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Villar-Quiles RN, Sternberg D, Tredez G, Beatriz Romero N, Evangelista T, Lafôret P, Cintas P, Sole G, Sacconi S, Bendahhou S, Franques J, Cances C, Noury JB, Delmont E, Blondy P, Perrin L, Hezode M, Fournier E, Fontaine B, Stojkovic T, Vicart S. Phenotypical variability and atypical presentations in a French cohort of Andersen-Tawil syndrome. Eur J Neurol 2022; 29:2398-2411. [PMID: 35460302 DOI: 10.1111/ene.15369] [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] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/31/2022] [Accepted: 04/18/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND PURPOSE Andersen-Tawil syndrome (ATS) is a skeletal muscle channelopathy caused by KCNJ2 mutations, characterized by a clinical triad of periodic paralysis, cardiac arrhythmias and dysmorphism. The muscle phenotype, particularly the atypical forms with prominent permanent weakness or predominantly painful symptoms, remains incompletely characterized. METHODS A retrospective clinical, histological, electroneuromyography (ENMG) and genetic analysis of molecularly confirmed ATS patients, diagnosed and followed up at neuromuscular reference centers in France, was conducted. RESULTS Thirty-five patients from 27 unrelated families carrying 17 different missense KCNJ2 mutations (four novel mutations) and a heterozygous KCNJ2 duplication are reported. The typical triad was observed in 42.9% of patients. Cardiac abnormalities were observed in 65.7%: 56.5% asymptomatic and 39.1% requiring antiarrhythmic drugs. 71.4% of patients exhibited dysmorphic features. Muscle symptoms were reported in 85.7%, amongst whom 13.3% had no cardiopathy and 33.3% no dysmorphic features. Periodic paralysis was present in 80% and was significantly more frequent in men. Common triggers were exercise, immobility and carbohydrate-rich diet. Ictal serum potassium concentrations were low in 53.6%. Of the 35 patients, 45.7% had permanent weakness affecting proximal muscles, which was mild and stable or slowly progressive over several decades. Four patients presented with exercise-induced pain and myalgia attacks. Diagnostic delay was 14.4 ± 9.5 years. ENMG long-exercise test performed in 25 patients (71.4%) showed in all a decremental response up to 40%. Muscle biopsy performed in 12 patients revealed tubular aggregates in six patients (associated in two of them with vacuolar lesions), dystrophic features in one patient and non-specific myopathic features in one patient; it was normal in four patients. DISCUSSION Recognition of atypical features (exercise-induced pain or myalgia and permanent weakness) along with any of the elements of the triad should arouse suspicion. The ENMG long-exercise test has a high diagnostic yield and should be performed. Early diagnosis is of utmost importance to improve disease prognosis.
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Affiliation(s)
- Rocio Nur Villar-Quiles
- Reference Center for Neuromuscular Disorders, APHP, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France.,Institute of Myology, Centre de Recherche en Myologie, UMRS974, Sorbonne Université - INSERM, Paris, France
| | - Damien Sternberg
- Reference Center for Muscle Channelopathies, Service de Biochimie et Centre de Génétique, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Grégoire Tredez
- Reference Center for Neuromuscular Disorders, APHP, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France
| | - Norma Beatriz Romero
- Institute of Myology, Centre de Recherche en Myologie, UMRS974, Sorbonne Université - INSERM, Paris, France.,Neuromuscular Morphology Unit, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France
| | - Teresinha Evangelista
- Reference Center for Neuromuscular Disorders, APHP, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France.,Institute of Myology, Centre de Recherche en Myologie, UMRS974, Sorbonne Université - INSERM, Paris, France.,Neuromuscular Morphology Unit, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France
| | - Pascal Lafôret
- Reference Center for Neuromuscular Disorders, APHP, Raymond-Poincaré Hospital, Paris, France
| | - Pascal Cintas
- Neurology Department, Pierre-Paul Riquet Hospital, CHU Toulouse, Toulouse, France
| | - Guilhem Sole
- Reference Centre for Neuromuscular Disorders, Pellegrin Hospital CHU Bordeaux, Bordeaux, France
| | - Sabrina Sacconi
- Neuromuscular Diseases and ALS Specialized Center, University of Nice-Sophia Antipolis, Nice, France
| | - Said Bendahhou
- UMR7370 CNRS, LP2M, Labex ICST, Faculty of Medicine, University of Nice-Sophia Antipolis, Nice, France
| | - Jérôme Franques
