunta RE. [Quality of life after brachial plexus lesions in adults]. HANDCHIR MIKROCHIR P 2013; 45:229-34. [PMID: 23970402 DOI: 10.1055/s-0033-1353161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Brachial plexus lesions are among the most severe injuries of the upper extremity. Despite intensive conservative and surgical treatment efforts, patients frequently suffer from serious impairments in the quality of life. This contribution presents the results of a retrospective clinical survey on the quality of life after brachial plexus injuries. Out of 38 treated patients, 25 patients could be included in the study. The disability of arm, shoulder and hand was evaluated by the DASH score and the quality of life by the FLZm, a questionnaire on life satisfaction. In addition, demographic data, work situation and mechanism and type of injury were recorded. The examined patients were mainly young males who were injured in traffic, in particular motorcycle accidents. The DASH score analysis revealed that plexus injuries are among the most disabling injuries of the upper extremity. The associated restrictions in the different sections of the quality of life involve not only the health-related section but also partnership, family and leisure time activities. A strong relation between the possibility to return to work and the quality of life was found. We recommend the use of the DASH score and the FLZm questionnaire on life satisfaction as routine tools for the evaluation of the therapeutic outcome after brachial plexus injuries.
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Affiliation(s)
- M Holdenried
- Handchirurgie, Plastische Chirurgie, Äshetische Chirurgie, Klinikum der Ludwig-Maximilians Universität, München
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21
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Blaschek A, Keeser D, Müller S, Koerte IK, Sebastian Schröder A, Müller-Felber W, Heinen F, Ertl-Wagner B. Early white matter changes in childhood multiple sclerosis: a diffusion tensor imaging study. AJNR Am J Neuroradiol 2013; 34:2015-20. [PMID: 23681354 DOI: 10.3174/ajnr.a3581] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Loss of integrity in nonlesional white matter occurs as a fundamental feature of multiple sclerosis in adults. The purpose of our study was to evaluate DTI-derived measures of white matter microstructure in children with MS compared with age- and sex-matched controls by using tract-based spatial statistics. MATERIALS AND METHODS Fourteen consecutive pediatric patients with MS (11 female/3 male; mean age, 15.1 ± 1.6 years; age range, 12-17 years) and age- and sex-matched healthy subjects (11 female/3 male; mean age, 14.8 ± 1.7 years) were included in the study. After we obtained DTI sequences, data processing was performed by using tract-based spatial statistics. RESULTS Compared with healthy age- and sex-matched controls, children with multiple sclerosis showed a global decrease in mean fractional anisotropy (P ≤ .001), with a concomitant increase in mean (P < .001), radial (P < .05), and axial diffusivity (P < .001). The most pronounced fractional anisotropy value decrease in patients with MS was found in the splenium of the corpus callosum (P < .001). An additional decrease in fractional anisotropy was identified in the right temporal and right and left parietal regions (P < .001). Fractional anisotropy of the white matter skeleton was related to disease duration and may, therefore, serve as a diagnostic marker. CONCLUSIONS The microstructure of white matter is altered early in the disease course in childhood multiple sclerosis.
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Affiliation(s)
- A Blaschek
- Department of Pediatric Neurology and Developmental Medicine, Hauner Children's Hospital, Ludwig-Maximilian-University, Munich, Germany
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Hahn A, Hennermann J, Marquardt T, Huemer M, Rohrbach M, Müller-Felber W, Mellies U, Stehling F, Kampmann C, Mengel E. M.Pompe im Kindesalter. Monatsschr Kinderheilkd 2012. [DOI: 10.1007/s00112-012-2789-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schenck TL, Bayer T, Enders A, Marton MA, Machens HG, Müller-Felber W, Giunta RE. [Splints in birth-related brachial plexus injuries]. HANDCHIR MIKROCHIR P 2011; 43:105-11. [PMID: 21509702 DOI: 10.1055/s-0031-1271660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Most cases of obstetrical brachial plexus palsies are mild traction injuries which resolve under physical therapy within several weeks or months. Severe ruptures or avulsion injuries of the plexus can lead to lifelong impairment of the upper extremities. Hence, in severe brachial plexus injuries the indications for brachial plexus reconstruction should be evaluated, early. At the age of about 3 months, the infant should be presented in a centre specialised in obstetrical brachial plexus palsies. In almost all cases intensive physical therapy is performed. In addition, many patients require splinting in order to gain function as part of the conservative therapy or for postoperative fixation. Depending on the type of splint, different demands are made on design, material and strategy of adjustment. Many different natural and synthetic materials are available for orthopaedic constructions. Because of its good adjustment options, the use of low temperature thermoplastic is steadily increasing. This contribution presents an overview of our currently used splints, new technical developments in our experience with more than 200 patients with obstetrical brachial plexus palsy. We present our experience with the most common splints for the use in fixation after birth-related brachial plexus surgery, subscapularis release, trapezius muscle transfer and functional improvement of hands with a lack of wrist extension.
