1
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Thewissen RMJ, Post MA, Maas DM, Veizaj R, Wagenaar I, Alsady M, Kools J, Bouman K, Zweers H, Meregalli PG, van der Kooi AJ, van Doorn PA, Groothuis JT, Lefeber DJ, Voermans NC. Oral ribose supplementation in dystroglycanopathy: A single case study. JIMD Rep 2024; 65:171-181. [PMID: 38736632 PMCID: PMC11078721 DOI: 10.1002/jmd2.12394] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 05/14/2024] Open
Abstract
Three forms of muscular dystrophy-dystroglycanopathies are linked to the ribitol pathway. These include mutations in the isoprenoid synthase domain-containing protein (ISPD), fukutin-related protein (FKRP), and fukutin (FKTN) genes. The aforementioned enzymes are required for generation of the ribitol phosphate linkage in the O-glycan of alpha-dystroglycan. Mild cases of dystroglycanopathy present with slowly progressive muscle weakness, while in severe cases the eyes and brain are also involved. Previous research showed that ribose increased the intracellular concentrations of cytidine diphosphate-ribitol (CDP-ribitol) and had a therapeutic effect. Here, we report the safety and effects of oral ribose supplementation during 6 months in a patient with limb girdle muscular dystrophy type 2I (LGMD2I) due to a homozygous FKRP mutation. Ribose was well tolerated in doses of 9 g or 18 g/day. Supplementation with 18 g of ribose resulted in a decrease of creatine kinase levels of 70%. Moreover, metabolomics showed a significant increase in CDP-ribitol levels with 18 g of ribose supplementation (p < 0.001). Although objective improvement in clinical and patient-reported outcome measures was not observed, the patient reported subjective improvement of muscle strength, fatigue, and pain. This case study indicates that ribose supplementation in patients with dystroglycanopathy is safe and highlights the importance for future studies regarding its potential effects.
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Affiliation(s)
- R. M. J. Thewissen
- Department of NeurologyDonders Institute for Brain, Cognition and Behavior, Radboud University Medical CenterNijmegenThe Netherlands
| | - M. A. Post
- Department of NeurologyDonders Institute for Brain, Cognition and Behavior, Radboud University Medical CenterNijmegenThe Netherlands
| | - D. M. Maas
- Department of RehabilitationDonders Institute for Brain, Cognition and Behavior, Radboud University Medical CenterNijmegenThe Netherlands
| | - R. Veizaj
- Translational Metabolic Laboratory, Department of Laboratory MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - I. Wagenaar
- Translational Metabolic Laboratory, Department of Laboratory MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - M. Alsady
- Department of NeurologyDonders Institute for Brain, Cognition and Behavior, Radboud University Medical CenterNijmegenThe Netherlands
| | - J. Kools
- Department of NeurologyDonders Institute for Brain, Cognition and Behavior, Radboud University Medical CenterNijmegenThe Netherlands
| | - K. Bouman
- Department of NeurologyDonders Institute for Brain, Cognition and Behavior, Radboud University Medical CenterNijmegenThe Netherlands
- Department of Pediatric NeurologyDonders Institute for Brain, Cognition and Behavior, Amalia Children's Hospital, Radboud University Medical CenterNijmegenThe Netherlands
| | - H. Zweers
- Department of GastroenterologyRadboud University Medical CenterNijmegenThe Netherlands
| | - P. G. Meregalli
- Department of CardiologyAmsterdam UMCAmsterdamThe Netherlands
| | | | | | - J. T. Groothuis
- Department of RehabilitationDonders Institute for Brain, Cognition and Behavior, Radboud University Medical CenterNijmegenThe Netherlands
| | - D. J. Lefeber
- Department of NeurologyDonders Institute for Brain, Cognition and Behavior, Radboud University Medical CenterNijmegenThe Netherlands
- Translational Metabolic Laboratory, Department of Laboratory MedicineRadboud University Medical CenterNijmegenThe Netherlands
| | - N. C. Voermans
- Department of NeurologyDonders Institute for Brain, Cognition and Behavior, Radboud University Medical CenterNijmegenThe Netherlands
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Voermans NC, Yang C, Schouten M, Girard T, Stowell K, Riazi S, Kamsteeg EJ, Snoeck M. The use of guidelines to assess the risk of malignant hyperthermia in individuals with an RYR1 variant. Neuromuscul Disord 2024; 35:40-41. [PMID: 38007345 DOI: 10.1016/j.nmd.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 10/13/2023] [Indexed: 11/27/2023]
Affiliation(s)
- N C Voermans
- Neuromuscular Center Nijmegen, Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Center, The Netherlands
| | - C Yang
- Malignant Hyperthermia Investigation Unit, Department of Anesthesiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - M Schouten
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands
| | - T Girard
- Clinic for Anaesthesia and Malignant Hyperthermie Investigation Unit, University Hospital Basel, Basel, Switzerland
| | - K Stowell
- School of Natural Sciences, Massey University, Palmerston North, New Zealand
| | - S Riazi
- Department of Anesthesia, Malignant Hyperthermia Investigation Unit, University Health Network, University of Toronto, Toronto, Canada
| | - E J Kamsteeg
- Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands
| | - M Snoeck
- Malignant Hyperthermia Investigation Unit, Department of Anesthesiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
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Van Tienen J, van Geenen C, Voet NB, Servais L, Voermans NC. My trial and training journey in X-linked myotubular myopathy: mountains and valleys. Neuromuscul Disord 2024; 36:23-27. [PMID: 38330679 DOI: 10.1016/j.nmd.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/20/2024] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Affiliation(s)
| | - C van Geenen
- Vita Movens, Praxis for Physical Therapy, the Netherlands
| | - N B Voet
- Department of Rehabilitation, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Rehabilitation, Rehabilitation Center Klimmendaal, Arnhem, the Netherlands
| | - L Servais
- MDUK Oxford Neuromuscular Centre and NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK; Division of Child Neurology, Centre de Référence des Maladies Neuromusculaires, Department of Pediatrics, University Hospital Liège and University of Liège, Liege, Belgium
| | - N C Voermans
- Department of Neurology, Radboud University Medical Centre, Neurology 664, P.O. Box 9101, Nijmegen, HB 6500, the Netherlands.
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Vincenten SCC, Teeselink S, Voermans NC, van Engelen BGM, Mul K, van Alfen N. Establishing the role of muscle ultrasound as an imaging biomarker in facioscapulohumeral muscular dystrophy. Neuromuscul Disord 2023; 33:936-944. [PMID: 37968164 DOI: 10.1016/j.nmd.2023.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/17/2023]
Abstract
Facioscapulohumeral muscular dystrophy (FSHD) is a hereditary muscle disease, that causes weakness and wasting of skeletal muscles. In this cross-sectional cohort-study on FSHD patients, we assessed muscle ultrasound findings and their relation to clinical outcome measures, evaluating the role of ultrasound as biomarker in FSHD. We included 115 genetically confirmed FSHD patients (52% males, age-range 22-80 years). They were subjected to a standardized muscle ultrasound protocol of seven truncal and upper- and lower extremity muscles bilaterally. Muscle images were scored using the Heckmatt scale. Muscle echogenicity was quantified using z-scores. Compound echogenicity and Heckmatt scores were calculated. Nearly all patients (94%) had one or multiple muscles with an increased echogenicity z-score. The trapezius muscle was most severely affected, followed by the rectus femoris muscle. Both compound ultrasound scores strongly with multiple clinical outcome measures (ρ 0.68-0.79, p < 0.001). While most muscles showed a high level of agreement between the echogenicity z-score and Heckmatt score (>95%), the tibialis anterior and gastrocnemius muscle showed lower levels of agreement (82 and 92%). In conclusion, our study confirms the use of muscle ultrasound as clinical severity biomarker and provides a solid base for future longitudinal studies to establish ultrasound as a monitoring biomarker in FSHD.
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Affiliation(s)
- S C C Vincenten
- Radboud University Medical Center, Clinical Neuromuscular Imaging Group, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - S Teeselink
- Radboud University Medical Center, Clinical Neuromuscular Imaging Group, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - N C Voermans
- Radboud University Medical Center, Clinical Neuromuscular Imaging Group, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - B G M van Engelen
- Radboud University Medical Center, Clinical Neuromuscular Imaging Group, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - K Mul
- Radboud University Medical Center, Clinical Neuromuscular Imaging Group, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
| | - N van Alfen
- Radboud University Medical Center, Clinical Neuromuscular Imaging Group, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands
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Kruijt N, van den Bersselaar LR, Hopman MTE, Snoeck MMJ, van Rijswick M, Wiggers TGH, Jungbluth H, Bongers CCWG, Voermans NC. Exertional Heat Stroke and Rhabdomyolysis: A Medical Record Review and Patient Perspective on Management and Long-Term Symptoms. Sports Med Open 2023; 9:33. [PMID: 37204519 DOI: 10.1186/s40798-023-00570-y] [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] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/19/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Exertional heat stroke (EHS) is a medical emergency, occurring when the body generates more heat than it can dissipate, and frequently associated with exertional rhabdomyolysis (ERM). In the present study we aimed to (I) identify clinical features and risk factors, (II) describe current prehospital management, (III) investigate long-term outcomes including the impact on mental health, and review the guidance received during restarting activities. We hope that our approach will improve individual and organizational heat illness preparedness, and improve follow-up care. METHODS We performed a prospective online survey and retrospective medical record review among athletes and military personnel with an episode of EHS/ERM in the Netherlands between 2010 and 2020. We evaluated prehospital management, risk factors, clinical features and long-term outcomes at 6 and 12 months after the event, including mental health symptoms. Furthermore, we investigated what guidance participants received during follow-up, and assessed the patients' perspective on these outcomes. RESULTS Sixty participants were included, 42 male (70%) and 18 female (30%), of which 47 presented with EHS (78%) and 13 with ERM (22%). Prehospital management was inconsistent and in the majority of participants not conducted according to available guidelines. Self-reported risk factors included not feeling well-acclimatized to environmental heat (55%) and peer pressure (28%). Self-reported long-term symptoms included muscle symptoms at rest (26%) or during exercise (28%), and neurological sequelae (11%). Validated questionnaires (CIS, HADS and SF-36) were indicative of severe fatigue (30%) or mood/anxiety disorders (11%). Moreover, 90% expressed a lack of follow-up care and that a more frequent and intensive follow-up would have been beneficial for their recovery process. CONCLUSION Our findings indicate major inconsistencies in the management of patients with EHS/ERM, emphasizing the compelling need for implementing standardized protocols. Based on the results of long-term outcome measures, we recommend to counsel and evaluate every patient not only immediately after the event, but also in the long-term.
