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van der Woude DR, Wadman RI, Asselman FL, Schoenmakers MAGC, Cuppen I, van der Pol WL, Bartels B. Exploring functional strength changes during nusinersen treatment in symptomatic children with SMA types 2 and 3. Neuromuscul Disord 2024; 41:1-7. [PMID: 38861761 DOI: 10.1016/j.nmd.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/13/2024]
Abstract
The Hammersmith Functional Motor Scale-Expanded (HFMSE) is a validated outcome measure for monitoring changes in functional strength in patients with spinal muscular atrophy (SMA). The objective of this study was to explore changes in HFMSE item-scores in children with SMA types 2 and 3a treated with nusinersen over a period of six to twenty months. We stratified patients according to motor ability (sitting and walking), and calculated numbers and percentages for each specific improvement (positive score change) or decrease (negative score change) for the total group and each subgroup and calculated frequency distributions of specific score changes. Ninety-one percent of the children showed improvement in at least 1 item, twenty-eight percent showed a score decrease in 1 or more items. In the first six to twenty months of nusinersen treatment motor function change was characterized by the acquisition of the ability to perform specific tasks with compensation strategies (score changes from 0 to 1). Children with the ability to sit were most likely to improve in items that assess rolling, whilst children with the ability to walk most likely improved in items that assess half-kneeling. The ability most frequently lost was hip flexion in supine position.
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Affiliation(s)
- Danny R van der Woude
- Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA Utrecht, the Netherlands
| | - Renske I Wadman
- Department of Neurology & Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, 3584 CX, Utrecht, the Netherlands
| | - Fay-Lynn Asselman
- Department of Neurology & Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, 3584 CX, Utrecht, the Netherlands
| | - Marja A G C Schoenmakers
- Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA Utrecht, the Netherlands
| | - Inge Cuppen
- Department of Neurology & Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, 3584 CX, Utrecht, the Netherlands
| | - W Ludo van der Pol
- Department of Neurology & Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, 3584 CX, Utrecht, the Netherlands
| | - Bart Bartels
- Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA Utrecht, the Netherlands.
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Hooijmans MT, Habets LE, van den Berg‐Faay SAM, Froeling M, Asselman F, Strijkers GJ, Jeneson JAL, Bartels B, Nederveen AJ, van der Pol WL. Multi-parametric quantitative magnetic resonance imaging of the upper arm muscles of patients with spinal muscular atrophy. NMR IN BIOMEDICINE 2022; 35:e4696. [PMID: 35052014 PMCID: PMC9286498 DOI: 10.1002/nbm.4696] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/24/2021] [Accepted: 01/17/2022] [Indexed: 06/09/2023]
Abstract
Quantitative magnetic resonance imaging (qMRI) is frequently used to map the disease state and disease progression in the lower extremity muscles of patients with spinal muscular atrophy (SMA). This is in stark contrast to the almost complete lack of data on the upper extremity muscles, which are essential for carrying out daily activities. The aim of this study was therefore to assess the disease state in the upper arm muscles of patients with SMA in comparison with healthy controls by quantitative assessment of fat fraction, diffusion indices, and water T2 relaxation times, and to relate these measures to muscle force. We evaluated 13 patients with SMA and 15 healthy controls with a 3-T MRI protocol consisting of DIXON, diffusion tensor imaging, and T2 sequences. qMRI measures were compared between groups and related to muscle force measured with quantitative myometry. Fat fraction was significantly increased in all upper arm muscles of the patients with SMA compared with healthy controls and correlated negatively with muscle force. Additionally, fat fraction was heterogeneously distributed within the triceps brachii (TB) and brachialis muscle, but not in the biceps brachii muscle. Diffusion indices and water T2 relaxation times were similar between patients with SMA and healthy controls, but we did find a slightly reduced mean diffusivity (MD), λ1, and λ3 in the TB of patients with SMA. Furthermore, MD was positively correlated with muscle force in the TB of patients with SMA. The variation in fat fraction further substantiates the selective vulnerability of muscles. The reduced diffusion tensor imaging indices, along with the positive correlation of MD with muscle force, point to myofiber atrophy. Our results show the feasibility of qMRI to map the disease state in the upper arm muscles of patients with SMA. Longitudinal data in a larger cohort are needed to further explore qMRI to map disease progression and to capture the possible effects of therapeutic interventions.
