Myotonia in the dog: a report of four cases

Clinical features of muscle stiffness in 37 dogs with concurrent naturally occurring hypercortisolism

BACKGROUND

Severe muscle stiffness (SMS) in dogs with hypercortisolism (HC) is uncommon.

OBJECTIVES

To evaluate signalment, presentation, treatments, and long-term outcomes of dogs with concurrent HC and SMS.

ANIMALS

Thirty-seven dogs.

METHODS

Medical records of dogs with HC and concurrent SMS were recruited from 10 institutions. Clinical information, test results, therapeutic responses, and survival times were reviewed.

RESULTS

All 37 dogs with HC and SMS had pituitary-dependent hypercortisolism (PDH); 36/37 weighed <20 kg. Signs and test results were typical of PDH aside from SMS, initially diagnosed in all 4 limbs in 9, pelvic limbs of 22, and thoracic limbs of 6 dogs. Hypercortisolism and SMS were diagnosed together in 3 dogs; HC 1-36 months before SMS in 23; SMS 1-12 months before HC in 11. Mitotane or trilostane, given to control HC in 36/37 dogs, improved or resolved HC signs in 28; SMS did not resolve, remaining static or worsening in 31/36 dogs, mildly improving in 5/19 dogs given additional therapies. Progression of SMS included additional limbs in 10 dogs and the masticatory muscles of 2. The median survival time from diagnosis of SMS was 965 days (range, 8-1188).

CONCLUSIONS AND CLINICAL IMPORTANCE

Concurrent SMS and HC is uncommon, possibly affecting only dogs with PDH. Development of SMS might occur before or after diagnosis of HC. Apart from SMS, the clinical picture and survival time of these dogs seem indistinguishable from those of dogs with HC in general. However, while muscle weakness usually resolves with HC treatment SMS does not.

Electrophysiological and histopathological findings of muscular disease suspected as myotonic dystrophy in a Shiba dog

An 8-year-old male Japanese Shiba exhibited muscle wasting and a stiff gait. A low-amplitude myotonic discharge was recorded by needle electromyography (EMG). A histopathological examination on a tru-cut biopsy sample from the muscle revealed myofiber size variations. Internal nuclei and cytoplasmic vacuoles were observed in many fibers. A type 1 fiber predominance and many hybrid type fibers were observed immunohistochemically. On the basis of these EMG and histopathological findings, myotonic dystrophy (DM) was suspected as tentative diagnosis. The cytoplasm around the vacuoles was immunopositive for cytochrome c, tom 20, and SOD-1, suggesting that these vacuoles might occur within mitochondria. Collectively, these results indicate that a mitochondrial abnormality partly play the role on the pathogenesis of present case.

An unusual myopathy in a dog

A nine-month-old Cavalier King Charles Spaniel was examined because it could not withdraw its tongue into its mouth and had difficulty eating and drinking. These clinical signs were first observed when the dog was two months of age. On percussion of the tongue a dimple could be produced and there was electromyographic evidence of myotonia. Histological examination showed replacement of muscle fibres by adipose tissue, focal areas of myonecrosis, neutrophil infiltration and proliferation of sub-sarcolemmal nuclei. These changes were considered to be consistent with a primary myopathy similar to paramyotonia in man. No related dogs were found to be affected.

Detection of a genetic mutation for myotonia congenita among Miniature Schnauzers and identification of a common carrier ancestor

OBJECTIVE

To develop a molecular genetic test to detect the mutant skeletal muscle chloride channel (CIC-1) allele that causes myotonia congenita in Miniature Schnauzers and to analyze the relationship of affected and carrier dogs.

ANIMALS

372 Miniature Schnauzers from the United States, Canada, Australia, and Europe that were tested between March 2000 and October 2001.

PROCEDURE

The sequence surrounding the mutation in the CIC-1 allele was amplified by use of a unique pair of primers. Polymerase chain reaction (PCR) products were digested with the restriction enzyme Hpy CH4 III and separated on a 6% polyacrylamide gel. Pedigrees from all available carrier and affected dogs were analyzed, and a composite pedigree was established.

RESULTS

Enzyme digestion of PCR products of the normal CIC-1 allele resulted in 3 fragments of 175, 135, and 30 bp, whereas PCR products of the mutant allele resulted in fragments of only 175 and 165 bp. Of the 372 Miniature Schnauzers, 292 (78.5%) were normal, 76 (20.4%) were carriers, and 4 (1.1%) were affected (myotonic) dogs. Frequency of the mutant allele was 0.113. Pedigree analysis revealed that a popular sire, documented to be a carrier, was a common ancestor of all carriers and affected dogs.

CONCLUSIONS AND CLINICAL RELEVANCE

A PCR-based enzyme digestion DNA test was developed. The mutant allele for this disease is frequent in Miniature Schnauzers that are related to a common carrier ancestor. Breeding dogs should be tested by this specific DNA test to help limit the spread of this deleterious mutation.

