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Sampaio F, Soares S, Pereira S, Lemos JA, Mota Á. Sodium Channel Myotonia and a Novel Gly701Asp Mutation in the SCN4A Gene: From an Ophthalmological Symptom to a Familial Disease. Neuroophthalmology 2021; 45:41-44. [PMID: 33762787 DOI: 10.1080/01658107.2020.1779316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
A six-month-old female child came to an ophthalmology consultation because of a convergent strabismus, myotonia of the orbicularis muscles and difficulty walking in cold environments. Further investigation identified a family history of muscular myotonia in the father, grandmother and uncle. The father also presented with ocular myotonia. The child and family members underwent genetic testing, which was negative for CLCN1 mutations but was positive for a novel heterozygotic Gly701Asp mutation in the SCN4A gene, compatible with sodium channel myotonia. The non-dystrophic myotonias are caused by dysfunction of key skeletal muscle ion channels. Before the advent of DNA sequencing, non-dystrophic myotonias were differentiated based on clinical phenotypes. Sodium channel myotonia disorders are classically of dominant inheritance, in which eye closure myotonia is the most frequent manifestation. Over 40 different mutations have been reported in the SCN4A gene. The Gly701Asp mutation in exon 13 identified in this family has not been described before.
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Affiliation(s)
- Filipa Sampaio
- Ophthalmology Department, Hospital Pedro Hispano, Unidade Local De Saúde De Matosinhos, Matosinhos, Portugal
| | - Sérgia Soares
- Pediatric Department, Hospital Pedro Hispano, Unidade Local De Saúde De Matosinhos, Matosinhos, Portugal
| | - Sara Pereira
- Ophthalmology Department, Hospital Pedro Hispano, Unidade Local De Saúde De Matosinhos, Matosinhos, Portugal
| | - José Alberto Lemos
- Ophthalmology Department, Hospital Pedro Hispano, Unidade Local De Saúde De Matosinhos, Matosinhos, Portugal
| | - Ágata Mota
- Ophthalmology Department, Hospital Pedro Hispano, Unidade Local De Saúde De Matosinhos, Matosinhos, Portugal
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Taminato T, Mori-Yoshimura M, Miki J, Sasaki R, Sato N, Oya Y, Nishino I, Takahashi Y. Paramyotonia Congenita with Persistent Distal and Facial Muscle Weakness: A Case Report with Literature Review. J Neuromuscul Dis 2020; 7:193-201. [PMID: 32083589 DOI: 10.3233/jnd-190440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Paramyotonia congenita (PC; OMIM 168300) is a non-dystrophic myotonia caused by mutations in the SCN4A gene. Transient muscle stiffness, usually induced by exposure to cold and aggravated by exercise, is the predominant clinical symptom, and interictal persistent weakness is uncommon. CASE REPORT We report a family with a history of PC accompanied by persistent hand muscle weakness with masticatory muscle involvement. Persistent weakness was exacerbated with age, and MR analysis showed marked atrophy of temporal, masseter, and finger flexor muscles with fatty replacement. The PC causative mutation T1313M in the SCN4A gene was prevalent in the family. Administration of acetazolamide chloride improved clinical symptoms and the results of cold and short exercise tests. Phenotypic variation within the family was remarkable, as the two younger affected patients did not present with persistent weakness or muscle atrophy. CONCLUSIONS PC associated with the T1313M mutation is a possible cause of persistent distal hand weakness.
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Affiliation(s)
- Tomoya Taminato
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Madoka Mori-Yoshimura
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Jun Miki
- Department of Neurology, Saku Central Hospital, Nagano Prefectural Federation of Agricultural Cooperatives for Health and Welfare, Nagano, Japan
| | - Ryogen Sasaki
- Department of Neurology, Kuwana City Medical Center, Mie, Japan
| | - Noriko Sato
- Department of Radiology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yasushi Oya
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Ichizo Nishino
- Department of Genome Medicine Development, Medical Genome Center, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yuji Takahashi
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
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Stunnenberg BC, LoRusso S, Arnold WD, Barohn RJ, Cannon SC, Fontaine B, Griggs RC, Hanna MG, Matthews E, Meola G, Sansone VA, Trivedi JR, van Engelen BG, Vicart S, Statland JM. Guidelines on clinical presentation and management of nondystrophic myotonias. Muscle Nerve 2020; 62:430-444. [PMID: 32270509 PMCID: PMC8117169 DOI: 10.1002/mus.26887] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/01/2020] [Accepted: 04/04/2020] [Indexed: 12/26/2022]
Abstract
The nondystrophic myotonias are rare muscle hyperexcitability disorders caused by gain-of-function mutations in the SCN4A gene or loss-of-function mutations in the CLCN1 gene. Clinically, they are characterized by myotonia, defined as delayed muscle relaxation after voluntary contraction, which leads to symptoms of muscle stiffness, pain, fatigue, and weakness. Diagnosis is based on history and examination findings, the presence of electrical myotonia on electromyography, and genetic confirmation. In the absence of genetic confirmation, the diagnosis is supported by detailed electrophysiological testing, exclusion of other related disorders, and analysis of a variant of uncertain significance if present. Symptomatic treatment with a sodium channel blocker, such as mexiletine, is usually the first step in management, as well as educating patients about potential anesthetic complications.