- Assistance Publique-Hôpitaux de Marseille, Department of Neurology and Neuromuscular Diseases, La Timone Hospital, Marseille, France
| | - Claude Cances
- AOC (Atlantique-Occitanie-Caraïbe) Reference Centre for Neuromuscular Disorders, Neuropediatric Department, Toulouse University Hospital, Toulouse, France
| | - J B Noury
- Neurology Department, Neuromuscular Center, CHRU Cavale Blanche, Brest, France
| | - Emilien Delmont
- Department of Neurology, University Hospital Timone, Marseille, France
| | - Patricia Blondy
- Reference Center for Muscle Channelopathies, Service de Biochimie et Centre de Génétique, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Laurence Perrin
- Pediatrics Department, APHP, Robert-Débré Hospital, Paris, France
| | - Marianne Hezode
- Reference Center for Neuromuscular Disorders, APHP, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France
| | - Emmanuel Fournier
- Reference Center for Neuromuscular Disorders, APHP, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France
| | - Bertrand Fontaine
- Reference Center for Neuromuscular Disorders, APHP, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France.,Institute of Myology, Centre de Recherche en Myologie, UMRS974, Sorbonne Université - INSERM, Paris, France.,Reference Center for Muscle Channelopathies, APHP, Institut de Myologie, Pitié-Salpêtrière Hospital, Paris, France
| | - Tanya Stojkovic
- Reference Center for Neuromuscular Disorders, APHP, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France.,Institute of Myology, Centre de Recherche en Myologie, UMRS974, Sorbonne Université - INSERM, Paris, France
| | - Savine Vicart
- Reference Center for Neuromuscular Disorders, APHP, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France.,Reference Center for Muscle Channelopathies, APHP, Institut de Myologie, Pitié-Salpêtrière Hospital, Paris, France
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Noury JB, Zagnoli F, Carré JL, Drouillard I, Petit F, Le Maréchal C, Marcorelles P, Rannou F. Exercise testing-based algorithms to diagnose McArdle disease and MAD defects. Acta Neurol Scand 2018; 138:301-307. [PMID: 29749052 DOI: 10.1111/ane.12957] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE As exercise intolerance and exercise-induced myalgia are commonly encountered in metabolic myopathies, functional screening tests are commonly used during the diagnostic work-up. Our objective was to evaluate the accuracy of isometric handgrip test (IHT) and progressive cycle ergometer test (PCET) to identify McArdle disease and myoadenylate deaminase (MAD) deficiency and to propose diagnostic algorithms using exercise-induced lactate and ammonia variations. METHODS A prospective sample of 46 patients underwent an IHT and a PCET as part of their exercise-induced myalgia and intolerance evaluation. The two diagnostics tests were compared against the results of muscle biopsy and/or the presence of mutations in PYGM. A total of 6 patients had McArdle disease, 5 a complete MAD deficiency (MAD absent), 12 a partial MAD deficiency, and 23 patients had normal muscle biopsy and acylcarnitine profile (disease control). RESULTS The two functional tests could diagnose all McArdle patients with statistical significance, combining a low lactate variation (IHT: <1 mmol/L, AUC = 0.963, P < .0001; PCET: <1 mmol/L, AUC = 0.990, P < .0001) and a large ammonia variation (IHT: >100 μmol/L, AUC = 0.944, P = .0005; PCET: >20 μmol/L, AUC = 1). PCET was superior to IHT for MAD absent diagnosis, combining very low ammonia variation (<10 μmol/L, AUC = 0.910, P < .0001) and moderate lactate variation (>1 mmol/L). CONCLUSIONS PCET-based decision tree was more accurate than IHT, with respective generalized squared correlations of 0.796 vs 0.668. IHT and PCET are both interesting diagnostic tools to identify McArdle disease, whereas cycle ergometer exercise is more efficient to diagnose complete MAD deficiency.
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Affiliation(s)
- J.-B. Noury
- Neurology Department; CHRU Cavale Blanche; Brest France
| | - F. Zagnoli
- Neurology Department; CHRU Cavale Blanche; Brest France
| | - J.-L. Carré
- Biochemistry Department-EA 4685; CHRU Cavale Blanche; Brest France
| | - I. Drouillard
- Biochemistry Department; Clermont-Tonnerre Armed Forces Hospital; Brest France
| | - F. Petit
- Molecular Genetics Department; APHP - GH Antoine Béclère; Clamart France
| | - C. Le Maréchal
- Institut National de la Santé et de la Recherche Médicale- UMR 1078; Brest France
| | - P. Marcorelles
- Pathology Department-EA 4685 LNB; CHRU Morvan; Brest France
| | - F. Rannou
- Physiology Department- EA 4324; CHRU Cavale Blanche; Brest France
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