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Bardhan M, Polavarapu K, Baskar D, Preethish-Kumar V, Vengalil S, Nashi S, Ganaraja VH, Sharma D, Kulanthaivelu K, Nandeesh B, Nalini A. Identification of a Novel Intronic Mutation in VMA21 Associated with a Classical Form of X-Linked Myopathy with Autophagy. Glob Med Genet 2024; 11:167-174. [PMID: 38736558 PMCID: PMC11087142 DOI: 10.1055/s-0044-1786815] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Introduction VMA21 -related myopathy is one of the rare forms of slowly progressive myopathy observed in males. Till now, there have been only a handful of reports, mainly from Europe and America, and two reports from India. Method Here, we describe a case of genetically confirmed VMA21 -associated myopathy with clinical, histopathological, and imaging features with a list of known VMA21 mutations. Results A 29-year-old man had the onset of symptoms at 18 years of age with features of proximal lower limb weakness. Muscle magnetic resonance imaging showed the preferential involvement of vasti and adductor magnus. A biopsy of the left quadriceps femoris showed features of autophagic vacuolar myopathy with vacuoles containing granular eosinophilic materials. In targeted next-generation sequencing, hemizygous mutation in the 3' splice site of intron 2 of the VMA21 gene (c.164-7 T > A) was identified and confirmed the diagnosis of X-linked myopathy with excessive autophagy. Conclusion This report expands the phenotypic and genotypic profile of VMA21 -related myopathy, with a yet unreported mutation in India.
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Affiliation(s)
- Mainak Bardhan
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Kiran Polavarapu
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, K1H 5B2, Ontario, Canada
| | - Dipti Baskar
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Veeramani Preethish-Kumar
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Valakunja H. Ganaraja
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Dinesh Sharma
- Deaprtment of Neuroradiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Karthik Kulanthaivelu
- Deaprtment of Neuroradiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - B.N. Nandeesh
- Department of Neuropathology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
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Vengalil S, Pruthi N, Bhat D, Uppar AM, Polavarapu K, Preethish-Kumar V, Nashi S, Rajesh S, Aswini NS, Behera BP, Vandhiyadevan GD, Prasad C, Baskar D, Kulanthaivelu K, Saravanan A, Kandavel T, Nishadham V, Huddar A, Unnikrishnan G, Thomas A, Keerthipriya MS, Sanka SB, Manjunath N, Valasani RK, Bardhan M, Nalini A. Monomelic Amyotrophy/Hirayama Disease: Surgical Outcome in a Large Cohort of Indian Patients. World Neurosurg 2024; 183:e88-e97. [PMID: 38006932 DOI: 10.1016/j.wneu.2023.11.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 11/17/2023] [Accepted: 11/18/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Hirayama disease (HD) is a cervical compressive myelopathy. Anterior cervical discectomy and fusion (ACDF) is identified as the best surgical approach. We evaluated surgical outcomes and factors influencing ACDF in HD. METHODS Between 2015 and 2019, 126 patients with HD underwent ACDF. Contrast magnetic resonance imaging of the cervical spine in full flexion was performed. Clinical examination and preoperative/postoperative assessment of hand function using Fugl-Meyer assessment, Jebsen-Taylor hand function test, and handheld dynamometry were performed at 3-monthly intervals for 1 year. Surgical outcomes were assessed as per the Odom criteria and Hirayama outcome questionnaire. RESULTS Age at onset and duration of illness were 12-31 years (mean, 18 ± 2.7) and 1-96 months (32.7 ± 24.4), respectively. All patients had progressive weakness and wasting of the affected limb. Cord atrophy was seen in 97.1%, with epidural detachment and engorgement of the posterior epidural venous plexus in all. All patients underwent ACDF. Of these patients, 54% had an excellent/good outcome and 39% had a satisfactory outcome as per the Odom scale at last follow-up (mean, 44.9 ± 16.5 months) after surgery. Handheld dynamometry showed improvement from preoperative values to 1 year follow-up. Duration of illness and age at onset had a negative correlation and the preoperative Fugl-Meyer score had a positive correlation with improvement. CONCLUSIONS ACDF resulted in remarkable improvement or stabilization in neurologic deficits in many patients with HD. Because motor disability ensues over time, early surgical intervention during the progressive phase is advocated.
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Affiliation(s)
- Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Nupur Pruthi
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Dhananjay Bhat
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Alok Mohan Uppar
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Kiran Polavarapu
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa and Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Canada
| | | | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Srinithya Rajesh
- Department of Neurorehabilitation, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | | | - Bidyut Prava Behera
- Department of Neurorehabilitation, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | | | - Chandrajit Prasad
- Department of Neuro Imaging and Interventional neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Dipti Baskar
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Karthik Kulanthaivelu
- Department of Neuro Imaging and Interventional neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Akshaya Saravanan
- Department of Neuro Imaging and Interventional neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Thennarasu Kandavel
- Department of Biostatistics, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Vikas Nishadham
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Akshata Huddar
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Gopikrishnan Unnikrishnan
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Aneesha Thomas
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | | | - Sai Bhargava Sanka
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Nisha Manjunath
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Ravi Kiran Valasani
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Mainak Bardhan
- National Institute of Cholera and Enteric Diseases, Kolkata, Indian Council of Medical Research, New Delhi, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India.
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Baskar D, Polavarapu K, Preethish-Kumar V, Vengalil S, Nashi S, Töpf A, Thomas A, Sanka SB, Menon D, Srivastava K, Arunachal G, Nandeesh BN, Lochmüller H, Nalini A. Childhood-Onset Myopathy With Preserved Ambulation Caused by a Recurrent ADSSL1 Missense Variant. Neurol Genet 2024; 10:e200122. [PMID: 38229919 PMCID: PMC10790204 DOI: 10.1212/nxg.0000000000200122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/09/2023] [Indexed: 01/18/2024]
Abstract
Background and Objectives Distal myopathies are a heterogeneous group of primary muscle disorders with recessive or dominant inheritance. ADSSL1 is a muscle-specific adenylosuccinate synthase isoform involved in adenine nucleotide synthesis. Recessive pathogenic variants in the ADSSL1 gene located in chromosome 14q32.33 cause a distal myopathy phenotype. In this study, we present the clinical and genetic attributes of 6 Indian patients with this myopathy. Methods This was a retrospective study describing on Indian patients with genetically confirmed ADSSL1 myopathy. Details were obtained from the medical records. Results All patients presented in their first or early second decade. All had onset in the first decade with a mean age at presentation being 17.7 ± 8.4 years (range: 3-27 years) and M:F ratio being 1:2. The mean disease duration was 9.3 ± 5.2 years ranging from 2 to 15 years. All patients were ambulant with wheelchair bound state in 1 patient due to respiratory involvement. The median serum creatine kinase (CK) level was 185.5 IU/L (range: 123-1564 IU/L). In addition to salient features of ptosis, cardiac involvement, bulbar weakness, and proximo-distal limb weakness with fatigue, there were significant seasonal fluctuations and decremental response to repetitive nerve stimulation, which have not been previously reported. Muscle histopathology was heterogenous with the presence of rimmed vacuoles, nemaline rods, intracellular lipid droplets along with chronic myopathic changes. Subtle response to pyridostigmine treatment was reported. While 5 of 6 patients had homozygous c.781G>A (p.Asp261Asn) variation, 1 had homozygous c.794G>A (p.Gly265Glu) in ADSSL1 gene. Discussion This study expands the phenotypic spectrum and variability of ADSSL1 myopathy with unusual manifestations in this rare disorder. Because the variant c.781G>A (p.Asp261Asn) is the most common mutation among Indian patients similar to other Asian cohorts, this finding could be useful for genetic screening of suspected patients.
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Affiliation(s)
- Dipti Baskar
- From the Department of Neurology (D.B., S.V., S.N., A. Thomas, S.B.S., D.M., K.S., A.N.), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India; Children's Hospital of Eastern Ontario Research Institute (K.P., H.L.), Ottawa, Canada; Department of Neurology (V.P.-K.), Swansea University, Wales, United Kingdom; Brain and Mind Research Institute (H.L.), University of Ottawa; Division of Neurology (H.L.), Department of Medicine, The Ottawa Hospital, Canada; Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Catalonia, Spain; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center-University of Freiburg, Faculty of Medicine, Germany; John Walton Muscular Dystrophy Research Centre (A. Töpf), Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, United Kingdom; Department of Human Genetics (G.A.); and Department of Neuropathology (B.N.N.), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Kiran Polavarapu
- From the Department of Neurology (D.B., S.V., S.N., A. Thomas, S.B.S., D.M., K.S., A.N.), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India; Children's Hospital of Eastern Ontario Research Institute (K.P., H.L.), Ottawa, Canada; Department of Neurology (V.P.-K.), Swansea University, Wales, United Kingdom; Brain and Mind Research Institute (H.L.), University of Ottawa; Division of Neurology (H.L.), Department of Medicine, The Ottawa Hospital, Canada; Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Catalonia, Spain; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center-University of Freiburg, Faculty of Medicine, Germany; John Walton Muscular Dystrophy Research Centre (A. Töpf), Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, United Kingdom; Department of Human Genetics (G.A.); and Department of Neuropathology (B.N.N.), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Veeramani Preethish-Kumar
- From the Department of Neurology (D.B., S.V., S.N., A. Thomas, S.B.S., D.M., K.S., A.N.), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India; Children's Hospital of Eastern Ontario Research Institute (K.P., H.L.), Ottawa, Canada; Department of Neurology (V.P.-K.), Swansea University, Wales, United Kingdom; Brain and Mind Research Institute (H.L.), University of Ottawa; Division of Neurology (H.L.), Department of Medicine, The Ottawa Hospital, Canada; Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Catalonia, Spain; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center-University of Freiburg, Faculty of Medicine, Germany; John Walton Muscular Dystrophy Research Centre (A. Töpf), Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, United Kingdom; Department of Human Genetics (G.A.); and Department of Neuropathology (B.N.N.), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Seena Vengalil
- From the Department of Neurology (D.B., S.V., S.N., A. Thomas, S.B.S., D.M., K.S., A.N.), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India; Children's Hospital of Eastern Ontario Research Institute (K.P., H.L.), Ottawa, Canada; Department of Neurology (V.P.-K.), Swansea University, Wales, United Kingdom; Brain and Mind Research Institute (H.L.), University of Ottawa; Division of Neurology (H.L.), Department of Medicine, The Ottawa Hospital, Canada; Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Catalonia, Spain; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center-University of Freiburg, Faculty of Medicine, Germany; John Walton Muscular Dystrophy Research Centre (A. Töpf), Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, United Kingdom; Department of Human Genetics (G.A.); and Department of Neuropathology (B.N.N.), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Saraswati Nashi
- From the Department of Neurology (D.B., S.V., S.N., A. Thomas, S.B.S., D.M., K.S., A.N.), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India; Children's Hospital of Eastern Ontario Research Institute (K.P., H.L.), Ottawa, Canada; Department of Neurology (V.P.-K.), Swansea University, Wales, United Kingdom; Brain and Mind Research Institute (H.L.), University of Ottawa; Division of Neurology (H.L.), Department of Medicine, The Ottawa Hospital, Canada; Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Catalonia, Spain; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center-University of Freiburg, Faculty of Medicine, Germany; John Walton Muscular Dystrophy Research Centre (A. Töpf), Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, United Kingdom; Department of Human Genetics (G.A.); and Department of Neuropathology (B.N.N.), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Ana Töpf
- From the Department of Neurology (D.B., S.V., S.N., A. Thomas, S.B.S., D.M., K.S., A.N.), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India; Children's Hospital of Eastern Ontario Research Institute (K.P., H.L.), Ottawa, Canada; Department of Neurology (V.P.-K.), Swansea University, Wales, United Kingdom; Brain and Mind Research Institute (H.L.), University of Ottawa; Division of Neurology (H.L.), Department of Medicine, The Ottawa Hospital, Canada; Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Catalonia, Spain; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center-University of Freiburg, Faculty of Medicine, Germany; John Walton Muscular Dystrophy Research Centre (A. Töpf), Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, United Kingdom; Department of Human Genetics (G.A.); and Department of Neuropathology (B.N.N.), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Aneesha Thomas
- From the Department of Neurology (D.B., S.V., S.N., A. Thomas, S.B.S., D.M., K.S., A.N.), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India; Children's Hospital of Eastern Ontario Research Institute (K.P., H.L.), Ottawa, Canada; Department of Neurology (V.P.-K.), Swansea University, Wales, United Kingdom; Brain and Mind Research Institute (H.L.), University of Ottawa; Division of Neurology (H.L.), Department of Medicine, The Ottawa Hospital, Canada; Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Catalonia, Spain; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center-University of Freiburg, Faculty of Medicine, Germany; John Walton Muscular Dystrophy Research Centre (A. Töpf), Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, United Kingdom; Department of Human Genetics (G.A.); and Department of Neuropathology (B.N.N.), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Sai Bhargava Sanka
- From the Department of Neurology (D.B., S.V., S.N., A. Thomas, S.B.S., D.M., K.S., A.N.), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India; Children's Hospital of Eastern Ontario Research Institute (K.P., H.L.), Ottawa, Canada; Department of Neurology (V.P.-K.), Swansea University, Wales, United Kingdom; Brain and Mind Research Institute (H.L.), University of Ottawa; Division of Neurology (H.L.), Department of Medicine, The Ottawa Hospital, Canada; Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Catalonia, Spain; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center-University of Freiburg, Faculty of Medicine, Germany; John Walton Muscular Dystrophy Research Centre (A. Töpf), Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, United Kingdom; Department of Human Genetics (G.A.); and Department of Neuropathology (B.N.N.), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Deepak Menon
- From the Department of Neurology (D.B., S.V., S.N., A. Thomas, S.B.S., D.M., K.S., A.N.), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India; Children's Hospital of Eastern Ontario Research Institute (K.P., H.L.), Ottawa, Canada; Department of Neurology (V.P.-K.), Swansea University, Wales, United Kingdom; Brain and Mind Research Institute (H.L.), University of Ottawa; Division of Neurology (H.L.), Department of Medicine, The Ottawa Hospital, Canada; Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Catalonia, Spain; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center-University of Freiburg, Faculty of Medicine, Germany; John Walton Muscular Dystrophy Research Centre (A. Töpf), Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, United Kingdom; Department of Human Genetics (G.A.); and Department of Neuropathology (B.N.N.), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Kosha Srivastava
- From the Department of Neurology (D.B., S.V., S.N., A. Thomas, S.B.S., D.M., K.S., A.N.), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India; Children's Hospital of Eastern Ontario Research Institute (K.P., H.L.), Ottawa, Canada; Department of Neurology (V.P.-K.), Swansea University, Wales, United Kingdom; Brain and Mind Research Institute (H.L.), University of Ottawa; Division of Neurology (H.L.), Department of Medicine, The Ottawa Hospital, Canada; Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Catalonia, Spain; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center-University of Freiburg, Faculty of Medicine, Germany; John Walton Muscular Dystrophy Research Centre (A. Töpf), Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, United Kingdom; Department of Human Genetics (G.A.); and Department of Neuropathology (B.N.N.), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Gautham Arunachal
- From the Department of Neurology (D.B., S.V., S.N., A. Thomas, S.B.S., D.M., K.S., A.N.), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India; Children's Hospital of Eastern Ontario Research Institute (K.P., H.L.), Ottawa, Canada; Department of Neurology (V.P.-K.), Swansea University, Wales, United Kingdom; Brain and Mind Research Institute (H.L.), University of Ottawa; Division of Neurology (H.L.), Department of Medicine, The Ottawa Hospital, Canada; Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Catalonia, Spain; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center-University of Freiburg, Faculty of Medicine, Germany; John Walton Muscular Dystrophy Research Centre (A. Töpf), Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, United Kingdom; Department of Human Genetics (G.A.); and Department of Neuropathology (B.N.N.), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Bevinahalli N Nandeesh
- From the Department of Neurology (D.B., S.V., S.N., A. Thomas, S.B.S., D.M., K.S., A.N.), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India; Children's Hospital of Eastern Ontario Research Institute (K.P., H.L.), Ottawa, Canada; Department of Neurology (V.P.-K.), Swansea University, Wales, United Kingdom; Brain and Mind Research Institute (H.L.), University of Ottawa; Division of Neurology (H.L.), Department of Medicine, The Ottawa Hospital, Canada; Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Catalonia, Spain; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center-University of Freiburg, Faculty of Medicine, Germany; John Walton Muscular Dystrophy Research Centre (A. Töpf), Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, United Kingdom; Department of Human Genetics (G.A.); and Department of Neuropathology (B.N.N.), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Hanns Lochmüller
- From the Department of Neurology (D.B., S.V., S.N., A. Thomas, S.B.S., D.M., K.S., A.N.), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India; Children's Hospital of Eastern Ontario Research Institute (K.P., H.L.), Ottawa, Canada; Department of Neurology (V.P.-K.), Swansea University, Wales, United Kingdom; Brain and Mind Research Institute (H.L.), University of Ottawa; Division of Neurology (H.L.), Department of Medicine, The Ottawa Hospital, Canada; Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Catalonia, Spain; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center-University of Freiburg, Faculty of Medicine, Germany; John Walton Muscular Dystrophy Research Centre (A. Töpf), Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, United Kingdom; Department of Human Genetics (G.A.); and Department of Neuropathology (B.N.N.), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
| | - Atchayaram Nalini
- From the Department of Neurology (D.B., S.V., S.N., A. Thomas, S.B.S., D.M., K.S., A.N.), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India; Children's Hospital of Eastern Ontario Research Institute (K.P., H.L.), Ottawa, Canada; Department of Neurology (V.P.-K.), Swansea University, Wales, United Kingdom; Brain and Mind Research Institute (H.L.), University of Ottawa; Division of Neurology (H.L.), Department of Medicine, The Ottawa Hospital, Canada; Centro Nacional de Análisis Genómico (CNAG-CRG) (H.L.), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Catalonia, Spain; Department of Neuropediatrics and Muscle Disorders (H.L.), Medical Center-University of Freiburg, Faculty of Medicine, Germany; John Walton Muscular Dystrophy Research Centre (A. Töpf), Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, United Kingdom; Department of Human Genetics (G.A.); and Department of Neuropathology (B.N.N.), National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, India
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4
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Polavarapu K, Sunitha B, Töpf A, Preethish-Kumar V, Thompson R, Vengalil S, Nashi S, Bardhan M, Sanka SB, Huddar A, Unnikrishnan G, Arunachal G, Girija MS, Porter A, Azuma Y, Lorenzoni PJ, Baskar D, Anjanappa RM, Keertipriya M, Padmanabh H, Harikrishna GV, Laurie S, Matalonga L, Horvath R, Nalini A, Lochmüller H. Clinical and genetic characterisation of a large Indian congenital myasthenic syndrome cohort. Brain 2024; 147:281-296. [PMID: 37721175 PMCID: PMC10766255 DOI: 10.1093/brain/awad315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/20/2023] [Accepted: 08/10/2023] [Indexed: 09/19/2023] Open
Abstract
Congenital myasthenic syndromes (CMS) are a rare group of inherited disorders caused by gene defects associated with the neuromuscular junction and potentially treatable with commonly available medications such as acetylcholinesterase inhibitors and β2 adrenergic receptor agonists. In this study, we identified and genetically characterized the largest cohort of CMS patients from India to date. Genetic testing of clinically suspected patients evaluated in a South Indian hospital during the period 2014-19 was carried out by standard diagnostic gene panel testing or using a two-step method that included hotspot screening followed by whole-exome sequencing. In total, 156 genetically diagnosed patients (141 families) were characterized and the mutational spectrum and genotype-phenotype correlation described. Overall, 87 males and 69 females were evaluated, with the age of onset ranging from congenital to fourth decade (mean 6.6 ± 9.8 years). The mean age at diagnosis was 19 ± 12.8 (1-56 years), with a mean diagnostic delay of 12.5 ± 9.9 (0-49 years). Disease-causing variants in 17 CMS-associated genes were identified in 132 families (93.6%), while in nine families (6.4%), variants in genes not associated with CMS were found. Overall, postsynaptic defects were most common (62.4%), followed by glycosylation defects (21.3%), synaptic basal lamina genes (4.3%) and presynaptic defects (2.8%). Other genes found to cause neuromuscular junction defects (DES, TEFM) in our cohort accounted for 2.8%. Among the individual CMS genes, the most commonly affected gene was CHRNE (39.4%), followed by DOK7 (14.4%), DPAGT1 (9.8%), GFPT1 (7.6%), MUSK (6.1%), GMPPB (5.3%) and COLQ (4.5%). We identified 22 recurrent variants in this study, out of which eight were found to be geographically specific to the Indian subcontinent. Apart from the known common CHRNE variants p.E443Kfs*64 (11.4%) and DOK7 p.A378Sfs*30 (9.3%), we identified seven novel recurrent variants specific to this cohort, including DPAGT1 p.T380I and DES c.1023+5G>A, for which founder haplotypes are suspected. This study highlights the geographic differences in the frequencies of various causative CMS genes and underlines the increasing significance of glycosylation genes (DPAGT1, GFPT1 and GMPPB) as a cause of neuromuscular junction defects. Myopathy and muscular dystrophy genes such as GMPPB and DES, presenting as gradually progressive limb girdle CMS, expand the phenotypic spectrum. The novel genes MACF1 and TEFM identified in this cohort add to the expanding list of genes with new mechanisms causing neuromuscular junction defects.