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Affiliation(s)
- Melissa T. Hooijmans
- Department of Radiology and Nuclear Medicine, Amsterdam Movement SciencesAmsterdam University Medical CenterAmsterdamThe Netherlands
| | - Laura E. Habets
- Center for Child Development, Exercise and Physical Literacy, Wilhelmina Children's HospitalUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Sandra A. M. van den Berg‐Faay
- Department of Radiology and Nuclear Medicine, Amsterdam Movement SciencesAmsterdam University Medical CenterAmsterdamThe Netherlands
| | - Martijn Froeling
- Department of RadiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Fay‐Lynn Asselman
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - Gustav J. Strijkers
- Department of Biomedical Engineering and Physics, Amsterdam Movement SciencesAmsterdam University Medical CenterAmsterdamThe Netherlands
| | - Jeroen A. L. Jeneson
- Center for Child Development, Exercise and Physical Literacy, Wilhelmina Children's HospitalUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Bart Bartels
- Center for Child Development, Exercise and Physical Literacy, Wilhelmina Children's HospitalUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Aart J. Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam Movement SciencesAmsterdam University Medical CenterAmsterdamThe Netherlands
| | - W. Ludo van der Pol
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
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Stam M, Haakma W, Kuster L, Froeling M, Philippens MEP, Bos C, Leemans A, Otto LAM, van den Berg LH, Hendrikse J, van der Pol WL. Magnetic resonance imaging of the cervical spinal cord in spinal muscular atrophy. NEUROIMAGE-CLINICAL 2019; 24:102002. [PMID: 31622841 PMCID: PMC6812296 DOI: 10.1016/j.nicl.2019.102002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/23/2019] [Accepted: 09/02/2019] [Indexed: 12/13/2022]
Abstract
Objective In this study we investigated the potential value of magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) in characterizing changes in the cervical spinal cord and peripheral nerve roots in vivo in patients with spinal muscular atrophy (SMA). Methods We developed an MRI protocol with 4 sequences to investigate the cervical spinal cord and nerve roots on a 3 Tesla MRI system. We used 2 anatomical MRI sequences to investigate cross-sectional area (CSA) at each spinal segment and the diameter of ventral and dorsal nerve roots, and two diffusion tensor imaging (DTI) techniques to estimate the fractional anisotropy (FA), mean (MD), axial (AD) and radial diffusivity (RD) in 10 SMA patients and 20 healthy controls. Results There were no significant differences in CSA (p > .1), although an 8.5% reduction of CSA in patients compared to healthy controls was apparent at segment C7. DTI data showed a higher AD in grey matter of patients compared to healthy controls (p = .033). Significantly lower MD, AD and RD values were found in rostral nerve roots (C3-C5) in patients (p < .045). Conclusions We showed feasibility of an advanced 3 T MRI protocol that allowed differences to be determined between patients and healthy controls, confirming the potential of this technique to assess pathological mechanisms in SMA. After further development and confirmation of findings in a larger sample, these techniques may be used to study disease course of SMA in vivo and evaluate response to survival motor neuron (SMN) augmenting therapy. The developed MRI sequences measure (micro)structural spinal cord changes in SMA. cervical spinal cross-sectional area is overall (non-significantly) smaller in SMA. In nerve roots C3-C8 all DTI parameters were lower in patients compared to controls. Largest differences in DTI parameters were located at the rostral cervical segments.