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Affiliation(s)
- Bas C. Stunnenberg
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Samantha LoRusso
- Department of Neurology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - W. David Arnold
- Department of Neurology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Richard J. Barohn
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
| | - Stephen C. Cannon
- Department of Physiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Bertrand Fontaine
- Assistance Publique-Hôpitaix de Paris, Sorbonne Université, INSERM, Service of Neuro-Myology and UMR 974, Institute of Myology, University Hospital Pitié-Salpêtrière, Paris, France
| | - Robert C. Griggs
- Department of Neurology, University of Rochester, Rochester, New York
| | - Michael G. Hanna
- MRC Centre for Neuromuscular Diseases, Department of Neuromuscular diseases, UCL Queen Square Institute of Neurology, United Kingdom
| | - Emma Matthews
- MRC Centre for Neuromuscular Diseases, Department of Neuromuscular diseases, UCL Queen Square Institute of Neurology, United Kingdom
| | - Giovanni Meola
- Department of Neurorehabilitation Sciences, Casa Cura Policlinico, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Valeria A. Sansone
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Neurorehabilitation Unit, University of Milan, NEuroMuscular Omnicentre (NEMO), Fondazione Serena Onlus, Milan, Italy
| | - Jaya R. Trivedi
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, Texas
| | | | - Savine Vicart
- Assistance Publique-Hôpitaix de Paris, Sorbonne Université, INSERM, Service of Neuro-Myology and UMR 974, Institute of Myology, University Hospital Pitié-Salpêtrière, Paris, France
| | - Jeffrey M. Statland
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
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Avila-Smirnow D, Vargas Leal CP, Beytía Reyes MDLA, Cortés Zepeda R, Escobar RG, Kleinsteuber Saa K, Lagos Lucero M, Avaria Benapres MDLA, Padilla Pérez O, Casar Leturia JC, Mellado Sagredo C, Sternberg D. Non-dystrophic myotonia Chilean cohort with predominance of the SCN4A Gly1306Glu variant. Neuromuscul Disord 2020; 30:554-561. [DOI: 10.1016/j.nmd.2020.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/03/2020] [Accepted: 04/23/2020] [Indexed: 01/31/2023]
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Matthews E, Silwal A, Sud R, Hanna MG, Manzur AY, Muntoni F, Munot P. Skeletal Muscle Channelopathies: Rare Disorders with Common Pediatric Symptoms. J Pediatr 2017; 188:181-185.e6. [PMID: 28662944 DOI: 10.1016/j.jpeds.2017.05.081] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/31/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To ascertain the presenting symptoms of children with skeletal muscle channelopathies to promote early diagnosis and treatment. STUDY DESIGN Retrospective case review of 38 children with a skeletal muscle channelopathy attending the specialist pediatric neuromuscular service at Great Ormond Street Hospital over a 15-year period. RESULTS Gait disorder and leg cramps are a frequent presentation of myotonic disorders (19 of 29). Strabismus or extraocular myotonia (9 of 19) and respiratory and/or bulbar symptoms (11 of 19) are common among those with sodium channelopathy. Neonatal hypotonia was observed in periodic paralysis. Scoliosis and/or contractures were demonstrated in 6 of 38 children. School attendance or ability to engage fully in all activities was often limited (25 of 38). CONCLUSIONS Children with skeletal muscle channelopathies frequently display symptoms that are uncommon in adult disease. Any child presenting with abnormal gait, leg cramps, or strabismus, especially if intermittent, should prompt examination for myotonia. Those with sodium channel disease should be monitored for respiratory or bulbar complications. Neonatal hypotonia can herald periodic paralysis. Early diagnosis is essential for children to reach their full educational potential.