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Affiliation(s)
- Nick Kruijt
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Geert Grooteplein 10 (Route 652), 6525 GA, Nijmegen, The Netherlands.
- Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands.
| | - L R van den Bersselaar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Geert Grooteplein 10 (Route 652), 6525 GA, Nijmegen, The Netherlands
- Malignant Hyperthermia Investigation Unit, Department of Anesthesiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - M T E Hopman
- Department of Physiology, Radboudumc, Nijmegen, The Netherlands
| | - M M J Snoeck
- Malignant Hyperthermia Investigation Unit, Department of Anesthesiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - M van Rijswick
- Department of Exercise Medicine and Exercise Physiology, Royal Dutch Army, Utrecht, The Netherlands
| | - T G H Wiggers
- Department of Sports Medicine, Anna Hospital, Geldrop, The Netherlands
| | - H Jungbluth
- Randall Centre for Cell and Molecular Biophysics, Muscle Signalling Section, Faculty of Life Sciences and Medicine (FoLSM), King's College London, London, UK
- Department of Paediatric Neurology, Neuromuscular Service, Evelina Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - C C W G Bongers
- Department of Physiology, Radboudumc, Nijmegen, The Netherlands
| | - N C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Geert Grooteplein 10 (Route 652), 6525 GA, Nijmegen, The Netherlands
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Padberg GW, van Engelen BGM, Voermans NC. Facioscapulohumeral Disease as a myodevelopmental disease: Applying Ockham's razor to its various features. J Neuromuscul Dis 2023; 10:411-425. [PMID: 36872787 DOI: 10.3233/jnd-221624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Facioscapulohumeral muscular dystrophy (FSHD) is an exclusively human neuromuscular disease. In the last decades the cause of FSHD was identified: the loss of epigenetic repression of the D4Z4 repeat on chromosome 4q35 resulting in inappropriate transcription of DUX4. This is a consequence of a reduction of the array below 11 units (FSHD1) or of a mutation in methylating enzymes (FSHD2). Both require the presence of a 4qA allele and a specific centromeric SSLP haplotype. Muscles become involved in a rostro-caudally order with an extremely variable progression rate. Mild disease and non-penetrance in families with affected individuals is common. Furthermore, 2% of the Caucasian population carries the pathological haplotype without clinical features of FSHD.In order to explain the various features of FSHD we applied Ockham's Razor to all possible scenarios and removed unnecessary complexities. We postulate that early in embryogenesis a few cells escape epigenetic silencing of the D4Z4 repeat. Their number is assumed to be roughly inversely related to the residual D4Z4 repeat size. By asymmetric cell division, they produce a rostro-caudal and medio-lateral decreasing gradient of weakly D4Z4-repressed mesenchymal stem cells. The gradient tapers towards an end as each cell-division allows renewed epigenetic silencing. Over time, this spatial gradient translates into a temporal gradient based on a decreasing number of weakly silenced stem cells. These cells contribute to a mildly abnormal myofibrillar structure of the fetal muscles. They also form a downward tapering gradient of epigenetically weakly repressed satellite cells. When activated by mechanical trauma, these satellite cells de-differentiate and express DUX4. When fused to myofibrils they contribute to muscle cell death in various ways. Over time and dependent on how far the gradient reaches the FSHD phenotype becomes progressively manifest. We thus hypothesize FSHD to be a myodevelopmental disease with a lifelong attempt to restore DUX4 repression.
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Affiliation(s)
- G W Padberg
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - B G M van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - N C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
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Kramer JJ, Boon HTM, Leijten QH, Ter Laak H, Eshuis L, Kusters B, van Doorn JLM, Kamsteeg EJ, Eymard B, Doorduin J, Voermans NC. Dystrophic Myopathy of the Diaphragm with Recurrent Severe Respiratory Failure is Congenital Myasthenic Syndrome 11. J Neuromuscul Dis 2023; 10:271-277. [PMID: 36591657 PMCID: PMC10041432 DOI: 10.3233/jnd-221542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We here present the case of a patient with a congenital myasthenic syndrome (CMS) due to pathogenic variants in the RAPSN gene. During childhood he experienced recurrent episodes of respiratory failure during respiratory infections. This and other cases were reported as isolated dystrophy of the diaphragmatic musculature. In adulthood, whole exome sequencing revealed two heterozygous pathogenic variants in the RAPSN gene. This led to the revision of the diagnosis to rapsyn CMS11 (OMIM:616326, MONDO:0014588). EMG, muscle ultrasound and the revision of muscle biopsies taken in childhood support this diagnosis. After the revision of the diagnosis, treatment with pyridostigmine was started. This resulted in a reduction of fatigability and an improvement in functional abilities and quality of life.
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Affiliation(s)
- J J Kramer
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - H T M Boon
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Henk Ter Laak
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - L Eshuis
- Department of Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - B Kusters
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J L M van Doorn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - E J Kamsteeg
- Department of Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - B Eymard
- Institute de Myologie, Paris, France
| | - J Doorduin
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - N C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
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van de Geest-Buit WA, Rasing NB, Mul K, Deenen JCW, Vincenten SCC, Siemann I, Lanser A, Groothuis JT, van Engelen BG, Custers JAE, Voermans NC. Facing facial weakness: psychosocial outcomes of facial weakness and reduced facial function in facioscapulohumeral muscular dystrophy. Disabil Rehabil 2022:1-10. [DOI: 10.1080/09638288.2022.2092779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- W. A. van de Geest-Buit
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - N. B. Rasing
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - K. Mul
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J. C. W. Deenen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S. C. C. Vincenten
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - I. Siemann
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A. Lanser
- Patient Representative and Chairman FSHD Advocacy Group, Patient Organization for Muscular Diseases Spierziekten Nederland, Baarn, The Netherlands
| | - J. T. Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - B. G. van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J. A. E. Custers
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - N. C. Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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van den Bersselaar LR, Riazi S, Snoeck M, Jungbluth H, Voermans NC. 259th ENMC international workshop: Anaesthesia and neuromuscular disorders 11 December, 2020 and 28-29 May, 2021. Neuromuscul Disord 2021; 32:86-97. [PMID: 34916120 DOI: 10.1016/j.nmd.2021.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 02/07/2023]
Affiliation(s)
- L R van den Bersselaar
- Department of Anaesthesiology, Malignant Hyperthermia Investigation Unit, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology, Radboud University Medical Center, Reinier Postlaan 4, P.O. Box 9101, 6500 HB, Nijmegen 6525 GC, the Netherlands
| | - S Riazi
- Department of Anesthesiology and Pain Medicine, Malignant Hyperthermia Investigation Unit, University Health Network, University of Toronto, Toronto, Canada
| | - Mmj Snoeck
- Department of Anaesthesiology, Malignant Hyperthermia Investigation Unit, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - H Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom; Randall Centre for Cell and Molecular Biophysics, Muscle Signalling Section, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - N C Voermans
- Department of Neurology, Radboud University Medical Center, Reinier Postlaan 4, P.O. Box 9101, 6500 HB, Nijmegen 6525 GC, the Netherlands.
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Voermans NC, Vriens-Munoz Bravo M, Padberg GW, Laforêt P. 1st FSHD European Trial Network workshop:Working towards trial readiness across Europe. Neuromuscul Disord 2021; 31:907-918. [PMID: 34404575 DOI: 10.1016/j.nmd.2021.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/15/2021] [Indexed: 01/29/2023]
Affiliation(s)
- N C Voermans
- FSHD Europe, Radboud University Medical Centre, P.O. Box 9101, Nijmegen 6500 HB, the Netherlands.
| | - M Vriens-Munoz Bravo
- FSHD Europe, Radboud University Medical Centre, P.O. Box 9101, Nijmegen 6500 HB, the Netherlands
| | - G W Padberg
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - P Laforêt
- Nord-Est-Ile de France Neuromuscular Reference Center, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris Myology Institute, Neuromuscular Pathology Reference Center, Groupe Hospitalier Universitaire La Pitié-Salpêtrière, Sorbonne Universités UPMC Univ Paris 06, Paris, France
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11
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van den Bersselaar LR, Greven T, Bulger T, Voermans NC, van Petegem F, Schiemann AH, Parker R, Burling SM, Jungbluth H, Stowell KM, Kamsteeg EJ, Snoeck MMJ. RYR1 variant c.38T>G, p.Leu13Arg causes hypersensitivity of the ryanodine receptor-1 and is pathogenic for malignant hyperthermia. Br J Anaesth 2021; 127:e63-e65. [PMID: 34127251 DOI: 10.1016/j.bja.2021.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - T Greven
- Department of Anaesthesia, Nijmegen, the Netherlands
| | | | - N C Voermans
- Department of Anaesthesia, Nijmegen, the Netherlands
| | | | | | | | | | | | | | - E J Kamsteeg
- Department of Anaesthesia, Nijmegen, the Netherlands
| | - M M J Snoeck
- Department of Anaesthesia, Nijmegen, the Netherlands.
