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Coratti G, Pane M, Brogna C, D'Amico A, Pegoraro E, Bello L, Sansone VA, Albamonte E, Ferraroli E, Mazzone ES, Fanelli L, Messina S, Sframeli M, Catteruccia M, Cicala G, Capasso A, Ricci M, Frosini S, De Luca G, Rolle E, De Sanctis R, Forcina N, Norcia G, Passamano L, Scutifero M, Gardani A, Pini A, Monaco G, D'Angelo MG, Leone D, Zanin R, Vita GL, Panicucci C, Bruno C, Mongini T, Ricci F, Berardinelli A, Battini R, Masson R, Baranello G, Dosi C, Bertini E, Nigro V, Politano L, Mercuri E. Gain and loss of upper limb abilities in Duchenne muscular dystrophy patients: A 24-month study. Neuromuscul Disord 2024; 34:75-82. [PMID: 38157655 DOI: 10.1016/j.nmd.2023.11.011] [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: 08/18/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024]
Abstract
Duchenne muscular dystrophy (DMD) is a neuromuscular condition characterized by muscle weakness. The Performance of upper limb (PUL) test is designed to evaluate upper limb function in DMD patients across three domains. The aim of this study is to identify frequently lost or gained PUL 2.0 abilities at distinct functional stages in DMD patients. This retrospective study analyzed prospectively collected data on 24-month PUL 2.0 changes related to ambulatory function. Ambulant patients were categorized based on initial 6MWT distance, non-ambulant patients by time since ambulation loss. Each PUL 2.0 item was classified as shift up, no change, or shift down. The study's cohort incuded 274 patients, with 626 paired evaluations at the 24-month mark. Among these, 55.1 % had activity loss, while 29.1 % had gains. Ambulant patients showed the lowest loss rates, mainly in the shoulder domain. The highest loss rate was in the shoulder domain in the transitioning subgroup and in elbow and distal domains in the non-ambulant patients. Younger ambulant patients demonstrated multiple gains, whereas in the other functional subgroups there were fewer gains, mostly tied to singular activities. Our findings highlight divergent upper limb domain progression, partly linked to functional status and baseline function.
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Affiliation(s)
- Giorgia Coratti
- Centro Clinico Nemo, IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy; Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marika Pane
- Centro Clinico Nemo, IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy; Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudia Brogna
- Centro Clinico Nemo, IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Adele D'Amico
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Elena Pegoraro
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Luca Bello
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Valeria A Sansone
- The NEMO Clinical Center in Milan, Neurorehabilitation Unit, University of Milan, ASST Niguarda Hospital, Milan, Italy
| | - Emilio Albamonte
- The NEMO Clinical Center in Milan, Neurorehabilitation Unit, University of Milan, ASST Niguarda Hospital, Milan, Italy
| | | | | | - Lavinia Fanelli
- Centro Clinico Nemo, IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Sonia Messina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Maria Sframeli
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Michela Catteruccia
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Gianpaolo Cicala
- Centro Clinico Nemo, IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy; Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Capasso
- Centro Clinico Nemo, IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy; Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Martina Ricci
- Centro Clinico Nemo, IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy; Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Silvia Frosini
- Department of Developmental Neuroscience, IRCCS Stella Maris, Pisa, Italy
| | - Giacomo De Luca
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Enrica Rolle
- Neuromuscular Center, AOU Città della Salute e della Scienza, University of Torino, Turin, Italy
| | - Roberto De Sanctis
- Centro Clinico Nemo, IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy; Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Forcina
- Centro Clinico Nemo, IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Giulia Norcia
- Centro Clinico Nemo, IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Luigia Passamano
- Cardiomiology and Medical Genetics, Luigi Vanvitelli University Hospital, Naples, Italy
| | - Marianna Scutifero
- Cardiomiology and Medical Genetics, Luigi Vanvitelli University Hospital, Naples, Italy
| | - Alice Gardani
- Child and Adolescence Neurological Unit, National Neurological Institute Casimiro Mondino Foundation, IRCCS, IRCCS Mondino Foundation, Pavia, Italy
| | - Antonella Pini
- Child Neurology and Psychiatry Unit, IRCCS Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy
| | - Giulia Monaco
- Child Neurology and Psychiatry Unit, IRCCS Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy
| | | | - Daniela Leone
- Centro Clinico Nemo, IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Riccardo Zanin
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Gian Luca Vita
- Unit of Neurology, IRCCS Centro Neurolesi Bonino-Pulejo - P.O. Piemonte, Messina, Italy
| | - Chiara Panicucci
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health-DINOGMI, Center of Translational and Experimental Myology, IRCCS Istituto Giannina Gaslini IRCCS, University of Genova, Genova, Italy
| | - Claudio Bruno
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health-DINOGMI, Center of Translational and Experimental Myology, IRCCS Istituto Giannina Gaslini IRCCS, University of Genova, Genova, Italy
| | - Tiziana Mongini
- Neuromuscular Center, AOU Città della Salute e della Scienza, University of Torino, Turin, Italy
| | - Federica Ricci
- Neuromuscular Center, AOU Città della Salute e della Scienza, University of Torino, Turin, Italy
| | - Angela Berardinelli
- Child and Adolescence Neurological Unit, National Neurological Institute Casimiro Mondino Foundation, IRCCS, IRCCS Mondino Foundation, Pavia, Italy
| | - Roberta Battini
- Department of Developmental Neuroscience, IRCCS Stella Maris, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Riccardo Masson
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giovanni Baranello
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Claudia Dosi
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Enrico Bertini
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Vincenzo Nigro
- Department of Precision Medicine, Luigi Vanvitelli and Telethon Institute of Genetics and Medicine, University of Campania, Italy
| | - Luisa Politano
- Cardiomiology and Medical Genetics, Luigi Vanvitelli University Hospital, Naples, Italy
| | - Eugenio Mercuri
- Centro Clinico Nemo, IRCCS, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy; Pediatric Neurology, Università Cattolica del Sacro Cuore, Rome, Italy.