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Affiliation(s)
- Marloes Stam
- UMC Utrecht Brain Center, Department of Neurology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Wieke Haakma
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lidy Kuster
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Martijn Froeling
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marielle E P Philippens
- Department of Radiotherapy, Cancer Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Clemens Bos
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Alexander Leemans
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Louise A M Otto
- UMC Utrecht Brain Center, Department of Neurology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Leonard H van den Berg
- UMC Utrecht Brain Center, Department of Neurology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - W Ludo van der Pol
- UMC Utrecht Brain Center, Department of Neurology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
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Villalón E, Lee NN, Marquez J, Lorson CL. Muscle fiber-type selective propensity to pathology in the nmd mouse model of SMARD1. Biochem Biophys Res Commun 2019; 516:313-319. [PMID: 31256932 DOI: 10.1016/j.bbrc.2019.06.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/21/2019] [Indexed: 12/01/2022]
Abstract
Spinal muscular atrophy with respiratory distress type 1 (SMARD1) is an autosomal recessive disease that causes distal limb muscle atrophy, due to motor neuron degeneration. Similar to other motor neuron diseases, SMARD1 shows differential vulnerability to denervation in various muscle groups, which is recapitulated in the nmd mouse, a model of SMARD1. In multiple neurodegenerative disease models, transcriptomic analysis has identified differentially expressed genes between vulnerable motor neuron populations, but the mechanism leading to susceptibility is largely unknown. To investigate if denervation vulnerability is linked to intrinsic muscle properties, we analyzed muscle fiber-type composition in muscles from motor units that show different degrees of denervation in nmd mice: gastrocnemius, tibialis anterior (TA), and extensor digitorum longus (EDL). Our results revealed that denervation vulnerability correlated with atrophy and loss of MyHC-IIb and MyHC-IIx muscle fiber types. Interestingly, increased vulnerability also correlated with an increased abundance of MyHC-I and MyHC-IIa muscle fibers. These results indicated that MyHC-IIx muscle fibers are the most vulnerable to denervation, followed by MyHC-IIb muscle fibers. Moreover, our data indicate that type MyHC-IIa and MyHC-IIb muscle fibers show resistance to denervation and compensate for the loss of MyHC-IIx and MyHC-IIb muscle fibers in the most vulnerable muscles. Taken together these results provide a basis for the selective vulnerability to denervation of specific muscles in nmd mice and identifies new targets for potential therapeutic intervention.
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Affiliation(s)
- Eric Villalón
- Bond Life Sciences Center, University of Missouri, Columbia, MO, 65211, USA; Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri, Columbia, MO, 65211, USA
| | - Naomi N Lee
- Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri, Columbia, MO, 65211, USA
| | - Jose Marquez
- Bond Life Sciences Center, University of Missouri, Columbia, MO, 65211, USA; Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri, Columbia, MO, 65211, USA
| | - Christian L Lorson
- Bond Life Sciences Center, University of Missouri, Columbia, MO, 65211, USA; Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri, Columbia, MO, 65211, USA.
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Villalón E, Shababi M, Kline R, Lorson ZC, Florea KM, Lorson CL. Selective vulnerability in neuronal populations in nmd/SMARD1 mice. Hum Mol Genet 2019; 27:679-690. [PMID: 29272405 DOI: 10.1093/hmg/ddx434] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 12/15/2017] [Indexed: 12/12/2022] Open
Abstract
Spinal muscular atrophy with respiratory distress type 1 (SMARD1) is an autosomal recessive motor neuron disease causing distal limb muscle atrophy that progresses proximally and is accompanied by diaphragmatic paralysis. Neuromuscular junction (NMJ) alterations have been reported in muscles of SMARD1 model mice, known as nmd mice, with varying degrees of severity, suggesting that different muscles are specifically and selectively resistant or susceptible to denervation. To evaluate the extent of NMJ pathology in a broad range of muscles, a panel of axial and appendicular muscles were isolated and immunostained from nmd mice. These analyses revealed that selective distal appendage muscles were highly vulnerable to denervation. Susceptibility to pathology was not limited to NMJ alterations, but included defects in myelination within those neurons innervating susceptible muscles. Interestingly, end plate fragmentation was present within all muscles independent of the extent of NMJ alterations, suggesting that end plate fragmentation is an early hallmark of SMARD1 pathogenesis. Expressing the full-length IGHMBP2 cDNA using an adeno-associated virus (AAV9) significantly decreased all aspects of muscle and nerve disease pathology. These results shed new light onto the pathogenesis of SMARD1 by identifying specific motor units that are resistant and susceptible to neurodegeneration in an important model of SMARD1.