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12
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Loonen TGJ, Horlings CGC, Vincenten SCC, Beurskens CHG, Knuijt S, Padberg GWAM, Statland JM, Voermans NC, Maal TJJ, van Engelen BGM, Mul K. Characterizing the face in facioscapulohumeral muscular dystrophy. J Neurol 2020; 268:1342-1350. [PMID: 33113021 PMCID: PMC7990805 DOI: 10.1007/s00415-020-10281-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 11/30/2022]
Abstract
Objective To evaluate facial weakness in patients with FSHD to better define clinical signs, and pilot a facial weakness severity score. Methods 87 FSHD patients and 55 controls were video recorded while performing seven facial tasks. The videos were assessed by three independent examiners to compile an overview of signs of facial weakness. Next, videos were semi-quantitatively assessed using a newly developed 4-point facial weakness score (FWS). This score was evaluated and correlated to other FSHD disease characteristics. Results Patients had lower scores on the total FWS than controls (mean score 43 ± 28, range 4–118, vs 14 ± 9, range 0–35, p < 0.001) and on all seven individual facial tasks (all p < 0.001). 54% of patients had FWS scores outside the range of controls. Patients had more asymmetry between the left and right side of the face than controls. About 10% of the patients had very mild facial weakness. These were mostly males (89%) with longer D4Z4 repeat sizes of 7–9 units. More severe facial weakness correlated to more severe overall disease severity and shorter D4Z4 repeat size, but not to disease duration. Interobserver agreement for the FWS between three raters was low with a Fleiss Kappa of 0.437. Conclusion This study provides an overview of the clinical spectrum of facial weakness and its relation to other disease characteristics. The 4-point scale we introduced to grade the severity of facial weakness enables correlation of facial weakness to disease characteristics, but is not suited as clinical outcome measure for longitudinal studies.
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Affiliation(s)
- T G J Loonen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.,Radboudumc 3D-Lab, Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - C G C Horlings
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - S C C Vincenten
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - C H G Beurskens
- Department of Orthopedics, Section of Physical Therapy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S Knuijt
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - G W A M Padberg
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - J M Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - N C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - T J J Maal
- Radboudumc 3D-Lab, Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - B G M van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - K Mul
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
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13
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Kruijt N, van den Bersselaar LR, Kamsteeg EJ, Verbeeck W, Snoeck MMJ, Everaerd DS, Abdo WF, Jansen DRM, Erasmus CE, Jungbluth H, Voermans NC. The etiology of rhabdomyolysis: an interaction between genetic susceptibility and external triggers. Eur J Neurol 2020; 28:647-659. [PMID: 32978841 PMCID: PMC7821272 DOI: 10.1111/ene.14553] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/09/2020] [Indexed: 01/04/2023]
Abstract
Background and purpose Rhabdomyolysis is a medical emergency characterized by acute skeletal muscle breakdown with a sudden rise and subsequent fall of serum creatine kinase (CK) levels. Rhabdomyolysis events are provoked by exposure to external triggers, possibly in combination with an increased genetic susceptibility. We aimed to describe comprehensively the external triggers and potentially pathogenic genetic variants possibly implicated in increased rhabdomyolysis susceptibility. Methods We performed a retrospective single‐center study, including a total of 1302 patients with an acute CK level exceeding 2000 IU/l. Results Anoxia was the most frequently reported trigger (40%). A subset of 193 patients were clinically suspected of an underlying genetic disorder (recurrent episodes, a positive family history, very high or persistently increased CK levels). In 72 of these patients, an unequivocal genetic defect was identified. A total of 22 genes with pathogenic variants were identified, including 52 different variants. Of those, 11 genes have been previously associated with rhabdomyolysis (ACADVL, ANO5, CPT2, DMD, DYSF, FKRP, HADHA, PGM1, LPIN1, PYGM, RYR1). Eleven genes are probably implicated in increased susceptibility (including AGL, CAPN3, CNBP, DMPK, MAGT1, ACADM, SCN4A, SGCA, SGCG, SMPD1, TANGO2). Conclusion These findings suggest that the spectrum of genetic susceptibility for rhabdomyolysis has not yet been completely clarified. With the increasing availability of next‐generation sequencing in a diagnostic setting, we expect that in more cases a genetic defect will be identified.
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Affiliation(s)
- N Kruijt
- Department of Neurology, Radboudumc, Nijmegen, The Netherlands
| | - L R van den Bersselaar
- Department of Neurology, Radboudumc, Nijmegen, The Netherlands.,Malignant Hyperthermia Investigation Unit, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - E J Kamsteeg
- Department of Human Genetics, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - W Verbeeck
- Department of Pharmacology and Toxicology, Radboudumc, Nijmegen, The Netherlands.,Vincent van Gogh Institute for Psychiatry, Venlo, Venray, The Netherlands
| | - M M J Snoeck
- Malignant Hyperthermia Investigation Unit, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - D S Everaerd
- Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands
| | - W F Abdo
- Department of Intensive Care Medicine, Radboudumc, Nijmegen, The Netherlands
| | - D R M Jansen
- Department of Geriatrics, Radboudumc, Nijmegen, The Netherlands
| | - C E Erasmus
- Department of Neurology, Radboudumc, Nijmegen, The Netherlands.,Department of Paediatrics, Radboudumc, Nijmegen, The Netherlands
| | - H Jungbluth
- Randall Division for Cell and Molecular Biophysics, Muscle Signalling Section, King's College, London, UK.,Department of Basic and Clinical Neuroscience, IoPPN, King's College, London, UK.,Department of Paediatric Neurology, Neuromuscular Service, Guy's and St Thomas' Hospital NHS Foundation Trust, Evelina Children's Hospital, London, UK
| | - N C Voermans
- Department of Neurology, Radboudumc, Nijmegen, The Netherlands
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14
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Knuiman GJ, Küsters B, Eshuis L, Snoeck M, Lammens M, Heytens L, De Ridder W, Baets J, Scalco RS, Quinlivan R, Holton J, Bodi I, Wraige E, Radunovic A, von Landenberg C, Reimann J, Kamsteeg EJ, Sewry C, Jungbluth H, Voermans NC. The histopathological spectrum of malignant hyperthermia and rhabdomyolysis due to RYR1 mutations. J Neurol 2019; 266:876-887. [PMID: 30788618 PMCID: PMC6420893 DOI: 10.1007/s00415-019-09209-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/16/2019] [Accepted: 01/19/2019] [Indexed: 12/22/2022]
Abstract
Objective The histopathological features of malignant hyperthermia (MH) and non-anaesthetic (mostly exertional) rhabdomyolysis (RM) due to RYR1 mutations have only been reported in a few cases. Methods We performed a retrospective multi-centre cohort study focussing on the histopathological features of patients with MH or RM due to RYR1 mutations (1987–2017). All muscle biopsies were reviewed by a neuromuscular pathologist. Additional morphometric and electron microscopic analysis were performed where possible. Results Through the six participating centres we identified 50 patients from 46 families, including patients with MH (n = 31) and RM (n = 19). Overall, the biopsy of 90% of patients showed one or more myopathic features including: increased fibre size variability (n = 44), increase in the number of fibres with internal nuclei (n = 30), and type I fibre predominance (n = 13). Abnormalities on oxidative staining, generally considered to be more specifically associated with RYR1-related congenital myopathies, were observed in 52%, and included unevenness (n = 24), central cores (n = 7) and multi-minicores (n = 3). Apart from oxidative staining abnormalities more frequently observed in MH patients, the histopathological spectrum was similar between the two groups. There was no correlation between the presence of cores and the occurrence of clinically detectable weakness or presence of (likely) pathogenic variants. Conclusions Patients with RYR1-related MH and RM exhibit a similar histopathological spectrum, ranging from mild myopathic changes to cores and other features typical of RYR1-related congenital myopathies. Suggestive histopathological features may support RYR1 involvement, also in cases where the in vitro contracture test is not informative. Electronic supplementary material The online version of this article (10.1007/s00415-019-09209-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- G J Knuiman
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - B Küsters
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - L Eshuis
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M Snoeck
- National MH Investigation Unit, Department of Anaesthesiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - M Lammens
- Department of Pathology, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - L Heytens
- Malignant Hyperthermia Research Unit, University of Antwerp, Antwerp, Belgium
| | - W De Ridder
- Neurogenetics Group, Center for Molecular Neurology, VIB, Antwerp, Belgium
- Laboratory of Neuromuscular Pathology, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
- Department of Neurology, Neuromuscular Reference Centre, Antwerp University Hospital, Antwerp, Belgium
| | - J Baets
- Neurogenetics Group, Center for Molecular Neurology, VIB, Antwerp, Belgium
- Laboratory of Neuromuscular Pathology, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
- Department of Neurology, Neuromuscular Reference Centre, Antwerp University Hospital, Antwerp, Belgium
| | - R S Scalco
- MRC Centre for Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - R Quinlivan
- MRC Centre for Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - J Holton
- MRC Centre for Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - I Bodi
- Department of Paediatric Neurology, Neuromuscular Service, Evelina Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - E Wraige
- Department of Paediatric Neurology, Neuromuscular Service, Evelina Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - A Radunovic
- Barts Neuromuscular Diseases Centre, Royal London Hospital, London, UK
| | - C von Landenberg
- Muscle Lab, Department of Neurology, University of Bonn Medical Centre, Bonn, Germany
| | - J Reimann
- Muscle Lab, Department of Neurology, University of Bonn Medical Centre, Bonn, Germany
| | - E-J Kamsteeg
- Department of Human Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - C Sewry
- Dubowitz Neuromuscular Centre, UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - H Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
- Muscle Signalling Section, Randall Division for Cell and Molecular Biophysics, King's College, London, UK
- Department of Basic and Clinical Neuroscience, King's College, IoPPN, London, UK
| | - N C Voermans
- Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands.
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15
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van Ruitenbeek E, Custers JAE, Verhaak C, Snoeck M, Erasmus CE, Kamsteeg EJ, Schouten MI, Coleman C, Treves S, Van Engelen BG, Jungbluth H, Voermans NC. Functional impairments, fatigue and quality of life in RYR1-related myopathies: A questionnaire study. Neuromuscul Disord 2018; 29:30-38. [PMID: 30578099 DOI: 10.1016/j.nmd.2018.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 01/01/2023]
Abstract
Mutations in RYR1 are a common genetic cause of non-dystrophic neuromuscular disorders. To obtain baseline data concerning the prevalence of fatigue, the psychological disease burden and quality of life associated with these common conditions, we performed a questionnaire study. Seventy-two patients were included in this study, 33 with a congenital myopathy and 39 with malignant hyperthermia or exertional rhabdomyolysis. Our results showed that patients with RYR1-related myopathies have more functional impairments and significant chronic fatigue compared to healthy controls, with almost half of patients being severely fatigued. Whilst fatigue, pain and associated physical and social difficulties were more pronounced in those with permanent phenotypes, individuals with intermittent phenotypes also scored higher in all relevant categories compared to healthy controls. These findings indicate that RYR1-related myopathies, despite being often considered relatively mild conditions, are nevertheless associated with severe fatigue and functional limitations, resulting in substantial loss of quality of life. Moreover, milder but in essence similar findings in patients with RYR1-related malignant hyperthermia and rhabdomyolysis suggest that those phenotypes are not truly episodic but in fact associated with a substantial permanent disease burden. These preliminary data should help to design more comprehensive quality of life studies to inform standards of care.