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Affiliation(s)
- Kiran Polavarapu
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada
| | - Balaraju Sunitha
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne NE1 3BZ, UK
- Department of Clinical Neurosciences, University of Cambridge School of Clinical Medicine, Cambridge CB2 0SP, UK
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford OX3 9DU, UK
| | - Ana Töpf
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne NE1 3BZ, UK
| | - Veeramani Preethish-Kumar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
- Department of Neurology, Neurofoundation, Salem, Tamil Nadu 636009, India
| | - Rachel Thompson
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Mainak Bardhan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Sai Bhargava Sanka
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Akshata Huddar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
- Department of Neurology, St Johns Medical College Hospital, Bangalore 560034, India
| | - Gopikrishnan Unnikrishnan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
- Department of Neurology, Amruta Institute of Medical Sciences, Kochi 682041, India
| | - Gautham Arunachal
- Department of Human Genetics, National Institute of Mental Health and Neurosciences, Bengaluru 560029, India
| | - Manu Santhappan Girija
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Anna Porter
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne NE1 3BZ, UK
| | - Yoshiteru Azuma
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne NE1 3BZ, UK
| | - Paulo José Lorenzoni
- Neuromuscular Disorders Division, Service of Neurology, Department of Internal Medicine, Hospital de Clínicas, Universidade Federal do Paraná, Rua General Carneiro, Curitiba - PR 80060-900, Brazil
| | - Dipti Baskar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Ram Murthy Anjanappa
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Madassu Keertipriya
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Hansashree Padmanabh
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | | | - Steve Laurie
- Centro Nacional de Análisis Genómico (CNAG-CRG), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Barcelona, Catalonia 08028, Spain
| | - Leslie Matalonga
- Centro Nacional de Análisis Genómico (CNAG-CRG), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Barcelona, Catalonia 08028, Spain
| | - Rita Horvath
- Department of Clinical Neurosciences, University of Cambridge School of Clinical Medicine, Cambridge CB2 0SP, UK
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Hanns Lochmüller
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada
- Centro Nacional de Análisis Genómico (CNAG-CRG), Center for Genomic Regulation, Barcelona Institute of Science and Technology (BIST), Barcelona, Catalonia 08028, Spain
- Brain and Mind Research Institute, University of Ottawa, Ottawa, ON K1H 8M5, Canada
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, ON K1H 8M5, Canada
- Department of Neuropediatrics and Muscle Disorders, Medical Center–University of Freiburg, Faculty of Medicine, Freiburg 79110, Germany
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5
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Chawla T, Reddy N, Jankar R, Vengalil S, Polavarapu K, Arunachal G, Preethish-Kumar V, Nashi S, Bardhan M, Rajeshwaran J, Afsar M, Warrier M, Thomas PT, Thennarasu K, Nalini A. Myotonic Dystrophy Type 1 (DM1): Clinical Characteristics and Disease Progression in a Large Cohort. Neurol India 2024; 72:83-89. [PMID: 38443007 DOI: 10.4103/neuroindia.ni_1432_20] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 10/25/2021] [Indexed: 03/07/2024]
Abstract
BACKGROUND DM1 is a multisystem disorder caused by expansion of a CTG triplet repeat in the 3' non-coding region of DMPK. Neuropsychological consequences and sleep abnormalities are important associations in DM1. OBJECTIVE To describe the clinical phenotype, disease progression and characterize the sleep alterations and cognitive abnormalities in a sub-set of patients. MATERIALS AND METHODS A retrospective study on 120 genetically confirmed DM1 cases. Findings in neuropsychological assessment and multiple sleep questionnaires were compared with 14 age and sex matched healthy individuals. All 120 patients were contacted through letters/telephonic consultation/hospital visits to record their latest physical and functional disabilities. RESULTS The mean age at symptom onset was 23.1 ± 11.4 years, M: F = 3.8:1, mean duration of illness = 14.3 ± 9.5 years. Clinically 54.2% had adult onset form, juvenile = 27.5%, infantile = 10.8%, late adult onset = 7.5%. Paternal transmission occurred more frequently. The predominant initial symptoms were myotonia (37.5%), hand weakness (21.7%), lower limb weakness (23.3%) and bulbar (10%). Twenty patients completed sleep questionnaires (SQ). Abnormal scores were noted in Epworth sleepiness scale (55%); Pittsburgh sleep quality index (45%); Berlin SQ (30%); Rapid eye movement sleep Behaviour Disorder SQ (15%); Restless leg syndrome rating scale (10%). Neuropsychological assessment of 20 patients revealed frontal executive dysfunction, attention impairment and visuospatial dysfunction. Frontal lobe was most affected (72%) followed by parietal (16%) and temporal lobe (12%). CONCLUSIONS The current study provides a comprehensive account of the clinical characteristics in Indian patients with DM1. Hypersomnolence was most commonly seen. Excessive daytime sleepiness and Sleep disordered breathing were the most common sleep related abnormality. Cognitive impairment comprised predominantly of frontal lobe dysfunction.
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Affiliation(s)
- Tanushree Chawla
- Department of Neurology, Children's Hospital of Eastern Ontario Research Institute, The Ottawa Hospital, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Nishanth Reddy
- Department of Neurology, Children's Hospital of Eastern Ontario Research Institute, The Ottawa Hospital, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Rahul Jankar
- Department of Neurology, Children's Hospital of Eastern Ontario Research Institute, The Ottawa Hospital, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Seena Vengalil
- Department of Neurology, Children's Hospital of Eastern Ontario Research Institute, The Ottawa Hospital, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Kiran Polavarapu
- Department of Neurology, Children's Hospital of Eastern Ontario Research Institute, The Ottawa Hospital, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
- Department of Division of Neurology, Department of Medicine, Children's Hospital of Eastern Ontario Research Institute, The Ottawa Hospital, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Gautham Arunachal
- Department of Human Genetics, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Veeramani Preethish-Kumar
- Department of Neurology, Children's Hospital of Eastern Ontario Research Institute, The Ottawa Hospital, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Saraswati Nashi
- Department of Neurology, Children's Hospital of Eastern Ontario Research Institute, The Ottawa Hospital, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Mainak Bardhan
- Department of Neurology, Children's Hospital of Eastern Ontario Research Institute, The Ottawa Hospital, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
- Department of Division of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Jamuna Rajeshwaran
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Mohammad Afsar
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Manjusha Warrier
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Priya T Thomas
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Kandavel Thennarasu
- Department of Biostatistics, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Atchayaram Nalini
- Department of Neurology, Children's Hospital of Eastern Ontario Research Institute, The Ottawa Hospital, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
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6
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Girija MS, Menon D, Polavarapu K, Preethish-Kumar V, Vengalil S, Nashi S, Keertipriya M, Bardhan M, Thomas PT, Kiran VR, Nishadham V, Sadasivan A, Huddar A, Unnikrishnan GK, Inbaraj G, Krishnamurthy A, Kramer BW, Sathyaprabha TN, Nalini A. Qualitative and Quantitative Electrocardiogram Parameters in a Large Cohort of Children with Duchenne Muscle Dystrophy in Comparison with Age-Matched Healthy Subjects: A Study from South India. Ann Indian Acad Neurol 2024; 27:53-57. [PMID: 38495238 PMCID: PMC10941898 DOI: 10.4103/aian.aian_989_23] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 11/28/2023] [Accepted: 12/05/2023] [Indexed: 03/19/2024] Open
Abstract
Background Electrocardiography (ECG) remains an excellent screening tool for cardiac assessment in Duchenne muscular dystrophy (DMD), but an accurate interpretation requires comparison with age-matched healthy controls. Objective We examined various ECG parameters in children with DMD, in comparison with age-matched controls. Methods Standard 12-lead ECG tracings of serial patients were screened for quality and selected. Controls were healthy, age-matched school-going children. Both quantitative and qualitative ECG parameters were analyzed. Results After screening, ECGs from 252 patients with DMD (8.32 ± 3.12 years, 2-21 years) and ECGs from 151 age-matched healthy controls (9.72 ± 2.23, 4-19 years) were included. A significantly higher heart rate, shorter R-R interval, and taller R wave in V1 were seen across all age group of DMD in comparison to controls, with the difference increasing with age. While QT prolongation was seen in all age groups of DMD, QTc prolongation was seen only at 10 years or more. Incomplete right bundle branch block (RBBB) and pathological Q waves in inferolateral leads were exclusive in DMD, with the latter declining with age. Evidence for left ventricular (LV) pathology, such as tall R in V5/V6, increase in SV1 + RV6 height, and QRS complex duration, were seen only in the age group of 10 years or more. Conclusion Stratification based on age and comparison with age-matched healthy subjects showed that several ECG parameters were influenced by age, and it also identified age-dependent evidence for LV pathology and QTc prolongation in DMD.
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Affiliation(s)
- Manu S. Girija
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Deepak Menon
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Kiran Polavarapu
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
- Division of Neurology, Department of Medicine, Children's Hospital of Eastern Ontario Research Institute, The Ottawa Hospital, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Veeramani Preethish-Kumar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Madassu Keertipriya
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Mainak Bardhan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Priya T. Thomas
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Valasani R. Kiran
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vikas Nishadham
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Arun Sadasivan
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Akshata Huddar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Gopi K. Unnikrishnan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ganagarajan Inbaraj
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Arjun Krishnamurthy
- Department of Computer Sciences, School of Engineering, Dayananda Sagar University, Bengaluru, Karnataka, India
| | - Boris W. Kramer
- Department of Paediatrics, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Talakad N. Sathyaprabha
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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7
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Thomas PT, Warrier MG, Arun S, Bhuvaneshwari B, Vengalil S, Nashi S, Preethish-Kumar V, Polavarapu K, Rajaram P, Nalini A. An individualised psychosocial intervention program for persons with MND/ALS and their families in low resource settings. Chronic Illn 2023; 19:458-471. [PMID: 35469482 DOI: 10.1177/17423953221097076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To develop individualised psychosocial intervention program for people with MND and their families in India. METHODS People with MND and healthcare staff were constructively involved in co-designing the intervention program in four phases adapted from the MRC framework: 1. A detailed need assessment phase where 30 participants shared their perceptions of psychosocial needs 2. Developing the intervention module (synthesis of narrative review, identified needs); 3. Feasibility testing of the intervention program among seven participants; 4. Feedback from participants on the feasibility (acceptance, practicality adaptation). The study adopted an exploratory research design. RESULTS Intervention program of nine sessions, addressing psychosocial challenges through the different stages of progression of the illness and ways to handle the challenges, specific to the low resource settings, was developed and was found to be feasible. People with MND and families who participated in the feasibility study shared the perceived benefit through feedback interviews. CONCLUSION MND has changing needs and challenges. Intervention programme was found to be feasible to be implemented among larger group to establish efficacy.
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Affiliation(s)
- Priya Treesa Thomas
- Department of Psychiatric Social Work, 29148National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Manjusha G Warrier
- Department of Psychology, 119667CHRIST (Deemed to be University), Bangalore
| | - S Arun
- Department of Counselling Psychology, Montfort College, Bangalore
| | - B Bhuvaneshwari
- Department of Psychiatry, 236748St John's Medical college and hospital, Bangalore, India
| | - Seena Vengalil
- Department of Neurology, 29148National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Saraswati Nashi
- Department of Neurology, 29148National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Veeramani Preethish-Kumar
- Department of Neurology, 29148National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Kiran Polavarapu
- Department of Neurology, 29148National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Prakashi Rajaram
- Department of Psychiatric Social Work, 29148National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Atchayaram Nalini
- Department of Neurology, 29148National Institute of Mental Health and Neuro Sciences, Bangalore, India
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8
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Unnikrishnan G, Polavarapu K, Bardhan M, Nashi S, Vengalil S, Preethish-Kumar V, Valasani RK, Huddar A, Nishadham V, Nandeesh BN, Nalini A. Phenotype Genotype Characterization of FKRP-related Muscular Dystrophy among Indian Patients. J Neuromuscul Dis 2023:JND221618. [PMID: 37154180 DOI: 10.3233/jnd-221618] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND The phenotypic spectrum of Fukutin-related protein (FKRP) mutations is highly variable and comprises of limb girdle muscular dystrophy (LGMD) R9 (previously LGMD 2I) and FKRP related congenital muscular dystrophies. OBJECTIVE To identify the distinct genotype phenotype pattern in Indian patients with FKRP gene mutations. METHODS We retrospectively reviewed the case files of patients with muscular dystrophy having a genetically confirmed FKRP mutation. All patients had undergone genetic testing using next-generation sequencing. RESULTS Our patients included five males and four females presenting between 1.5 years and seven years of age (median age - 3 years). The initial symptom was a delayed acquisition of gross motor developmental milestones in seven patients and recurrent falls and poor sucking in one patient each. Two patients had a language delay, with both having abnormalities on the brain MRI. Macroglossia, scapular winging, and facial weakness were noted in one, three and four patients respectively. Calf muscle hypertrophy was seen in eight patients and ankle contractures in six. At the last follow-up, three patients had lost ambulation (median age - 7 years; range 6.5-9 years) and three patients had not attained independent ambulation. Creatine kinase levels ranged between 2793 and 32,396 U/L (mean 12,120 U/L). A common mutation - c.1343C>T was noted in 5 patients in our cohort. Additionally, four novel mutations were identified. Overall, six patients had an LGMD R9 phenotype, and three had a congenital muscular dystrophy phenotype. CONCLUSION Patients with FKRP mutations can have varied presentations. A Duchenne-like phenotype was the most commonly encountered pattern in our cohort, with c.1343C>T being the most common mutation.
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Affiliation(s)
| | - Kiran Polavarapu
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Mainak Bardhan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Ravi Kiran Valasani
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Akshata Huddar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Vikas Nishadham
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
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9
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Manjunath V, Thenral SG, Lakshmi BR, Nalini A, Bassi A, Karthikeyan KP, Piyusha K, Menon R, Malhotra A, Praveena LS, Anjanappa RM, Murugan SMS, Polavarapu K, Bardhan M, Preethish-Kumar V, Vengalil S, Nashi S, Sanga S, Acharya M, Raju R, Pai VR, Ramprasad VL, Gupta R. Large Region of Homozygous (ROH) Identified in Indian Patients with Autosomal Recessive Limb-Girdle Muscular Dystrophy with p.Thr182Pro Variant in SGCB Gene. Hum Mutat 2023. [DOI: 10.1155/2023/4362273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
The sarcoglycanopathies are autosomal recessive limb-girdle muscular dystrophies (LGMDs) caused by the mutations in genes encoding the α, β, γ, and δ proteins which stabilizes the sarcolemma of muscle cells. The clinical phenotype is characterized by progressive proximal muscle weakness with childhood onset. Muscle biopsy findings are diagnostic in confirming dystrophic changes and deficiency of one or more sarcoglycan proteins. In this study, we summarized 1,046 LGMD patients for which a precise diagnosis was identified using targeted sequencing. The most frequent phenotypes identified in the patients are LGMDR1 (19.7%), LGMDR4 (19.0%), LGMDR2 (17.5%), and MMD1 (14.5%). Among the reported genes, each of CAPN3, SGCB, and DYSF variants was reported in more than 10% of our study cohort. The most common variant SGCB p.Thr182Pro was identified in 146 (12.5%) of the LGMD patients, and in 97.9% of these patients, the variant was found to be homozygous. To understand the genetic structure of the patients carrying SGCB p.Thr182Pro, we genotyped 68 LGMD patients using a whole genome microarray. Analysis of the array data identified a large ~1 Mb region of homozygosity (ROH) (chr4:51817441-528499552) suggestive of a shared genomic region overlapping the recurrent missense variant and shared across all 68 patients. Haplotype analysis identified 133 marker haplotypes that were present in ~85.3% of the probands as a double allele and absent in all random controls. We also identified 5 markers (rs1910739, rs6852236, rs13122418, rs13353646, and rs6554360) which were present in a significantly higher proportion in the patients compared to random control set (
) and the population database. Of note, admixture analysis was suggestive of greater proportion of West Eurasian/European ancestry as compared to random controls. Haplotype analysis and frequency in the population database indicate a probable event of founder effect. Further systematic study is needed to identify the communities and regions where the SGCB p.Thr182Pro variant is observed in higher proportions. After identifying these communities and//or region, a screening program is needed to identify carriers and provide them counselling.