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Affiliation(s)
- T L Schenck
- Technische Universität München, Klinik und Poliklinik für Plastische Chirurgie und Handchirurgie, München.
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Müller-Höcker J, Horvath R, Schäfer S, Hessel H, Müller-Felber W, Kühr J, Copeland WC, Seibel P. Mitochondrial DNA depletion and fatal infantile hepatic failure due to mutations in the mitochondrial polymerase γ (POLG) gene: a combined morphological/enzyme histochemical and immunocytochemical/biochemical and molecular genetic study. J Cell Mol Med 2011; 15:445-56. [PMID: 19538466 PMCID: PMC3822808 DOI: 10.1111/j.1582-4934.2009.00819.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 05/06/2009] [Indexed: 11/27/2022] Open
Abstract
Combined morphological, immunocytochemical, biochemical and molecular genetic studies were performed on skeletal muscle, heart muscle and liver tissue of a 16-months boy with fatal liver failure. The pathological characterization of the tissues revealed a severe depletion of mtDNA (mitochondrial DNA) that was most pronounced in liver, followed by a less severe, but still significant depletion in skeletal muscle and the heart. The primary cause of the disease was linked to compound heterozygous mutations in the polymerase γ (POLG) gene (DNA polymerase γ; A467T, K1191N). We present evidence, that compound heterozygous POLG mutations lead to tissue selective impairment of mtDNA replication and thus to a mosaic defect pattern even in the severely affected liver. A variable defect pattern was found in liver, muscle and heart tissue as revealed by biochemical, cytochemical, immunocytochemical and in situ hybridization analysis. Functionally, a severe deficiency of cytochrome-c-oxidase (cox) activity was seen in the liver. Although mtDNA depletion was detected in heart and skeletal muscle, there was no cox deficiency in these tissues. Depletion of mtDNA and microdissection of cox-positive or negative areas correlated with the histological pattern in the liver. Interestingly, the mosaic pattern detected for cox-activity and mtDNA copy number fully aligned with the immunohistologically revealed defect pattern using Pol γ, mtSSB- and mtTFA-antibodies, thus substantiating the hypothesis that nuclear encoded proteins located within mitochondria become unstable and are degraded when they are not actively bound to mtDNA. Their disappearance could also aggravate the mtDNA depletion and contribute to the non-homogenous defect pattern.
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Affiliation(s)
- J Müller-Höcker
- Pathologisches Institut der Ludwig-Maximilians-Universität, München, Germany.
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25
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Schoser B, Goebel HH, Janisch I, Quasthoff S, Rother J, Bergmann M, Müller-Felber W, Windpassinger C. Consequences of mutations within the C terminus of the FHL1 gene. Neurology 2009; 73:543-51. [PMID: 19687455 DOI: 10.1212/wnl.0b013e3181b2a4b3] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mutations in the four-and-a-half LIM domain 1 gene (FHL1) cause X-linked late-onset scapuloaxioperoneal myopathy characterized by postural muscle atrophy with rigid spine syndrome with pseudoathleticism/hypertrophy (XMPMA), reducing body myopathy (RBM), and scapuloperoneal myopathy. Divergences in these diseases are hitherto unclear; therefore, we searched for additional families to elucidate differences and similarities of these allelic FHL1opathies. METHODS Using genotyping and phenotyping (mutational analysis, muscle histopathology, and Western blotting) we characterized 10 affected men and 8 women from 7 families. RESULTS All patients displayed the XMPMA phenotype. In 1 family with a novel missense mutation, 2 affected men had an aneurysm of the sinus of Valsalva in addition. In 5 affected men and 2 affected women from 4 families, the C224W missense mutation in FHL1 was detected, which putatively disrupts the fourth LIM domain. In 3 other families with 5 affected men and 1 female, 2 novel missense variants and a novel splice-site mutation in the C terminus of FHL1 were found. Muscle morphology revealed mild to moderate degenerative myopathy with myofiber hypertrophy of both fiber types at younger age and cytoplasmic bodies in the majority of the samples. Reducing bodies, pathognomonic for RBM, were not found. Western blotting revealed no detectable FHL1A protein in our patients. CONCLUSIONS As a consequence of C terminal FHL1 gene mutations, the X-linked myopathy characterized by postural muscle atrophy (XMPMA) phenotype and morphotype with cytoplasmic bodies are found. In the spectrum of FHL1opathies, the preserved FHL1C protein is likely responsible for the moderate XMPMA phenotype compared with the more severe reducing body myopathy/scapuloperoneal myopathy phenotype.