Myotonia and disorders of altered muscle cell membrane excitability

Altered excitability of the skeletal muscle membrane (sarcolemma) can result in clinical signs of muscle dysfunction. Hyperexcitability of the sarcolemma results in myotonia, and hypoexcitability results in paresis or paralysis. Our understanding of the physiologic and molecular bases of disorders of sarcolemmal excitability is rapidly increasing as techniques for evaluation are improved. This article reviews muscle excitability disorders in dogs and cats and their pathogenesis.

Equine muscular dystrophy with myotonia

OBJECTIVES

To describe a case of equine muscular dystrophy with myotonia.

METHODS

A 5-year-old horse presented with hypertrophy and delayed relaxation of the muscles of the hindlimbs from age 2 months. Testicular atrophy developed from 2 years of age. Action and percussion myotonia was associated with weakness in these muscles, and EMG showed diffuse myotonic discharges and myopathic features. Biopsy of the gluteal muscle showed adipose and connective tissue infiltration, marked variation in muscle fibre size, and moth-eaten, ring and whorled fibres.

RESULTS

Injection of apamin, a peptide blocker of calcium-activated potassium channels, which inhibits myotonia in human myotonic dystrophy, was ineffective in blocking myotonic discharges. Discharges promptly abated with 2% lidocaine injection.

CONCLUSIONS

Myotonia in this horse is associated with dystrophic changes similar to human myotonic dystrophy, though there are some pharmacological differences.

Dental and craniofacial findings in eight miniature schnauzer dogs affected by myotonia congenita: preliminary results

Myotonia is a clinical sign characterized by the delay of skeletal muscle relaxation following the cessation of a voluntary activity or the termination of an electrical or mechanical stimulus. Recently, Miniature Schnauzers with myotonia congenita associated with defective chloride ion conductance across the skeletal muscle membrane were identified. Congenital myotonia in these dogs appears to follow an autosomal recessive mode of inheritance. Craniofacial and dental findings of eight Miniature Schnauzer dogs with myotonia congenita are described in the present paper. These findings include: delayed dental eruption of both deciduous and permanent dentition: persistent deciduous dentition; unerupted or partially erupted permanent teeth: crowding and rotation of premolar and or incisor teeth: missing teeth: increased interproximal space between the maxillary fourth premolar and first molar teeth: decreased interproximal space between the maxillary canine and lateral incisor teeth: inability to fully close the mouth due to malocclusion: distoclusion: and, decreased mandibular range of motion. A long narrow skull with a flattened zygomatic arch and greater mandibular body curvature were also consistent findings in the affected dogs. The small number of dogs studied prevents conclusive statements about the origin of these abnormalities, however it is interesting that only 1 of 45 unaffected Miniature Schnauzer dogs showed similar traits.

Congenital myotonia in related kittens

Four closely related domestic shorthair kittens were investigated following the detection of abnormalities in their gait, difficulty opening their mouths and muscle hypertrophy. They walked with a stiff, stilted gait, with the stiffness reducing during exercise. Startling of the kittens resulted in hyperextension of the limbs and falling to lateral recumbency, or spasm of the orbicularis oculi muscle, prolonged prolapse of the nictitating membranes and flattening of the ears. One kitten was intermittently dysphonic. Endotracheal intubation of the anaesthetised kittens was difficult due to an inability to open the mouth to a wide angle, and narrowing of the glottis due to muscle spasm. A diagnosis of congenital myotonia was made based on the clinical signs, the kittens' ages, typical myotonic discharges on electromyography, and the histopathological and histochemical findings in muscle. This is the first report of congenital myotonia in this species.

A new inherited muscular disorder in Japanese quails (Coturnix coturnix japonica)

Thirteen adult mutant (LWC strain) Japanese quails (Coturnix coturnix japonica), between the ages of 8 and 60 weeks were examined for a progressive muscular disorder. The disorder, inherited as an autosomal dominant trait, was clinically apparent as early as 28 days of age; it was characterized by generalized myotonia, muscle stiffness, and muscle weakness. Affected birds were identified by their inability to lift their wings vertically upward and by their inability to right themselves when placed on their dorsum. Electromyographic studies in two mutant quails showed high-frequency repetitive discharges comparable to those of myotonic runs. These discharges persisted after nerve resection. The distinctive histopathologic changes in the various muscles examined were ring fibers, sarcoplasmic masses, and internal migration of sarcolemmal nuclei. A slight decrease in the size of type IIB muscle fibers and a slight increase in the size of type IIA fibers were observed in the M. pectoralis thoracicus of affected quails. In older affected birds, inter- and intrafascicular fatty infiltration with replacement of type IIB fibers by fat cells was seen in the pectoral muscles. Single fiber necrosis, nonspecific lymphorrages, and variations in the muscle fiber size and shape were also noted. The typical muscle lesions and multisystem involvement, which was manifested by testicular degeneration and atrophy in the male LWC specimens and bilateral lenticular cataracts in 6 of 13 affected mutant quails, suggest resemblance of this new inherited muscular disorder to myotonic dystrophy in man.