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10
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Van Haute L, O'Connor E, Díaz-Maldonado H, Munro B, Polavarapu K, Hock DH, Arunachal G, Athanasiou-Fragkouli A, Bardhan M, Barth M, Bonneau D, Brunetti-Pierri N, Cappuccio G, Caruana NJ, Dominik N, Goel H, Helman G, Houlden H, Lenaers G, Mention K, Murphy D, Nandeesh B, Olimpio C, Powell CA, Preethish-Kumar V, Procaccio V, Rius R, Rebelo-Guiomar P, Simons C, Vengalil S, Zaki MS, Ziegler A, Thorburn DR, Stroud DA, Maroofian R, Christodoulou J, Gustafsson C, Nalini A, Lochmüller H, Minczuk M, Horvath R. TEFM variants impair mitochondrial transcription causing childhood-onset neurological disease. Nat Commun 2023; 14:1009. [PMID: 36823193 PMCID: PMC9950373 DOI: 10.1038/s41467-023-36277-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/20/2023] [Indexed: 02/25/2023] Open
Abstract
Mutations in the mitochondrial or nuclear genomes are associated with a diverse group of human disorders characterized by impaired mitochondrial respiration. Within this group, an increasing number of mutations have been identified in nuclear genes involved in mitochondrial RNA biology. The TEFM gene encodes the mitochondrial transcription elongation factor responsible for enhancing the processivity of mitochondrial RNA polymerase, POLRMT. We report for the first time that TEFM variants are associated with mitochondrial respiratory chain deficiency and a wide range of clinical presentations including mitochondrial myopathy with a treatable neuromuscular transmission defect. Mechanistically, we show muscle and primary fibroblasts from the affected individuals have reduced levels of promoter distal mitochondrial RNA transcripts. Finally, tefm knockdown in zebrafish embryos resulted in neuromuscular junction abnormalities and abnormal mitochondrial function, strengthening the genotype-phenotype correlation. Our study highlights that TEFM regulates mitochondrial transcription elongation and its defect results in variable, tissue-specific neurological and neuromuscular symptoms.
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Affiliation(s)
- Lindsey Van Haute
- MRC Mitochondrial Biology Unit, University of Cambridge, Cambridge, CB2 0XY, UK
| | - Emily O'Connor
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, ON, Canada
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Héctor Díaz-Maldonado
- Department of Biochemistry and Cell Biology, University of Gothenburg, SE-405 30, Gothenburg, Sweden
| | - Benjamin Munro
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Kiran Polavarapu
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, ON, Canada
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Daniella H Hock
- Department of Biochemistry and Pharmacology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, 30 Flemington Road, Parkville, VIC, 3052, Australia
| | - Gautham Arunachal
- Department of Human genetics, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Alkyoni Athanasiou-Fragkouli
- UCL London, Department of Neuromuscular Disorders, Institute of Neurology, University College London, London, UK
| | - Mainak Bardhan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Magalie Barth
- Department of Genetics, Mitovasc INSERM 1083, CNRS 6015, University Hospital of Angers, Angers, France
| | - Dominique Bonneau
- Department of Genetics, Mitovasc INSERM 1083, CNRS 6015, University Hospital of Angers, Angers, France
| | - Nicola Brunetti-Pierri
- Department of Translational Medicine, University of Naples Federico II, Via s. Pansini, 5, 80131, Naples, Italy
| | - Gerarda Cappuccio
- Department of Translational Medicine, University of Naples Federico II, Via s. Pansini, 5, 80131, Naples, Italy
| | - Nikeisha J Caruana
- Department of Biochemistry and Pharmacology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, 30 Flemington Road, Parkville, VIC, 3052, Australia
- Institute for Health and Sport (IHES), Victoria University, Melbourne, VIC, 3011, Australia
| | - Natalia Dominik
- UCL London, Department of Neuromuscular Disorders, Institute of Neurology, University College London, London, UK
| | - Himanshu Goel
- Hunter Genetics, Waratah, University of Newcastle, Callaghan, NSW, 2298, Australia
| | - Guy Helman
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Henry Houlden
- UCL London, Department of Neuromuscular Disorders, Institute of Neurology, University College London, London, UK
| | - Guy Lenaers
- Department of Genetics, Mitovasc INSERM 1083, CNRS 6015, University Hospital of Angers, Angers, France
| | - Karine Mention
- Pediatric Inherited Metabolic Disorders, Hôpital Jeanne de Flandre, Lille, France
| | - David Murphy
- UCL London, Department of Neuromuscular Disorders, Institute of Neurology, University College London, London, UK
| | - Bevinahalli Nandeesh
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Catarina Olimpio
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | | | - Vincent Procaccio
- Department of Genetics, Mitovasc INSERM 1083, CNRS 6015, University Hospital of Angers, Angers, France
| | - Rocio Rius
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, 3010, Australia
| | | | - Cas Simons
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Maha S Zaki
- Clinical Genetics Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, 12311, Egypt
| | - Alban Ziegler
- Department of Genetics, Mitovasc INSERM 1083, CNRS 6015, University Hospital of Angers, Angers, France
| | - David R Thorburn
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, 3010, Australia
| | - David A Stroud
- Department of Biochemistry and Pharmacology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, 30 Flemington Road, Parkville, VIC, 3052, Australia
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Reza Maroofian
- UCL London, Department of Neuromuscular Disorders, Institute of Neurology, University College London, London, UK
| | - John Christodoulou
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Claes Gustafsson
- Department of Biochemistry and Cell Biology, University of Gothenburg, SE-405 30, Gothenburg, Sweden
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Hanns Lochmüller
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, ON, Canada
- Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Michal Minczuk
- MRC Mitochondrial Biology Unit, University of Cambridge, Cambridge, CB2 0XY, UK.
| | - Rita Horvath
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
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11
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Baskar D, Vengalil S, Nashi S, Bardhan M, Srivastava K, Sanka SB, Polavarapu K, Menon D, Preethish-Kumar V, Padmanabha H, Arunachal G, Nalini A. MYH2-related Myopathy: Expanding the Clinical Spectrum of Chronic Progressive External Ophthalmoplegia (CPEO). J Neuromuscul Dis 2023; 10:727-730. [PMID: 37154181 PMCID: PMC10357141 DOI: 10.3233/jnd-230017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 05/10/2023]
Abstract
Chronic progressive external ophthalmoplegia (CPEO) is symptom complex with progressive ptosis and restricted ocular motility without diplopia. MYH2 myopathy is rare disorder presenting with CPEO and muscle weakness. We report two Indian patients of MYH2 myopathy with unique features. Patient-1 presented with early adult-onset esophageal reflux followed by, proximal lower limb weakness, proptosis, CPEO without ptosis. He had elevated creatine kinase along with characteristic muscle MRI findings of prominent semitendinosus and medial gastrocnemius involvement. Patient -2 presented with early adult onset CPEO without limb weakness. His creatine kinase was normal. Both the patients had novel MYH2 mutations: a homozygous 5'splice variation in intron 4 (c.348 + 2dup) in patient 1 and homozygous single base pair deletion in exon 32 (p. Ala1480ProfsTer11) in patient 2. Unique features noted include adult onset, isolated CPEO, proptosis, esophageal reflux disease and absence of skeletal abnormalities. MYH2 myopathy has to be considered in adult patients with CPEO.
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Affiliation(s)
- Dipti Baskar
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Mainak Bardhan
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Kosha Srivastava
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Sai Bhargava Sanka
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Kiran Polavarapu
- Department of Medicine, Children’s Hospitalof Eastern Ontario Research Institute, University of Ottawa and Division of Neurology, The Ottawa Hospital, Ottawa, Canada
| | - Deepak Menon
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | | | - Hansashree Padmanabha
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Gautham Arunachal
- Department of Human Genetics, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
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12
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Inbaraj G, Arjun K, Meghana A, Preethish-Kumar V, John AP, Polavarapu K, Nashi S, Sekar D, Udupa K, Prathuysha PV, Prasad K, Bardhan M, Raju TR, Kramer BW, Nalini A, Sathyaprabha TN. Neuro-Cardio-Autonomic Modulations in Children with Duchenne Muscular Dystrophy. J Neuromuscul Dis 2023; 10:227-238. [PMID: 36847014 DOI: 10.3233/jnd-221621] [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: 02/23/2023]
Abstract
BACKGROUND AND OBJECTIVE Duchenne muscular dystrophy (DMD) is a degenerative X-linked muscle disease. Death frequently results from complications in cardiopulmonary systems. Preclinical/early diagnosis of cardiac autonomic abnormalities may aid initiate cardioprotective therapy and enhance prognosis. METHODS A cross sectional, prospective study of 38 DMD boys compared with 37 age-matched healthy controls was conducted. Lead II electrocardiography and beat-to-beat blood pressure were recorded to assess heart rate variability (HRV), blood pressure variability (BPV), and baroreceptor sensitivity (BRS) in a standardized environment. Data were analysed and correlated with disease severity and genotype. RESULTS In the DMD group, the median age at assessment was 8 years [IQR 7-9 years], the median age at disease onset was 3 years [IQR, 2-6 years], and the mean duration of illness was 4 years [IQR, 2.5-5]. DNA sequencing showed deletions in 34/38 (89.5 %) and duplications in 4/38 (10.5%) patients. The median heart rate in DMD children was significantly higher [101.19 (Range, 94.71-108.49)] /min compared to controls [81 (Range, 76.2-92.76)] /min (p < 0.05). All the assessed HRV and BPV parameters were significantly impaired in DMD cases except for the coefficient of variance of systolic blood pressure. Further, BRS parameters were also significantly reduced in DMD, excluding alpha-LF. A positive correlation was found between alpha HF with age at onset and duration of illness. CONCLUSION This study demonstrates a distinct early impairment of neuro-cardio-autonomic regulation in DMD. Simple yet effective non-invasive techniques such as HRV, BPV, and BRS may help identify cardiac dysfunction in a pre-clinical state, paving the way for early cardio-protective therapies and limiting disease progression in DMD patients.
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Affiliation(s)
- Ganagarajan Inbaraj
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Krishnamurthy Arjun
- Department of CSE, School of Engineering, Dayananda Sagar University, Bangalore
| | - Adoor Meghana
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Anu P John
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Kiran Polavarapu
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Deepha Sekar
- Department of Molecular Genetics, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Kaviraja Udupa
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Parthipulli V Prathuysha
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Krishna Prasad
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Mainak Bardhan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Trichur R Raju
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Boris W Kramer
- Department of Paediatrics, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Talakad N Sathyaprabha
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bangalore, India
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13
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Nashi S, Polavarapu K, Bardhan M, Anjanappa RM, Preethish-Kumar V, Vengalil S, Padmanabha H, Geetha TS, Prathyusha PV, Ramprasad V, Joshi A, Chawla T, Unnikrishnan G, Sharma P, Huddar A, Uppilli B, Thomas A, Baskar D, Mathew S, Menon D, Arunachal G, Faruq M, Thangaraj K, Nalini A. Genotype-phenotype correlation and natural history study of dysferlinopathy: a single-centre experience from India. Neurogenetics 2023; 24:43-53. [PMID: 36580222 DOI: 10.1007/s10048-022-00707-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/15/2022] [Indexed: 12/30/2022]
Abstract
Dysferlinopathies are a group of limb-girdle muscular dystrophies causing significant disability in the young population. There is a need for studies on large cohorts to describe the clinical, genotypic and natural history in our subcontinent. To describe and correlate the clinical, genetic profile and natural history of genetically confirmed dysferlinopathies. We analysed a retrospective cohort of patients with dysferlinopathy from a single quaternary care centre in India. A total of 124 patients with dysferlinopathy were included (40 females). Median age at onset and duration of illness were 21 years (range, 13-50) and 48 months (range, 8-288), respectively. The average follow-up period was 60 months (range, 12-288). Fifty-one percent had LGMD pattern of weakness at onset; 23.4% each had Miyoshi and proximo-distal type while isolated hyperCKemia was noted in 1.6%. About 60% were born to consanguineous parents and 26.6% had family history of similar illness. Twenty-three patients (18.6%) lost ambulation at follow-up; the median time to loss of independent ambulation was 120 months (range, 72-264). Single-nucleotide variants (SNVs) constituted 78.2% of patients; INDELs 14.5% and 7.3% had both SNVs and INDELs. Earlier age at onset was noted with SNVs. There was no correlation between the other clinical parameters and ambulatory status with the genotype. Thirty-seven (45.7%) novel pathogenic/likely pathogenic (P/LP) variants were identified out of a total of 81 variations. The c.3191G > A variant was the most recurrent mutation. Our cohort constitutes a clinically and genetically heterogeneous group of dysferlinopathies. There is no significant correlation between the clinico-genetic profile and the ambulatory status.
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Affiliation(s)
- Saraswati Nashi
- Department of Neurology, Neuroscience Faculty Center, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India
| | - Kiran Polavarapu
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
| | - Mainak Bardhan
- Department of Neurology, Neuroscience Faculty Center, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India
| | - Ram Murthy Anjanappa
- Department of Neurology, Neuroscience Faculty Center, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India
| | - Veeramani Preethish-Kumar
- Department of Neurology, Neuroscience Faculty Center, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India
| | - Seena Vengalil
- Department of Neurology, Neuroscience Faculty Center, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India
| | - Hansashree Padmanabha
- Department of Neurology, Neuroscience Faculty Center, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India
| | | | - P V Prathyusha
- Department of Biostatistics, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | | | - Aditi Joshi
- CSIR-Institute of Genomics and Integrative Biology (IGIB), Delhi, India
| | - Tanushree Chawla
- Department of Neurology, Neuroscience Faculty Center, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India
| | - Gopikirshnan Unnikrishnan
- Department of Neurology, Neuroscience Faculty Center, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India
| | - Pooja Sharma
- CSIR-Institute of Genomics and Integrative Biology (IGIB), Delhi, India
| | - Akshata Huddar
- Department of Neurology, Neuroscience Faculty Center, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India
| | | | - Abel Thomas
- Department of Neurology, Neuroscience Faculty Center, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India
| | - Dipti Baskar
- Department of Neurology, Neuroscience Faculty Center, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India
| | - Susi Mathew
- CSIR-Institute of Genomics and Integrative Biology (IGIB), Delhi, India
| | - Deepak Menon
- Department of Neurology, Neuroscience Faculty Center, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India
| | - Gautham Arunachal
- Department of Human Genetics, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Mohammed Faruq
- CSIR-Institute of Genomics and Integrative Biology (IGIB), Delhi, India
| | | | - Atchayaram Nalini
- Department of Neurology, Neuroscience Faculty Center, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India.
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14
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Girija MS, Tiwari R, Vengalil S, Nashi S, Preethish-Kumar V, Polavarapu K, Kulanthaivelu K, Arbind A, Bardhan M, Huddar A, Unnikrishnan G, Kiran VR, Chawla T, Nandeesh B, Nagaraj C, Nalini A. PET-MRI in idiopathic inflammatory myositis: a comparative study of clinical and immunological markers with imaging findings. Neurol Res Pract 2022; 4:49. [PMID: 36210472 PMCID: PMC9549636 DOI: 10.1186/s42466-022-00213-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 08/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We sought to determine the utility of PET-MRI in diagnosing Idiopathic Inflammatory Myositis (IIM), and look for association between FDG uptake and clinical, pathological and laboratory parameters. METHODS A retrospective, observational study was conducted on IIM patients having positive serum autoantibodies and who underwent PET-MRI (3-Tesla SIEMENS Biograph MR scanner) between 2017 and 2021. Thirty patients who underwent PET-MRI to detect systemic metastasis without muscle involvement formed the control group. RESULTS In the IIM cohort, female: male sex ratio was 1.73, mean age at diagnosis was 40.33 years, and the mean duration of illness was 7 months. 33.33% of patients had severe limb weakness. Mi2B (43.33%), Mi2A (43.33%), PL-7(10%), PL-12(6.67%), SRP (16.67%), Tif1gamma (3.33%), NxP2 (3.33%), Ro-52(40%), PM-Scl, U1-RNP, ANA (26.67%) were the serum autoantibodies identified. Using SUV max Ratio to quantify FDG uptake, PET-MRI showed a sensitivity of 100% with 93.3% specificity in diagnosing IIM.FDG uptake was maximum in proximal lower limb region followed by proximal upper limb. Multivariate regression analysis showed that the severity of muscle weakness, serum Mi2B antibody positivity and serum creatinine kinase levels had a significant positive correlation with FDG uptake (value of 0.005, 0.043, 0.042, respectively for whole-body FDG uptake). FDG uptake also showed good correlation with histopathological features and muscle MRI, but there was no significant association with treatment response. Three female patients in our cohort had primary malignancy involving the breast, uterus, and cervix. CONCLUSIONS PET-MRI is a promising diagnostic modality for IIM. PET-MRI reflects the severity of muscle inflammation, showing good association with various clinical/laboratory parameters, histopathology, and muscle MRI. Parameters associated with severe muscle inflammation in PET-MRI-clinical severity of muscle weakness, Mi2B positivity, and serum creatine kinase levels-may be used as clinical/laboratory markers of disease severity in IIM. PET-MRI has the added advantage of detection of systemic malignancy.