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Affiliation(s)
- B Schoser
- Friedrich-Baur Institute, Department of Neurology, Ludwig-Maximilians University Munich, Ziemssenstr. 1a, 80336 Munich, Germany.
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Strothotte S, Strigl-Pill N, Grunert B, Kornblum C, Eger K, Wessig C, Deschauer M, Breunig F, Glocker FX, Vielhaber S, Brejova A, Hilz M, Reiners K, Müller-Felber W, Mengel E, Spranger M, Schoser B. Enzyme replacement therapy with alglucosidase alfa in 44 patients with late-onset glycogen storage disease type 2: 12-month results of an observational clinical trial. J Neurol 2009; 257:91-7. [DOI: 10.1007/s00415-009-5275-3] [Citation(s) in RCA: 166] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Revised: 07/07/2009] [Accepted: 07/23/2009] [Indexed: 10/20/2022]
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Winchester B, Bali D, Bodamer OA, Caillaud C, Christensen E, Cooper A, Cupler E, Deschauer M, Fumić K, Jackson M, Kishnani P, Lacerda L, Ledvinová J, Lugowska A, Lukacs Z, Maire I, Mandel H, Mengel E, Müller-Felber W, Piraud M, Reuser A, Rupar T, Sinigerska I, Szlago M, Verheijen F, van Diggelen OP, Wuyts B, Zakharova E, Keutzer J. Methods for a prompt and reliable laboratory diagnosis of Pompe disease: report from an international consensus meeting. Mol Genet Metab 2008; 93:275-81. [PMID: 18078773 DOI: 10.1016/j.ymgme.2007.09.006] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Accepted: 09/11/2007] [Indexed: 11/20/2022]
Abstract
Pompe disease is an autosomal recessive disorder of glycogen metabolism caused by a deficiency of the lysosomal enzyme acid alpha-glucosidase (GAA). It presents at any age, with variable rates of progression ranging from a rapidly progressive course, often fatal by one-year of age, to a more slowly, but nevertheless relentlessly progressive course, resulting in significant morbidity and premature mortality. In infants, early initiation of enzyme replacement therapy is needed to gain the maximum therapeutic benefit, underscoring the need for early diagnosis. Several new methods for measuring GAA activity have been developed. The Pompe Disease Diagnostic Working Group met to review data generated using the new methods, and to establish a consensus regarding the application of the methods for the laboratory diagnosis of Pompe disease. Skin fibroblasts and muscle biopsy have traditionally been the samples of choice for measuring GAA activity. However, new methods using blood samples are rapidly becoming adopted because of their speed and convenience. Measuring GAA activity in blood samples should be performed under acidic conditions (pH 3.8-4.0), using up to 2 mM of the synthetic substrate 4-methylumbelliferyl-alpha-D-glucoside or glycogen (50 mg/mL), in the presence of acarbose (3-9 microM) to inhibit the isoenzyme maltase-glucoamylase. The activity of a reference enzyme should also be measured to confirm the quality of the sample. A second test should be done to support the diagnosis of Pompe disease until a program for external quality assurance and proficiency testing of the enzymatic diagnosis in blood is established.
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Schoser BGH, Müller-Höcker J, Horvath R, Gempel K, Pongratz D, Lochmüller H, Müller-Felber W. Adult-onset glycogen storage disease type 2: clinico-pathological phenotype revisited. Neuropathol Appl Neurobiol 2007; 33:544-59. [PMID: 17573812 DOI: 10.1111/j.1365-2990.2007.00839.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The need for clinical awareness and diagnostic precision of glycogen storage disease type 2 (GSD2) has increased, as enzyme replacement therapy has become available. So far, only small series have reported the muscle pathology of late-onset GSD2. We reassessed 43 muscle biopsies of 38 GSD2 patients. In all patients the diagnosis of GSD2 has been established by biochemistry and/or mutational analysis of the GAA gene. Additionally to the expected morphological features, ultrastructural analysis revealed a high incidence of autophagic vacuoles, lipofuscin debris, structural Z-line disorganization and histological neurogenic-like pattern that were not thoroughly appreciated, previously. Comparing age at onset and morphology, excessive vacuolar and autophagic myopathy and mitochondrial disorganization of virtually all fibres is common in infants. At juvenile onset, a more moderate vacuolization without significant differences in overall morphology is notable. At late-onset, the spectrum of vacuolar myopathy is more divergent, ranging from almost normal to severe. Here pronounced secondary alterations are observed that include lipofuscin debris, autophagic vacuoles with residual lysosomal bodies and granular inclusions, structural mitochondrial and Z-line texture alterations. Moreover, there is a high incidence of subtle neurogenic-like alteration in all subtypes. Nineteen patients were genetically tested; in 15 patients the common leaky splicing mutation c.-45T>G (or IVS1-13T>G) in intron1 of the GAA gene was found on at least one allele, facilitating genetic screening. In our patients, GAA genotype appears not to be associated with secondary alterations such as autophagic vacuoles, structural alterations or neurogenic-like changes. These findings may have implications for our understanding of the pathogenesis of GSD2 and for assessing therapeutic success of enzyme replacement therapy.