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Pane M, Coratti G, Brogna C, Bovis F, D'Amico A, Pegoraro E, Bello L, Sansone V, Albamonte E, Ferraroli E, Mazzone ES, Fanelli L, Messina S, Catteruccia M, Cicala G, Ricci M, Frosini S, De Luca G, Rolle E, De Sanctis R, Forcina N, Norcia G, Passamano L, Gardani A, Pini A, Monaco G, D'Angelo MG, Capasso A, Leone D, Zanin R, Vita GL, Panicucci C, Bruno C, Mongini T, Ricci F, Berardinelli A, Battini R, Masson R, Baranello G, Dosi C, Bertini E, Politano L, Mercuri E. Longitudinal Analysis of PUL 2.0 Domains in Ambulant and Non-Ambulant Duchenne Muscular Dystrophy Patients: How do they Change in Relation to Functional Ability? J Neuromuscul Dis 2023:JND221556. [PMID: 37066919 DOI: 10.3233/jnd-221556] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND The performance of upper limb 2.0 (PUL) is widely used to assess upper limb function in DMD patients. The aim of the study was to assess 24 month PUL changes in a large cohort of DMD patients and to establish whether domains changes occur more frequently in specific functional subgroups. METHODS The PUL was performed in 311 patients who had at least one pair of assessments at 24 months, for a total of 808 paired assessments. Ambulant patients were subdivided according to the ability to walk: >350, 250-350, ≤250 meters. Non ambulant patients were subdivided according to the time since they lost ambulation: <1, 1-2, 2-5 or >5 years. RESULTS At 12 months, the mean PUL 2.0 change on all the paired assessments was -1.30 (-1.51--1.05) for the total score, -0.5 (-0.66--0.39) for the shoulder domain, -0.6 (-0.74--0.5) for the elbow domain and -0.1 (-0.20--0.06) for the distal domain.At 24 months, the mean PUL 2.0 change on all the paired assessments was -2.9 (-3.29--2.60) for the total score, -1.30 (-1.47--1.09) for the shoulder domain, -1.30 (-1.45--1.11) for the elbow domain and -0.4 (-1.48--1.29) for the distal domain.Changes at 12 and 24 months were statistically significant between subgroups with different functional abilities for the total score and each domain (p < 0.001). CONCLUSION There were different patterns of changes among the functional subgroups in the individual domains. The time of transition, including the year before and after loss of ambulation, show the peak of negative changes in PUL total scores that reflect not only loss of shoulder but also of elbow activities. These results suggest that patterns of changes should be considered at the time of designing clinical trials.