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Affiliation(s)
- Manu Santhappan Girija
- grid.416861.c0000 0001 1516 2246Department of Neurology, National Institute of Mental Health And Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka 560029 India
| | - Ravindu Tiwari
- grid.416861.c0000 0001 1516 2246Department of Neurology, National Institute of Mental Health And Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka 560029 India
| | - Seena Vengalil
- grid.416861.c0000 0001 1516 2246Department of Neurology, National Institute of Mental Health And Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka 560029 India
| | - Saraswati Nashi
- grid.416861.c0000 0001 1516 2246Department of Neurology, National Institute of Mental Health And Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka 560029 India
| | - Veeramani Preethish-Kumar
- grid.416861.c0000 0001 1516 2246Department of Neurology, National Institute of Mental Health And Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka 560029 India
| | - Kiran Polavarapu
- grid.28046.380000 0001 2182 2255Children’s Hospital of Eastern Ontario Research Institute; Division of Neurology, Department of Medicine, The Ottawa Hospital, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON Canada
| | - Karthik Kulanthaivelu
- grid.416861.c0000 0001 1516 2246Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health And Neurosciences (NIMHANS), Bangalore, Karnataka 560029 India
| | - Arpana Arbind
- grid.416861.c0000 0001 1516 2246Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health And Neurosciences (NIMHANS), Bangalore, Karnataka 560029 India
| | - Mainak Bardhan
- grid.416861.c0000 0001 1516 2246Department of Neurology, National Institute of Mental Health And Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka 560029 India
| | - Akshata Huddar
- grid.416861.c0000 0001 1516 2246Department of Neurology, National Institute of Mental Health And Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka 560029 India
| | - Gopikrishnan Unnikrishnan
- grid.416861.c0000 0001 1516 2246Department of Neurology, National Institute of Mental Health And Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka 560029 India
| | - Valasani Ravi Kiran
- grid.416861.c0000 0001 1516 2246Department of Neurology, National Institute of Mental Health And Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka 560029 India
| | - Tanushree Chawla
- grid.416861.c0000 0001 1516 2246Department of Neurology, National Institute of Mental Health And Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka 560029 India
| | - Bevinahalli Nandeesh
- grid.416861.c0000 0001 1516 2246Department of Neuropathology, National Institute of Mental Health And Neurosciences (NIMHANS), Bangalore, 560029 India
| | - Chandana Nagaraj
- grid.416861.c0000 0001 1516 2246Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health And Neurosciences (NIMHANS), Bangalore, Karnataka 560029 India
| | - Atchayaram Nalini
- grid.416861.c0000 0001 1516 2246Department of Neurology, National Institute of Mental Health And Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka 560029 India
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15
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Polavarapu K, Thompson R, Matalonga L, Nandeesh B, Vengalil S, Preethish-Kumar V, Laurie S, Nalini A, Lochmüller H. FP.21 Congenital myasthenic syndrome with Desmin aggregates: A novel association in recessive desminopathies due to a recurrent intronic DES mutation. Neuromuscul Disord 2022. [DOI: 10.1016/j.nmd.2022.07.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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16
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Nishadham V, Bardhan M, Polavarapu K, Vengalil S, Nashi S, Menon D, Ganaraja VH, Preethish-Kumar V, Valasani RK, Huddar A, Unnikrishnan GK, Thomas A, Saravanan A, Kulanthaivelu K, Nalini A, Nandeesh BN. Thymic Lesions in Myasthenia Gravis: A Clinicopathological Study from India. J Neuromuscul Dis 2022; 9:411-422. [DOI: 10.3233/jnd-210785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background and Objectives: Thymic pathology is common in Myasthenia Gravis(MG) and plays a crucial role in its pathogenesis and clinical outcome. This study aims to discuss the clinicohistopathological spectrum of thymic lesions in MG. Methods: In this retrospective study, MG patients who underwent thymectomy from 2011 to 2020 were included. Clinical, radiological, serological, and histopathological details are described. Results: Of 83 patients(F = 45; M = 38), 7(8%) had ocular myasthenia, and the remaining 76(92%) had the generalized form. At onset, the median age was 36 years(M = 44; F = 31). AChR antibody was positive in 71/79 patients. RNST showed decrement response in 68/78 patients. The histopathological study demonstrated thymoma in 44(53%), thymic hyperplasias [32(38%)], involuted thymus [5(6%)], thymic cyst (1) and thymic lipoma (1). WHO grading of thymoma: B2- 48%, AB-18%, B-18%, B3-14%, A-2.3% . In these, capsular infiltration was noted in 11/44, 9 had focal and 2 had diffuse infiltration. Active germinal centers were present in 20/32 patients with thymic hyperplasia and 4/44 with thymoma. Thymomas were predominant in males and thymic hyperplasia in females. The age of onset and antibody positivity rate was higher in thymoma patients. Conclusion: In our cohort, there is a female preponderance. Thymoma was the commonest pathology followed by hyperplasia. We observed earlier onset of myasthenia in females. AChR antibody positivity rate was more frequent in thymomas. This study indicates that clinico-radiological evaluation adequately supported by serology and histopathology can effectively recognize the type of thymic pathology that can guide these patients’ treatment planning, management, prognosis and follow-up.
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Affiliation(s)
- Vikas Nishadham
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | - Mainak Bardhan
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | - Kiran Polavarapu
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | - Deepak Menon
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | | | - Veeramani Preethish-Kumar
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | - Ravi Kiran Valasani
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | - Akshata Huddar
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | - Gopi Krishnan Unnikrishnan
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | - Abel Thomas
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | - Akshaya Saravanan
- Neurointerventional and Imaging, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | - Karthik Kulanthaivelu
- Neurointerventional and Imaging, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka India
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Kharel S, Ojha R, Preethish-Kumar V, Bhagat R. C-reactive protein levels in patients with amyotrophic lateral sclerosis: A systematic review. Brain Behav 2022; 12:e2532. [PMID: 35201675 PMCID: PMC8933772 DOI: 10.1002/brb3.2532] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/31/2021] [Accepted: 02/06/2022] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease affecting cortical and spinal motor neurons. There is a lack of optimal biomarkers to diagnose and prognosticate the ALS patients. C-reactive protein (CRP), an inflammatory marker, has shown promising results in ALS patients. MATERIALS AND METHODS PubMed, Embase, and Google Scholar databases were searched from 2000 to June 1, 2021 for suitable studies showing the relationship between CRP and ALS. The concentration of CRP levels was assessed between ALS patients and controls. Further, end outcomes like ALS functional rating scale (ALSFRS-R), survival status, and mortality risks were assessed in relation to CRP levels. RESULTS Eleven studies including five case-control, five cohorts, and one randomized control study were assessed. There were 2785 ALS patients and 3446 healthy controls. A significant increment in CRP levels among ALS patients in comparison with healthy controls were seen in most of the studies. ALSFRS-R and disease progression were found to be significantly correlated with CRP levels. Overall accuracy of CRP in CSF was 62% described in a single study. CONCLUSION Although CRP has shown promise as a prognostic biomarker, extensive cohort studies are required to assess its prognostic value and accuracy in diagnosing ALS taking into account the confounding factors.
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Affiliation(s)
- Sanjeev Kharel
- Department of Internal Medicine, Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Maharajgunj, Kathmandu, Nepal
| | - Rajeev Ojha
- Department of Neurology, Tribhuvan University Institute of Medicine, Maharajgunj, Kathmandu, Nepal
| | | | - Riwaj Bhagat
- Department of Neurology, Boston University Medical Center, Boston, Massachusetts, USA
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Rajula RR, Saini J, Unnikrishnan G, Vengalil S, Nashi S, Bardhan M, Huddar A, Chawla T, Sindhu DM, Ganaraja VH, Polavarapu K, Preethish-Kumar V, Kandavel T, Nalini A. Muscle ultrasonography in detecting fasciculations: A noninvasive diagnostic tool for amyotrophic lateral sclerosis. J Clin Ultrasound 2022; 50:286-291. [PMID: 34653263 DOI: 10.1002/jcu.23084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/28/2021] [Accepted: 09/30/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVES Muscle ultrasound (MUS) is an emerging noninvasive tool to identify fasciculations in amyotrophic lateral sclerosis (ALS). We assessed the utility of MUS in detecting fasciculations in suspected ALS patients. METHODS Thirty-three patients (25 men) with possible (n = 7), probable (n = 12), or definite ALS according to Awaji criteria were studied. Electromyography was done in biceps brachii, quadriceps, and thoracic paraspinal muscles and MUS in biceps, triceps, deltoid, abductor-digiti-minimi, quadriceps, hamstrings, tibialis anterior, thoracic paraspinal, and tongue muscles. RESULTS The age at onset and illness duration was 49.73 ± 12.7 years and 13.57 ± 9.7 months, respectively. Limb-onset = 24 patients (72.7%) and bulbar-onset = 9 (27.3%). Totally 561 muscles were examined by MUS. Fasciculations were detected in 84.3% of muscles, 98.4% with and 73% without clinical fasciculations (p < 0.001). Fasciculation detection rate (FDR) by MUS was significantly higher in muscles with wasting (95.6%) than without wasting (77.6%, p < 0.001). Compared with EMG, FDR was significantly higher with MUS in quadriceps (81.8% vs. 51.5%, p = 0.002) and thoracic paraspinal muscles (75.8% vs. 42.4%, p = 0.013). The proportion of patients with definite ALS increased from 42% by clinical examination to 70% after combining EMG and MUS findings. CONCLUSIONS MUS is more sensitive in detecting fasciculations than electromyography (EMG) and provides a safer, faster, painless, and noninvasive alternative to EMG in detecting fasciculations in ALS.
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Affiliation(s)
- Rahul Reddy Rajula
- Department of Neurology, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru, India
| | - Jitender Saini
- Department of NeuroImaging and Interventional Radiology, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru, India
| | - Gopikrishnan Unnikrishnan
- Department of Neurology, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru, India
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru, India
| | - Mainak Bardhan
- Department of Neurology, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru, India
| | - Akshata Huddar
- Department of Neurology, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru, India
| | - Tanushree Chawla
- Department of Neurology, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru, India
| | | | | | - Kiran Polavarapu
- Children's Hospital of Eastern Ontario Research Institute; Division of Neurology, Department of Medicine, The Ottawa Hospital; Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Veeramani Preethish-Kumar
- Department of Neurology, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru, India
| | - Thennarasu Kandavel
- Department of Biostatistics, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru, India
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19
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Nalini A, Vengalil S, Polavarapu K, Preethish-Kumar V, Nashi S, Arunachal G, Chawla T, Bardhan M, Mohan D, Christopher R, Bevinahalli N, Kulanthaivelu K, Nishino I, Faruq M. Mutation spectrum of primary lipid storage myopathies. Ann Indian Acad Neurol 2022; 25:106-113. [PMID: 35342266 PMCID: PMC8954319 DOI: 10.4103/aian.aian_333_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 10/16/2021] [Accepted: 10/27/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Lipid storage myopathies (LSM) constitute an important group of treatable myopathies. Genetic testing is essential for confirming the diagnosis and also helps in explaining phenotypic heterogeneity. The objective of this study was to describe the clinical features and genetic spectrum of LSM seen in a quaternary referral center in India. Methods: Eleven cases of suspected LSM underwent clinical, biochemical, histopathological and genetic evaluation. Tandem Mass Spectrometry and clinical exome sequencing with Sanger validation were performed. Results: All patients had exertion induced myalgia and either progressive or episodic limb girdle muscle weakness (LGMW). The age of onset ranged 10 to 31 years (mean- 21 ± 6.7y), age at presentation- 14 to 49 years (mean- 26.5 ± 9.5y). Mutations identified: ETFDH = 5, CPT2 = 3, FLAD1 = 1, ACADVL = 1, FLAD1 = 1. Dropped head syndrome was seen in two patients with ETFDH mutations. Bulbar symptoms and Beevor's sign were noted in a patient with FLAD1 variant. Novel variants were identified in seven patients. Conclusions: This is the first report on the genetic spectrum of LSM from India. LSM should be considered in patients with exertion induced myalgias, LGMW, cranial nerve involvement or dropped head syndrome. Genetic testing is essential for identification of these treatable disorders.
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20
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Rajula RR, Saini J, Unnikrishnan G, Vengalil S, Nashi S, Bardhan M, Huddar A, Chawla T, Sindhu DM, Ganaraja VH, Polavarapu K, Preethish-Kumar V, Kandavel T, Sathyaprabha TN, Nalini A. Diaphragmatic ultrasound: Prospects as a tool to assess respiratory muscle involvement in amyotrophic lateral sclerosis. J Clin Ultrasound 2022; 50:131-135. [PMID: 34609007 DOI: 10.1002/jcu.23069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/28/2021] [Accepted: 09/04/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Ultrasonography (USG) of the diaphragm is a promising alternative to pulmonary function tests (PFT) for assessing respiratory function in amyotrophic lateral sclerosis/motor neuron disease (ALS/MND). METHODS We studied 33 patients fulfilling Awaji criteria (definite = 14; probable = 12; possible = 7) and 33 age and gender-matched controls. Diaphragm thickness was measured using USG at the end of expiration (DTex) and end of inspiration (DTin). The thickness ratio (TR) was calculated as DTin/DTex. The mean age at onset and duration were 49.73 ± 12.7 years and 13.57 ± 9.7 months, respectively. Men = 25 (75.8%); Limb onset ALS/MND = 24 patients (72.7%); bulbar onset = 9 (27.3%). RESULTS Compared to controls, ALS/MND patients had reduced mean DTex (2.22 ± 0.29 mm vs. 2.02 ± 0.32 mm, p = .012) and DTin (4.0 ± 0.71 mm vs. 3.41 ± 0.38 mm, p < .001). PFTs done in 31 patients showed restrictive abnormality in 80.6%. Significant positive correlation was seen between percentage of predicted forced vital capacity (FVC%) and DTin (p = .009) and TR (p = .037) but not with DTex (p = .852). No significant correlation was seen between diaphragmatic thickness and other PFT parameters or ALSFRS scores. CONCLUSION The diaphragmatic thickness showed a significant decrease in ALS/MND as compared to controls. End-inspiratory diaphragmatic thickness and TR correlated well with %FVC. Thus, diaphragmatic USG could be a potential alternative to PFTs in assessing respiratory function in ALS/MND patients having the advantage of less patient participation and ease of performing in late stages of ALS/MND.
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Affiliation(s)
- Rahul Reddy Rajula
- Department of Neurology, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Gopikrishnan Unnikrishnan
- Department of Neurology, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Mainak Bardhan
- Department of Neurology, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Akshata Huddar
- Department of Neurology, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Tanushree Chawla
- Department of Neurology, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Dodmalur Mallikarjuna Sindhu
- Department of Neurology, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | | | - Kiran Polavarapu
- Department of Neurology, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Veeramani Preethish-Kumar
- Department of Neurology, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Thennarasu Kandavel
- Department of Biostatistics, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Talakad N Sathyaprabha
- Department of Neurophysiology, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
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21
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Beijer D, Polavarapu K, Preethish-Kumar V, Bardhan M, Dohrn MF, Rebelo A, Züchner S, Nalini A. [CASE REPORT] Homozygous N-terminal missense variant in PLEKHG5 associated with intermediate CMT: a case report. J Neuromuscul Dis 2021; 9:347-351. [PMID: 34897098 DOI: 10.3233/jnd-210716] [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: 11/15/2022]
Abstract
Mutations in PLEKHG5, a pleckstrin homology domain containing member of the GEF family, are associated with distal spinal muscular atrophy and intermediate Charcot-Marie-Tooth disease. Here, we describe an isolated case with distal intermediate neuropathy with scapular winging. By whole exome sequencing, we identified the homozygous PLEKHG5 Arg97Gln missense mutation, located in the N-terminal region of the protein. This mutation resides between a zinc-finger motif and a RBD domain, involved in binding rnd3, a RhoA effector protein. We conclude that based on the characteristic phenotype presented by the patient and the supportive genetic findings, the PLEKHG5 mutation is the causative variant.
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Affiliation(s)
- Danique Beijer
- Dr. John T. Macdonald Foundation, Department of Human Genetics and John P. Hussman Institute for Human Genomics, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Kiran Polavarapu
- Children's Hospital of Eastern Ontario ResearchInstitute; Division of Neurology, Department of Medicine, The Ottawa Hospital; Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Veeramani Preethish-Kumar
- Children's Hospital of Eastern Ontario ResearchInstitute; Division of Neurology, Department of Medicine, The Ottawa Hospital; Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Mainak Bardhan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Maike F Dohrn
- Dr. John T. Macdonald Foundation, Department of Human Genetics and John P. Hussman Institute for Human Genomics, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Adriana Rebelo
- Dr. John T. Macdonald Foundation, Department of Human Genetics and John P. Hussman Institute for Human Genomics, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Stephan Züchner
- Dr. John T. Macdonald Foundation, Department of Human Genetics and John P. Hussman Institute for Human Genomics, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
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22
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Chawla T, Preethish-Kumar V, Polavarapu K, Vengalil S, Bardhan M, Puri R, Verma J, Christopher R, Supriya M, Nashi S, Prasad C, Nadeesh B, Nalini A. Late Onset Pompe Disease with Novel Mutations and Atypical Phenotypes. J Neuromuscul Dis 2021; 9:261-273. [PMID: 34864681 DOI: 10.3233/jnd-210728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Late onset Pompe disease (LOPD) is rare and generally manifests predominantly as progressive limb girdle muscle weakness. It is linked to the pathogenic mutations in GAA gene, which leads to glycogen accumulation in various tissues. MATERIALS AND METHODS We describe the unusual clinical, biochemical, histopathological and genetic characteristics of 5 cases of LOPD. RESULTS The first case had progressive anterior horn cell like disease (AHCD) that evolved later to classical limb girdle syndrome and respiratory failure, the second patient had rigid spine syndrome with gastrointestinal manifestations, the third had limb girdle weakness superimposed with episodic prolonged worsening and respiratory failure, the fourth had large fibre sensory neuropathy without primary muscle involvement and the fifth presented with classical limb girdle muscle weakness. Two homozygous missense mutations c.1461C > A (p.Phe487Leu) and c.1082C > T (p.Pro361Leu) in the GAA gene were identified in case 1 and 2 respectively. Case 3 was compound heterozygous with inframe c.1935_1940del (p.Val646_Cys647del) and an intronic splice effecting variant c.-32-13T > G. Compound heterozygous missense variants c.971C > T (p.Pro324Leu) and c.794G > A (p.Ser265Asn) were identified in case 4. Case 5 had a frameshift insertion c.1396dupG (p.Val466GlyfsTer40) and a synonymous splice affecting variant c.546G > T(p.Thr182=). CONCLUSION We are describing for the first time from India on LOPD with unusual phenotypes identified. A high degree of clinical suspicion and diagnosing rare phenotypes of Pompe disease is imperative to consider early initiation of Enzyme Replacement Therapy (ERT).