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Affiliation(s)
- B G H Schoser
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-University, Munich, Germany.
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Schoser B, Hilton-Jones D, Müller-Felber W, Kubisch C, Vincent A, Van den Bergh P. G.O.4 Immune-mediated rippling muscle disease with myasthenia gravis: a report of 7 patients. Neuromuscul Disord 2006. [DOI: 10.1016/j.nmd.2006.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Müller JS, Baumeister SK, Rasic VM, Krause S, Todorovic S, Kugler K, Müller-Felber W, Abicht A, Lochmüller H. Impaired receptor clustering in congenital myasthenic syndrome with novel RAPSN mutations. Neurology 2006; 67:1159-64. [PMID: 16931511 DOI: 10.1212/01.wnl.0000233837.79459.40] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Congenital myasthenic syndromes (CMS) with underlying RAPSN mutations turned out to be of high clinical relevance due to their worldwide frequency. To date, all reported patients with CMS with sequence variations in the translated region of RAPSN carry the mutation N88K on at least one allele. The authors report two patients lacking the common N88K allele but harboring differing novel mutations of the RAPSN gene on both alleles: one patient is homozygous for a missense mutation (R164C); the second patient is compound heterozygous for a splice (IVS1-15C>A) and another missense mutation (L283P). METHODS The authors analyzed the RAPSN gene for sequence variations and carried out in vitro studies in order to delineate the potential pathogenicity of the three novel RAPSN mutations. RESULTS For the putative splice mutation (IVS1-15C>A), the authors constructed wild-type and mutated RAPSN minigenes for transfection and subsequent RNA analysis. The mutation generates a novel acceptor splice site leading to retention of 13 nucleotides of intron 1 in the mature mRNA and subsequently to a frameshift transcript. Cotransfection of wild-type AChR subunits with RAPSN-constructs carrying R164C and L283P indicate that both mutations diminish coclustering of AChR with rapsyn. CONCLUSIONS Screening for the common mutation RAPSN N88K facilitates targeted genetic analysis in congenital myasthenic syndromes. However, absence of a N88K allele does not exclude underlying RAPSN mutations as cause of the congenital myasthenic syndromes. Sequencing of the entire gene may be considered in patients with joint contractures and respiratory problems even in the absence of the mutation N88K.
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Affiliation(s)
- J S Müller
- Friedrich-Baur-Institute, Department of Neurology, Munich, Germany
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31
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Strigl-Pill N, König A, Schröder M, Beranek H, Schoser BGH, Spaeth M, Pongratz D, Müller-Felber W. Prediction of response to IVIg treatment in patients with lower motor neurone disorders. Eur J Neurol 2006; 13:135-40. [PMID: 16490043 DOI: 10.1111/j.1468-1331.2006.01142.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The distinction between multifocal motor neuropathy, treatable by intravenous immunoglobulins (IVIg), and degenerative motor neurone disorders is often difficult. To find predictive factors for the response to IVIg treatment, 40 consecutive patients with pure lower motor neurone disorders (LMND) were prospectively examined. They all received at least two times IVIg (2 g/kg bodyweight). Prior to the first and before all the following treatments a standardized evaluation was performed including clinical examination, neurophysiological and laboratory evaluation. According to changes in the neurological examination and the Neuromuscular Symptom Score, the patients were divided into responders and non-responders after the second course of treatment. In our study, no single clinical, neurophysiological, or laboratory parameter was sensitive enough to predict response. The only single parameter that highly correlated with a positive response to treatment was an elevated GM1 antibody titre. Lack of response to IVIg treatment is likely in patients with generalization of electromyographic signs of denervation beyond the clinically involved site, proximal localization of the weakness, and an elevated level of the creatinekinase. Conduction blocks do not distinguish between both groups. We propose a scoring system combining clinical, serological and neurophysiological data in order to decide which patients with LMND may receive IVIg.