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Affiliation(s)
- Marika Pane
- Pediatric Neurology, Università Cattolica delSacro Cuore, Rome, Italy
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
| | - Giorgia Coratti
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
| | - Claudia Brogna
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
| | - Francesca Bovis
- Department of Health Sciences (DISSAL), University of Genova, Genova, Italy
| | - Adele D'Amico
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children'sHospital, Rome, Italy
| | - Elena Pegoraro
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Luca Bello
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Valeria Sansone
- The NEMO Clinical Center in Milan, Neurorehabilitation Unit, University of Milan, ASST Niguarda Hospital, Milan, Italy
| | - Emilio Albamonte
- The NEMO Clinical Center in Milan, Neurorehabilitation Unit, University of Milan, ASST Niguarda Hospital, Milan, Italy
| | | | | | - Lavinia Fanelli
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
| | - Sonia Messina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Michela Catteruccia
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children'sHospital, Rome, Italy
| | - Gianpaolo Cicala
- Pediatric Neurology, Università Cattolica delSacro Cuore, Rome, Italy
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
| | - Martina Ricci
- Pediatric Neurology, Università Cattolica delSacro Cuore, Rome, Italy
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
| | - Silvia Frosini
- Department of Developmental Neuroscience, IRCCS Stella Maris, Pisa, Italy
| | - Giacomo De Luca
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children'sHospital, Rome, Italy
| | - Enrica Rolle
- Neuromuscular Center, AOU Città della Salute e della Scienza, University of Torino, Turin, Italy
| | - Roberto De Sanctis
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
| | - Nicola Forcina
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
| | - Giulia Norcia
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
| | - Luigia Passamano
- Department of Experimental Medicine, Cardiomiology and Medical Genetics, Second University of Naples, Naples, Italy
| | - Alice Gardani
- Child and Adolescence NeurologicalUnit, National Neurological Institute Casimiro MondinoFoundation, IRCCS, Pavia, Italy
| | - Antonella Pini
- Child Neurologyand Psychiatry Unit, IRCCS Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy
| | - Giulia Monaco
- Child Neurologyand Psychiatry Unit, IRCCS Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy
| | | | - Anna Capasso
- Pediatric Neurology, Università Cattolica delSacro Cuore, Rome, Italy
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
| | - Daniela Leone
- Centro Clinico Nemo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
| | - Riccardo Zanin
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Gian Luca Vita
- Unit of Neurology, IRCCS Centro Neurolesi Bonino-Pulejo - P.O. Piemonte, Messina, Italy
| | - Chiara Panicucci
- Center of Translational and Experimental Myology, IRCCS Istituto Giannina Gaslini, and Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and ChildHealth-DINOGMI, University of Genova, Genova, Italy
| | - Claudio Bruno
- Center of Translational and Experimental Myology, IRCCS Istituto Giannina Gaslini, and Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and ChildHealth-DINOGMI, University of Genova, Genova, Italy
| | - Tiziana Mongini
- Neuromuscular Center, AOU Città della Salute e della Scienza, University of Torino, Turin, Italy
| | - Federica Ricci
- Neuromuscular Center, AOU Città della Salute e della Scienza, University of Torino, Turin, Italy
| | - Angela Berardinelli
- Child and Adolescence NeurologicalUnit, National Neurological Institute Casimiro MondinoFoundation, IRCCS, Pavia, Italy
| | - Roberta Battini
- Department of Developmental Neuroscience, IRCCS Stella Maris, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Riccardo Masson
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giovanni Baranello
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Claudia Dosi
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Enrico Bertini
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children'sHospital, Rome, Italy
| | - Luisa Politano
- Cardiomyology and Medical Genetics Unit, Università degli Studi della CampaniaLuigi Vanvitelli Scuola di Medicina e Chirurgia, Napoli, Italy
| | - Eugenio Mercuri
- Pediatric Neurology, Università Cattolica delSacro Cuore, Rome, Italy
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3
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Maggi L, Bello L, Bonanno S, Govoni A, Caponnetto C, Passamano L, Grandis M, Trojsi F, Cerri F, Gardani A, Ferraro M, Gadaleta G, Zangaro V, Caumo L, Maioli M, Tanel R, Saccani E, Meneri M, Vacchiano V, Ricci G, Sorarù G, D'Errico E, Bortolani S, Pavesi G, Gellera C, Zanin R, Corti S, Silvestrini M, Politano L, Schenone A, Previtali SC, Berardinelli A, Turri M, Verriello L, Coccia M, Mantegazza R, Liguori R, Filosto M, Marrosu G, Tiziano FD, Siciliano G, Simone IL, Mongini T, Comi G, Pegoraro E. Adults with spinal muscular atrophy: a large-scale natural history study shows gender effect on disease. J Neurol Neurosurg Psychiatry 2022; 93:1253-1261. [PMID: 36220341 DOI: 10.1136/jnnp-2022-329320] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Natural history of spinal muscular atrophy (SMA) in adult age has not been fully elucidated yet, including factors predicting disease progression and response to treatments. Aim of this retrospective, cross-sectional study, is to investigate motor function across different ages, disease patterns and gender in adult SMA untreated patients. METHODS Inclusion criteria were as follows: (1) clinical and molecular diagnosis of SMA2, SMA3 or SMA4 and (2) clinical assessments performed in adult age (>18 years). RESULTS We included 64 (38.8%) females and 101 (61.2%) males (p=0.0025), among which 21 (12.7%) SMA2, 141 (85.5%) SMA3 and 3 (1.8%) SMA4. Ratio of sitters/walkers within the SMA3 subgroup was significantly (p=0.016) higher in males (46/38) than in females (19/38). Median age at onset was significantly (p=0.0071) earlier in females (3 years; range 0-16) than in males (4 years; range 0.3-28), especially in patients carrying 4 SMN2 copies. Median Hammersmith Functional Rating Scale Expanded scores were significantly (p=0.0040) lower in males (16, range 0-64) than in females (40, range 0-62); median revised upper limb module scores were not significantly (p=0.059) different between males (24, 0-38) and females (33, range 0-38), although a trend towards worse performance in males was observed. In SMA3 patients carrying three or four SMN2 copies, an effect of female sex in prolonging ambulation was statistically significant (p=0.034). CONCLUSIONS Our data showed a relevant gender effect on SMA motor function with higher disease severity in males especially in the young adult age and in SMA3 patients.