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Affiliation(s)
- E van Ruitenbeek
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J A E Custers
- Department of Medical Psychology, Radboudumc, Nijmegen, The Netherlands
| | - C Verhaak
- Department of Medical Psychology, Radboudumc, Nijmegen, The Netherlands
| | - M Snoeck
- Department of Anesthesiology, Canisius Wilhelmina Hospital Nijmegen, The Netherlands
| | - C E Erasmus
- Department of Pediatric Neurology, Radboudumc, Nijmegen, The Netherlands
| | - E J Kamsteeg
- Department of Human Genetics, Radboudumc, Nijmegen, The Netherlands
| | - M I Schouten
- Department of Human Genetics, Radboudumc, Nijmegen, The Netherlands
| | - C Coleman
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK
| | - S Treves
- Basel University, Basel, Switzerland
| | - B G Van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK; Randall Division for Cell and Molecular Biophysics, Muscle Signaling Section, King's College, London, UK; Department of Basic and Clinical Neuroscience, IoPPN, King's College London, London, UK
| | - N C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
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16
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Kouwenberg CV, Voermans NC, Quinlivan R, van den Engel-Hoek L. Mastication and Oral Motor Function in McArdle Disease: Patient Reported Complaints. J Neuromuscul Dis 2018; 5:353-357. [PMID: 30103350 DOI: 10.3233/jnd-180320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Exertional myalgia and cramps of the limb and trunk muscles are typical in McArdle disease, but mastication and oral motor limitations have not been systematically investigated before. OBJECTIVE Determine the reported prevalence and characteristics of limitations on oral motor activities, mastication, swallowing, and other oral motor activities in patients with McArdle disease. METHODS An observational study was carried out in 28 patients using a standardised questionnaire on mastication and oral motor function. RESULTS 57% of the participants reported difficulties with mastication. Muscle cramps during mastication occurred in 57% of the patients. A feeling that food remains in the throat occurred in 32%. Adaptations during mastication were needed in 42% of the patients. Mastication difficulties, muscle cramps during mastication and mastication adjustments were inversely correlated with age (r2 = - 0.445, p < 0.05; r2 = - 0.509, p < 0.01; r2 = - 0.456, p < 0.05). Feeling of food remaining in throat, cramps during mastication and during other oral motor muscle activities, were correlated with disease severity (r2 = 0.476, p < 0.01; r2 = 0.463, p < 0.01; r2 = 0.461, p < 0.01; r2 = 0.432, p < 0.05). CONCLUSIONS In short, reported mastication difficulties are prevalent in people with McArdle disease, most frequently in younger people. Therefore, awareness of mastication and oral motor problems is required.
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Affiliation(s)
- C V Kouwenberg
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - N C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - R Quinlivan
- MRC Centre for Neuromuscular Diseases and Department of Molecular Neuroscience, University College London Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - L van den Engel-Hoek
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
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17
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Guglielmi V, Voermans NC, Oosterhof A, Nowis D, van Engelen BG, Tomelleri G, Vattemi G. Evidence of ER stress and UPR activation in patients with Brody disease and Brody syndrome. Neuropathol Appl Neurobiol 2018; 44:533-536. [DOI: 10.1111/nan.12431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 11/27/2022]
Affiliation(s)
- V. Guglielmi
- Department of Neurosciences, Biomedicine and Movement Sciences; Section of Clinical Neurology; University of Verona; Verona Italy
| | - N. C. Voermans
- Neuromuscular Centre Nijmegen; Department of Neurology; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - A. Oosterhof
- Department of Biochemistry; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - D. Nowis
- Laboratory of Experimental Medicine; Center of New Technologies; University of Warsaw; Warsaw Poland
- Genomic Medicine; Medical University of Warsaw; Warsaw Poland
| | - B. G. van Engelen
- Neuromuscular Centre Nijmegen; Department of Neurology; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - G. Tomelleri
- Department of Neurosciences, Biomedicine and Movement Sciences; Section of Clinical Neurology; University of Verona; Verona Italy
| | - G. Vattemi
- Department of Neurosciences, Biomedicine and Movement Sciences; Section of Clinical Neurology; University of Verona; Verona Italy
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18
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Witting N, Laforêt P, Voermans NC, Roux-Buisson N, Bompaire F, Rendu J, Duno M, Feillet F, Kamsteeg EJ, Poulsen NS, Dahlqvist JR, Romero NB, Fauré J, Vissing J, Behin A. Phenotype and genotype of muscle ryanodine receptor rhabdomyolysis-myalgia syndrome. Acta Neurol Scand 2018; 137:452-461. [PMID: 29635721 DOI: 10.1111/ane.12885] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Rhabdomyolysis and myalgia are common conditions, and mutation in the ryanodine receptor 1 gene (RYR1) is suggested to be a common cause. Due to the large size of RYR1, however, sequencing has not been widely accessible before the recent advent of next-generation sequencing technology and limited phenotypic descriptions are therefore available. MATERIAL & METHODS We present the medical history, clinical and ancillary findings of patients with RYR1 mutations and rhabdomyolysis and myalgia identified in Denmark, France and The Netherlands. RESULTS Twenty-two patients with recurrent rhabdomyolysis (CK > 10 000) or myalgia with hyperCKemia (>1.5 × ULN) and a RYR1 mutation were identified. One had mild wasting of the quadriceps muscle, but none had fixed weakness. Symptoms varied from being restricted to intense exercise to limiting ADL function. One patient developed transient kidney failure during rhabdomyolysis. Two received immunosuppressants on suspicion of myositis. None had episodes of malignant hyperthermia. Muscle biopsies were normal, but CT/MRI showed muscle hypertrophy in most. Delay from first symptom to diagnosis was 12 years on average. Fifteen different dominantly inherited mutations were identified. Ten were previously described as pathogenic and 5 were novel, but rare/absent from the background population, and predicted to be pathogenic by in silico analyses. Ten of the mutations were reported to give malignant hyperthermia susceptibility. CONCLUSION Mutations in RYR1 should be considered as a significant cause of rhabdomyolysis and myalgia syndrome in patients with the characteristic combination of rhabdomyolysis, myalgia and cramps, creatine kinase elevation, no weakness and often muscle hypertrophy.
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Affiliation(s)
- N. Witting
- Department of Neurology; Copenhagen Neuromuscular Centre; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - P. Laforêt
- Centre de Référence de Pathologie Neuromusculaire Paris-Est; Groupe Hospitalier Pitié-Salpêtrière; Institut de Myologie; AP-HP; Paris Cedex France
| | - N. C. Voermans
- Department of Human Genetics; Radboud University Medical Centre; Nijmegen The Netherlands
| | - N. Roux-Buisson
- INSERM U121; Equipe CMyPath; Institut des Neurosciences; Grenoble France
- Biochimie Génétique et Moléculaire; Institut de Biologie et Pathologie; CHU; Grenoble France
| | - F. Bompaire
- Neurologie; Hopital d'instruction des Armées Percy; Clamart France
| | - J. Rendu
- INSERM U121; Equipe CMyPath; Institut des Neurosciences; Grenoble France
- Biochimie Génétique et Moléculaire; Institut de Biologie et Pathologie; CHU; Grenoble France
| | - M. Duno
- Department of Clinical Genetics; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - F. Feillet
- Service de Médecine Infantile 1; Centre de Référence des Maladies Héréditaires du Métabolisme; Centre Hospitalier Universitaire Brabois-Enfants; Vandœuvre-lès-Nancy France
| | - E.-J. Kamsteeg
- Department of Human Genetics; Radboud University Medical Centre; Nijmegen The Netherlands
| | - N. S. Poulsen
- Department of Neurology; Copenhagen Neuromuscular Centre; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - J. R. Dahlqvist
- Department of Neurology; Copenhagen Neuromuscular Centre; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - N. B. Romero
- Laboratoire de Pathologie Musculaire Risler; Groupe Hospitalier Pitié-Salpêtrière; Paris France
| | - J. Fauré
- INSERM U121; Equipe CMyPath; Institut des Neurosciences; Grenoble France
- Biochimie Génétique et Moléculaire; Institut de Biologie et Pathologie; CHU; Grenoble France
| | - J. Vissing
- Department of Neurology; Copenhagen Neuromuscular Centre; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - A. Behin
- Centre de Référence de Pathologie Neuromusculaire Paris-Est; Groupe Hospitalier Pitié-Salpêtrière; Institut de Myologie; AP-HP; Paris Cedex France
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19
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van der Sluijs BM, Raz V, Lammens M, van den Heuvel LP, Voermans NC, van Engelen BGM. Intranuclear Aggregates Precede Clinical Onset in Oculopharyngeal Muscular Dystrophy. J Neuromuscul Dis 2018; 3:101-109. [PMID: 27854203 DOI: 10.3233/jnd-150118] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Oculopharyngeal muscular dystrophy (OPMD) has long been characterized by a combination of bilateral ptosis and dysphagia and subsequent limb girdle weakness. The role of the typical intranuclear inclusion in the pathophysiology is unresolved. OBJECTIVE The aim of this study was to describe the clinical and histopathological features of oculopharyngeal muscular dystrophy (OPMD). We examined this in a Dutch cohort including presymptomatic Ala-expanded-PABPN1 carriers and late symptomatic patients. METHODS We performed a prospective, observational study in OPMD patients and adult children of genetically confirmed OPMD patients. The study includes a structured history, a detailed neurological examination, muscle histology and biochemical analysis. Forty patients and 18 adult children participated in this study, among whom were six presymptomatic mutation carriers. One patient died during the study and had given permission to autopsy. RESULTS In addition to the characteristic OPMD symptoms including ptosis and dysphagia, other symptoms such as limb girdle and axial weakness, and external ophthalmoplegia were frequently observed. Intranuclear aggregates were observed in the biopsies of presymptomatic carriers. Biochemical analysis of the biopsies of the presymptomatic carriers showed no mitochondrial dysfunction. The autopsy showed that muscle weakness correlated with histopathological findings in five different muscles in an individual patient. CONCLUSIONS The main findings of this nationwide study are the presence of intranuclear aggregates before clinical onset and the absence of mitochondrial changes in Ala-expanded-PABPN1 carriers. This indicates that the expression of Ala-expanded-PABPN1 causes the formation of nuclear aggregates before the onset of muscle weakness. Normal results of biochemical analysis in presymptomatic carriers suggest that possible mitochondrial dysfunction occurs later. Furthermore we confirmed that limb girdle weakness occurs frequently in Dutch OPMD patients. This study thus expands the OPMD research towards characterization of presymptomatic carriers.