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Müller-Felber W. [Muscular pain in viral infections]. MMW Fortschr Med 2005; 147:45-6. [PMID: 16255516] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Affiliation(s)
- W Müller-Felber
- FriedrichBaur-Institut, Neurologische Klinik der LMU München
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33
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Walter MC, Petersen JA, Stucka R, Fischer D, Schröder R, Vorgerd M, Schroers A, Schreiber H, Hanemann CO, Knirsch U, Rosenbohm A, Huebner A, Barisic N, Horvath R, Komoly S, Reilich P, Müller-Felber W, Pongratz D, Müller JS, Auerswald EA, Lochmüller H. FKRP (826C>A) frequently causes limb-girdle muscular dystrophy in German patients. J Med Genet 2004; 41:e50. [PMID: 15060126 PMCID: PMC1735747 DOI: 10.1136/jmg.2003.013953] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- M C Walter
- Gene Center, Friedrich-Baur-Institute, and Department of Neurology, Ludwig-Maximilians-University of Munich, Germany
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34
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Walter MC, Dekomien G, Schlotter-Weigel B, Reilich P, Pongratz D, Müller-Felber W, Epplen JT, Huebner A, Lochmüller H. Respiratory insufficiency as a presenting symptom of LGMD2D in adulthood. Acta Myol 2004; 23:1-5. [PMID: 15298081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Several forms of recessive limb girdle muscular dystrophy (LGMD2C-F) are due to mutations in genes coding for sarcoglycans. Clinically, most sarcoglycanopathies present in childhood with skeletal muscle wasting and early loss of ambulation; respiratory insufficiency is rare. However, some cases of LGMD2D with a late onset and a milder course have been reported. In this study, two adult brothers, compound heterozygous for two missense mutations of the SGCA gene (Arg77Cys, Val247Met), presented with respiratory insufficiency while they were still ambulatory.
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Affiliation(s)
- M C Walter
- Friedrich-Baur-Institute, Department of Neurology, Gene Center, Ludwig-Maximilians-University of Munich, Germany
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35
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Müller-Felber W. [Diagnostics and therapy of myositis]. Fortschr Neurol Psychiatr 2003; 71:549-62. [PMID: 14551856 DOI: 10.1055/s-2003-42875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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36
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Müller JS, Mildner G, Müller-Felber W, Schara U, Krampfl K, Petersen B, Petrova S, Stucka R, Mortier W, Bufler J, Kurlemann G, Huebner A, Merlini L, Lochmüller H, Abicht A. Rapsyn N88K is a frequent cause of congenital myasthenic syndromes in European patients. Neurology 2003; 60:1805-10. [PMID: 12796535 DOI: 10.1212/01.wnl.0000072262.14931.80] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mutations in various genes of the neuromuscular junction may cause congenital myasthenic syndromes (CMS). Most mutations identified to date affect the epsilon-subunit gene of the acetylcholine receptor (AChR), leading to end-plate AChR deficiency. Recently, three different mutations in the RAPSN gene have been identified in four CMS patients with AChR deficiency. OBJECTIVE To perform mutation analysis of the RAPSN gene in patients with sporadic or autosomal recessive CMS. METHODS One hundred twenty CMS patients from 110 unrelated families were analyzed for the RAPSN mutation N88K by restriction fragment length polymorphism and sequence analysis. RESULTS In 12 CMS patients from 10 independent families, RAPSN N88K was identified either homozygous or heteroallelic to another missense mutation. Symptoms usually started perinatally or in the first years of life. However, one patient did not show any myasthenic symptoms before the third decade. Clinical symptoms typically included bilateral ptosis, weakness of facial, bulbar, and limb muscles, and a favorable response to anticholinesterase treatment. Crisis-like exacerbations with respiratory insufficiency provoked by stress, fever, or infections in early childhood were frequent. All RAPSN N88K families originate from Central or Western European countries. Genotype analysis indicated that they derive from a common ancestor (founder). CONCLUSIONS The RAPSN mutation N88K is a frequent cause of rapsyn-related CMS in European patients. In general, patients (RAPSN N88K) were characterized by mild to moderate myasthenic symptoms with favorable response to anticholinesterase treatment. However, severity and onset of symptoms may vary to a great extent.
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Affiliation(s)
- J S Müller
- Friedrich Baur Institute, Department of Neurology, and Gene Center, Ludwig Maximilians University, Munich, Germany
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Walter MC, Lochmüller H, Schlotter-Weigel B, Meindl T, Müller-Felber W. Successful treatment of muscle sarcoidosis with thalidomide. Acta Myol 2003; 22:22-5. [PMID: 12966701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
A 36-year-old male patient suffered from therapy resistant sarcoidosis with long-standing contractures, myopathy, skin lesions and pulmonary changes. Low-dose therapy with thalidomide (50 mg/day) was well tolerated, and the patient rapidly improved. Thalidomide was effective for muscular, cutaneous, and pulmonary involvement in our patient. This is the first report on the efficacy of thalidomide in muscle sarcoidosis. Therefore, thalidomide may become a second-line agent in patients with severe muscle and skin involvement, but further studies are warranted.
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Affiliation(s)
- M C Walter
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians University of Munich, Ziemssenstr. 1a, 80336 Munich, Germany.