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Affiliation(s)
- Lorenzo Maggi
- Neuroimmunology and Neuromuscular Disease Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Luca Bello
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Silvia Bonanno
- Neuroimmunology and Neuromuscular Disease Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Alessandra Govoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Luigia Passamano
- Cardiomyology and Medical Genetics Unit, University Hospital "L Vanvitelli", Napoli, Italy
| | - Marina Grandis
- IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), Università di Genova, Genova, Italy
| | - Francesca Trojsi
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Federica Cerri
- Department of Neurology, IRCCS Ospedale San Raffaele, Milano, Italy
| | | | - Manfredi Ferraro
- Department of Neurosciences Rita Levi Montalcini, University of Turin, Turin, Italy
| | - Giulio Gadaleta
- Department of Neurosciences Rita Levi Montalcini, University of Turin, Turin, Italy
| | - Vittoria Zangaro
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Luca Caumo
- Department of Neurosciences, University of Padova, Padova, Italy
| | | | | | - Elena Saccani
- Specialistic Medicine Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Megi Meneri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Veria Vacchiano
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, Universita degli Studi di Bologna, Bologna, Italy
| | - Giulia Ricci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gianni Sorarù
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Eustachio D'Errico
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Sara Bortolani
- Department of Neurosciences Rita Levi Montalcini, University of Turin, Turin, Italy
| | - Giovanni Pavesi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Cinzia Gellera
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Riccardo Zanin
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Stefania Corti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mauro Silvestrini
- Department of Neurological Sciences, Ospedali Riuniti di Ancona, Ancona, Italy.,Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Luisa Politano
- Cardiomyology and Medical Genetics Unit, University Hospital "L Vanvitelli", Napoli, Italy
| | - Angelo Schenone
- IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), Università di Genova, Genova, Italy
| | | | | | - Mara Turri
- Department of Neurology/Stroke Unit, San Maurizio Hospital, Bolzano, Italy
| | - Lorenzo Verriello
- Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Michela Coccia
- Department of Neurological Sciences, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Renato Mantegazza
- Neuroimmunology and Neuromuscular Disease Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Rocco Liguori
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, Universita degli Studi di Bologna, Bologna, Italy
| | - Massimiliano Filosto
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,NeMO-Brescia Clinical Center for Neuromuscular Diseases, Brescia, Italy
| | | | - Francesco Danilo Tiziano
- Department of Life Sciences and Public Health, Section of Genomic Medicine, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Roma, Italy.,Department of Laboratory Science and Infectious Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Gabriele Siciliano
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Isabella Laura Simone
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Tiziana Mongini
- Department of Neurosciences Rita Levi Montalcini, University of Turin, Turin, Italy
| | - Giacomo Comi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, University of Milan, Milano, Italy
| | - Elena Pegoraro
- Department of Neurosciences, University of Padova, Padova, Italy
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4
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Pasca L, Gardani A, Paoletti M, Velardo D, Berardinelli A. Good response to the late treatment with ataluren in a boy with Duchenne muscular dystrophy: could the previous mild course of the disease have affected the outcome? Acta Myol 2022; 41:121-125. [PMID: 36349184 PMCID: PMC9628801 DOI: 10.36185/2532-1900-078] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022]
Abstract
Duchenne muscular dystrophy (DMD) is a severe, progressive X-linked recessive disorder, caused by the absence of the dystrophin protein. A resolutive therapy for DMD is not yet available. The first approved drug for DMD patients with nonsense mutations is ataluren, approved for the treatment of children aged ≥ 2 yrs, that seems effective in slowing the disease progression. An earlier introduction of ataluren seems to give better results. We report the case of a 14-year-old DMD patient with a nonsense mutation in exon 70, still ambulant, who started taking ataluren at 12 years and remained stable for the following two years. The patient was on steroid since the age of 6, with beneficial effects. At two-years follow-up, an optimal disease evolution was observed, associated with a constant decrease of creatine kinase blood levels. Despite the late start of the treatment, ataluren seems to have significantly contributed to the stabilization of the functional status in this patient though it cannot be excluded that the result may have been influenced by the previous favorable course of the disease. However, further studies should be planned in patients with similar age treated with ataluren to better evaluate the treatment's results compared to the natural course of the disease.