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Affiliation(s)
- Tanushree Chawla
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Kiran Polavarapu
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Mainak Bardhan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - RatnaDua Puri
- Department of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Jyotsna Verma
- Department of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Rita Christopher
- Department of Neurochemistry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Manjunath Supriya
- Department of Neurochemistry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Chandrajit Prasad
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Bevinahalli Nadeesh
- Departmentof Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
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23
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Ganaraja VH, Polavarapu K, Bardhan M, Preethish-Kumar V, Leena S, Anjanappa RM, Vengalil S, Nashi S, Arunachal G, Gunasekaran S, Mohan D, Raju S, Unnikrishnan G, Huddar A, Ravi-Kiran V, Thomas PT, Nalini A. Disease Progression and Mutation Pattern in a Large Cohort of LGMD R1/LGMD 2A Patients from India. Glob Med Genet 2021; 9:34-41. [PMID: 35169782 PMCID: PMC8837411 DOI: 10.1055/s-0041-1736567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/18/2021] [Indexed: 10/31/2022] Open
Abstract
AbstractCalpainopathy is caused by mutations in the CAPN3. There is only one clinical and genetic study of CAPN3 from India and none from South India. A total of 72 (male[M]:female [F] = 34:38) genetically confirmed probands from 72 independent families are included in this study. Consanguinity was present in 54.2%. The mean age of onset and duration of symptoms are 13.5 ± 6.4 and 6.3 ± 4.7 years, respectively. Positive family history occurred in 23.3%. The predominant initial symptoms were proximal lower limb weakness (52.1%) and toe walking (20.5%). At presentation, 97.2% had hip girdle weakness, 69.4% had scapular winging, and 58.3% had contractures. Follow-up was available in 76.4%, and 92.7% were ambulant at a mean age of 23.7 ± 7.6 years and duration of 4.5 years, remaining 7.3% became wheelchair-bound at 25.5 ± 5.7 years of age (mean duration = 13.5 ± 4.6), 4.1% were aged more than 40 years (duration range = 5–20). The majority remained ambulant 10 years after disease onset. Next-generation sequencing (NGS) detected 47 unique CAPN3 variants in 72 patients, out of which 19 are novel. Missense variants were most common occurring in 59.7% (homozygous = 29; Compound heterozygous = 14). In the remaining 29 patients (40.3%), at least one suspected loss of function variant was present. Common recurrent variants were c.2051–1G > T and c.2338G > C in 9.7%, c.1343G > A, c.802–9G > A, and c.1319G > A in 6.9% and c.1963delC in 5.5% of population. Large deletions were observed in 4.2%. Exon 10 mutations accounted for 12 patients (16.7%). Our study highlights the efficiency of NGS technology in screening and molecular diagnosis of limb-girdle muscular dystrophy with recessive form (LGMDR1) patients in India.
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Affiliation(s)
- Valakunja H. Ganaraja
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Kiran Polavarapu
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
- Division of Neurology, Department of Medicine, Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, The Ottawa Hospital, Ottawa, Canada
| | - Mainak Bardhan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Veeramani Preethish-Kumar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Shingavi Leena
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ram M. Anjanappa
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
- Division of Neurology, Department of Medicine, Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, The Ottawa Hospital, Ottawa, Canada
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Gautham Arunachal
- Department of Human Genetics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Swetha Gunasekaran
- Department of Human Genetics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Dhaarini Mohan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sanita Raju
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Gopikrishnan Unnikrishnan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Akshata Huddar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Valasani Ravi-Kiran
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Priya T. Thomas
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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24
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Huddar A, Polavarapu K, Preethish-Kumar V, Bardhan M, Unnikrishnan G, Nashi S, Vengalil S, Priyadarshini P, Kulanthaivelu K, Arunachal G, Lochmüller H, Nalini A. Expanding the Phenotypic Spectrum of ECEL1-Associated Distal Arthrogryposis. Children (Basel) 2021; 8:children8100909. [PMID: 34682174 PMCID: PMC8534696 DOI: 10.3390/children8100909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/25/2021] [Accepted: 10/06/2021] [Indexed: 11/21/2022]
Abstract
Distal arthrogryposis type 5D (DA5D), a rare autosomal recessive disorder, is caused by mutations in ECEL1. We describe two consanguineous families (three patients) with novel ECEL1 gene mutations detected by next-generation sequencing (NGS). A 12-year-old boy (patient 1) presented with birth asphyxia, motor developmental delay, multiple joint contractures, pes planus, kyphoscoliosis, undescended testis, hypophonic speech with a nasal twang, asymmetric ptosis, facial weakness, absent abductor pollicis brevis, bifacial, and distal lower limb weakness. Muscle MRI revealed asymmetric fatty infiltration of tensor fascia lata, hamstring, lateral compartment of the leg, and gastrocnemius. In addition, 17-year-old monozygotic twins (patients 2 and 3) presented with motor development delay, white hairlock, hypertelorism, tented upper lip, bulbous nose, tongue furrowing, small low set ears, multiple contractures, pes cavus, prominent hyperextensibility at the knee, hypotonia of lower limbs, wasting and weakness of all limbs (distal > proximal), areflexia, and high steppage gait. One had perinatal insult, seizures, mild intellectual disability, unconjugated eye movements, and primary optic atrophy. In the twins, MRI revealed extensive fatty infiltration of the gluteus maximus, quadriceps, hamstrings, and anterior and posterior compartment of the leg. Electrophysiology showed prominent motor axonopathy. NGS revealed rare homozygous missense variants c.602T > C (p.Met201Thr) in patient 1 and c.83C > T (p.Ala28Val) in patients 2 and 3, both localized in exon 2 of ECEL1 gene. Our three cases expand the clinical, imaging, and molecular spectrum of the ECEL1-mutation-related DA5D.
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Affiliation(s)
- Akshata Huddar
- Department of Neurology, National Institute of Mental Health and Neuro-Sciences, Bengaluru 560029, India; (A.H.); (V.P.-K.); (M.B.); (G.U.); (S.N.); (S.V.)
| | - Kiran Polavarapu
- Children’s Hospital of Eastern Ontario Research Institute, Department of Medicine, Division of Neurology, The Ottawa Hospital, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON K1H 8L1, Canada; (K.P.); (H.L.)
| | - Veeramani Preethish-Kumar
- Department of Neurology, National Institute of Mental Health and Neuro-Sciences, Bengaluru 560029, India; (A.H.); (V.P.-K.); (M.B.); (G.U.); (S.N.); (S.V.)
| | - Mainak Bardhan
- Department of Neurology, National Institute of Mental Health and Neuro-Sciences, Bengaluru 560029, India; (A.H.); (V.P.-K.); (M.B.); (G.U.); (S.N.); (S.V.)
| | - Gopikrishnan Unnikrishnan
- Department of Neurology, National Institute of Mental Health and Neuro-Sciences, Bengaluru 560029, India; (A.H.); (V.P.-K.); (M.B.); (G.U.); (S.N.); (S.V.)
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neuro-Sciences, Bengaluru 560029, India; (A.H.); (V.P.-K.); (M.B.); (G.U.); (S.N.); (S.V.)
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neuro-Sciences, Bengaluru 560029, India; (A.H.); (V.P.-K.); (M.B.); (G.U.); (S.N.); (S.V.)
| | - Priyanka Priyadarshini
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neuro-Sciences, Bengaluru 560029, India; (P.P.); (K.K.)
| | - Karthik Kulanthaivelu
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neuro-Sciences, Bengaluru 560029, India; (P.P.); (K.K.)
| | - Gautham Arunachal
- Department of Human Genetics, National Institute of Mental Health and Neuro-Sciences, Bengaluru 560029, India;
| | - Hanns Lochmüller
- Children’s Hospital of Eastern Ontario Research Institute, Department of Medicine, Division of Neurology, The Ottawa Hospital, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON K1H 8L1, Canada; (K.P.); (H.L.)
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neuro-Sciences, Bengaluru 560029, India; (A.H.); (V.P.-K.); (M.B.); (G.U.); (S.N.); (S.V.)
- Correspondence: ; Tel.: +91-80-26995139; Fax: +91-80-26564830
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Siddiqui S, Polavarapu K, Bardhan M, Preethish-Kumar V, Joshi A, Nashi S, Vengalil S, Raju S, Chawla T, Leena S, Mathur A, Nayak S, Mohan D, Shamim U, Prasad C, Lochmüller H, Faruq M, Nalini A. Distinct and Recognisable Muscle MRI Pattern in a Series of Adults Harbouring an Identical GMPPB Gene Mutation. J Neuromuscul Dis 2021; 9:95-109. [PMID: 34633329 DOI: 10.3233/jnd-200628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND PURPOSE Mutations in the GMPPB gene affect glycosylation of α-dystroglycan, leading to varied clinical phenotypes. We attempted to delineate the muscle MR imaging spectrum of GMPPB-related Congenital Myasthenic syndrome (CMS) in a single-center cohort study. OBJECTIVE To identify the distinct patterns of muscle involvement in GMPPB gene mutations. METHODS We analyzed the muscle MR images of 7 genetically proven cases of GMPPB dystroglycanopathy belonging to three families and studied the potential qualitative imaging pattern to aid in clinico -radiological diagnosis in neuromuscular practice. All individuals underwent muscle MRI (T1, T2, STIR/PD Fat sat. sequences in 1.5 T machine) of the lower limbs. Qualitative assessment and scoring were done for muscle changes using Mercuri staging for fibro-fatty replacement on T1 sequence and Borsato score for myoedema on STIR sequence. RESULTS All patients were of South Indian origin and presented as slowly progressive childhood to adult-onset fatigable limb-girdle muscle weakness, elevated creatine kinase level, and positive decrement response in proximal muscles. Muscle biopsy revealed features of dystrophy. All patients demonstrated identical homozygous mutation c.1000G > A in the GMPPB gene. MRI demonstrated early and severe involvement of paraspinal muscles, gluteus minimus, and relatively less severe involvement of the short head of the biceps femoris. A distinct proximo-distal gradient of affliction was identified in the glutei, vasti, tibialis anterior and peronei. Also, a postero-anterior gradient was observed in the gracilis muscle. CONCLUSION Hitherto unreported, the distinctive MR imaging pattern described here, coupled with relatively slowly progressive symptoms of fatigable limb-girdle weakness, would facilitate an early diagnosis of the milder form of GMPPB- dystroglycanopathy associated with homozygous GMPPB gene mutation.
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Affiliation(s)
- Shahyan Siddiqui
- Department of Neuroimaging and Interventional radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Kiran Polavarapu
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Mainak Bardhan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | - Aditi Joshi
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Sanita Raju
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Tanushree Chawla
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Shingavi Leena
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Aradhana Mathur
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Sushmita Nayak
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Dhaarini Mohan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Uzma Shamim
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Chandrajit Prasad
- Department of Neuroimaging and Interventional radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Hanns Lochmüller
- Children's Hospital of Eastern Ontario Research Institute; Division of Neurology, Department of Medicine, The Ottawa Hospital; Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Mohammed Faruq
- Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
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26
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Preethish-Kumar V, Shah A, Polavarapu K, Kumar M, Safai A, Vengalil S, Nashi S, Deepha S, Govindaraj P, Afsar M, Rajeswaran J, Nalini A, Saini J, Ingalhalikar M. Disrupted structural connectome and neurocognitive functions in Duchenne muscular dystrophy: classifying and subtyping based on Dp140 dystrophin isoform. J Neurol 2021; 269:2113-2125. [PMID: 34505932 DOI: 10.1007/s00415-021-10789-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Neurocognitive disabilities in Duchenne muscular dystrophy (DMD) children beginning in early childhood and distal DMD gene deletions involving disruption of Dp140 isoform are more likely to manifest significant neurocognitive impairments. MRI data analysis techniques like brain-network metrics can provide information on microstructural integrity and underlying pathophysiology. METHODS A prospective study on 95 participants [DMD = 57, and healthy controls (HC) = 38]. The muscular dystrophy functional rating scale (MDFRS) scores, neuropsychology batteries, and multiplex ligand-dependent probe amplification (MLPA) testing were used for clinical assessment, IQ estimation, and genotypic classification. Diffusion MRI and network-based statistics were used to analyze structural connectomes at various levels and correlate with clinical markers. RESULTS Motor and executive sub-networks were extracted and analyzed. Out of 57 DMD children, 23 belong to Dp140 + and 34 to Dp140- subgroup. Motor disabilities are pronounced in Dp140- subgroup as reflected by lower MDFRS scores. IQ parameters are significantly low in all-DMD cases; however, the Dp140- has specifically lowest scores. Significant differences were observed in global efficiency, transitivity, and characteristic path length between HC and DMD. Subgroup analysis demonstrates that the significance is mainly driven by participants with Dp140- than Dp140 + isoform. Finally, a random forest classifier model illustrated an accuracy of 79% between HC and DMD and 90% between DMD- subgroups. CONCLUSIONS Current findings demonstrate structural network-based characterization of abnormalities in DMD, especially prominent in Dp140-. Our observations suggest that participants with Dp140 + have relatively intact connectivity while Dp140- show widespread connectivity alterations at global, nodal, and edge levels. This study provides valuable insights supporting the genotype-phenotype correlation of brain-behavior involvement in DMD children.
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Affiliation(s)
| | - Apurva Shah
- Symbiosis Centre for Medical Image Analysis, Symbiosis International University, Mulshi, Pune, Maharashtra, India
| | - Kiran Polavarapu
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Manoj Kumar
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Apoorva Safai
- Symbiosis Centre for Medical Image Analysis, Symbiosis International University, Mulshi, Pune, Maharashtra, India
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Sekar Deepha
- Neuromuscular Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Periyasamy Govindaraj
- Neuromuscular Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Mohammad Afsar
- Department of Neuropsychology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Jamuna Rajeswaran
- Department of Neuropsychology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India.
| | - Madhura Ingalhalikar
- Symbiosis Centre for Medical Image Analysis, Symbiosis International University, Mulshi, Pune, Maharashtra, India.
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Swayang PS, Nalini A, Preethish-Kumar V, Udupa K, Yadav R, Vengalil S, Reshma SS, Polavarapu K, Nashi S, Sathyaprabha TN, Treesa Thomas P, Maya B, Jamuna R, Mahadevan A, Netravathi M. CASPR2-Related Morvan Syndrome: Autonomic, Polysomnographic, and Neuropsychological Observations. Neurol Clin Pract 2021; 11:e267-e276. [PMID: 34484901 DOI: 10.1212/cpj.0000000000000978] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/07/2020] [Indexed: 12/16/2022]
Abstract
Objective Morvan syndrome is characterized by central, autonomic, and peripheral hyperexcitability due to contactin-associated protein 2 (CASPR2) antibody. Our objective was to study the clinical spectrum, electrophysiologic, autonomic, polysomnographic, and neuropsychological profile in patients with CASPR2-related Morvan syndrome. Methods Serum and CSF samples that were CASPR2 antibody positive from 2016 to 2019 were assessed. Among them, patients with Morvan syndrome diagnosed based on clinical and electrophysiologic basis were included. Results Fourteen (M:F = 10:4) patients with Morvan syndrome were included with age at onset of 37.1 ± 17.5 years. The clinical features were muscle twitching (12), insomnia (12), pain (11), paresthesias (9), hyperhidrosis (7), hypersalivation (6), double incontinence (3), spastic speech (2), dysphagia (2), behavioral disturbances (2), seizures (1), and cold intolerance (1). Neurologic examination revealed myokymia (12), hyperactive tendon reflexes (10), and tremor (6). EMG revealed neuromyotonia (12) and increased spontaneous activity (7). Autonomic function tests conducted in 8 patients revealed definite autonomic dysfunction (4), orthostatic hypotension (2), early dysfunction (1), and postural orthostatic tachycardia syndrome (1). Polysomnography findings in 6 patients revealed insomnia (3), absence of deep sleep (1), high-frequency beta activity (1), REM behavior disorder (1), and periodic leg movements (1). Neuropsychological evaluation showed subtle involvement of the left frontal and temporal lobe. Malignancy workup was negative. All patients were treated with steroids. There was complete neurologic resolution in follow-up with persistent neuropathic pain in 5 patients. Conclusions This study has contributed to the growing knowledge on CASPR2-related Morvan syndrome. It is important for an increased awareness and early recognition as it is potentially treatable by immunotherapy.