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Padovan CS, Sostak P, Reich P, Kolb HJ, Müller-Felber W, Straube A. [Neuromuscular complications after allogeneic bone marrow transplantation]. Nervenarzt 2003; 74:159-66. [PMID: 12596017 DOI: 10.1007/s00115-002-1465-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Neuromuscular syndromes following allogeneic bone marrow transplantation (BMT), although occasionally described,were not the focus of studies concerning neurologic complications following bone marrow transplantation. In this study,we summarize different polyneuropathy syndromes following BMT and report on patients with myasthenia gravis and inflammatory neuromuscular disorders such as myositis or fasciitis. Concerning the etiology of neuropathies, a neurotoxicity of immunosuppressants,a preexisting disorder due to the underlying disease as well as an association with graft-versus-host disease (GVHD) is discussed.GVHD-associated polyneuropathies as well as muscular complications have been found to occur during the early BMT phase, while myasthenia gravis is a late neurologic complication of GVHD.
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Affiliation(s)
- C S Padovan
- Neurologische Klinik, Ludwig-Maximilians-Universität München, Munich.
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39
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Muehlenberg K, Fiedler A, Schaumann I, Müller-Felber W, Wiedmann KH. [Intestinal pseudoobstructions and gastric necrosis in mitochondrial myopathy]. Dtsch Med Wochenschr 2002; 127:611-5. [PMID: 11907863 DOI: 10.1055/s-2002-22669] [Citation(s) in RCA: 11] [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: 10/17/2022]
Abstract
HISTORY AND CLINICAL FINDINGS A 24-year-old female patient suffered for 4 months from recurrent abdominal pain, vomiting and diarrhea. Signs of an acute abdomen were the initial reason for admitting the patient to our hospital. The slim, pale patient had a complete bloated abdomen. Neurological status was normal. INVESTIGATIONS, TREATMENT AND COURSE Radiographic examination showed a paralytic ileus with a megacolon. The recurrent abdominal symptoms were due to a covered perforation of the stomach. This was shrunken, scarred and had to be resected. Further intestinal pseudoobstructions were accompanied by substantial exsudations in the lungs, intestines and abdomen. At this time mutism like behavior patterns and an ophthalmoplegia appeared. Leukoencephalopathy in brain MRI scans and increased liquor-lactate suggested mitochondrial myopathy. DIAGNOSIS The diagnosis of a mitochondrial myopathy was confirmed by increased liquor-lactate level, muscle biopsy with ragged-red fibers as well as abnormal mitochondrias and molecular-genetic investigations (mtDNA point mutation A3243G). Associations to MELAS (mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes) and MNGIE (mitochondrial neuro-gastrointestinal encephalomyopathy) syndrome are discussed. CONCLUSIONS Unclear recurrent gastrointestinal symptoms even in the absence of neurological changes may reflect a mitochondrial disease. This applies especially to young patients with recurrent anorexia, vomiting and pseudoobstruction. In case of additional symptoms like ophthalmopathy, deafness, diabetes mellitus or signs of a MELAS syndrome the search for a mitochondrial system disorder is mandatory.
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Affiliation(s)
- K Muehlenberg
- Med. Klinik II, Gastroenterologie, Infektionskrankheiten, Rheumatologie/Immunologie, Krankenhaus Barmherzige Brüder Regensburg, Germany
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Merlini L, Gooding R, Lochmüller H, Müller-Felber W, Walter MC, Angelicheva D, Talim B, Hallmayer J, Kalaydjieva L. Genetic identity of Marinesco-Sjögren/myoglobinuria and CCFDN syndromes. Neurology 2002; 58:231-6. [PMID: 11805249 DOI: 10.1212/wnl.58.2.231] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [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: 12/26/2022] Open
Abstract
OBJECTIVE AND BACKGROUND To describe three Gypsy families with Marinesco-Sjögren syndrome (MSS), demyelinating neuropathy, and recurrent episodes of myoglobinuria in five of the six affected subjects. Because these families originated from the same genetically isolated founder population as did patients with congenital cataracts facial dysmorphism neuropathy (CCFDN) syndrome, and because the two syndromes have clinical manifestations in common, we hypothesized that the two related, albeit distinct, syndromes may represent clinical variants of a single genetic disorder. METHODS Clinical studies were conducted and linkage and haplotype analyses were performed for the three families. A total of 16 individuals, including the 6 with MSS and 10 unaffected relatives, were genotyped for six polymorphic microsatellite markers from the CCFDN region on 18qter. RESULTS Linkage analysis of markers in the 18qter region, where we previously had located the CCFDN gene, produced a lod score of 3.55, demonstrating colocalization of the gene responsible for MSS with demyelinating neuropathy and myoglobinuria with the CCFDN gene. Moreover, the patients with MSS shared the conserved marker haplotype found in CCFDN chromosomes. CONCLUSIONS These data suggest that Marinesco-Sjögren syndrome with peripheral neuropathy and myoglobinuria, and congenital cataracts facial dysmorphism neuropathy syndrome are genetically identical and are caused by a single founder mutation.