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Affiliation(s)
- Ludovica Pasca
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy, Department of Brain and Behaviour Neuroscience, University of Pavia, Pavia, Italy
| | - Alice Gardani
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | - Matteo Paoletti
- Department of Neuroradiology, IRCCS Mondino Foundation, Pavia, Italy
| | - Daniele Velardo
- IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico; Neurology Unit, Milan, Italy
| | - Angela Berardinelli
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy,Correspondence Angela Berardinelli Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, via Mondino 2, 27100 Pavia, Italy. E-mail:
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Savini G, Asteggiano C, Paoletti M, Parravicini S, Pezzotti E, Solazzo F, Muzic SI, Santini F, Deligianni X, Gardani A, Germani G, Farina LM, Bergsland N, Gandini Wheeler-Kingshott CAM, Berardinelli A, Bastianello S, Pichiecchio A. Pilot Study on Quantitative Cervical Cord and Muscular MRI in Spinal Muscular Atrophy: Promising Biomarkers of Disease Evolution and Treatment? Front Neurol 2021; 12:613834. [PMID: 33854470 PMCID: PMC8039452 DOI: 10.3389/fneur.2021.613834] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 02/15/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction: Nusinersen is a recent promising therapy approved for the treatment of spinal muscular atrophy (SMA), a rare disease characterized by the degeneration of alpha motor neurons (αMN) in the spinal cord (SC) leading to progressive muscle atrophy and dysfunction. Muscle and cervical SC quantitative magnetic resonance imaging (qMRI) has never been used to monitor drug treatment in SMA. The aim of this pilot study is to investigate whether qMRI can provide useful biomarkers for monitoring treatment efficacy in SMA. Methods: Three adult SMA 3a patients under treatment with nusinersen underwent longitudinal clinical and qMRI examinations every 4 months from baseline to 21-month follow-up. The qMRI protocol aimed to quantify thigh muscle fat fraction (FF) and water-T2 (w-T2) and to characterize SC volumes and microstructure. Eleven healthy controls underwent the same SC protocol (single time point). We evaluated clinical and imaging outcomes of SMA patients longitudinally and compared SC data between groups transversally. Results: Patient motor function was stable, with only Patient 2 showing moderate improvements. Average muscle FF was already high at baseline (50%) and progressed over time (57%). w-T2 was also slightly higher than previously published data at baseline and slightly decreased over time. Cross-sectional area of the whole SC, gray matter (GM), and ventral horns (VHs) of Patients 1 and 3 were reduced compared to controls and remained stable over time, while GM and VHs areas of Patient 2 slightly increased. We found altered diffusion and magnetization transfer parameters in SC structures of SMA patients compared to controls, thus suggesting changes in tissue microstructure and myelin content. Conclusion: In this pilot study, we found a progression of FF in thigh muscles of SMA 3a patients during nusinersen therapy and a concurrent slight reduction of w-T2 over time. The SC qMRI analysis confirmed previous imaging and histopathological studies suggesting degeneration of αMN of the VHs, resulting in GM atrophy and demyelination. Our longitudinal data suggest that qMRI could represent a feasible technique for capturing microstructural changes induced by SMA in vivo and a candidate methodology for monitoring the effects of treatment, once replicated on a larger cohort.
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Affiliation(s)
- Giovanni Savini
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Carlo Asteggiano
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Matteo Paoletti
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Stefano Parravicini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Elena Pezzotti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Francesca Solazzo
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Shaun I Muzic
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Francesco Santini
- Department of Radiology, Division of Radiological Physics, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Xeni Deligianni
- Department of Radiology, Division of Radiological Physics, University Hospital Basel, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, Allschwil, Switzerland
| | - Alice Gardani
- Child Neuropsychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Giancarlo Germani
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Lisa M Farina
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Niels Bergsland
- Buffalo Neuroimaging Analysis Center, Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, United States.,IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Claudia A M Gandini Wheeler-Kingshott
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, Russell Square, London, United Kingdom.,Brain Connectivity Research Unit, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Stefano Bastianello
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Anna Pichiecchio
- Advanced Imaging and Radiomics Center, Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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6
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Provenzi L, Grumi S, Gardani A, Aramini V, Dargenio E, Naboni C, Vacchini V, Borgatti R. Italian parents welcomed a telehealth family-centred rehabilitation programme for children with disability during COVID-19 lockdown. Acta Paediatr 2021; 110:194-196. [PMID: 33098116 DOI: 10.1111/apa.15636] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Livio Provenzi