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Affiliation(s)
- B M van der Sluijs
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Neurology, Gelre Hospital Zutphen, Zutphen, The Netherlands
| | - V Raz
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - M Lammens
- Department of Pathology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium.,Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - L P van den Heuvel
- Department of Laboratory Medicine and Pediatrics, Translational Metabolic Laboratory, Radboud University Medical Centre, The Netherlands
| | - N C Voermans
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - B G M van Engelen
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
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20
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Molenaar JP, Voermans NC, de Jong LA, Stegeman DF, Doorduin J, van Engelen BG. Repeatability and reliability of muscle relaxation properties induced by motor cortical stimulation. J Appl Physiol (1985) 2018. [PMID: 29543137 DOI: 10.1152/japplphysiol.00455.2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Impaired muscle relaxation is a feature of many neuromuscular disorders. However, few tests are available to quantify muscle relaxation. Transcranial magnetic stimulation (TMS) of the motor cortex can induce muscle relaxation by abruptly inhibiting corticospinal drive. The aim of our study was to investigate whether repeatability and reliability of TMS-induced relaxation are greater than voluntary relaxation. Furthermore, effects of sex, cooling, and fatigue on muscle relaxation properties were studied. Muscle relaxation of deep finger flexors was assessed in 25 healthy subjects (14 men and 11 women, age 39.1 ± 12.7 and 45.3 ± 8.7 yr, respectively) with handgrip dynamometry. All outcome measures showed greater repeatability and reliability in TMS-induced relaxation compared with voluntary relaxation. The within-subject coefficient of variability of normalized peak relaxation rate was lower in TMS-induced relaxation than in voluntary relaxation (3.0% vs. 19.7% in men and 6.1% vs. 14.3% in women). The repeatability coefficient was lower (1.3 vs. 6.1 s-1 in men and 2.3 vs. 3.1 s-1 in women) and the intraclass correlation coefficient was higher (0.95 vs. 0.53 in men and 0.78 vs. 0.69 in women) for TMS-induced relaxation compared with voluntary relaxation. TMS enabled demonstration of slowing effects of sex, muscle cooling, and muscle fatigue on relaxation properties that voluntary relaxation could not. In conclusion, repeatability and reliability of TMS-induced muscle relaxation were greater compared with voluntary muscle relaxation. TMS-induced muscle relaxation has the potential to be used in clinical practice for diagnostic purposes and therapy effect monitoring in patients with impaired muscle relaxation. NEW & NOTEWORTHY Transcranial magnetic stimulation (TMS)-induced muscle relaxation demonstrates greater repeatability and reliability compared with voluntary relaxation, represented by the ability to demonstrate typical effects of sex, cooling, and fatigue on muscle relaxation properties that were not seen in voluntary relaxation. In clinical practice, TMS-induced muscle relaxation could be used for diagnostic purposes and therapy effect monitoring. Furthermore, fewer subjects will be needed for future studies when using TMS to demonstrate differences in muscle relaxation properties.
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Affiliation(s)
- J P Molenaar
- Department of Neurology, Radboud University Medical Center , Nijmegen , The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Nijmegen , The Netherlands
| | - N C Voermans
- Department of Neurology, Radboud University Medical Center , Nijmegen , The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Nijmegen , The Netherlands
| | - L A de Jong
- Department of Neurology, Radboud University Medical Center , Nijmegen , The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Nijmegen , The Netherlands
| | - D F Stegeman
- Department of Neurology, Radboud University Medical Center , Nijmegen , The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Nijmegen , The Netherlands
| | - J Doorduin
- Department of Neurology, Radboud University Medical Center , Nijmegen , The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Nijmegen , The Netherlands
| | - B G van Engelen
- Department of Neurology, Radboud University Medical Center , Nijmegen , The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Nijmegen , The Netherlands
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21
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Demirdas S, Dulfer E, Robert L, Kempers M, van Beek D, Micha D, van Engelen BG, Hamel B, Schalkwijk J, Loeys B, Maugeri A, Voermans NC. Recognizing the tenascin-X deficient type of Ehlers-Danlos syndrome: a cross-sectional study in 17 patients. Clin Genet 2016; 91:411-425. [PMID: 27582382 DOI: 10.1111/cge.12853] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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: 04/21/2016] [Revised: 08/19/2016] [Accepted: 08/22/2016] [Indexed: 11/30/2022]
Abstract
The tenascin-X (TNX) deficient type Ehlers-Danlos syndrome (EDS) is similar to the classical type of EDS. Because of the limited awareness among geneticists and the challenge of the molecular analysis of the TNXB gene, the TNX-deficient type EDS is probably to be under diagnosed. We therefore performed an observational, cross-sectional study. History and physical examination were performed. Results of serum TNX measurements were collected and mutation analysis was performed by a combination of next-generation sequencing (NGS), Sanger sequencing and multiplex ligation-dependent probe amplification (MLPA). Included were 17 patients of 11 families with autosomal recessive inheritance and childhood onset. All patients had hyperextensible skin without atrophic scarring. Hypermobility of the joints was observed in 16 of 17 patients. Deformities of the hands and feet were observed frequently. TNX serum level was tested and absent in 11 patients (seven families). Genetic testing was performed in all families; 12 different mutations were detected, most of which are suspected to lead to non-sense mRNA mediated decay. In short, patients with the TNX-deficient type EDS typically have generalized joint hypermobility, skin hyperextensibility and easy bruising. In contrast to the classical type, the inheritance pattern is autosomal recessive and atrophic scarring is absent. Molecular analysis of TNXB in a diagnostic setting is challenging.
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Affiliation(s)
- S Demirdas
- Department of Clinical Genetics, Erasmus Medical Centre, Rotterdam, the Netherlands.,Department of Human Genetics, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - E Dulfer
- Department of Genetics, University Medical Centre Groningen, Groningen, the Netherlands
| | - L Robert
- Department of Genetics, Guy's and St Thomas' Hospital, London, UK
| | - M Kempers
- Department of Human Genetics, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - D van Beek
- Department of Clinical Genetics, Centre for Connective Tissue Research, VU University Medical Centre, Amsterdam, the Netherlands
| | - D Micha
- Department of Clinical Genetics, Centre for Connective Tissue Research, VU University Medical Centre, Amsterdam, the Netherlands
| | - B G van Engelen
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - B Hamel
- Department of Human Genetics, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - J Schalkwijk
- Department of Dermatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - B Loeys
- Department of Human Genetics, Radboud University Medical Centre, Nijmegen, the Netherlands.,Centre for Medical Genetics, University Hospital of Antwerp/University of Antwerp, Antwerp, Belgium
| | - A Maugeri
- Department of Clinical Genetics, Centre for Connective Tissue Research, VU University Medical Centre, Amsterdam, the Netherlands
| | - N C Voermans
- Department of Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands
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22
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Voermans NC, Snoeck M, Jungbluth H. RYR1-related rhabdomyolysis: A common but probably underdiagnosed manifestation of skeletal muscle ryanodine receptor dysfunction. Rev Neurol (Paris) 2016; 172:546-558. [PMID: 27663056 DOI: 10.1016/j.neurol.2016.07.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 07/29/2016] [Indexed: 01/04/2023]
Abstract
Mutations in the skeletal muscle ryanodine receptor (RYR1) gene are associated with a wide spectrum of inherited myopathies presenting throughout life. Malignant hyperthermia susceptibility (MHS)-related RYR1 mutations have emerged as a common cause of exertional rhabdomyolysis, accounting for up to 30% of rhabdomyolysis episodes in otherwise healthy individuals. Common triggers are exercise and heat and, less frequently, viral infections, alcohol and drugs. Most subjects are normally strong and have no personal or family history of malignant hyperthermia. Heat intolerance and cold-induced muscle stiffness may be a feature. Recognition of this (probably not uncommon) rhabdomyolysis cause is vital for effective counselling, to identify potentially malignant hyperthermia-susceptible individuals and to adapt training regimes. Studies in various animal models provide insights regarding possible pathophysiological mechanisms and offer therapeutic perspectives.