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Affiliation(s)
- L Merlini
- Neuromuscular Unit, Istituto Ortopedico Rizzoli, Bologna, Italy
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41
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Müller-Felber W, Reimers CD. Kompressionssyndrome bei rheumatischen Erkrankungen. AKTUEL RHEUMATOL 2001. [DOI: 10.1055/s-2001-19061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Müller-Felber W. [Therapy of polyneuropathies. Causal and symptomatic]. MMW Fortschr Med 2001; 143 Suppl 2:54-9. [PMID: 11434260] [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: 02/20/2023]
Abstract
In the first instance, polyneuropathies are treated causally. The most common underlying cause is diabetes mellitus or alcohol abuse. In a large number of patients with polyneuropathy, however, the underlying cause cannot be definitively identified. For these--but equally for patients with etiologically clear polyneuropathy--a stock-taking of clinical symptoms should be carried out and, where indicated, symptomatic treatment initiated. In addition to medication aimed at combating pain, muscular spasm, autonomic functional disorders, and for the prevention of thrombosis, physical measures (physiotherapy, foot care, orthopedic shoes) are of primary importance.
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Affiliation(s)
- W Müller-Felber
- Friedrich-Baur-Institut, Ludwig-Maximilians-Universität München
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Walter MC, Lochmüller H, Schlotter B, Reilich P, Müller-Felber W, Pongratz D. [New insights in pathogenesis and therapy of sporadic inclusion body myositis (s-IBM)]. Nervenarzt 2001; 72:117-21. [PMID: 11256145 DOI: 10.1007/s001150050723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sporadic inclusion body myositis (s-IBM) is a chronic progressive inflammatory myopathy which occurs preferentially in older patients. Histologic hallmarks are rimmed vacuoles and eosinophilic cytoplasmatic inclusions. The etiology is still unknown, but different pathogenetic mechanisms such as slow virus infection, autoimmunopathogenesis, myonuclear alterations, and mitochondrial defects have been implicated. A relation to neurodegenerative disorders and prion diseases has also been suggested. There is a poor response if any to immunosuppressive therapy. Stabilization of disease progression was shown only by intravenous immunoglobulin (IVIG) therapy. Future findings in the field of s-IBM pathogenesis may result in better therapeutic options.
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Affiliation(s)
- M C Walter
- Friedrich-Baur-Institut, Medizinische Klink, Klinikum der Ludwig-Maximilians-Universität, Ziemssenstr. 1a, 80336 München.
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Müller-Felber W, Pongratz D, Reimers C. 64th ENMC International Workshop: therapeutic approaches to dermatomyositis, polymyositis, and inclusion body myositis29-31 January 1999, Naarden, The Netherlands. Neuromuscul Disord 2001; 11:88-92. [PMID: 11166170 DOI: 10.1016/s0960-8966(00)00161-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- W Müller-Felber
- Friedrich-Baur-Institut, Ludwig Maximilians University, Munich, Germany
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45
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Klopstock T, Querner V, Schmidt F, Gekeler F, Walter M, Hartard M, Henning M, Gasser T, Pongratz D, Straube A, Dieterich M, Müller-Felber W. A placebo-controlled crossover trial of creatine in mitochondrial diseases. Neurology 2000; 55:1748-51. [PMID: 11113239 DOI: 10.1212/wnl.55.11.1748] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To test the efficacy and safety of creatine (Cr) monohydrate in mitochondrial diseases, 16 patients with chronic progressive external ophthalmoplegia or mitochondrial myopathy were randomized in a crossover design to receive double-blind placebo or 20 g Cr/day for 4 weeks. Cr was well tolerated, but there were no significant effects with regard to exercise performance, eye movements, or activities of daily life. The power of this pilot study was limited and future multicenter trials are needed.
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Affiliation(s)
- T Klopstock
- Department of Neurology, Ludwig-Maximilians-Universität München, Germany.
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Walter MC, Lochmüller H, Reilich P, Klopstock T, Huber R, Hartard M, Hennig M, Pongratz D, Müller-Felber W. Creatine monohydrate in muscular dystrophies: A double-blind, placebo-controlled clinical study. Neurology 2000; 54:1848-50. [PMID: 10802796 DOI: 10.1212/wnl.54.9.1848] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors assessed the safety and efficacy of creatine monohydrate (Cr) in various types of muscular dystrophies in a double-blind, crossover trial. Thirty-six patients (12 patients with facioscapulohumeral dystrophy, 10 patients with Becker dystrophy, 8 patients with Duchenne dystrophy, and 6 patients with sarcoglycan-deficient limb girdle muscular dystrophy) were randomized to receive Cr or placebo for 8 weeks. There was mild but significant improvement in muscle strength and daily-life activities by Medical Research Council scales and the Neuromuscular Symptom Score. Cr was well tolerated throughout the study period.