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation Pavia Italy
| | - Serena Grumi
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation Pavia Italy
| | - Alice Gardani
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation Pavia Italy
| | - Valentina Aramini
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation Pavia Italy
| | - Erika Dargenio
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation Pavia Italy
| | - Cecilia Naboni
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation Pavia Italy
| | - Valeria Vacchini
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation Pavia Italy
| | - Renato Borgatti
- Child Neurology and Psychiatry Unit IRCCS Mondino Foundation Pavia Italy
- Department of Brain and Behavioral Science University of Pavia Pavia Italy
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7
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Grumi S, Provenzi L, Gardani A, Aramini V, Dargenio E, Naboni C, Vacchini V, Borgatti R. Rehabilitation services lockdown during the COVID-19 emergency: the mental health response of caregivers of children with neurodevelopmental disabilities. Disabil Rehabil 2020; 43:27-32. [PMID: 33167738 DOI: 10.1080/09638288.2020.1842520] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The present study investigated the impact of the COVID-19-related rehabilitation services lockdown on the mental health of caregivers of children with neurodevelopmental disabilities. METHODS Between 26 March and 11 May 2020, 84 caregivers filled out ad-hoc and standardized questionnaires through an online survey in order to measure their psychological response to the emergency and lockdown as well as their levels of parenting stress, anxiety and depression. RESULTS Worries about COVID-19 contagion and concerns for the child left without rehabilitation programs were the greatest sources of mental health burden for caregivers. Nonetheless, only the concerns for the child were significantly associated with caregivers' reports of stress, depressive and anxious symptoms. DISCUSSION These findings highlight the burden faced by caregivers of children with neurodevelopmental disabilities during the COVID-19 emergency in Italy. These families should be considered as a high-risk population that requires dedicated healthcare attention, such as promoting continuity of care by investing in tele-rehabilitation programs. Implications for rehabilitation Caregivers of children with disability reported symptoms of anxiety and depression during COVID-19 emergency. Major concerns regarded COVID-19 contagion risk and child development during rehabilitation lockdown. Caregivers' psychological symptoms were associated with concerns for child development during the lockdown. Parents of children with disability may face relevant stress during and after COVID-19 psychological burden. During COVID-19 recovery, policy-makers and clinicians should dedicate specific care actions for families of children with disability.
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Affiliation(s)
- Serena Grumi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Livio Provenzi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Alice Gardani
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Valentina Aramini
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Erika Dargenio
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Cecilia Naboni
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Valeria Vacchini
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Renato Borgatti
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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Pane M, Coratti G, Brogna C, Mazzone ES, Mayhew A, Fanelli L, Messina S, D’Amico A, Catteruccia M, Scutifero M, Frosini S, Lanzillotta V, Colia G, Cavallaro F, Rolle E, De Sanctis R, Forcina N, Petillo R, Barp A, Gardani A, Pini A, Monaco G, D’Angelo MG, Zanin R, Vita GL, Bruno C, Mongini T, Ricci F, Pegoraro E, Bello L, Berardinelli A, Battini R, Sansone V, Albamonte E, Baranello G, Bertini E, Politano L, Sormani MP, Mercuri E. Upper limb function in Duchenne muscular dystrophy: 24 month longitudinal data. PLoS One 2018; 13:e0199223. [PMID: 29924848 PMCID: PMC6010252 DOI: 10.1371/journal.pone.0199223] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 01/12/2018] [Indexed: 11/18/2022] Open
Abstract
The aim of the study was to establish 24 month changes in upper limb function using a revised version of the performance of upper limb test (PUL 2.0) in a large cohort of ambulant and non-ambulant boys with Duchenne muscular dystrophy and to identify possible trajectories of progression. Of the 187 patients studied, 87 were ambulant (age range: 7–15.8 years), and 90 non-ambulant (age range: 9.08–24.78). The total scores changed significantly over time (p<0.001). Non-ambulant patients had lower total scores at baseline (mean 19.7) when compared to the ambulant ones (mean 38.4). They also had also a bigger decrease in total scores over 24 months compared to the ambulant boys (4.36 vs 2.07 points). Multivariate model analysis showed that the Performance of Upper Limb changes reflected the entry level and ambulation status, that were independently associated to the slope of Performance of Upper Limb changes. This information will be of help both in clinical practice and at the time of designing clinical trials.