Creatine kinase in the dog: a review

In the dog, creatine kinase (CK) is mostly present in the skeletal muscles, myocardium, brain and intestine. The MM isoenzyme predominates in muscles and myocardium. In plasma, reference values depend on the technique used and CK-MB accounts for about 30-45% of total CK activity. Sex has no influence on plasma CK activity, which is higher in young dogs than in adults. Plasma CK is elevated after physical exercise. After its release from the cells, CK reaches the plasma mostly via the lymphatic route and then remains in the plasma compartment. It is rapidly cleared with a half-life of about 2 hours. Muscle diseases are the main source of plasma CK elevations: inherited myopathies, malignant hyperthermia, hypothyroidism, vitamin E-selenium deficiency, prolonged decubitus, intramuscular injections, surgery, etc. Plasma CK is also increased in experimental myocardial infarction, for which the dog is an interesting model, allowing quantification of the damage by measuring the total CK activity released.

A myopathy associated with muscle hypertonicity in the Cavalier King Charles Spaniel

Clinical signs of electrically silent muscle hypertonicity are described in five Cavalier King Charles dogs. Biopsies of the biceps femoris and triceps muscles, when examined with the electron microscope, revealed evidence of sarcotubular and mitochondrial abnormalities. These included enlargement of the sarcoplasmic reticulum, hydropic degeneration of mitochondria, tubular proliferations in the vicinity of the triads and vacuolar invagination of mitochondria. The exact nature of these findings is not clear and it is suggested that utilization of tracer techniques would help to explain them.

Spontaneous primary myopathies in domestic mammals: a review

By reviewing the literature concerning primary myopathies in man and animals, a classification of spontaneous primary myopathies in domestic mammals is made. This classification is based on aetiological factors. Primary myopathies are divided into metabolic, immunologic, toxic, nutritional, congenital, inherited, and inflammatory myopathies. Muscular dystrophies, in accordance with the definition in human cases, are considered as a separate entity. In the description of the different muscle disorders the emphasis is on the structural changes and the pathogenesis. Clinical signs and diagnostic criteria are considered only briefly.

Clinical application of neuromuscular electrophysiology in the dog: a review

A review of the literature concerning the application of electromyography and electroneurography in canine neurology is presented. Measurements of amplitude and duration of motor unit potentials in normal dogs varied largely in the various reports. It was therefore concluded that these measurements are of limited clinical value. The results of motor and sensory nerve conduction studies in normal dogs are summarised. The differences between the methods used are discussed. It is concluded that variations in reported normal values are due mainly to differences in method. The application of electromyography and electroneurography in neuromuscular disorders in the dog is systematically presented, based upon the reported diagnoses. The considerable number of first descriptions of newly-recognised and described neuromuscular diseases appears to be related to the introduction of neuromuscular electrophysiology into veterinary medicine.

Hereditary myopathy in Labrador retrievers: a morphologic study

Skeletal muscle and peripheral nerve were obtained over several years from 12 Labrador retrievers with signs of hereditary myopathy. Biopsy and necropsy samples were examined by histology and histochemistry. Despite normal findings in peripheral nerves, a wide range of morphologic changes were observed in muscle including features generally considered characteristic of neurogenic disease. These included small and large muscle fiber group atrophy, presence of small angular fibers, and occasional fiber type grouping. Other prominent changes in muscle were increased numbers of internal nuclei, architectural disturbances, type II fiber deficiency, necrosis, regeneration, and fibrosis--all of which are more usually associated with destructive myopathies or muscular dystrophies. The pathology of this condition, therefore, includes features of both neurogenic and myopathic disease, while the underlying pathophysiology remains unclear.

Subclinical myopathy associated with hyperadrenocorticism in the dog

One of seven dogs with clinical signs of hyperadrenocorticism had clinical evidence of neuromuscular disorder. Clinical diagnosis of hyperadrenocorticism was confirmed by plasma cortisol concentrations before and after adrenocorticotrophin hormone and dexamethasone administration. Electromyographic studies showed bizarre, high frequency discharges in all dogs. Examination of muscle biopsies taken from the biceps femoris muscle from each dog revealed mild degenerative changes of fiber size variation, focal necrosis and fiber splitting. Ragged red fibers were prominent and appeared to be related to mitochondrial aggregates. Significant (P less than 0.05) type 1 and 2 fiber atrophy was found in all dogs. Fiber grouping was present in four dogs. Studies of fascicular biopsies of the peroneal nerve showed thinly myelinated fibers, onion-bulb formation, segmental demyelination and short intercalated internodes. These findings suggested a glucocorticoid-related myopathy in hyperadrenocorticism that also may have a neurogenic component.

A myopathy associated with myotonia in the dog

The pathology of two cases of canine myopathy associated with myotonia are presented. The changes were interpreted as dystrophic. The most obvious features were a rounding on cross section and variation in fibre size with numerous internal nuclei, many of which formed chains. Degeneration and regeneration were seen and there was a slight increase in perimysial and endomysial connective tissue. Only one ringed fibre was seen, but no sarcoplasmic masses. Enzyme histochemistry failed to demonstrate any selective Type I fibre atrophy. The peripheral and central nervous systems were normal in both cases.