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Affiliation(s)
- M C Walter
- Friedrich-Baur-Institute, Ludwig-Maximilians-University of Munich, Germany.
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47
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Affiliation(s)
- W Müller-Felber
- Friedrich-Baur-Institut, Klinikum Innenstadt, Ludwig Maximilians Universität München
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48
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Toepfer M, Schroeder M, Müller-Felber W, Lochmüller H, Sitter T, Pongratz D, Schiffl H. Successful management of polyneuropathy associated with IgM gammopathy of undetermined significance with antibody-based immunoadsorption. Clin Nephrol 2000; 53:404-7. [PMID: 11305816] [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: 02/19/2023] Open
Abstract
Peripheral polyneuropathies associated with monoclonal IgM gammopathy of undetermined significance often have a progressive course and optimal treatment has not been established. We report on a patient diagnosed with polyneuropathy associated with benign IgM gammopathy, who was successfully treated with antibody-based immunoadsorption only. The neurological symptoms of the patient improved continuously over six months of treatment. Controlled trials should be performed to define this indication for antibody-based immunoadsorption therapy.
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Affiliation(s)
- M Toepfer
- Division of Nephrology, Medizinische Klinik, Ludwig-Maximilians-Universität, München, Germany
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Walter MC, Lochmüller H, Toepfer M, Schlotter B, Reilich P, Schröder M, Müller-Felber W, Pongratz D. High-dose immunoglobulin therapy in sporadic inclusion body myositis: a double-blind, placebo-controlled study. J Neurol 2000; 247:22-8. [PMID: 10701893 DOI: 10.1007/s004150050005] [Citation(s) in RCA: 154] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sporadic inclusion body myositis (s-IBM) is an acquired inflammatory muscle disease of unknown cause. In general, s-IBM presents with slowly progressive, asymmetric weakness, and atrophy of skeletal muscle. There is a mild transitory or nil responsiveness to standard immunosuppressive treatment. A controlled cross-over study of 22 s-IBM patients over 3 months showed a partial improvement in those treated with high-dose intravenous immunoglobulin therapy (IVIG) versus placebo. The present study included 22 patients aged 32-75 years and with a mean duration of disease of 5.2+/-3.6 years. They were randomized by a double-blind, placebo-controlled, cross-over design to monthly infusions of 2 g/kg bodyweight IVIG or to placebo for 6 months each, followed by the alternative treatment. After 6 and 12 months the response to treatment was evaluated, using a modified Medical Research Council scale, Neuromuscular Symptom Score (NSS), the patient's own assessment of improvement, arm outstretched time, and electromyography. No serious side effects were seen, in particular no viral infection and no major cardiac or neurological complications. Overall there was no progression of the disease in 90% of patients, unlike that which might have been expected in untreated patients. A mild and significant improvement (11%) in clinical symptoms was found using NSS, but not with other test procedures. There was a trend to mild improvement in treated patients when using other tests. Individual responses to treatment was heterogeneous. The validity of this study may be reduced by mismatch of groups with regard to age at onset and variability in disease expression. The findings of this study largely confirm those of a previous IVIG trial. Treatment with IVIG may be mildly effective in s-IBM by preventing disease progression or inducing mild improvement. Long-term studies are needed to evaluate further the benefit of IVIG therapy in s-IBM.
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Affiliation(s)
- M C Walter
- Department of Neurology, Friedrich-Baur-Institut, Medizinische Klink, University of Munich, Germany.
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Müller-Felber W, Ansevin CF, Ricker K, Müller-Jenssen A, Töpfer M, Goebel HH, Pongratz DE. Immunosuppressive treatment of rippling muscles in patients with myasthenia gravis. Neuromuscul Disord 1999; 9:604-7. [PMID: 10619721 DOI: 10.1016/s0960-8966(99)00065-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Rippling muscle disease is a rare autosomal dominant disorder that may occur sporadically. In this report two patients presenting with rippling muscles followed by myasthenia gravis are described. Our first patient developed rippling muscles about 1 month after infection with Yersinia enterocolitica. Two years later myasthenia gravis appeared. Our second patient had a 2-year history of asthma prior to the onset of rippling muscles which preceded the myasthenic symptoms by 4-8 weeks. Acetylcholine receptor and anti-skeletal muscle antibody titers were positive in both patients. In both patients the rippling phenomena worsened with pyridostigmine treatment but markedly improved after immunosuppression with azathioprine.
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Affiliation(s)
- W Müller-Felber
- Friedrich-Baur Institute, Department of Neurology, Klinikum Innenstadt, University of Munich, Germany
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