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Affiliation(s)
- Emma Matthews
- Medical Research Council Center for Neuromuscular Diseases, University College London and National Hospital for Neurology and Neurosurgery, London, UK.
| | - Arpana Silwal
- Dubowitz Neuromuscular Center and MRC Center for Neuromuscular Diseases, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Richa Sud
- Neurogenetics Unit, Institute of Neurology, London, UK
| | - Michael G Hanna
- Medical Research Council Center for Neuromuscular Diseases, University College London and National Hospital for Neurology and Neurosurgery, London, UK
| | - Adnan Y Manzur
- Dubowitz Neuromuscular Center and MRC Center for Neuromuscular Diseases, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Francesco Muntoni
- Dubowitz Neuromuscular Center and MRC Center for Neuromuscular Diseases, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Pinki Munot
- Dubowitz Neuromuscular Center and MRC Center for Neuromuscular Diseases, UCL Great Ormond Street Institute of Child Health, London, UK
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Yang X, Jia H, An R, Xi J, Xu Y. Sequence CLCN1 and SCN4A in patients with Nondystrophic myotonias in Chinese populations: Genetic and pedigree analysis of 10 families and review of the literature. Channels (Austin) 2016; 11:55-65. [PMID: 27415035 DOI: 10.1080/19336950.2016.1212140] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Myotonia congenita (MC), paramyotonia congenita (PC) and sodium channel myotonias(SCM) were belonged to Non-dystrophic myotonias, in which muscle relaxation is delayed after voluntary or evoked contraction. These diseases can not be simply distinguished only based on symptoms and signs but also on genetics: more than 100 mutations in the CLCN1 gene have been associated with MC, while at least 20 mutations in the SCN4A gene have been associated with PC and SCM. Most of these genetics studies have been conducted outside China, only several MC, PC, and SCM families accepted gene scan were reported in China. Therefore we analyzed genetic mutations in CLCN1 and SCN4A in 10 Chinese families clinically diagnosed with Non-dystrophic myotonias. Our result revealed 12 potential disease-causing mutations(3 mutations were novel) that were present in the probands and affected family members. We also reviewed all available literature on mutations linked to these 3 disease in Chinese populations. Our results may help identify genetic determinants as well as clarify genotype-phenotype relationships.
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Affiliation(s)
- Xinglong Yang
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu , Sichuan Province , P.R. China
| | - Hua Jia
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu , Sichuan Province , P.R. China
| | - Ran An
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu , Sichuan Province , P.R. China
| | - Jing Xi
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu , Sichuan Province , P.R. China
| | - Yanming Xu
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu , Sichuan Province , P.R. China
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Moreira SD, Barreto R, Roriz JM. Becker myotonia-a recently identified mutation in iberian descendants with apparent acetazolamide-responsive phenotype. Muscle Nerve 2014; 51:933-4. [PMID: 25487368 DOI: 10.1002/mus.24534] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sandra D Moreira
- Neurology Department, Centro Hospitalar Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - Rui Barreto
- Neurology Department, Centro Hospitalar Entre Douro e Vouga, Santa Maria da Feira, Portugal
| | - José Mário Roriz
- Neurology Department, Centro Hospitalar Entre Douro e Vouga, Santa Maria da Feira, Portugal
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Heterozygous CLCN1 mutations can modulate phenotype in sodium channel myotonia. Neuromuscul Disord 2014; 24:953-9. [PMID: 25088311 DOI: 10.1016/j.nmd.2014.06.439] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 06/17/2014] [Accepted: 06/23/2014] [Indexed: 11/23/2022]
Abstract
Nondystrophic myotonias are characterized by muscle stiffness triggered by voluntary movement. They are caused by mutations in either the CLCN1 gene in myotonia congenita or in the SCN4A gene in paramyotonia congenita and sodium channel myotonias. Clinical and electrophysiological phenotypes of these disorders have been well described. No concomitant mutations in both genes have been reported yet. We report five patients from three families showing myotonia with both chloride and sodium channel mutations. Their clinical and electrophysiological phenotypes did not fit with the phenotype known to be associated with the mutation initially found in SCN4A gene, which led us to screen and find an additional mutation in CLCN1 gene. Our electrophysiological and clinical observations suggest that heterozygous CLCN1 mutations can modify the clinical and electrophysiological expression of SCN4A mutation.
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