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Affiliation(s)
- Panda Sudha Swayang
- Departments of Neurology (PSS, AN, VP-K, KU, RY, SV, SSR, KP, SN, MN), Neurophysiology (TNS), Psychiatric Social Work (PTT), Neuroimaging & Interventional Neuroradiology (NIIR) (BM), Neuropsychology (RJ), and Neuropathology (AM), National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Atchayaram Nalini
- Departments of Neurology (PSS, AN, VP-K, KU, RY, SV, SSR, KP, SN, MN), Neurophysiology (TNS), Psychiatric Social Work (PTT), Neuroimaging & Interventional Neuroradiology (NIIR) (BM), Neuropsychology (RJ), and Neuropathology (AM), National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Veeramani Preethish-Kumar
- Departments of Neurology (PSS, AN, VP-K, KU, RY, SV, SSR, KP, SN, MN), Neurophysiology (TNS), Psychiatric Social Work (PTT), Neuroimaging & Interventional Neuroradiology (NIIR) (BM), Neuropsychology (RJ), and Neuropathology (AM), National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Kaviraja Udupa
- Departments of Neurology (PSS, AN, VP-K, KU, RY, SV, SSR, KP, SN, MN), Neurophysiology (TNS), Psychiatric Social Work (PTT), Neuroimaging & Interventional Neuroradiology (NIIR) (BM), Neuropsychology (RJ), and Neuropathology (AM), National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Ravi Yadav
- Departments of Neurology (PSS, AN, VP-K, KU, RY, SV, SSR, KP, SN, MN), Neurophysiology (TNS), Psychiatric Social Work (PTT), Neuroimaging & Interventional Neuroradiology (NIIR) (BM), Neuropsychology (RJ), and Neuropathology (AM), National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Seena Vengalil
- Departments of Neurology (PSS, AN, VP-K, KU, RY, SV, SSR, KP, SN, MN), Neurophysiology (TNS), Psychiatric Social Work (PTT), Neuroimaging & Interventional Neuroradiology (NIIR) (BM), Neuropsychology (RJ), and Neuropathology (AM), National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Sheikh Sultana Reshma
- Departments of Neurology (PSS, AN, VP-K, KU, RY, SV, SSR, KP, SN, MN), Neurophysiology (TNS), Psychiatric Social Work (PTT), Neuroimaging & Interventional Neuroradiology (NIIR) (BM), Neuropsychology (RJ), and Neuropathology (AM), National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Kiran Polavarapu
- Departments of Neurology (PSS, AN, VP-K, KU, RY, SV, SSR, KP, SN, MN), Neurophysiology (TNS), Psychiatric Social Work (PTT), Neuroimaging & Interventional Neuroradiology (NIIR) (BM), Neuropsychology (RJ), and Neuropathology (AM), National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Saraswati Nashi
- Departments of Neurology (PSS, AN, VP-K, KU, RY, SV, SSR, KP, SN, MN), Neurophysiology (TNS), Psychiatric Social Work (PTT), Neuroimaging & Interventional Neuroradiology (NIIR) (BM), Neuropsychology (RJ), and Neuropathology (AM), National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - T N Sathyaprabha
- Departments of Neurology (PSS, AN, VP-K, KU, RY, SV, SSR, KP, SN, MN), Neurophysiology (TNS), Psychiatric Social Work (PTT), Neuroimaging & Interventional Neuroradiology (NIIR) (BM), Neuropsychology (RJ), and Neuropathology (AM), National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Priya Treesa Thomas
- Departments of Neurology (PSS, AN, VP-K, KU, RY, SV, SSR, KP, SN, MN), Neurophysiology (TNS), Psychiatric Social Work (PTT), Neuroimaging & Interventional Neuroradiology (NIIR) (BM), Neuropsychology (RJ), and Neuropathology (AM), National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Bhat Maya
- Departments of Neurology (PSS, AN, VP-K, KU, RY, SV, SSR, KP, SN, MN), Neurophysiology (TNS), Psychiatric Social Work (PTT), Neuroimaging & Interventional Neuroradiology (NIIR) (BM), Neuropsychology (RJ), and Neuropathology (AM), National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Rajeshwaran Jamuna
- Departments of Neurology (PSS, AN, VP-K, KU, RY, SV, SSR, KP, SN, MN), Neurophysiology (TNS), Psychiatric Social Work (PTT), Neuroimaging & Interventional Neuroradiology (NIIR) (BM), Neuropsychology (RJ), and Neuropathology (AM), National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Anita Mahadevan
- Departments of Neurology (PSS, AN, VP-K, KU, RY, SV, SSR, KP, SN, MN), Neurophysiology (TNS), Psychiatric Social Work (PTT), Neuroimaging & Interventional Neuroradiology (NIIR) (BM), Neuropsychology (RJ), and Neuropathology (AM), National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - M Netravathi
- Departments of Neurology (PSS, AN, VP-K, KU, RY, SV, SSR, KP, SN, MN), Neurophysiology (TNS), Psychiatric Social Work (PTT), Neuroimaging & Interventional Neuroradiology (NIIR) (BM), Neuropsychology (RJ), and Neuropathology (AM), National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
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Vengalil S, Polavarapu K, Nashi S, Preethish-Kumar V, Prakash Mahajan N, Keerthipriya M, Pradeep Chandra Reddy C, Arunachal G, Gayathri N, Nalini A. Muscle disorders P-MU002. Mutation spectrum of congenital muscular dystrophies: A case series from India. Clin Neurophysiol 2021. [DOI: 10.1016/j.clinph.2021.02.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Nalini A, Polavarapu K, Preethish-Kumar V, Vengalil S, Nashi S, Pruti N, Bhat D, Mohan Uppar A. Symposium 3: Motor neuron disease SY3.1. Monomelic amyotrophy – Experience from a large cohort. Clin Neurophysiol 2021. [DOI: 10.1016/j.clinph.2021.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Nagabushana D, Polavarapu K, Bardhan M, Arunachal G, Gunasekaran S, Preethish-Kumar V, Anjanappa RM, Thomas P, Sadasivan A, Vengalil S, Nashi S, Chawla T, Warrier M, Keerthipriya M, Raju S, Mohan D, Nalini A. Comparison of The Carrier Frequency of Pathogenic Variants of DMD Gene in an Indian Cohort. J Neuromuscul Dis 2021; 8:525-535. [PMID: 33843695 DOI: 10.3233/jnd-210658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Duchenne muscular dystrophy (DMD) is an X-linked disorder caused due to large deletions, duplications,and small pathogenic variants. This article compares the carrier frequency of different pathogenic variants in the DMD gene for the first time in an Indian cohort. METHODS Ninety-one mothers of genetically confirmed DMD probands are included in this study. Pathogenic variants in the DMD gene in probands were detected by multiplex ligation-dependent probe amplification (MLPA) or next-generation sequencing (NGS). Maternal blood samples were evaluated either by MLPA or Sanger sequencing. The demographic and clinical details for screening of muscle weakness and cardiomyopathy were collected from the confirmed carriers. RESULTS Out of 91 probands, large deletions and duplications were identified in 46 and 6 respectively, while 39 had small variants. Among the small variants, substitutions predicted to cause nonsense mutations were the most common (61.5%), followed by frameshift causing small insertion/deletions (25.6%) and splice affecting intronic variants (12.8%). Notably, 19 novel small variants predicted to be disease-causing were identified. Of the 91 mothers, 53 (58.7%) were confirmed to be carriers. Exonic deletions had a significantly lower carrier frequency of 47.8% as compared to small variants (64.1%). The mean age of the carriers at evaluation was 30 years. Among the carriers, two were symptomatic with onset in the 4th decade, manifesting with progressive proximal muscle weakness and dilated cardiomyopathy. CONCLUSION Carrier frequency of small pathogenic variants differs significantly from large deletions. Small pathogenic variants are more commonly inherited, whereas large deletions arise de novo.
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Affiliation(s)
- Divya Nagabushana
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Kiran Polavarapu
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India.,Children's Hospital of Eastern Ontario Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada.,Brain and Mind Research Institute, University of Ottawa, ON, Canada
| | - Mainak Bardhan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Gautham Arunachal
- Department of Human Genetics, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Swetha Gunasekaran
- Department of Human Genetics, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | - Ram Murthy Anjanappa
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - PriyaTreesa Thomas
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Arun Sadasivan
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Tanushree Chawla
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Manjusha Warrier
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Muddasu Keerthipriya
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Sanita Raju
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Dhaarini Mohan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
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Gopal S, Rudrappa S, Sekar A, Preethish-Kumar V, Masapu D. Customized and Cost-Effective 3D Printed Mold for Cranioplasty: India's First Single Center Experience. Neurol India 2021; 69:611-617. [PMID: 34169853 DOI: 10.4103/0028-3886.319221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Context Autologous bone is the most commonly used flap in cranioplasty to repair the defect; however, synthetic materials are available. Poly methyl methacrylate (PMMA) is an effective polymer owing to its thermoplastic and radiolucent properties comparable to bone strength. Three-dimensional (3D) printing combined with computer-assisted design (CAD) is a simple, low-cost method to print molds that ensure surgical success. Materials and Methods A total of 114 patients underwent cranioplasty (July 2015-April 2018), and 25 of them using 3D printed template molds due to unavailability of autologous bone. The clinical features, patient demographics, and surgical parameters were analyzed. The visual analog score for cosmesis (VASC) and Odom's score was obtained pre and post-op. Results The mean age of the patients is 38.4 ± 14.6 years (Range, 9-66). The primary pathology for undergoing craniectomy is stroke (n = 13; 52%), traumatic brain injury (10; 40%) and tumor (2; 8%). The reason for nonavailability of flap was infection (n = 14;56%), flap resorption (4;16%), and trauma or tumor (7;28%). The mean time for manufacturing the 3D printed template is 13.2 ± 2.1 h. On follow-up, median Odom's score is excellent in 52% of cases, good in 40%, and fair in 8%. The mean VASC score on follow up is 8.2 ± 1.3. Three patients developed minor postoperative complications. Conclusion This is the first study from a single tertiary care center in India to systematically evaluate the outcomes in 3D cranioplasty using CAD and 3D printing technology. This method would be optimal especially in developing countries since PMMA is cost effective and also gives an ideal cosmetic effect.
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Affiliation(s)
- Swaroop Gopal
- Department of Neurosurgery, Institute of Neurosciences, Sakra World Hospital, Bellandur, Bengaluru, Karnataka, India
| | - Satish Rudrappa
- Department of Neurosurgery, Institute of Neurosciences, Sakra World Hospital, Bellandur, Bengaluru, Karnataka, India
| | - Arunkumar Sekar
- Department of Neurosurgery, Institute of Neurosciences, Sakra World Hospital, Bellandur, Bengaluru, Karnataka, India
| | - Veeramani Preethish-Kumar
- Department of Neurology, Institute of Neurosciences, Sakra World Hospital, Bellandur, Bengaluru, Karnataka, India
| | - Dheeraj Masapu
- Department of Neuroanasthesia, Institute of Neurosciences, Sakra World Hospital, Bellandur, Bengaluru, Karnataka, India
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Santhoshkumar R, Preethish-Kumar V, Polavarapu K, Reghunathan D, Chaudhari S, Satyamoorthy K, Vengalil S, Nashi S, Faruq M, Joshi A, Atchayaram N, Narayanappa G. A Novel L1 Linker Mutation in DES Resulted in Total Absence of Protein. J Mol Neurosci 2021; 71:2468-2473. [PMID: 34106405 DOI: 10.1007/s12031-021-01856-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 05/06/2021] [Indexed: 11/29/2022]
Abstract
Desminopathies (MIM*601419) are clinically heterogeneous, manifesting with myopathy and/or cardiomyopathy and with intra-sarcoplasmic desmin-positive deposits. They have either an autosomal dominant (AD) or recessive (AR) pattern of inheritance. Desmin is a crucial intermediate filament protein regulating various cellular functions in muscle cells. Here, we report a 13-year-old girl, born of second-degree consanguineous parents, with normal developmental milestones, who presented with dilated cardiomyopathy, respiratory insufficiency and predominant distal upper limb weakness. A striking feature on muscle biopsy was the presence of a peripheral chain of nuclei in addition to myopathic features. Immunostaining showed complete lack of desmin expression, further confirmed by western blot analysis. Ultrastructurally, subsarcolemmal granular material, expanded Z-band aggregation, distortion of myofilaments, focal Z-band streaming, lobed and clustered myonuclei were observed. Next-generation sequencing revealed a novel homozygous nonsense mutation c.448C>T, p.R150X in the patient, while the parents were heterozygous carriers. Single mitochondrial DNA deletion and isolated complex IV deficiency were noted. Our findings add to the ever-expanding phenotype and molecular spectrum of desminopathies.
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Affiliation(s)
- Rashmi Santhoshkumar
- Department of Neuropathology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, 560 029, India
| | - Veeramani Preethish-Kumar
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, 560 029, India
| | - Kiran Polavarapu
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, 560 029, India
| | - Dinesh Reghunathan
- Department of Cell and Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Sima Chaudhari
- Department of Cell and Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Kapaettu Satyamoorthy
- Department of Cell and Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, 560 029, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, 560 029, India
| | - Muhammed Faruq
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, 110 007, India
| | - Aditi Joshi
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, 110 007, India
| | - Nalini Atchayaram
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, 560 029, India
| | - Gayathri Narayanappa
- Department of Neuropathology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, 560 029, India.
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Bardhan M, Polavarapu K, Bevinahalli NN, Preethish-Kumar V, Anjanappa RM, Arunachal G, Shingavi L, Vengalil S, Nashi S, Chawla T, Nagabushana D, Mohan D, Horvath R, Nishino I, Nalini A. Correction: Megaconial congenital muscular dystrophy secondary to novel CHKB mutations resemble atypical Rett syndrome. J Hum Genet 2021; 66:841. [PMID: 33767318 DOI: 10.1038/s10038-021-00920-2] [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: 11/09/2022]
Affiliation(s)
- Mainak Bardhan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Kiran Polavarapu
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India.,Children's Hospital of Eastern Ontario Research Institute; Division of Neurology, Department of Medicine, The Ottawa Hospital; Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Nandeesh N Bevinahalli
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | - Ram Murthy Anjanappa
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Gautham Arunachal
- Department of Human Genetics, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Leena Shingavi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Tanushree Chawla
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Divya Nagabushana
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Dhaarini Mohan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Rita Horvath
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, Tokyo, Japan
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India.
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Polavarapu K, Vengalil S, Preethish-Kumar V, Arunachal G, Nashi S, Mohan D, Chawla T, Bardhan M, Nandeesh B, Gupta P, Gowda VK, Lochmüller H, Nalini A. Recessive VAMP1 mutations associated with severe congenital myasthenic syndromes - A recognizable clinical phenotype. Eur J Paediatr Neurol 2021; 31:54-60. [PMID: 33631708 DOI: 10.1016/j.ejpn.2021.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/31/2021] [Accepted: 02/10/2021] [Indexed: 12/01/2022]
Abstract
Three unrelated girls, all born to consanguineous parents had respiratory distress, severe hypotonia at birth along with prominent fatigable muscle weakness and characteristic myopathic facies. In addition, patient 1 had fatigable ptosis, ophthalmoparesis and profound bulbar weakness and required nasogastric feeding from birth. A feeding gastrostomy was inserted at 9 months of age. She continued to have severe bulbar and limb weakness with dropped head at 5 years of age. Patient 2 and 3 did not have ocular signs at the time of initial presentation during infancy and at 2 years of age respectively. None of the patients attained independent walking. Patient 3, currently aged 16 years continues to be wheelchair bound and has only mild non-progressive bulbar weakness with normal cognitive development. Muscle biopsy in patient 1 and 3 showed predominant myopathic features admixed with small sized (atrophic/hypoplastic) fibres. Next generation sequencing confirmed the presence of a homozygous loss of function VAMP1 mutations in all three patients: A single nucleotide deletion resulting in frameshift: c.66delT (p.Gly23AlafsTer6) in patient 1 and nonsense mutations c.202C>T (pArg68Ter) and c.97C>T (p.Arg33Ter) in patient 2 and 3 respectively. Minimal but definite improvement in muscle power with pyridostigmine was reported in patients 1 and 2. This is the first report of VAMP1 mutations causing CMS from the Indian subcontinent, describing a clinically recognizable severe form of VAMP1-related CMS and highlighting the need for a strong index of suspicion for early genetic diagnosis of potentially treatable CMS phenotypes.
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Affiliation(s)
- Kiran Polavarapu
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | - Gautham Arunachal
- Human Genetics, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Dhaarini Mohan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Tanushree Chawla
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Mainak Bardhan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Bevinahalli Nandeesh
- Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Priya Gupta
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bangalore, India
| | - Vykuntaraju K Gowda
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bangalore, India
| | - Hanns Lochmüller
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada; Division of Neurology, Department of Medicine, The Ottawa Hospital, Canada; Brain and Mind Research Institute, University of Ottawa, Ottawa, Canada
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India.
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Sadasivan A, Warrier MG, Polavarapu K, Preethish-Kumar V, Nair MG, Keerthipriya MS, Vengalil S, Sagar JV, Kishore T, Nalini A, Thomas PT. Palliative Care in Duchenne Muscular Dystrophy: A Study on Parents' Understanding. Indian J Palliat Care 2021; 27:146-151. [PMID: 34035633 PMCID: PMC8121239 DOI: 10.4103/ijpc.ijpc_259_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/02/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Duchene muscular dystrophy (DMD) is a neuromuscular disease of childhood, which has clear progression. The international standardized care guidelines for DMD suggest that palliative care is essential for the affected children. Objective To explore the parent's understanding of palliative care services available for children with DMD and the challenges faced by them in utilizing the same. Methods A cross-sectional qualitative exploratory study was conducted among six families of boys diagnosed with DMD. A semi-structured interview guide with prompts was used to conduct in-depth interviews which lasted for an average of 1 h. Thematic analysis was done to identify the pattern or themes. Results The major themes identified were "palliative care, living with DMD, Awareness about palliative care services and challenges." Awareness about palliative care services is the dominant theme identified as influencing rest of the experiences narrated by the parents of children with DMD. Discussion Integration of palliative care services from an early stage of the illness can help the child to make transition from one stage to another stage of the illness. To ensure the utilization of the available palliative care services, there is a need to create awareness about it among the general public. Conclusion Introducing the concept of palliation of symptoms and ensuring quality of life of the child with DMD by accessing the available services can aid the parents to reach out for help for their child.
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Affiliation(s)
- Arun Sadasivan
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Manjusha G Warrier
- Department of Psychology, Christ University, Bengaluru, Karnataka, India
| | - Kiran Polavarapu
- Department of Postdoctoral Fellow, Children's Hospital of Eastern Ontario Research Institute, Ottwa, Canada
| | | | - Meera G Nair
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - M S Keerthipriya
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - John Vijay Sagar
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Thomas Kishore
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Priya Treesa Thomas
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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36
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Santhoshkumar R, Preethish-Kumar V, Mangalaparthi KK, Unni S, Padmanabhan B, T S KP, Nongthomba U, Atchayaram N, Narayanappa G. A Dominant C150Y Mutation in FHL1 Induces Structural Alterations in LIM2 Domain Causing Protein Aggregation In Human and Drosophila Indirect Flight Muscles. J Mol Neurosci 2021; 71:2324-2335. [PMID: 33515430 DOI: 10.1007/s12031-020-01777-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 12/11/2020] [Indexed: 11/29/2022]
Abstract
FHL1-related myopathies are rare X-linked dominant myopathies. Though clinically classified into several subgroups, spinal and scapuloperoneal muscle involvement are common to all. In this study, we identified c.449G > A, p.C150Y mutation by clinical exome sequencing in two patients from same family (son and mother) of Indian origin who presented with multiple contractures. Muscle biopsy showed numerous intracytoplasmic aggregates intensely stained on HE and MGT. The strong reactions to M-NBT revealed aggregates to be reducing bodies and positively labeled to anti-FHL1 antibody. Ultrastructurally, Z-band streaming and granular and granulofilamentous material were seen. Further, the translational evidence of mutant peptide was confirmed using mass spectrometric analysis. To establish p.C150Y as the cause for protein aggregation, in vivo studies were carried out using transgenic Drosophila model which highlighted Z-band abnormalities and protein aggregates in indirect flight muscles with compromised physiological function. Thus, recapitulating the X-linked human disease phenotype. Additionally, the molecular dynamics simulation analysis unraveled the drastic change in α-helix of LIM2, the region immediately next to site of C150Y mutation that could be the plausible cause for protein aggregation. To the best of our knowledge, this is the first study of p.C150Y mutation in FHL1 identified in Indian patients with in vivo and in silico analysis to establish the cause for protein aggregation in muscle.
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Affiliation(s)
- Rashmi Santhoshkumar
- Department of Neuropathology, National Institute of Mental Health and Neuro Sciences, Bengaluru, 560 029, Karnataka, India
| | - Veeramani Preethish-Kumar
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, 560 029, Karnataka, India
| | - Kiran K Mangalaparthi
- Institute of Bioinformatics, International Technology Park, Bengaluru, 560 066, Karnataka, India
| | - Sruthi Unni
- Department of Biophysics, National Institute of Mental Health and Neuro Sciences, Bengaluru, 560 029, Karnataka, India
| | - Balasundaram Padmanabhan
- Department of Biophysics, National Institute of Mental Health and Neuro Sciences, Bengaluru, 560 029, Karnataka, India
| | - Keshava Prasad T S
- Center for Systems Biology and Molecular Medicine, Yenepoya Research Center, Yenepoya Deemed to be University, Mangaluru, 575 018, Karnataka, India
| | - Upendra Nongthomba
- Department of Molecular Reproduction Development and Genetics, Indian Institute of Science (IISc), Bengaluru, 560 012, Karnataka, India
| | - Nalini Atchayaram
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, 560 029, Karnataka, India
| | - Gayathri Narayanappa
- Department of Neuropathology, National Institute of Mental Health and Neuro Sciences, Bengaluru, 560 029, Karnataka, India.
