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Kruijt N, van den Bersselaar LR, Hopman MTE, Snoeck MMJ, van Rijswick M, Wiggers TGH, Jungbluth H, Bongers CCWG, Voermans NC. Exertional Heat Stroke and Rhabdomyolysis: A Medical Record Review and Patient Perspective on Management and Long-Term Symptoms. Sports Med Open 2023; 9:33. [PMID: 37204519 DOI: 10.1186/s40798-023-00570-y] [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] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/19/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Exertional heat stroke (EHS) is a medical emergency, occurring when the body generates more heat than it can dissipate, and frequently associated with exertional rhabdomyolysis (ERM). In the present study we aimed to (I) identify clinical features and risk factors, (II) describe current prehospital management, (III) investigate long-term outcomes including the impact on mental health, and review the guidance received during restarting activities. We hope that our approach will improve individual and organizational heat illness preparedness, and improve follow-up care. METHODS We performed a prospective online survey and retrospective medical record review among athletes and military personnel with an episode of EHS/ERM in the Netherlands between 2010 and 2020. We evaluated prehospital management, risk factors, clinical features and long-term outcomes at 6 and 12 months after the event, including mental health symptoms. Furthermore, we investigated what guidance participants received during follow-up, and assessed the patients' perspective on these outcomes. RESULTS Sixty participants were included, 42 male (70%) and 18 female (30%), of which 47 presented with EHS (78%) and 13 with ERM (22%). Prehospital management was inconsistent and in the majority of participants not conducted according to available guidelines. Self-reported risk factors included not feeling well-acclimatized to environmental heat (55%) and peer pressure (28%). Self-reported long-term symptoms included muscle symptoms at rest (26%) or during exercise (28%), and neurological sequelae (11%). Validated questionnaires (CIS, HADS and SF-36) were indicative of severe fatigue (30%) or mood/anxiety disorders (11%). Moreover, 90% expressed a lack of follow-up care and that a more frequent and intensive follow-up would have been beneficial for their recovery process. CONCLUSION Our findings indicate major inconsistencies in the management of patients with EHS/ERM, emphasizing the compelling need for implementing standardized protocols. Based on the results of long-term outcome measures, we recommend to counsel and evaluate every patient not only immediately after the event, but also in the long-term.
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Affiliation(s)
- Nick Kruijt
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Geert Grooteplein 10 (Route 652), 6525 GA, Nijmegen, The Netherlands.
- Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands.
| | - L R van den Bersselaar
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Geert Grooteplein 10 (Route 652), 6525 GA, Nijmegen, The Netherlands
- Malignant Hyperthermia Investigation Unit, Department of Anesthesiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - M T E Hopman
- Department of Physiology, Radboudumc, Nijmegen, The Netherlands
| | - M M J Snoeck
- Malignant Hyperthermia Investigation Unit, Department of Anesthesiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - M van Rijswick
- Department of Exercise Medicine and Exercise Physiology, Royal Dutch Army, Utrecht, The Netherlands
| | - T G H Wiggers
- Department of Sports Medicine, Anna Hospital, Geldrop, The Netherlands
| | - H Jungbluth
- Randall Centre for Cell and Molecular Biophysics, Muscle Signalling Section, Faculty of Life Sciences and Medicine (FoLSM), King's College London, London, UK
- Department of Paediatric Neurology, Neuromuscular Service, Evelina Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - C C W G Bongers
- Department of Physiology, Radboudumc, Nijmegen, The Netherlands
| | - N C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Geert Grooteplein 10 (Route 652), 6525 GA, Nijmegen, The Netherlands
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van den Bersselaar L, Gubbels M, Jungbluth H, Schouten M, van der Kooi A, Quinlivan R, Scheffer G, Riazi S, Snoeck M, Voermans N. Perioperative Care for Patients with Neuromuscular Disorders in the Netherlands –A Questionnaire Study Among Anaesthesiologists, Neurologists and Clinical Geneticists. J Neuromuscul Dis 2022; 9:765-775. [DOI: 10.3233/jnd-221512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Patients with neuromuscular disorders are at increased risk of suffering perioperative complications. Current knowledge concerning this topic is based on small retrospective studies and expert opinion. Therefore, an individualized multidisciplinary approach to perioperative anaesthesia planning is invaluable to anticipate difficulties and to optimize outcomes. Objective: To evaluate current practice regarding preoperative counselling and perioperative care of neuromuscular patients, with the aim to facilitate standardization and improvement of perioperative care for neuromuscular patients. Methods: A questionnaire-based cross-sectional, observational study was conducted between July, 1st 2020 and December, 31st, 2020 in Dutch anaesthesia, neurology and clinical genetics departments. Main outcome measures were 1.) frequency of consultation requests for neuromuscular patients prior to surgery, 2.) current practice, educational activities and departmental approach to this topic and 3.) preoperative counselling of neuromuscular patients. Results: A total of 83 departments participated. Consultations for a neuromuscular patient scheduled for anaesthesia were requested from anaesthesia and neurology department only infrequently. Local guidelines concerning perioperative care of neuromuscular patients were available in 36.4% of the participating departments. Quality of specific training for residents and staff anaesthetists/neurologists covering perioperative care of neuromuscular patients was rated as ‘very good’ or ‘good’ by 42.9% . Neuromuscular patients scheduled for surgery were ‘always’ or ‘often’ discussed in multidisciplinary meetings involving anaesthesiologists and neurologists in 20.8% of the participating departments. Conclusion: Perioperative care for neuromuscular patients in the Netherlands is highly variable and might benefit from guidelines, education of health care professionals and multidisciplinary meetings between anaesthesiologists and neurologists on a regular basis.
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Affiliation(s)
- L.R. van den Bersselaar
- Malignant Hyperthermia Investigation Unit, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M.H.M. Gubbels
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H. Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina’s Children Hospital, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, United Kingdom
- Randall Centre for Cell and Molecular Biophysics, Muscle Signalling Section, Faculty of Life Sciences and Medicine (FoLSM), King’s College London, London, United Kingdom
| | - M.I. Schouten
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A.J. van der Kooi
- Department of Neurology, Amsterdam University Medical Center, Neuroscience institute, Amsterdam, The Netherlands
| | - R. Quinlivan
- MRC Centre for Neuromuscular Diseases, National Hospital, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - G.J. Scheffer
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S. Riazi
- Department of Anesthesiology and Pain Medicine, