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Vill K, Blaschek A, Gläser D, Kuhn M, Haack T, Alhaddad B, Wagner M, Kovacs-Nagy R, Tacke M, Gerstl L, Schroeder AS, Borggraefe I, Mueller C, Schlotter-Weigel B, Schoser B, Walter MC, Müller-Felber W. Early-Onset Myopathies: Clinical Findings, Prevalence of Subgroups and Diagnostic Approach in a Single Neuromuscular Referral Center in Germany. J Neuromuscul Dis 2019; 4:315-325. [PMID: 29172004 DOI: 10.3233/jnd-170231] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Early-onset myopathies are a heterogeneous group of neuromuscular diseases with broad clinical, genetic and histopathological overlap. The diagnostic approach has considerably changed since high throughput genetic methods (next generation sequencing, NGS) became available. OBJECTIVE We present diagnostic subgroups in a single neuromuscular referral center and describe an algorithm for the diagnostic work-up. METHODS The diagnostic approach of 98 index patients was retrospectively analysed. In 56 cases targeted sequencing of a known gene was performed, in 44 patients NGS was performed using large muscle specific panels, and in 12 individuals whole exome sequencing (WES) was undertaken. One patient was diagnosed via array CGH. Clinical features of all patients are provided. RESULTS The final diagnosis could be found in 63 out of 98 patients (64%) with molecular genetic analysis. In 55% targeted gene sequencing could establish the genetic diagnosis. However, this rate largely depended on the presence of distinct histological or clinical features. NGS (large myopathy-related panels and WES) revealed genetic diagnosis in 58.5% (52% and 67%, respectively). The genes detected by WES in our cohort of patients were all covered by the panels. Based on our findings we propose an algorithm for a practical diagnostic approach.Prevalences:MTM1- and LAMA2-patients are the two biggest subgroups, followed by SEPN1-, RYR1- and Collagen VI-related diseases. 31% of genetically confirmed cases represents a group with overlap between "congenital myopathies (CM)" and "congenital muscular dystrophies (CMD)". In 36% of the patients a specific genetic diagnosis could not be assigned. CONCLUSIONS A final diagnosis can be confirmed by high throughput genetic analysis in 58.5% of the cases, which is a higher rate than reported in the literature for muscle biopsy and should in many cases be considered as a first diagnostic tool. NGS cannot replace neuromuscular expertise and a close discussion with the geneticists on NGS is mandatory. Targeted candidate gene sequencing still plays a role in selected cases with highly suspicious clinical or histological features. There is a relevant clinical and genetic overlap between the entities CM and CMD.
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Affiliation(s)
- K Vill
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Center for Neuromuscular Disorders in Childhood. Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
| | - A Blaschek
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Center for Neuromuscular Disorders in Childhood. Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
| | - D Gläser
- genetikum® Center for Human Genetics, Neu-Ulm, Germany
| | - M Kuhn
- genetikum® Center for Human Genetics, Neu-Ulm, Germany
| | - T Haack
- Institute of Human Genetics, Technische Universität München, Munich, Germany.,Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany.,Institute of Human Genetics, University of Tübingen, Germany
| | - B Alhaddad
- Institute of Human Genetics, Technische Universität München, Munich, Germany.,Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - M Wagner
- Institute of Human Genetics, Technische Universität München, Munich, Germany.,Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany.,Institute für Neurogenomik, Helmholtz Zentrum München, Neuherberg, Germany
| | - R Kovacs-Nagy
- Institute of Human Genetics, Technische Universität München, Munich, Germany
| | - M Tacke
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Center for Neuromuscular Disorders in Childhood. Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
| | - L Gerstl
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Center for Neuromuscular Disorders in Childhood. Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
| | - A S Schroeder
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Center for Neuromuscular Disorders in Childhood. Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
| | - I Borggraefe
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Center for Neuromuscular Disorders in Childhood. Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
| | - C Mueller
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Center for Neuromuscular Disorders in Childhood. Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
| | - B Schlotter-Weigel
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-Universität, München, Munich, Germany
| | - B Schoser
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-Universität, München, Munich, Germany
| | - M C Walter
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-Universität, München, Munich, Germany
| | - W Müller-Felber
- Division of Pediatric Neurology, Developmental Medicine and Social Pediatrics, Center for Neuromuscular Disorders in Childhood. Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany
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Abstract
AIM Traumatic dental injuries (TDIs) are among the most serious dental public health problems in childhood. This study aimed to determine the prevalence of anterior tooth TDIs in 7- to 18-year-old children who presented for treatment over a period between January 2007 and December 2016, and to survey the effect of an increased health awareness and educational campaign about the risk of TDIs and the importance of prevention methods in decreasing their prevalence compared with data published in the years 1985-1999. MATERIALS AND METHODS The current study was carried out on 454 children who presented for treatment at the Department of Paediatric Dentistry and Orthodontics in Budapest, Hungary. RESULTS The prevalence of TDIs was 1%. Males experienced more dental injuries than females. The incidence of dental trauma peaked at 9 years of age. The most observed injury was luxation. Most accidents occurred during playtime at home. TDIs occurred most frequently in the spring. CONCLUSION The increased health awareness, a wide educational campaign about the risk of TDIs and the importance of prevention methods have essentially contributed to the decrease in the prevalence of TDIs, with an increase of luxation injuries and a decrease of teeth fractures.
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Affiliation(s)
- B Alhaddad
- Semmelweis University of Medicine Faculty of Dentistry, Department of Pedodontics and Orthodontics, Budapest, Hungary
| | - N K Rózsa
- Semmelweis University of Medicine Faculty of Dentistry, Department of Pedodontics and Orthodontics, Budapest, Hungary
| | - I Tarján
- Semmelweis University of Medicine Faculty of Dentistry, Department of Pedodontics and Orthodontics, Budapest, Hungary
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Braunisch MC, Gallwitz H, Abicht A, Diebold I, Holinski-Feder E, Van Maldergem L, Lammens M, Kovács-Nagy R, Alhaddad B, Strom TM, Meitinger T, Senderek J, Rudnik-Schöneborn S, Haack TB. Extension of the phenotype of biallelic loss-of-function mutations in SLC25A46 to the severe form of pontocerebellar hypoplasia type I. Clin Genet 2017; 93:255-265. [PMID: 28653766 DOI: 10.1111/cge.13084] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 06/18/2017] [Accepted: 06/20/2017] [Indexed: 01/04/2023]
Abstract
Biallelic mutations in SLC25A46, encoding a modified solute transporter involved in mitochondrial dynamics, have been identified in a wide range of conditions such as hereditary motor and sensory neuropathy with optic atrophy type VIB (OMIM: *610826) and congenital lethal pontocerebellar hypoplasia (PCH). To date, 18 patients from 13 families have been reported, presenting with the key clinical features of optic atrophy, peripheral neuropathy, and cerebellar atrophy. The course of the disease was highly variable ranging from severe muscular hypotonia at birth and early death to first manifestations in late childhood and survival into the fifties. Here we report on 4 patients from 2 families diagnosed with PCH who died within the first month of life from respiratory insufficiency. Patients from 1 family had pathoanatomically proven spinal motor neuron degeneration (PCH1). Using exome sequencing, we identified biallelic disease-segregating loss-of-function mutations in SLC25A46 in both families. Our study adds to the definition of the SLC25A46-associated phenotypic spectrum that includes neonatal fatalities due to PCH as the severe extreme.
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Affiliation(s)
- M C Braunisch
- Institute of Human Genetics, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Department of Nephrology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - H Gallwitz
- Department of Pediatrics, Socio-Pediatric Center, Klinikum Memmingen, Memmingen, Germany
| | - A Abicht
- Medical Genetics Center, Munich, Germany.,Friedrich-Baur-Institut, Neurologische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - I Diebold
- Medical Genetics Center, Munich, Germany
| | - E Holinski-Feder
- Medical Genetics Center, Munich, Germany.,Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität München, Munich, Germany
| | - L Van Maldergem
- Center for Human Genetics, University of Franche-Comté, Besançon, France
| | - M Lammens
- Department of Pathology, Antwerp University Hospital, Edegem, Belgium.,Department of Neuropathology, Born Bunge Institute, Antwerp University, Wilrijk, Belgium
| | - R Kovács-Nagy
- Institute of Human Genetics, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - B Alhaddad
- Institute of Human Genetics, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - T M Strom
- Institute of Human Genetics, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - T Meitinger
- Institute of Human Genetics, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - J Senderek
- Friedrich-Baur-Institut, Neurologische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - S Rudnik-Schöneborn
- Division of Human Genetics, Medical University Innsbruck, Innsbruck, Austria.,Institut für Humangenetik, Uniklinik RWTH Aachen, Aachen, Germany
| | - T B Haack
- Institute of Human Genetics, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany.,Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
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Bublitz S, Alhaddad B, Synofzik M, Kuhl V, Lindner A, Freiberg C, Schmidt H, Strom T, Haack T, Deschauer M. Expanding the phenotype of DNAJC3
mutations: A case with hypothyroidism additionally to diabetes mellitus and multisystemic neurodegeneration. Clin Genet 2017; 92:561-562. [DOI: 10.1111/cge.13069] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 06/05/2017] [Accepted: 06/06/2017] [Indexed: 11/29/2022]
Affiliation(s)
- S.K. Bublitz
- Department of Neurology, Klinikum rechts der Isar; Technische Universität München; Munich Germany
| | - B. Alhaddad
- Institute of Human Genetics; Technische Universität München; München Germany
| | - M. Synofzik
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research (HIH); University of Tübingen, and German Center for Neurodegenerative Diseases (DZNE); Tübingen Germany
| | - V. Kuhl
- Department of Neurology; Marienhospital Stuttgart; Stuttgart Germany
| | - A. Lindner
- Department of Neurology; Marienhospital Stuttgart; Stuttgart Germany
| | - C. Freiberg
- Department of Pediatrics; Universitätsmedizin Göttingen; Göttingen Germany
| | - H. Schmidt
- Division of Pediatric Endocrinology; University Children's Hospital, Ludwig-Maximilian University; Munich Germany
| | - T.M. Strom
- Institute of Human Genetics; Helmholtz Zentrum München; Neuherberg Germany
| | - T.B. Haack
- Institute of Human Genetics; Technische Universität München; München Germany
| | - M. Deschauer
- Department of Neurology, Klinikum rechts der Isar; Technische Universität München; Munich Germany
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Alhaddad B, Smith FJ, Robertson T, Watman G, Taylor KMG. Patients' practices and experiences of using nebuliser therapy in the management of COPD at home. BMJ Open Respir Res 2015; 2:e000076. [PMID: 25806114 PMCID: PMC4360584 DOI: 10.1136/bmjresp-2014-000076] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 01/29/2015] [Accepted: 02/04/2015] [Indexed: 11/23/2022] Open
Abstract
Background and aim How patients use their nebulisers at home is vital to ensure effective treatment and optimal health outcomes for patients with chronic obstructive pulmonary disease (COPD). The aim of the study was to identify the practicalities and problems associated with nebuliser use by patients with COPD at home, which may impact on the safety and effectiveness of therapy. Design and setting A cross-sectional descriptive study in which participants were recruited from two levels of care: primary care, involving 38 GP practices in North West London, and intermediate care with a major acute hospital. Method In-depth interviews were conducted with a representative sample of 50 patients with COPD using nebulisers in their home, recruited from general practice populations and at hospital discharge. A checklist was used to record activities and patients demonstrated use of their nebuliser. Qualitative procedures were employed to identify the range of problems experienced with nebuliser use. Results A wide range of practical issues was identified at all stages: problems prior to nebulisation: setting up equipment, lack of instructions, manual dexterity and time required. Problems during medication administration: inhalation technique, duration of nebulisation and understanding how to achieve optimal efficacy. Problems post-administration: inadequate cleaning of nebuliser components, access to accessories and use of damaged parts or self-repairs. Other problems included noise, weight and non-portability of equipment. Conclusions Patients with COPD using nebulisers at home experienced problems with all aspects, many of which may be anticipated to compromise clinical outcomes. Healthcare providers should be aware of these problems to effectively support patients with COPD with the use of their nebulisers at home.
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Affiliation(s)
- B Alhaddad
- Public Authority for Applied Education & Training , College of Health Sciences , Shuwaikh , Kuwait
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Alhaddad B, O'Rourke C, Alalwani M, Zraik B, Yadav R, Chatterjee S. SAT0305 Interstitial Lung Disease (ILD) in Patients with Anti-Jo-1 Syndrome (AJS): A Descriptive Analysis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Alhaddad B, Ballou S, Aponte J. AB0828 Comparing Synovial Fluids and Inflammatory Markers during Acute Pseudogout in Patients with and without Known Inflammatory Arthropathy. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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