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Affiliation(s)
- N C Voermans
- Department of Neurology, Radboud University Medical Centre, R. Postlaan 4 (route 935), P.O. Box 9101, 6500 Nijmegen (935), The Netherlands.
| | - M Snoeck
- Department of Anaesthesia, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - H Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK; Randall Division of Cell and Molecular Biophysics, Muscle Signalling Section, London, UK; Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
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23
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Scalco RS, Voermans NC, Piercy RJ, Jungbluth H, Quinlivan R. Dantrolene as a possible prophylactic treatment for RYR1-related rhabdomyolysis. Eur J Neurol 2016; 23:e56-7. [PMID: 27431030 DOI: 10.1111/ene.13051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 04/21/2016] [Indexed: 11/28/2022]
Affiliation(s)
- R S Scalco
- MRC Centre for Neuromuscular Diseases, UCL, London, UK
| | - N C Voermans
- Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - R J Piercy
- Comparative Neuromuscular Diseases Laboratory, Royal Veterinary College, London
| | - H Jungbluth
- Department of Clinical and Basic Neuroscience, IoPPN, King's College, UK
| | - R Quinlivan
- MRC Centre for Neuromuscular Diseases, UCL, London, UK
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24
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Snoeck M, Treves S, Molenaar JP, Kamsteeg EJ, Jungbluth H, Voermans NC. "Human Stress Syndrome" and the Expanding Spectrum of RYR1-Related Myopathies. Cell Biochem Biophys 2016; 74:85-7. [PMID: 26972305 DOI: 10.1007/s12013-015-0704-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- M Snoeck
- National MH Investigation Unit, Department of Anesthesiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - S Treves
- Departments of Biomedicine and Anesthesia, University Hospital Basel, Basel, Switzerland
| | - J P Molenaar
- Department of Neurology, Radboud University Medical Centre, 935, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - E J Kamsteeg
- Department of Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - H Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK.,Randall Division for Cell and Molecular Biophysics, Muscle Signalling Section, King's College, London, UK
| | - N C Voermans
- Department of Neurology, Radboud University Medical Centre, 935, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
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25
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Guglielmi V, Oosterhof A, Voermans NC, Cardani R, Molenaar JP, van Kuppevelt TH, Meola G, van Engelen BG, Tomelleri G, Vattemi G. Characterization of sarcoplasmic reticulum Ca(2+) ATPase pumps in muscle of patients with myotonic dystrophy and with hypothyroid myopathy. Neuromuscul Disord 2016; 26:378-85. [PMID: 27133661 DOI: 10.1016/j.nmd.2016.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 03/31/2016] [Accepted: 04/01/2016] [Indexed: 10/22/2022]
Abstract
Sarcoplasmic/endoplasmic reticulum Ca(2+) ATPase (SERCA) pumps play the major role in lowering cytoplasmic calcium concentration in skeletal muscle by catalyzing the ATP-dependent transport of Ca(2+) from the cytosol to the lumen of the sarcoplasmic reticulum (SR). Although SERCA abnormalities have been hypothesized to contribute to the dysregulation of intracellular Ca(2+) homeostasis and signaling in muscle of patients with myotonic dystrophy (DM) and hypothyroid myopathy, the characterization of SERCA pumps remains elusive and their impairment is still unclear. We assessed the activity of SR Ca(2+)-ATPase, expression levels and fiber distribution of SERCA1 and SERCA2, and oligomerization of SERCA1 protein in muscle of patients with DM type 1 and 2, and with hypothyroid myopathy. Our data provide evidence that SR Ca(2+) ATPase activity, protein levels and muscle fiber distribution of total SERCA1 and SERCA2, and SERCA1 oligomerization pattern are similar in patients with both DM1 and DM2, hypothyroid myopathy and in control subjects. We prove that SERCA1b, the neonatal isoform of SERCA1, is expressed at protein level in muscle of patients with DM2 and, in lower amount, of patients with DM1. Our present study demonstrates that SERCA function is not altered in muscle of patients with DM and with hypothyroid myopathy.
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Affiliation(s)
- V Guglielmi
- Department of Neurological and Movement Sciences, Section of Clinical Neurology, University of Verona, Italy
| | - A Oosterhof
- Department of Biochemistry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - N C Voermans
- Neuromuscular Centre Nijmegen, Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - R Cardani
- Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, Italy
| | - J P Molenaar
- Neuromuscular Centre Nijmegen, Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - T H van Kuppevelt
- Department of Biochemistry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - G Meola
- Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, Italy
| | - B G van Engelen
- Neuromuscular Centre Nijmegen, Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - G Tomelleri
- Department of Neurological and Movement Sciences, Section of Clinical Neurology, University of Verona, Italy
| | - G Vattemi
- Department of Neurological and Movement Sciences, Section of Clinical Neurology, University of Verona, Italy.
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26
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Bloem BR, Voermans NC, Aerts MB, Bhatia KP, van Engelen BGM, van de Warrenburg BP. The wrong end of the telescope: neuromuscular mimics of movement disorders (and vice versa). Pract Neurol 2016; 16:264-9. [PMID: 26965497 DOI: 10.1136/practneurol-2015-001311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2016] [Indexed: 11/04/2022]
Abstract
The rapid advances in modern neurology have led to increased specialisation in clinical practice. Being an expert in a neurology subspecialty offers advantages for diagnosing and managing specific disorders. However, specialisation also risks tunnel vision: interpreting symptoms and signs within one's own framework of reference, while ignoring differential diagnostic options from other subspecialties. This is particularly relevant when the patient's presentation potentially belongs to different neurological subspecialties. We illustrate this challenge by highlighting a series of clinical features that partially overlap between two common subspecialties: movement disorders and neuromuscular disorders. An overlap in clinical presentation is not rare, and includes, for example, involuntary eyelid closure (which could be active eye closure due to blepharospasm, or ptosis due to weakness). Other overlapping features include abnormal postures, involuntary movements and gait changes. We describe two of these overlapping features in more detail and emphasise the possible consequences of 'looking through the wrong end of the telescope' in such patients, as this may lead to a wrong differential diagnosis, unnecessary investigations and a delayed treatment start.
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Affiliation(s)
- B R Bloem
- Department of Neurology, Donders Institute of Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - N C Voermans
- Department of Neurology, Donders Institute of Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M B Aerts
- Department of Neurology, Donders Institute of Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - K P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, UK
| | - B G M van Engelen
- Department of Neurology, Donders Institute of Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - B P van de Warrenburg
- Department of Neurology, Donders Institute of Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
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27
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Molenaar JP, Voermans NC, van Hoeve BJ, Kamsteeg EJ, Kluijtmans LA, Kusters B, Jungbluth HJ, van Engelen BG. Fever-induced recurrent rhabdomyolysis due to a novel mutation in the ryanodine receptor type 1 gene. Intern Med J 2015; 44:819-20. [PMID: 25081049 DOI: 10.1111/imj.12498] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 04/08/2014] [Indexed: 11/27/2022]
Affiliation(s)
- J P Molenaar
- Department of Neurology, Radboud University Medical Centre, Nijmegen, the Netherlands
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28
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Donkervoort S, Bönnemann CG, Loeys B, Jungbluth H, Voermans NC. The neuromuscular differential diagnosis of joint hypermobility; S. Donkervoort, C. G. Bönnemann, B. Loeys, H. Jungbluth, and N. C. Voermans; Am J Med Genet C Semin Med Genet. 2015 Mar;169(1):23-42. Am J Med Genet A 2015. [DOI: 10.1002/ajmg.a.37244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- S. Donkervoort
- National Institutes of Health; National Institute of Neurological Disorders and Stroke; Neurogenetics Branch; Neuromuscular and Neurogenetic Disorders of Childhood Section; Bethesda Maryland
| | - C. G. Bönnemann
- National Institutes of Health; National Institute of Neurological Disorders and Stroke; Neurogenetics Branch; Neuromuscular and Neurogenetic Disorders of Childhood Section; Bethesda Maryland
| | - B. Loeys
- Department of Human Genetics; Radboud University Nijmegen Medical Centre; The Netherlands and center for medical genetics; Antwerp University Hospital and University of Antwerp; Antwerp Belgium
| | - H. Jungbluth
- Department of Paediatric Neurology - Neuromuscular Service; Evelina Children's Hospital; Guy's & St Thomas' NHS Foundation Trust; London UK
- Randall Division of Cell and Molecular Biophysics; Muscle Signalling Section; King's College London; London UK
- Department of Basic and Clinical Neuroscience; Institute of Psychiatry; Psychology and Neuroscience (IoPPN); King's College London; London UK
| | - N. C. Voermans
- Department of Neurology; Radboud University Nijmegen Medical Centre; The Netherlands
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29
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Snoeck M, van Engelen BGM, Küsters B, Lammens M, Meijer R, Molenaar JPF, Raaphorst J, Verschuuren-Bemelmans CC, Straathof CSM, Sie LTL, de Coo IF, van der Pol WL, de Visser M, Scheffer H, Treves S, Jungbluth H, Voermans NC, Kamsteeg EJ. RYR1-related myopathies: a wide spectrum of phenotypes throughout life. Eur J Neurol 2015; 22:1094-112. [PMID: 25960145 DOI: 10.1111/ene.12713] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 02/06/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Although several recent studies have implicated RYR1 mutations as a common cause of various myopathies and the malignant hyperthermia susceptibility (MHS) trait, many of these studies have been limited to certain age groups, confined geographical regions or specific conditions. The aim of the present study was to investigate the full spectrum of RYR1-related disorders throughout life and to use this knowledge to increase vigilance concerning malignant hyperthermia. METHODS A retrospective cohort study was performed on the clinical, genetic and histopathological features of all paediatric and adult patients in whom an RYR1 mutation was detected in a national referral centre for both malignant hyperthermia and inherited myopathies (2008-2012). RESULTS The cohort of 77 non-related patients (detection rate 28%) included both congenital myopathies with permanent weakness and 'induced' myopathies such as MHS and non-anaesthesia-related episodes of rhabdomyolysis or hyperCKemia, manifested throughout life and triggered by various stimuli. Sixty-one different mutations were detected, of which 24 were novel. Some mutations are present in both dominant (MHS) and recessive modes (congenital myopathy) of inheritance, even within families. Histopathological features included an equally wide spectrum, ranging from only subtle abnormalities to prominent cores. CONCLUSIONS This broad range of RYR1-related disorders often presents to the general paediatric and adult neurologist. Its recognition is essential for genetic counselling and improving patients' safety during anaesthesia. Future research should focus on in vitro testing by the in vitro contracture test and functional characterization of the large number of RYR1 variants whose precise effects currently remain uncertain.