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Affiliation(s)
- Marika Pane
- Pediatric Neurology and Nemo Clinical Centre, Fondazione Policlinico Universitario "A. Gemelli IRCSS", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgia Coratti
- Pediatric Neurology and Nemo Clinical Centre, Fondazione Policlinico Universitario "A. Gemelli IRCSS", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudia Brogna
- Pediatric Neurology and Nemo Clinical Centre, Fondazione Policlinico Universitario "A. Gemelli IRCSS", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elena Stacy Mazzone
- Pediatric Neurology and Nemo Clinical Centre, Fondazione Policlinico Universitario "A. Gemelli IRCSS", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Mayhew
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, International Centre for Life, Newcastle Upon Tyne, United Kingdom
| | - Lavinia Fanelli
- Pediatric Neurology and Nemo Clinical Centre, Fondazione Policlinico Universitario "A. Gemelli IRCSS", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sonia Messina
- Department of Clinical and Experimental Medicine and Nemo Sud Clinical Center, University of Messina, Messina, Italy
| | - Adele D’Amico
- Unit of Neuromuscular and Neurodegenerative Disorders, Department of Neurosciences, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Michela Catteruccia
- Unit of Neuromuscular and Neurodegenerative Disorders, Department of Neurosciences, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Marianna Scutifero
- Cardiomiology and Medical Genetics, Department of Experimental Medicine, Second University of Naples, Naples, Italy
| | - Silvia Frosini
- Department of Developmental Neuroscience, IRCCS Stella Maris, Pisa, Italy
| | - Valentina Lanzillotta
- Center of Myology and Neurodegenerative Disorders and Physical and Rehabilitation Medicine Unit, Istituto Giannina Gaslini, Genova, Italy
| | - Giulia Colia
- Unit of Neuromuscular and Neurodegenerative Disorders, Department of Neurosciences, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Filippo Cavallaro
- Department of Clinical and Experimental Medicine and Nemo Sud Clinical Center, University of Messina, Messina, Italy
| | - Enrica Rolle
- Neuromuscular Center, AOU Città della Salute e della Scienza, University of Torino, Turin, Italy
| | - Roberto De Sanctis
- Pediatric Neurology and Nemo Clinical Centre, Fondazione Policlinico Universitario "A. Gemelli IRCSS", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicola Forcina
- Pediatric Neurology and Nemo Clinical Centre, Fondazione Policlinico Universitario "A. Gemelli IRCSS", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberta Petillo
- Cardiomiology and Medical Genetics, Department of Experimental Medicine, Second University of Naples, Naples, Italy
| | - Andrea Barp
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Alice Gardani
- Child and Adolescence Neurological Unit, National Neurological Institute Casimiro Mondino Foundation, IRCCS, Pavia, Italy
| | - Antonella Pini
- Child Neurology and Psychiatry Unit, IRCCS Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy
| | - Giulia Monaco
- Child Neurology and Psychiatry Unit, IRCCS Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy
| | | | - Riccardo Zanin
- Developmental Neurology, Neurological Institute Carlo Besta, Milan, Italy
| | - Gian Luca Vita
- Department of Clinical and Experimental Medicine and Nemo Sud Clinical Center, University of Messina, Messina, Italy
| | - Claudio Bruno
- Center of Myology and Neurodegenerative Disorders and Physical and Rehabilitation Medicine Unit, Istituto Giannina Gaslini, Genova, Italy
| | - Tiziana Mongini
- Neuromuscular Center, AOU Città della Salute e della Scienza, University of Torino, Turin, Italy
| | - Federica Ricci
- Neuromuscular Center, AOU Città della Salute e della Scienza, University of Torino, Turin, Italy
| | - Elena Pegoraro
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Luca Bello
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Angela Berardinelli
- Child and Adolescence Neurological Unit, National Neurological Institute Casimiro Mondino Foundation, IRCCS, Pavia, Italy
| | - Roberta Battini
- Department of Developmental Neuroscience, IRCCS Stella Maris, Pisa, Italy
| | | | | | - Giovanni Baranello
- Developmental Neurology, Neurological Institute Carlo Besta, Milan, Italy
| | - Enrico Bertini
- Unit of Neuromuscular and Neurodegenerative Disorders, Department of Neurosciences, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Luisa Politano
- Cardiomiology and Medical Genetics, Department of Experimental Medicine, Second University of Naples, Naples, Italy
| | - Maria Pia Sormani
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Eugenio Mercuri
- Pediatric Neurology and Nemo Clinical Centre, Fondazione Policlinico Universitario "A. Gemelli IRCSS", Università Cattolica del Sacro Cuore, Rome, Italy
- * E-mail:
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9
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Pane M, Fanelli L, Mazzone ES, Olivieri G, D'Amico A, Messina S, Scutifero M, Battini R, Petillo R, Frosini S, Sivo S, Vita GL, Bruno C, Mongini T, Pegoraro E, De Sanctis R, Gardani A, Berardinelli A, Lanzillotta V, Carlesi A, Viggiano E, Cavallaro F, Sframeli M, Bello L, Barp A, Bianco F, Bonfiglio S, Rolle E, Palermo C, D'Angelo G, Pini A, Iotti E, Gorni K, Baranello G, Bertini E, Politano L, Sormani MP, Mercuri E. Benefits of glucocorticoids in non-ambulant boys/men with Duchenne muscular dystrophy: A multicentric longitudinal study using the Performance of Upper Limb test. Neuromuscul Disord 2015; 25:749-53. [PMID: 26248957 PMCID: PMC4597096 DOI: 10.1016/j.nmd.2015.07.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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: 06/01/2015] [Revised: 07/13/2015] [Accepted: 07/14/2015] [Indexed: 11/29/2022]
Abstract
The paper reports the effect of steroids on upper limb function in non ambulant DMD boys. Boys continuing steroids after loss of ambulation perform better than those who stopped at the time of loss of ambulation. The Performance of Upper Limb test can reliably capture change over time and the effect of intervention.