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37
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Polavarapu K, Bardhan M, Anjanappa RM, Vengalil S, Preethish-Kumar V, Shingavi L, Chawla T, Nashi S, Mohan D, Arunachal G, Geetha TS, Ramprasad V, Nalini A. Nemaline Rod/Cap Myopathy Due to Novel Homozygous MYPN Mutations: The First Report from South Asia and Comprehensive Literature Review. J Clin Neurol 2021; 17:409-418. [PMID: 34184449 PMCID: PMC8242322 DOI: 10.3988/jcn.2021.17.3.409] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose Pathogenic variants in the myopalladin gene (MYPN) are known to cause mildly progressive nemaline/cap myopathy. Only nine cases have been reported in the English literature. Methods A detailed evaluation was conducted of the clinical, muscle magnetic resonance imaging (MRI), and genetic findings of two unrelated adults with MYPN-related cap myopathy. Genetic analysis was performed using whole-exome sequencing. MRI was performed on a 1.5-T device in patient 1. Results Two unrelated adults born to consanguineous parents, a 28-year-old male and a 23-year-old female, were diagnosed with pathogenic variants in MYPN that cause cap myopathy. Both patients presented with early-onset, insidiously progressive, and minimally disabling proximodistal weakness with mild ptosis, facial weakness, and bulbar symptoms. Patient 1 had a prominent foot drop from the onset. Both patients were followed up at age 30 years, at which point serum creatine kinase concentrations were minimally elevated. There were no cardiac symptoms; electrocardiograms and two-dimensional echocardiograms were normal in both patients. Muscle MRI revealed preferential involvement of the glutei, posterior thigh muscles, and anterior leg muscles. Whole-exome sequencing revealed significant homozygous splice-site variants in both of the probands, affecting intron 10 of MYPN: c.1973+1G>C (patient 1) and c.1974-2A>C (patient 2). Conclusions This study elaborates on two patients with homozygous MYPN pathogenic variants, presenting as slowly progressive congenital myopathy. These patients are only the tenth and eleventh cases reported in the English literature, and the first from South Asia. The clinical phenotype reiterates the mild form of nemaline rod/cap myopathy. A comprehensive literature review is presented.
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Affiliation(s)
- Kiran Polavarapu
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India.,Children's Hospital of Eastern Ontario Research Institute; Division of Neurology, Department of Medicine, The Ottawa Hospital; Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Mainak Bardhan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Ram Murthy Anjanappa
- Department of Human Genetics, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | - Leena Shingavi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Tanushree Chawla
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Dhaarini Mohan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Gautham Arunachal
- Department of Human Genetics, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | | | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India.
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38
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Seshagiri DV, Huddar A, Nashi S, Ray S, Ramaswamy P, Oommen AT, Chawla T, Yadav S, Annapureddy J, Jankar R, Polavarapu K, Vengalil S, Preethish-Kumar V, Warrier M, Thomas PT, Shingavi L, Arunachal G, Yadav R, Nalini A. Altered REM sleep architecture in patients with Myotonic dystrophy type 1: is related to sleep apnea? Sleep Med 2021; 79:48-54. [PMID: 33472130 DOI: 10.1016/j.sleep.2020.12.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the sleep architecture and sleep respiratory abnormalities and to correlate with sleep symptoms in patients with Myotonic dystrophy type 1 (DM1). METHODS We recruited a cohort of genetically confirmed patients with DM1, who attended the Neuromuscular clinic between July 2016 and December 2019. Clinical, sleep and whole night polysomnography data were collected. The analysis of sleep architecture, sleep respiratory parameters and comparison with healthy controls (HC) was performed in our sleep laboratory. RESULTS A total of 59 patients with DM1 underwent sleep evaluation. Hypersomnolence in 42 (77.8%), ESS>10 in 23 (39%), and PSQI>5 in 18 (30.5%) were found in patients with DM1. Thirty-one (68.89%) patients with DM1 and 22 (95.65%) HC had more than 4-h of total sleep time (TST). More than 4 h of TST was taken to compare respiratory and sleep architecture parameters. Patients with DM1 had reduced sleep efficiency, reduced N2 sleep, and increase in N1 sleep, wake index, stage shift index, nocturnal sleep-onset REM periods compared to HC. AHI>15 was found in 16 (51.61%) DM1 and in 3 HC (13.64%). AHI had positive correlation with BMI, but not with age, ESS or disease progression (MIRS). All DM1 with AHI>15; 8(80%) and 1(33.33%) in AHI5to15, and AHI<5 groups, respectively had hypersomnolence. CONCLUSION In this first study on Indian cohort, daytime hypersomnolence, poor nocturnal sleep quality, sleep architecture irregularities are identified to be common in patients with DM1. These abnormalities may be explained by sleep-related breathing disorders that are highly prevalent in these patients.
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Affiliation(s)
| | - Akshata Huddar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Somdattaa Ray
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Palanyswamy Ramaswamy
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Abel Thomas Oommen
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Tanushree Chawla
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Srikanth Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Jagadish Annapureddy
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Rahul Jankar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Kiran Polavarapu
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | - Manjusha Warrier
- Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Priya Treesa Thomas
- Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Leena Shingavi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Gautham Arunachal
- Human Genetics, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India.
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39
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Chen Z, Maroofian R, Başak AN, Shingavi L, Karakaya M, Efthymiou S, Gustavsson EK, Meier L, Polavarapu K, Vengalil S, Preethish-Kumar V, Nandeesh BN, Gökçe Güneş N, Akan O, Candan F, Schrank B, Zuchner S, Murphy D, Kapoor M, Ryten M, Wirth B, Reilly MM, Nalini A, Houlden H, Sarraf P. Novel variants broaden the phenotypic spectrum of PLEKHG5-associated neuropathies. Eur J Neurol 2020; 28:1344-1355. [PMID: 33220101 DOI: 10.1111/ene.14649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 11/12/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Pathogenic variants in PLEKHG5 have been reported to date to be causative in three unrelated families with autosomal recessive intermediate Charcot-Marie-Tooth disease (CMT) and in one consanguineous family with spinal muscular atrophy (SMA). PLEKHG5 is known to be expressed in the human peripheral nervous system, and previous studies have shown its function in axon terminal autophagy of synaptic vesicles, lending support to its underlying pathogenetic mechanism. Despite this, there is limited knowledge of the clinical and genetic spectrum of disease. METHODS We leverage the diagnostic utility of exome and genome sequencing and describe novel biallelic variants in PLEKHG5 in 13 individuals from nine unrelated families originating from four different countries. We compare our phenotypic and genotypic findings with a comprehensive review of cases previously described in the literature. RESULTS We found that patients presented with variable disease severity at different ages of onset (8-25 years). In our cases, weakness usually started proximally, progressing distally, and can be associated with intermediate slow conduction velocities and minor clinical sensory involvement. We report three novel nonsense and four novel missense pathogenic variants associated with these PLEKHG5-associated neuropathies, which are phenotypically spinal muscular atrophy (SMA) or intermediate Charcot-Marie-Tooth disease. CONCLUSIONS PLEKHG5-associated neuropathies should be considered as an important differential in non-5q SMAs even in the presence of mild sensory impairment and a candidate causative gene for a wide range of hereditary neuropathies. We present this series of cases to further the understanding of the phenotypic and molecular spectrum of PLEKHG5-associated diseases.
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Affiliation(s)
- Zhongbo Chen
- Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, University College London, London, UK.,Department of Neuromuscular Disease, University College London Queen Square Institute of Neurology, University College London, London, UK
| | - Reza Maroofian
- Department of Neuromuscular Disease, University College London Queen Square Institute of Neurology, University College London, London, UK
| | - A Nazlı Başak
- School of Medicine, Neurodegeneration Research Laboratory, KUTTAM-NDAL, Koç University, Istanbul, Turkey
| | - Leena Shingavi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Mert Karakaya
- Institute of Human Genetics, Center for Molecular Medicine and Center for Rare Diseases, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephanie Efthymiou
- Department of Neuromuscular Disease, University College London Queen Square Institute of Neurology, University College London, London, UK
| | - Emil K Gustavsson
- Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, University College London, London, UK
| | - Leyla Meier
- Institute of Human Genetics, Center for Molecular Medicine and Center for Rare Diseases, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Kiran Polavarapu
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.,Division of Neurology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Veeramani Preethish-Kumar
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Bevinahalli N Nandeesh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Nalan Gökçe Güneş
- Neurology Department, Ankara Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Onur Akan
- Neurology Department, Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Fatma Candan
- Neurology Department, Göztepe Training and Research Hospital, Medeniyet University, Istanbul, Turkey
| | - Bertold Schrank
- Department of Neurology, DKD Helios Kliniken, Wiesbaden, Germany
| | - Stephan Zuchner
- Department of Human Genetics and Hussman Institute for Human Genomics, University of Miami Miler School of Medicine, Miami, Florida, USA
| | - David Murphy
- Department of Neuromuscular Disease, University College London Queen Square Institute of Neurology, University College London, London, UK
| | - Mahima Kapoor
- Department of Neuromuscular Disease, University College London Queen Square Institute of Neurology, University College London, London, UK
| | - Mina Ryten
- Department of Neurodegenerative Disease, University College London Queen Square Institute of Neurology, University College London, London, UK
| | - Brunhilde Wirth
- Institute of Human Genetics, Center for Molecular Medicine and Center for Rare Diseases, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Mary M Reilly
- Department of Neuromuscular Disease, University College London Queen Square Institute of Neurology, University College London, London, UK
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Henry Houlden
- Department of Neuromuscular Disease, University College London Queen Square Institute of Neurology, University College London, London, UK
| | - Payam Sarraf
- Department of Neuromuscular Diseases, Iranian Centre of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Sarath Chander V, Govindasamy R, Masapu D, Preethish-Kumar V, Rudrappa S. Role of expansile duraplasty and neural monitoring in surgery for Anterior Thoracic Spinal Cord Herniation. Interdisciplinary Neurosurgery 2020. [DOI: 10.1016/j.inat.2020.100859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Sanga S, Ghosh A, Kumar K, Polavarapu K, Preethish-Kumar V, Vengalil S, Nashi S, Bardhan M, Arunachal G, Raju S, Gayathri N, Biswas NK, Chakrabarti S, Nalini A, Roy S, Acharya M. Whole-exome analyses of congenital muscular dystrophy and congenital myopathy patients from India reveal a wide spectrum of known and novel mutations. Eur J Neurol 2020; 28:992-1003. [PMID: 33124102 DOI: 10.1111/ene.14616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/22/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Congenital muscular dystrophies (CMDs) and congenital myopathies (CMs) are a group of genetically and clinically heterogeneous degenerative primary muscle disorders with onset at birth or during infancy. Due to vast heterogeneity, clinical examination and protein-based analyses often fail to identify the genetic causes of these diseases. The aim of this study was to genetically diagnose a cohort of 36 difficult-to-diagnose CMD and CM cases of Indian origin using next-generation sequencing methods. METHODS Whole-exome sequencing (WES) was performed to identify pathogenic mutations in previously reported CMD and CM-related genes using variant calling and stringent variant filtration process. Subsequently, in silico homology modelling and molecular dynamics simulations (MDS) studies were undertaken for a number of novel and missense variants. RESULTS A total of 33 and 21 rare and deleterious mutations were identified in 28 genes previously reported in CMD and CM based on OMIM, ClinVar and Orphanet, respectively. We could accurately diagnose 54% patients (n = 12/22) in the CMD group and 35% patients (n = 5/14) in the CM group. Furthermore, MDS studies for mutations located in LMNA, LAMA2 and RYR1 suggest that the wild-type proteins are more stable than their mutant counterparts, implying a potential mechanism of pathogenesis. CONCLUSION The WES findings led us to identify reported as well as novel variants for the first time in Indian patients with CMD and CM. This allowed us to achieve an accurate genetic diagnosis, which was difficult using conventional diagnostic tools. Transferring these WES findings to clinical practice will help guide clinical care of the affected patients and inform genetic counselling.
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Affiliation(s)
- Shamita Sanga
- National Institute of Biomedical Genomics, Kalyani, India
| | - Arnab Ghosh
- National Institute of Biomedical Genomics, Kalyani, India
| | - Krishna Kumar
- Structural Biology and Bioinformatics Division, Indian Institute of Chemical Biology, Kolkata, India
| | - Kiran Polavarapu
- Department of Neurology, National Institute of Mental Health and Neuroscience, Bengaluru, India
| | | | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neuroscience, Bengaluru, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neuroscience, Bengaluru, India
| | - Mainak Bardhan
- Department of Neurology, National Institute of Mental Health and Neuroscience, Bengaluru, India
| | - Gautham Arunachal
- Department of Human Genetics, National Institute of Mental Health and Neuroscience, Bengaluru, India
| | - Sanita Raju
- Department of Neurology, National Institute of Mental Health and Neuroscience, Bengaluru, India
| | - Narayanappa Gayathri
- Department of Neuropathology, National Institute of Mental Health and Neuroscience, Bengaluru, India
| | | | - Saikat Chakrabarti
- Structural Biology and Bioinformatics Division, Indian Institute of Chemical Biology, Kolkata, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neuroscience, Bengaluru, India
| | - Sudipto Roy
- Institute of Molecular and Cell Biology, Singapore City, Singapore.,Department of Biological Sciences, National University of Singapore, Singapore City, Singapore.,Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
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Govindasamy R, Preethish-Kumar V, Gopal S, Rudrappa S. Is Transoral Surgery Still a Relevant Procedure in Atlantoaxial Instability? Int J Spine Surg 2020; 14:657-664. [PMID: 33077434 PMCID: PMC7671436 DOI: 10.14444/7096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The treatment of atlantoaxial instability (AAI) involves stable fixation and fusion with adequate decompression of spinal cord. After the advent of the Goel posterior joint manipulation technique, most of the once irreducible atlantoaxial dislocations (AAD) could be reduced and the need for transoral odontoidectomy became almost nil. Here we tried to iterate the indications of anterior transoral odontoid surgery for AAI in the current scenario. METHODS A retrospective study compiling the clinical, radiological, and surgical characteristics of 6 cases (5 scenarios). These patients underwent anterior transoral surgery alone or in combination with a posterior approach. RESULTS Two patients had a well-formed occipito-cervical fusion mass, with a displaced odontoid and unreduced C1-C2 joint causing cervical myelopathy. A middle-aged woman presented with unreduced AAD following failed C1-C2 joint distraction technique. A displaced dystopic os odontoideum ossicle was found in an adolescent boy, prohibiting the reduction of AAD. A young man had displacement of the fractured odontoid segment with intact transverse alar ligament and C1-C2 joint complex. One patient had a rare scenario of abnormal orientation of the C1-C2 joint. All 6 patients were successfully treated with adequate spinal cord decompression achieved by the anterior transoral route and stabilization by either the anterior approach itself or in combination with posterior surgery. All had significantly better postoperative outcomes except for 1 patient who expired due to poor respiratory reserve. CONCLUSION We tried to emphasize the indications for using transoral anterior odontoid surgery over the posterior approach in the management of AAI. This will prevent the surgical technique of anterior odontoidectomy from becoming an obsolete procedure in the current practice.
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Affiliation(s)
- Ramachandran Govindasamy
- Institute of Neurosciences, Sakra World Hospital, Bellandur, Bangalore, India
- Department of Spine Surgery, Sakra World Hospital, Bellandur, Bangalore, India
| | | | - Swaroop Gopal
- Institute of Neurosciences, Sakra World Hospital, Bellandur, Bangalore, India
| | - Satish Rudrappa
- Institute of Neurosciences, Sakra World Hospital, Bellandur, Bangalore, India
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Varghese AM, Ghosh M, Bhagat SK, Vijayalakshmi K, Preethish-Kumar V, Vengalil S, Chevula PCR, Nashi S, Polavarapu K, Sharma M, Dhaliwal RS, Philip M, Nalini A, Alladi PA, Sathyaprabha TN, Raju TR. Chitotriosidase, a biomarker of amyotrophic lateral sclerosis, accentuates neurodegeneration in spinal motor neurons through neuroinflammation. J Neuroinflammation 2020; 17:232. [PMID: 32762702 PMCID: PMC7412641 DOI: 10.1186/s12974-020-01909-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 01/14/2020] [Accepted: 07/21/2020] [Indexed: 12/22/2022] Open
Abstract
Background Cerebrospinal fluid from amyotrophic lateral sclerosis patients (ALS-CSF) induces neurodegenerative changes in motor neurons and gliosis in sporadic ALS models. Search for identification of toxic factor(s) in CSF revealed an enhancement in the level and enzyme activity of chitotriosidase (CHIT-1). Here, we have investigated its upregulation in a large cohort of samples and more importantly its role in ALS pathogenesis in a rat model. Methods CHIT-1 level in CSF samples from ALS (n = 158), non-ALS (n = 12) and normal (n = 48) subjects were measured using ELISA. Enzyme activity was also assessed (ALS, n = 56; non-ALS, n = 10 and normal-CSF, n = 45). Recombinant CHIT-1 was intrathecally injected into Wistar rat neonates. Lumbar spinal cord sections were stained for Iba1, glial fibrillary acidic protein and choline acetyl transferase to identify microglia, astrocytes and motor neurons respectively after 48 h of injection. Levels of tumour necrosis factor-α and interleukin-6 were measured by ELISA. Findings CHIT-1 level in ALS-CSF samples was increased by 20-fold and it can distinguish ALS patients with a sensitivity of 87% and specificity of 83.3% at a cut off level of 1405.43 pg/ml. Enzyme activity of CHIT-1 was also 15-fold higher in ALS-CSF and has a sensitivity of 80.4% and specificity of 80% at cut off value of 0.1077989 μmol/μl/min. Combining CHIT-1 level and activity together gave a positive predictive value of 97.78% and negative predictive value of 100%. Administration of CHIT-1 increased microglial numbers and astrogliosis in the ventral horn with a concomitant increase in the levels of pro-inflammatory cytokines. Amoeboid-shaped microglial and astroglial cells were also present around the central canal. CHIT-1 administration also resulted in the reduction of motor neurons. Conclusions CHIT-1, an early diagnostic biomarker of sporadic ALS, activates glia priming them to attain a toxic phenotype resulting in neuroinflammation leading to motor neuronal death.
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Affiliation(s)
- Anu Mary Varghese
- Department of Neurophysiology, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bengaluru, 560 029, India
| | - Mausam Ghosh
- Department of Neurophysiology, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bengaluru, 560 029, India
| | - Savita Kumari Bhagat
- Department of Neurophysiology, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bengaluru, 560 029, India
| | - K Vijayalakshmi
- Department of Neurophysiology, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bengaluru, 560 029, India
| | - Veeramani Preethish-Kumar
- Department of Clinical Neuroscience, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bengaluru, 560 029, India
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bengaluru, 560 029, India
| | - Pradeep-Chandra-Reddy Chevula
- Department of Neurophysiology, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bengaluru, 560 029, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bengaluru, 560 029, India
| | - Kiran Polavarapu
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bengaluru, 560 029, India
| | - Meenakshi Sharma
- Division of Non Communicable Disease, Indian Council of Medical Research, New Delhi, India
| | | | - Mariamma Philip
- Department of Biostatistics, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bengaluru, 560 029, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bengaluru, 560 029, India
| | - Phalguni Anand Alladi
- Department of Clinical Pharmacology & Neurotoxicology, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bengaluru, 560 029, India
| | - Talakad N Sathyaprabha
- Department of Neurophysiology, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bengaluru, 560 029, India
| | - Trichur R Raju
- Department of Neurophysiology, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bengaluru, 560 029, India.