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Affiliation(s)
- M Snoeck
- National MH Investigation Unit, Department of Anesthesiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - B G M van Engelen
- Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - B Küsters
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Pathology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M Lammens
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Pathology, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - R Meijer
- Department of Human Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J P F Molenaar
- Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J Raaphorst
- Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands
| | - C C Verschuuren-Bemelmans
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - C S M Straathof
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - L T L Sie
- Department of Neuropediatrics, Juliana Children's Hospital/Haga Hospital, The Hague, Nijmegen, The Netherlands
| | - I F de Coo
- Department of Neurology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - W L van der Pol
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M de Visser
- Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands
| | - H Scheffer
- Department of Human Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - S Treves
- Departments of Anesthesia and Biomedicine, University Hospital Basel, Basel, Switzerland
| | - H Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK.,Randall Division for Cell and Molecular Biophysics, Muscle Signalling Section, King's College, London, UK.,Department of Basic and Clinical Neuroscience, IoPPN, King's College, London, UK
| | - N C Voermans
- Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - E-J Kamsteeg
- Department of Human Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
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30
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Voermans NC, Sie LTL, van Alfen N, van Engelen BG, Küsters B. Histological abnormalities induced by the electromyography needle. Neuromuscul Disord 2013; 24:77-8. [PMID: 24238661 DOI: 10.1016/j.nmd.2013.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 08/27/2013] [Accepted: 09/03/2013] [Indexed: 11/25/2022]
Affiliation(s)
- N C Voermans
- Department of Neurology, Radboud University Nijmegen Medical Centre, The Netherlands.
| | - L T L Sie
- Department of Pediatric Neurology, Radboud University Nijmegen Medical Centre, The Netherlands
| | - N van Alfen
- Department of Neurology, Radboud University Nijmegen Medical Centre, The Netherlands; Department of Clinical Neurophysiology, Radboud University Nijmegen Medical Centre, The Netherlands
| | - B G van Engelen
- Department of Neurology, Radboud University Nijmegen Medical Centre, The Netherlands
| | - B Küsters
- Department of Pathology, Radboud University Nijmegen Medical Centre, The Netherlands
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31
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Dlamini N, Voermans NC, Lillis S, Stewart K, Kamsteeg EJ, Drost G, Quinlivan R, Snoeck M, Norwood F, Radunovic A, Straub V, Roberts M, Vrancken AFJE, van der Pol WL, de Coo RIFM, Manzur AY, Yau S, Abbs S, King A, Lammens M, Hopkins PM, Mohammed S, Treves S, Muntoni F, Wraige E, Davis MR, van Engelen B, Jungbluth H. Mutations in RYR1 are a common cause of exertional myalgia and rhabdomyolysis. Neuromuscul Disord 2013; 23:540-8. [PMID: 23628358 DOI: 10.1016/j.nmd.2013.03.008] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 03/08/2013] [Accepted: 03/12/2013] [Indexed: 12/23/2022]
Abstract
Mutations in the skeletal muscle ryanodine receptor (RYR1) gene are a common cause of neuromuscular disease, ranging from various congenital myopathies to the malignant hyperthermia (MH) susceptibility trait without associated weakness. We sequenced RYR1 in 39 unrelated families with rhabdomyolysis and/or exertional myalgia, frequent presentations in the neuromuscular clinic that often remain unexplained despite extensive investigations. We identified 9 heterozygous RYR1 mutations/variants in 14 families, 5 of them (p.Lys1393Arg; p.Gly2434Arg; p.Thr4288_Ala4290dup; p.Ala4295Val; and p.Arg4737Gln) previously associated with MH. Index cases presented from 3 to 45 years with rhabdomyolysis, with or without exertional myalgia (n=12), or isolated exertional myalgia (n=2). Rhabdomyolysis was commonly triggered by exercise and heat and, less frequently, viral infections, alcohol and drugs. Most cases were normally strong and had no personal MH history. Inconsistent additional features included heat intolerance, and cold-induced muscle stiffness. Muscle biopsies showed mainly subtle changes. Familial RYR1 mutations were confirmed in relatives with similar or no symptoms. These findings suggest that RYR1 mutations may account for a substantial proportion of patients presenting with unexplained rhabdomyolysis and/or exertional myalgia. Associated clinico-pathological features may be subtle and require a high degree of suspicion. Additional family studies are paramount in order to identify potentially MH susceptible relatives.
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Affiliation(s)
- N Dlamini
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK
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Voermans NC, Kempers M, Lammens M, van Alfen N, Janssen MC, Bönnemann C, van Engelen BG, Hamel BC. Myopathy in a 20-year-old female patient with D4ST-1 deficient Ehlers-Danlos syndrome due to a homozygous CHST14 mutation. Am J Med Genet A 2012; 158A:850-5. [PMID: 22407744 DOI: 10.1002/ajmg.a.35232] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 12/24/2011] [Indexed: 12/14/2022]
Abstract
We here report on a 20-year-old female patient with EDS due to a homozygous CHST14 single nucleotide deletion resulting in D4ST-1 deficiency, accompanied by muscle hypoplasia and muscle weakness. Findings of muscle ultrasound, electromyography, and muscle biopsy pointed to a myopathy, similarly as in other EDS types. This myopathy probably contributes to the gross motor developmental delay in this type of EDS.
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Affiliation(s)
- N C Voermans
- Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Voermans NC, Verrijp K, Eshuis L, Balemans MCM, Egging D, Sterrenburg E, van Rooij IALM, van der Laak JAWM, Schalkwijk J, van der Maarel SM, Lammens M, van Engelen BG. Mild muscular features in tenascin-X knockout mice, a model of Ehlers-danlos syndrome. Connect Tissue Res 2011; 52:422-32. [PMID: 21405982 DOI: 10.3109/03008207.2010.551616] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Tenascin-X (TNX) is an extracellular matrix (ECM) glycoprotein, the absence of which in humans leads to a recessive form of Ehlers-Danlos syndrome (EDS), a group of inherited connective tissue disorders characterized by joint hypermobility, skin hyperextensibility, and tissue fragility. A mouse model of TNX-deficient type EDS has been used to characterize the dermatological, orthopedic, and obstetrical features. The growing insight in the clinical overlap between myopathies and inherited connective tissue disorders asks for a study of the muscular characteristics of inherited connective tissue diseases. Therefore, this study aims to define the muscular phenotype of TNX knockout (KO) mice. MATERIALS AND METHODS We performed a comprehensive study on the muscular phenotype of these TNX KO mice, consisting of standardized clinical assessment, muscle histology, and gene expression profiling of muscle tissue. Furthermore, peripheral nerve composition was studied by histology and electron microscopy. RESULTS The main findings are the presence of mild muscle weakness, mild myopathic features on histology, and functional upregulation of genes encoding proteins involved in ECM degradation and synthesis. Additionally, sciatic nerve samples showed mildly reduced collagen fibril density of endoneurium. DISCUSSION The muscular phenotype of TNX KO mice consists of mild muscle weakness with histological signs of myopathy and of increased turnover of the ECM in muscle. Furthermore, mildly reduced diameter of myelinated fibers and reduction of collagen fibril density of endoneurium may correspond with polyneuropathy in TNX-deficient EDS patients. This comprehensive assessment can serve as a starting point for further investigations on neuromuscular function in TNX KO mice.
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Affiliation(s)
- N C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, the Netherlands.
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Voermans NC, van Engelen BG. Coffee and muscle cramps. Neuromuscul Disord 2011; 21:832. [PMID: 21820900 DOI: 10.1016/j.nmd.2011.07.006] [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] [Received: 06/15/2011] [Accepted: 07/08/2011] [Indexed: 10/17/2022]
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Geurts ACH, Boonstra TA, Voermans NC, Diender MG, Weerdesteyn V, Bloem BR. Assessment of postural asymmetry in mild to moderate Parkinson's disease. Gait Posture 2011; 33:143-5. [PMID: 20951590 DOI: 10.1016/j.gaitpost.2010.09.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 09/19/2010] [Accepted: 09/20/2010] [Indexed: 02/02/2023]
Abstract
Asymmetry of symptoms of Parkinson's disease is clinically most evident for appendicular impairments. For axial impairments such as freezing of gait, asymmetry is less obvious. To date, asymmetries in balance control in PD patients have seldom been studied. Therefore, in this study we investigated whether postural control can be asymmetrically affected in mild to moderate PD patients. Seventeen PD patients were instructed to stand as still and symmetrically as possible on a dual force-plate during two trials. Dynamic postural asymmetry was assessed by comparing the centre-of-pressure velocities between both legs. Results showed that four patients (24%) had dynamic postural asymmetry, even after correcting for weight-bearing asymmetry. Hence, this study suggests that postural control can be asymmetrical in early PD. However, future studies should investigate the prevalence of dynamic postural asymmetry, in a larger group of PD patients. It should also be further investigated whether this approach can be used as a tool to support the initial diagnosis or monitor disease progression, or as an outcome measure for interventions aimed at improving balance in PD.
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Affiliation(s)
- A C H Geurts
- Department of Rehabilitation, Nijmegen Centre for Evidence Based Practice, Radboud University Nijmegen Medical Centre, The Netherlands.
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Gilhuis HJ, Grosveld WJHM, Voermans NC. Spontaneous intracranial hypotension in a patient with classical type Ehlers-Danlos syndrome. Neurol India 2011; 59:633-4. [DOI: 10.4103/0028-3886.84357] [Citation(s) in RCA: 4] [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: 11/04/2022]
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Voermans NC, Guillard M, Doedée R, Lammens M, Huizing M, Padberg GW, Wevers RA, van Engelen BG, Lefeber DJ. Clinical features, lectin staining, and a novel GNE frameshift mutation in hereditary inclusion body myopathy. Clin Neuropathol 2010; 29:71-77. [PMID: 20175955 PMCID: PMC3500779] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
We present a comprehensive report of two siblings with hereditary inclusion body myopathy (HIBM). The clinical features and histological characteristics of the muscle biopsies showed the typical pattern of predominantly distal vacuolar myopathy with quadriceps sparing. This was confirmed by muscle MRI. PNA lectin staining showed an increased signal at the sarcolemma in patient muscle sections compared to control muscle, indicating reduced sialylation of glycoconjugates. Mutation analysis revealed compound heterozygous mutations in the GNE gene, encoding the key enzyme in sialic acid synthesis UDP-N-acetylglucosamine 2-epimerase/N-acetylmannosamine kinase: a missense mutation (c.2086G > A; p.V696M) previously described in HIBM patients of Indian origin, and a novel frame shift mutation (c.1295delA; p.K432RfsX17) leading to a premature stopcodon. These findings confirmed the diagnosis of HIBM on the histological, molecular and biochemical level.