The aim of this study was to establish the possible effect of glucocorticoid treatment on upper limb function in a cohort of 91 non-ambulant DMD boys and adults of age between 11 and 26 years. All 91 were assessed using the Performance of Upper Limb test. Forty-eight were still on glucocorticoid after loss of ambulation, 25 stopped steroids at the time they lost ambulation and 18 were GC naïve or had steroids while ambulant for less than a year. At baseline the total scores ranged between 0 and 74 (mean 41.20). The mean total scores were 47.92 in the glucocorticoid group, 36 in those who stopped at loss of ambulation and 30.5 in the naïve group (p < 0.001). The 12-month changes ranged between −20 and 4 (mean −4.4). The mean changes were −3.79 in the glucocorticoid group, −5.52 in those who stopped at loss of ambulation and −4.44 in the naïve group. This was more obvious in the patients between 12 and 18 years and at shoulder and elbow levels. Our findings suggest that continuing glucocorticoids throughout teenage years and adulthood after loss of ambulation appears to have a beneficial effect on upper limb function.
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Affiliation(s)
- Marika Pane
- Child Neurology and Psychiatry Unit, Catholic University, Rome, Italy
| | - Lavinia Fanelli
- Child Neurology and Psychiatry Unit, Catholic University, Rome, Italy
| | | | - Giorgia Olivieri
- Child Neurology and Psychiatry Unit, Catholic University, Rome, Italy
| | - Adele D'Amico
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children's Hospital, Rome, Italy
| | - Sonia Messina
- Department of Neurosciences and Nemo Sud Clinical Center, University of Messina, Messina, Italy
| | - Marianna Scutifero
- Cardiomiology and Medical Genetics, Department of Experimental Medicine, Second University of Naples, Naples, Italy
| | - Roberta Battini
- Department of Developmental Neuroscience, IRCCS Stella Maris, Pisa, Italy
| | - Roberta Petillo
- Cardiomiology and Medical Genetics, Department of Experimental Medicine, Second University of Naples, Naples, Italy
| | - Silvia Frosini
- Department of Developmental Neuroscience, IRCCS Stella Maris, Pisa, Italy
| | - Serena Sivo
- Child Neurology and Psychiatry Unit, Catholic University, Rome, Italy
| | - Gian Luca Vita
- Department of Neurosciences and Nemo Sud Clinical Center, University of Messina, Messina, Italy
| | - Claudio Bruno
- Center of Myology and Neurodegenerative Disorders and Physical and Rehabilitation Medicine Unit, Istituto Giannina Gaslini, Genova, Italy
| | - Tiziana Mongini
- Neuromuscular Center, AOU Città della Salute e della Scienza, University of Torino, Turin, Italy
| | - Elena Pegoraro
- Department of Neurosciences, University of Padua, Padua, Italy
| | | | | | | | - Valentina Lanzillotta
- Center of Myology and Neurodegenerative Disorders and Physical and Rehabilitation Medicine Unit, Istituto Giannina Gaslini, Genova, Italy
| | - Adelina Carlesi
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children's Hospital, Rome, Italy
| | - Emanuela Viggiano
- Cardiomiology and Medical Genetics, Department of Experimental Medicine, Second University of Naples, Naples, Italy
| | - Filippo Cavallaro
- Department of Neurosciences and Nemo Sud Clinical Center, University of Messina, Messina, Italy
| | - Maria Sframeli
- Department of Neurosciences and Nemo Sud Clinical Center, University of Messina, Messina, Italy
| | - Luca Bello
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Andrea Barp
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Flaviana Bianco
- Child Neurology and Psychiatry Unit, Catholic University, Rome, Italy
| | - Serena Bonfiglio
- Child Neurology and Psychiatry Unit, IRCCS Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy
| | - Enrica Rolle
- Neuromuscular Center, AOU Città della Salute e della Scienza, University of Torino, Turin, Italy
| | - Concetta Palermo
- Child Neurology and Psychiatry Unit, Catholic University, Rome, Italy
| | | | - Antonella Pini
- Child Neurology and Psychiatry Unit, IRCCS Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy
| | - Elena Iotti
- Pediatric Neurology and Myopathology Units, Neurological Institute Carlo Besta, Milan, Italy
| | | | - Giovanni Baranello
- Pediatric Neurology and Myopathology Units, Neurological Institute Carlo Besta, Milan, Italy
| | - Enrico Bertini
- Unit of Neuromuscular and Neurodegenerative Disorders, Bambino Gesù Children's Hospital, Rome, Italy
| | - Luisa Politano
- Cardiomiology and Medical Genetics, Department of Experimental Medicine, Second University of Naples, Naples, Italy
| | - Maria Pia Sormani
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Eugenio Mercuri
- Child Neurology and Psychiatry Unit, Catholic University, Rome, Italy.
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