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Preethish-Kumar V, Shah A, Kumar M, Ingalhalikar M, Polavarapu K, Afsar M, Rajeswaran J, Vengalil S, Nashi S, Thomas PT, Sadasivan A, Warrier M, Nalini A, Saini J. In Vivo Evaluation of White Matter Abnormalities in Children with Duchenne Muscular Dystrophy Using DTI. AJNR Am J Neuroradiol 2020; 41:1271-1278. [PMID: 32616576 DOI: 10.3174/ajnr.a6604] [Citation(s) in RCA: 6] [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: 12/09/2019] [Accepted: 03/23/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE Duchenne muscular dystrophy is an X-linked disorder characterized by progressive muscle weakness and prominent nonmotor manifestations, such as a low intelligence quotient and neuropsychiatric disturbance. We investigated WM integrity in patients with Duchenne muscular dystrophy using DTI. MATERIALS AND METHODS Fractional anisotropy and mean, axial, and radial diffusivity (DTI measures) were used to assess WM microstructural integrity along with neuropsychological evaluation in patients with Duchenne muscular dystrophy (n = 60) and controls (n = 40). Exon deletions in the DMD gene were confirmed using multiplex ligation-dependent probe amplification. Patients were classified into proximal (DMD Dp140+) and distal (DMD Dp140-) subgroups based on the location of the exon deletion and expression of short dystrophin Dp140 isoform. WM integrity was examined using whole-brain Tract-Based Spatial Statistics and atlas-based analysis of DTI data. The Pearson correlation was performed to investigate the possible relationship between neuropsychological scores and DTI metrics. RESULTS The mean ages of Duchenne muscular dystrophy and control participants were 8.0 ± 1.2 years and 8.2 ± 1.4 years, respectively. The mean age at disease onset was 4.1 ± 1.8 years, and mean illness duration was 40.8 ± 25.2 months. Significant differences in neuropsychological scores were observed between the proximal and distal gene-deletion subgroups, with more severe impairment in the distal-deletion subgroup (P < .05). Localized fractional anisotropy changes were seen in the corpus callosum, parietal WM, and fornices in the patient subgroup with Dp140+, while widespread changes were noted in the Dp140- subgroup. The Dp140+ subgroup showed increased axial diffusivity in multiple WM regions relative to the Dp140- subgroup. No significant correlation was observed between clinical and neuropsychological scores and diffusion metrics. CONCLUSIONS Widespread WM differences are evident in patients with Duchenne muscular dystrophy relative to healthy controls. Distal mutations in particular are associated with extensive WM abnormalities and poor neuropsychological profiles.
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Affiliation(s)
| | - A Shah
- Symbiosis Centre for Medical Image Analysis (A.Shah, M.I.), Symbiosis International University, Mulshi Pune, Maharashtra, India
| | - M Kumar
- Neuroimaging and Interventional Radiology (M.K., J.S.)
| | - M Ingalhalikar
- Symbiosis Centre for Medical Image Analysis (A.Shah, M.I.), Symbiosis International University, Mulshi Pune, Maharashtra, India
| | - K Polavarapu
- From the Departments of Neurology (V.P.-K., K.P., S.V., S.N., A.N.)
| | - M Afsar
- Neuropsychology (M.A., J.R.)
| | | | - S Vengalil
- From the Departments of Neurology (V.P.-K., K.P., S.V., S.N., A.N.)
| | - S Nashi
- From the Departments of Neurology (V.P.-K., K.P., S.V., S.N., A.N.)
| | - P T Thomas
- Psychiatric Social Work (P.T.T., A.Sadasivan, M.W.), National Institute of Mental Health and Neurosciences, Bangalore, India
| | - A Sadasivan
- Psychiatric Social Work (P.T.T., A.Sadasivan, M.W.), National Institute of Mental Health and Neurosciences, Bangalore, India
| | - M Warrier
- Psychiatric Social Work (P.T.T., A.Sadasivan, M.W.), National Institute of Mental Health and Neurosciences, Bangalore, India
| | - A Nalini
- From the Departments of Neurology (V.P.-K., K.P., S.V., S.N., A.N.)
| | - J Saini
- Neuroimaging and Interventional Radiology (M.K., J.S.)
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Mahajan NP, Lavania M, Singh I, Nashi S, Preethish-Kumar V, Vengalil S, Polavarapu K, Pradeep-Chandra-Reddy C, Keerthipriya M, Mahadevan A, Yasha TC, Nandeesh BN, Gnanakumar K, Parry GJ, Sengupta U, Nalini A. Evidence for Mycobacterium leprae Drug Resistance in a Large Cohort of Leprous Neuropathy Patients from India. Am J Trop Med Hyg 2020; 102:547-552. [PMID: 31933458 DOI: 10.4269/ajtmh.19-0390] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Resistance to anti-leprosy drugs is on the rise. Several studies have documented resistance to rifampicin, dapsone, and ofloxacin in patients with leprosy. We looked for point mutations within the folP1, rpoB, and gyrA gene regions of the Mycobacterium leprae genome predominantly in the neural form of leprosy. DNA samples from 77 nerve tissue samples were polymerase chain reaction (PCR)-amplified for M leprae DNA and sequenced for drug resistance-determining regions of genes rpoB, folP1, and gyrA. The mean age at presentation and onset was 38.2 ± 13.4 (range 14-71) years and 34.9 ± 12.6 years (range 10-63) years, respectively. The majority had borderline tuberculoid leprosy (53 [68.8%]). Mutations associated with resistance were identified in 6/77 (7.8%) specimens. Mutations seen were those associated with resistance to rifampicin, ofloxacin, and dapsone. All the six patients were drug-naive. The clinical and pathological manifestations in this group did not differ from the drug-sensitive group. This study highlights the occurrence of resistance to the standard multidrug therapy and ofloxacin in leprosy. Among the entire cohort, 1/77 (1.3%) showed resistance to rifampicin, 2/77 (2.6%) to dapsone, and 5/77 (6.4%) to ofloxacin. Six new patients showing infection by mutant strains indicated the emergence of primary resistance. Resistance to ofloxacin could be due to frequent use of quinolones for many bacterial infections. The results of the study indicate the need for development of a robust and strict surveillance system for detecting drug resistance in leprosy in India.
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Affiliation(s)
- Niranjan Prakash Mahajan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Mallika Lavania
- Stanley Browne Research Laboratory, TLM Community Hospital, New Delhi, India
| | - Itu Singh
- Stanley Browne Research Laboratory, TLM Community Hospital, New Delhi, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Kiran Polavarapu
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Muddasu Keerthipriya
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | | | - Krishnamurthy Gnanakumar
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Gareth J Parry
- Department of Neurology, St John's Medical College, Bangalore, India
| | - Utpal Sengupta
- Stanley Browne Research Laboratory, TLM Community Hospital, New Delhi, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
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Vengalil S, Lavania M, Singh I, Nashi S, Preethish-Kumar V, Polavarapu K, Mahajan NP, Raju S, Pradeep-Chandra-Reddy C, Keerthipriya M, Mahadevan A, Yasha TC, Nandeesh B, Gnanakumar K, Parry GJ, Sengupta U, Nalini A. Appropriately Selected Nerve in Suspected Leprous Neuropathy Yields High Positive Results for Mycobacterium leprae DNA by Polymerase Chain Reaction Method. Am J Trop Med Hyg 2020; 103:209-213. [PMID: 32285768 DOI: 10.4269/ajtmh.19-0746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Identification of Mycobacterium leprae DNA by polymerase chain reaction (PCR) is a reliable and an affordable method to confirm leprosy. DNA from 87 nerve samples (61 from paraffin blocks and 26 fresh samples) was extracted. Mycobacterium leprae DNA was amplified by PCR from 80/87 (92%) specimens. Patients were seen over a period of 11 years (2007-2019), and leprosy was diagnosed based on clinical and characteristic histopathology findings. The clinical diagnostic possibilities were as follows: leprous neuropathy in 73/80 (91.3%), mononeuritis multiplex of unknown etiology in four (5.0%), vasculitic neuropathy in two (2.5%), and distal symmetric sensory motor neuropathy in one (1.3%). The biopsied nerves were as follows: superficial radial = 34 (42.6%), dorsal cutaneous branch of ulnar = 19 (23.8%), sural = 18 (22.5%), and superficial peroneal = 9 (11.3%), and corresponding neurological deficits were recorded in 77 (96.3%) cases. The histopathological diagnoses in total group were as follows: (borderline tuberculoid (BT) = 52, tuberculoid (TT) = 8, borderline lepromatous (BL) = 8, borderline borderline (BB) = 3, nonspecific inflammation = 3, healed/fibrosed = 4, and axonopathy = 2). Acid fast bacilli (AFB) was demonstrated in 11 (13.7%) samples. For comparison, 31 clinically and histopathologically defined non-leprous disease control nerves (inherited neuropathy = 20, vasculitis = 8, and nutritional neuropathy = 3) subjected to PCR were negative for M. leprae DNA. In most instances, there are multiple thickened peripheral nerves in suspected cases of leprosy, but neurological deficits pertaining to the thickened nerve are not as widespread. The current findings emphasize the importance of selecting the most appropriate nerve for biopsy to obtain a positive PCR result. We infer that clinical, histopathological, and PCR tests complement each other to help achieve a definitive diagnosis of leprosy particularly in pure neuritic leprosy and in leprous neuropathy with negative skin smears/biopsy.
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Affiliation(s)
- Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Mallika Lavania
- Stanley Browne Research Laboratory, TLM Community Hospital, New Delhi, India
| | - Itu Singh
- Stanley Browne Research Laboratory, TLM Community Hospital, New Delhi, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Kiran Polavarapu
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Niranjan Prakash Mahajan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Sanita Raju
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Muddasu Keerthipriya
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Bevinahalli Nandeesh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Krishnamurthy Gnanakumar
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Gareth J Parry
- Department of Neurology, St John's Medical College, Bangalore, India
| | - Utpal Sengupta
- Stanley Browne Research Laboratory, TLM Community Hospital, New Delhi, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
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Shamim U, Ambawat S, Singh J, Thomas A, Pradeep-Chandra-Reddy C, Suroliya V, Uppilli B, Parveen S, Sharma P, Chanchal S, Nashi S, Preethish-Kumar V, Vengalil S, Polavarapu K, Keerthipriya M, Mahajan NP, Reddy N, Thomas PT, Sadasivan A, Warrier M, Seth M, Zahra S, Mathur A, Vibha D, Srivastava AK, Nalini A, Faruq M. C9orf72 hexanucleotide repeat expansion in Indian patients with ALS: a common founder and its geographical predilection. Neurobiol Aging 2020; 88:156.e1-156.e9. [PMID: 32035847 DOI: 10.1016/j.neurobiolaging.2019.12.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 11/15/2019] [Accepted: 12/27/2019] [Indexed: 12/16/2022]
Abstract
Hexanucleotide repeat expansion in C9orf72 is defined as a major causative factor for familial amyotrophic lateral sclerosis (ALS). The mutation frequency varies dramatically among populations of different ethnicity; however, in most cases, C9orf72 mutant has been described on a common founder haplotype. We assessed its frequency in a study cohort involving 593 clinically and electrophysiologically defined ALS cases. We also investigated the presence of reported Finnish haplotype among the mutation carriers. The identified common haplotype region was further screened in 192 (carrying 2-6 G4C2 repeats) and 96 (≥7 repeats) control chromosomes. The G4C2 expansion was observed in 3.2% (19/593) of total cases where 9/19 (47.4%) positive cases belonged to the eastern region of India. Haplotype analysis revealed 11 G4C2-Ex carriers shared the common haplotype (haplo-A) background spanning a region of ∼90 kbp (rs895021-rs11789520) including rs3849942 (a well-known global at-risk loci with T allele for G4C2 expansion). The other 3 G4C2-Ex cases had a different haplotype (haplo-B) with core difference from haplo-A at G4C2-Ex flanking 31 kbp region between rs3849942 and rs11789520 SNPs (allele 'C' of rs3849942 which is a nonrisk allele). Out of other five G4C2-cases, four carried the risk allele T of rs3849942 while one harbored the non-risk allele. This study establishes the prevalence of C9orf72 expansion in Indian ALS cases providing further evidence for geographical predilection. The global core risk haplotype predominated C9orf72 expansion-positive ALS cases, yet the existence of a different haplotype suggests a second lineage (haplo B), which may have been derived from the Finnish core haplotype or may imply a unique haplotype among Asians. The association of risk haplotype with normal intermediate C9orf72 alleles reinforced its role in conferring instability to the C9orf72-G4C2 region. We thus present an effective support to interpret future burden of ALS cases in India.
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Affiliation(s)
- Uzma Shamim
- Genomics and Molecular Medicine Division, CSIR - Institute of Genomics and Integrative Biology, New Delhi, India
| | - Sakshi Ambawat
- Genomics and Molecular Medicine Division, CSIR - Institute of Genomics and Integrative Biology, New Delhi, India
| | - Jyotsna Singh
- Genomics and Molecular Medicine Division, CSIR - Institute of Genomics and Integrative Biology, New Delhi, India
| | - Aneesa Thomas
- Department of Neurology, Neuroscience Centre, All India Institute of Medical Sciences, New Delhi, India
| | | | - Varun Suroliya
- Department of Neurology, Neuroscience Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Bharathram Uppilli
- Genomics and Molecular Medicine Division, CSIR - Institute of Genomics and Integrative Biology, New Delhi, India
| | - Shaista Parveen
- Genomics and Molecular Medicine Division, CSIR - Institute of Genomics and Integrative Biology, New Delhi, India
| | - Pooja Sharma
- Genomics and Molecular Medicine Division, CSIR - Institute of Genomics and Integrative Biology, New Delhi, India
| | - Shankar Chanchal
- Genomics and Molecular Medicine Division, CSIR - Institute of Genomics and Integrative Biology, New Delhi, India
| | - Saraswati Nashi
- Neurology Department, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | - Seena Vengalil
- Neurology Department, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Kiran Polavarapu
- Neurology Department, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Muddasu Keerthipriya
- Neurology Department, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | - Neeraja Reddy
- Neurology Department, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Priya Treesa Thomas
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Arun Sadasivan
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Manjusha Warrier
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Malika Seth
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Sana Zahra
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Aradhana Mathur
- Genomics and Molecular Medicine Division, CSIR - Institute of Genomics and Integrative Biology, New Delhi, India
| | - Deepti Vibha
- Department of Neurology, Neuroscience Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Achal K Srivastava
- Department of Neurology, Neuroscience Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Atchayaram Nalini
- Neurology Department, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Mohammed Faruq
- Genomics and Molecular Medicine Division, CSIR - Institute of Genomics and Integrative Biology, New Delhi, India.
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Jabeen S, Saini J, Vengalil S, Lavania M, Singh I, Nashi S, Preethish-Kumar V, Polavarapu K, Mahajan NP, Mahadevan A, Yasha TC, Nandeesh B, Gnanakumar K, Sengupta U, Nalini A. Neuroimaging in leprosy: The nerves and beyond. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.jrid.2020.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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49
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Polavarapu K, Preethish-Kumar V, Vengalil S, Nashi S, Lavania M, Bhattacharya K, Mahadevan A, Yasha TC, Saini J, Sengupta U, Jabeen S, Nandeesh BN, Singh I, Mahajan NP, Pradeep-Chandra-Reddy C, Parry GJ, Nalini A. Brain and Spinal Cord Lesions in Leprosy: A Magnetic Resonance Imaging-Based Study. Am J Trop Med Hyg 2020; 100:921-931. [PMID: 30761984 DOI: 10.4269/ajtmh.17-0945] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Neurotropism and infiltration by Mycobacterium leprae of peripheral nerves causing neuropathy are well established, but reports of central nervous system (CNS) damage are exceptional. We report CNS magnetic resonance imaging (MRI) abnormalities of the brain and spinal cord as well as lesions in nerve roots and plexus in leprosy patients. Eight patients aged between 17 and 41 years underwent detailed clinical, histopathological, and MRI evaluation. All had prominent sensory-motor deficits with hypopigmented and hypo/anesthetic skin patches and thickened peripheral nerves. All demonstrated M. Leprae DNA in affected peripheral nerve tissue. All received multidrug therapy (MDT). Two patients had brainstem lesions with enhancing facial nuclei and nerves, and one patient had a lesion in the nucleus ambiguus. Two patients had enhancing spinal cord lesions. Follow-up MRI performed in four cases showed resolution of brainstem and cord lesions after starting on MDT. Thickened brachial and lumbosacral plexus nerves were observed in six and two patients, respectively, which partially resolved on follow-up MRI in the two cases who had reimaging. The site and side of the MRI lesions corresponded with the location and side of neurological deficits. This precise clinico-radiological correlation of proximal lesions could be explained by an immune reaction in the gray matter corresponding to the involved peripheral nerves, retrograde axonal and gray matter changes, or infection of the CNS and plexus by lepra bacilli. Further study of the CNS in patients with leprous neuropathy is needed to establish the exact nature of these CNS MRI findings.
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Affiliation(s)
- Kiran Polavarapu
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bangalore, India.,Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Veeramani Preethish-Kumar
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences, Bangalore, India.,Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Mallika Lavania
- Stanley Browne Research Laboratory, The Leprosy Mission, New Delhi, India
| | - Kajari Bhattacharya
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Jitender Saini
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Utpal Sengupta
- Stanley Browne Research Laboratory, The Leprosy Mission, New Delhi, India
| | - Shumyla Jabeen
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Bevinahalli N Nandeesh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Itu Singh
- Stanley Browne Research Laboratory, The Leprosy Mission, New Delhi, India
| | - Niranjan P Mahajan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Gareth J Parry
- Department of Neurology, St. John's Medical College, Bangalore, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
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50
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Vengalil S, Reddy N, Preethish-Kumar V, Polavarapu K, Mahajan NP, Nashi S, Arunachal G, Gunasekaran S, Pogoryelova O, Horvath R, Lochmuller H, Nalini A. GNE myopathy: Disease progression in a large cohort of genetically confirmed cases from a single centre in India. J Neurol Sci 2019. [DOI: 10.1016/j.jns.2019.10.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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