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Affiliation(s)
- Eric Villalón
- Department of Veterinary Pathobiology, Christopher S. Bond Life Sciences Center, University of Missouri, Columbia, MO 65211, USA.,Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri, Columbia, MO 65211, USA
| | - Monir Shababi
- Department of Veterinary Pathobiology, Christopher S. Bond Life Sciences Center, University of Missouri, Columbia, MO 65211, USA.,Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri, Columbia, MO 65211, USA
| | - Rachel Kline
- Department of Veterinary Pathobiology, Christopher S. Bond Life Sciences Center, University of Missouri, Columbia, MO 65211, USA.,Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri, Columbia, MO 65211, USA
| | - Zachary C Lorson
- Department of Veterinary Pathobiology, Christopher S. Bond Life Sciences Center, University of Missouri, Columbia, MO 65211, USA.,Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri, Columbia, MO 65211, USA
| | - Kyra M Florea
- Department of Veterinary Pathobiology, Christopher S. Bond Life Sciences Center, University of Missouri, Columbia, MO 65211, USA.,Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri, Columbia, MO 65211, USA
| | - Christian L Lorson
- Department of Veterinary Pathobiology, Christopher S. Bond Life Sciences Center, University of Missouri, Columbia, MO 65211, USA.,Department of Veterinary Pathobiology, College of Veterinary Medicine, University of Missouri, Columbia, MO 65211, USA
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Durmus H, Yilmaz R, Gulsen-Parman Y, Oflazer-Serdaroglu P, Cuttini M, Dursun M, Deymeer F. Muscle magnetic resonance imaging in spinal muscular atrophy type 3: Selective and progressive involvement. Muscle Nerve 2017; 55:651-656. [PMID: 27543937 DOI: 10.1002/mus.25385] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2016] [Indexed: 11/08/2022]
Abstract
INTRODUCTION In this study we sought to identify magnetic resonance imaging (MRI) signs of selective muscle involvement and disease progression in patients with spinal muscular atrophy type 3b (SMA3b). METHODS Twenty-five patients with genetically confirmed SMA3b underwent MRI on a 1.5-Tesla MR scanner. RESULTS MRI showed significantly more severe involvement of the iliopsoas than of the gluteus maximus muscles, and more severe involvement of the triceps brachii than of the biceps brachii muscles. The quadriceps femoris muscles were severely involved. The deltoid, adductor longus, portions of the hamstrings, gracilis, sartorius, and rectus abdominis muscles were well preserved. We found a significant positive correlation between MRI changes and disease duration for gluteus maximus and triceps brachii. Follow-up MRIs of 4 patients showed disease progression. CONCLUSIONS This study confirms the pattern of selective muscle involvement suggested by previous studies and further refines muscle MRI changes in SMA3b. Progressive muscle involvement is implicated. Muscle Nerve 55: 651-656, 2017.
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Affiliation(s)
- Hacer Durmus
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, Capa, 34390, Istanbul, Turkey
| | - Ravza Yilmaz
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Yesim Gulsen-Parman
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, Capa, 34390, Istanbul, Turkey
| | - Piraye Oflazer-Serdaroglu
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, Capa, 34390, Istanbul, Turkey
| | - Marina Cuttini
- Research Unit of Perinatal Epidemiology, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Memduh Dursun
- Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Feza Deymeer
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, Capa, 34390, Istanbul, Turkey
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