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Affiliation(s)
- N C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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Voermans NC, Dijk KGJV, Bos MM, Geus-Oei LFD, Verrips A, Lindert EJV. Postural headache in marfan syndrome associated with spinal cysts and liquor hypotension. Neuropediatrics 2009; 40:201-4. [PMID: 20135580 DOI: 10.1055/s-0029-1243164] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We here report a 13-year-old Marfan patient who suffered from severe, medication-resistant, intermittent headache, which was provoked when getting into an upright position and immediately relieved by lying down or after intravenous rehydration. The postural benefit and the sudden relief after intravenous hydration suggested (intermittent) intracranial hypotension, although a normal opening pressure on lumbar punction was observed and no cerebrospinal fluid (CSF) leakage was identified. Imaging studies revealed severe dural ectasia at lumbosacral level, and two intradural cysts and two extradural presacral cysts were detected. Most likely, altered hydrodynamics in intra- and extracranial spinal meningeal cysts caused intermittent CSF hypotension above these cysts, resulting in intermittent intracranial hypotension. Surgical marsupialisation of the intradural cysts proved to be effective. This resulted in a significant reduction of the headache during the clinical follow-up of eight years.
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Affiliation(s)
- N C Voermans
- Department of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Voermans NC, Timmermans J, van Alfen N, Pillen S, op den Akker J, Lammens M, Zwarts MJ, van Rooij IALM, Hamel BC, van Engelen BG. Neuromuscular features in Marfan syndrome. Clin Genet 2009; 76:25-37. [DOI: 10.1111/j.1399-0004.2009.01197.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Voermans NC, Bonnemann CG, Hamel BCJ, Jungbluth H, van Engelen BG. Joint hypermobility as a distinctive feature in the differential diagnosis of myopathies. J Neurol 2009; 256:13-27. [PMID: 19221853 DOI: 10.1007/s00415-009-0105-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Accepted: 09/08/2008] [Indexed: 02/07/2023]
Abstract
Congenital and adult-onset inherited myopathies represent a wide spectrum of syndromes. Classification is based upon clinical features and biochemical and genetic defects. Joint hypermobility is one of the distinctive clinical features that has often been underrecognized so far. We therefore present an overview of myopathies associated with joint hypermobility: Ullrich congenital muscular dystrophy, Bethlem myopathy, congenital muscular dystrophy with joint hyperlaxity, multi-minicore disease, central core disease, and limb girdle muscular dystrophy 2E with joint hyperlaxity and contractures. We shortly discuss a second group of disorders characterised by both muscular features and joint hypermobility: the inherited disorders of connective tissue Ehlers-Danlos syndrome and Marfan syndrome. Furthermore, we will briefly discuss the extent and pattern of joint hypermobility in these myopathies and connective tissue disorders and propose two grading scales commonly used to score the severity of joint hypermobility. We will conclude focusing on the various molecules involved in these disorders and on their role and interactions in muscle and tendon, with a view to further elucidate the pathophysiology of combined hypermobility and myopathy. Hopefully, this review will contribute to enhanced recognition of joint hypermobility and thus be of aid in differential diagnosis.
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Affiliation(s)
- N C Voermans
- Neuromuscular Centre Nijmegen, Dept. of Neurology, 935, Radboud University Nijmegen Medical Centre, 9101, 6500 HB Nijmegen, The Netherlands.
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Voermans NC, Minnema M, Lammens M, Schelhaas HJ, Kooi AVD, Lokhorst HM, van Engelen BG. Sporadic late-onset nemaline myopathy effectively treated by melphalan and stem cell transplant. Neurology 2008; 71:532-4. [PMID: 18565829 DOI: 10.1212/01.wnl.0000310814.54623.6f] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- N C Voermans
- Neuromuscular Centre Nijmegen, Nijmegen Medical Centre, Radboud University, the Netherlands
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Abstract
Localized scleroderma is characterized by idiopathic fibrosis of the skin and adjacent structures, and muscle involvement occurs predominantly in deep morphea. We report a patient with linear scleroderma who presented with slowly progressive atrophy, muscle weakness, and loss of function of her right arm, mimicking a neuromuscular disorder. Muscle biopsy eventually revealed zones of myositis, compatible with morphea profunda. Morphea profunda may thus present as a neuromuscular mimic, even in case of nonprogressive skin sclerosis. Myositis in morphea profunda is generally limited to one region, whereas inflammatory myopathies generally cause diffuse proximal muscle weakness and atrophy. Furthermore, skin changes in morphea profunda differ from those seen in dermatomyositis, and histological features of muscle biopsy can further distinguish between morphea profunda and inflammatory myopathies. Muscle biopsy in morphea profunda implies the risk of sampling error, whereas results of electromyography and muscle imaging might better represent the extent of muscle inflammation.
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Affiliation(s)
- N C Voermans
- Departments of Neurology, Neuromuscular Centre Nijmegen, Nijmegen Medical Centre, The Netherlands.
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Abstract
We report on a 16-year-old Dutch patient in whom rippling muscle disease (RMD) was diagnosed years after his mother had been falsely diagnosed with acid maltase deficiency. The autosomal dominant mode of inheritance of the neuromuscular symptoms in this family had led to a re-evaluation of the diagnosis of acid maltase deficiency. Physical examination revealed the three key features leading to the clinical diagnosis of RMD: rippling, mounding, and percussion-induced rapid muscle contraction. Mutation analysis revealed a novel heterozygous missense mutation in the caveolin-3 gene (c.79C > G; p.Arg27Gly) in both the index patient and his mother. This case report stresses the importance of adhering to the mode of inheritance in the diagnosis of neuromuscular disorders. It also indicates that typical RMD phenomena are not easily acknowledged among paediatricians or neurologists. We therefore present an overview of these clinical characteristics of rippling muscle disease RMD.
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Affiliation(s)
- N C Voermans
- Neuromuscular Centre Nijmegen, Department of Neurology, Radboud University Nijmegen Medical Centre, Nigmegen, The Netherlands.
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Voermans NC, Jenniskens GJ, Hamel BC, Schalkwijk J, Guicheney P, van Engelen BG. Ehlers-Danlos syndrome due to tenascin-X deficiency: muscle weakness and contractures support overlap with collagen VI myopathies. Am J Med Genet A 2007; 143A:2215-9. [PMID: 17702048 DOI: 10.1002/ajmg.a.31899] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Voermans NC, Altenburg TM, Hamel BC, de Haan A, van Engelen BG. Reduced quantitative muscle function in tenascin-X deficient Ehlers-Danlos patients. Neuromuscul Disord 2007; 17:597-602. [PMID: 17588758 DOI: 10.1016/j.nmd.2007.04.004] [Citation(s) in RCA: 26] [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] [Received: 12/12/2006] [Revised: 04/16/2007] [Accepted: 04/19/2007] [Indexed: 10/23/2022]
Abstract
The Ehlers-Danlos Syndrome (EDS) is a heterogeneous group of heritable connective tissue disorders. Skeletal muscle features belong to the clinical criteria of EDS and are generally interpreted to result from increased tendon distensibility or exercise avoidance. However, muscle function in EDS has hardly been investigated as such. We performed a pilot study consisting of clinical investigations, electromyography, muscle ultrasound, muscle biopsy, and quantitative muscle function tests on two EDS patients with deficiency of tenascin-X. Quantitative muscle function proved severely reduced despite normal findings on electromyography and muscle biopsy. These findings dispute the interpretation of increased tendon distensibility. We hypothesize that alterations in the extracellular matrix modify myofascial force transmission and thus influence muscle function in EDS.
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Affiliation(s)
- N C Voermans
- Neuromuscular Centre Nijmegen, Department of Neurology, 935, Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands.
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Affiliation(s)
- N C Voermans
- Department of Neurology, Radboud University Nijmegen Medical Centre, The Netherlands
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Abstract
The term 'split hand' refers to a pattern of dissociated atrophy of hand muscles and was first described in ALS. We hypothesize that this phenomenon also occurs in 'normal' aging. We investigated healthy subjects of different ages and found a progressive dissociation in atrophy of the hand muscles, as measured with compound muscle action potential amplitudes, with increasing age. Different possible causes of this progressive dissociation are discussed. It might be related to preferential use of thenar muscles in humans, which render these muscles and their motor neurons more susceptible to oxidative stress. In addition, a difference in intrinsic susceptibility to oxidative stress might be involved. The relation between normal age-related muscle loss (sarcopenia) and the pathologic loss in motor neuron disease is discussed.
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Affiliation(s)
- N C Voermans
- Neuromuscular Centre Nijmegen, Institute of Neurology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Voermans NC, Koetsveld AC, Zwarts MJ. Segmental overlap: foot drop in S1 radiculopathy. Acta Neurochir (Wien) 2006; 148:809-13; discussion 813. [PMID: 16523224 DOI: 10.1007/s00701-006-0754-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2005] [Accepted: 12/22/2005] [Indexed: 10/24/2022]
Abstract
Knowledge of segmental innervation of skeletal muscles is essential for diagnosing lumbar radiculopathy. Myotomes and dermatomes are traditionally thought to be innervated by a single spinal segment, but experimental studies have shown that this pattern of segmental innervation allows considerable overlap. This implies that muscles (or dermatomes) are innervated not only by axons of one spinal segment, but also partially by axons of adjacent spinal levels. We describe a patient in whom overlap in segmental innervation complicated adequate diagnosis of a recurrent lumbar hernia. Further, we present an outline of electrophysiological and anatomical studies on segmental innervation.
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Affiliation(s)
- N C Voermans
- Neuromuscular Centre Nijmegen, Department of Neurology, Radboud University Nijmegen Medical Centre, The Netherlands.
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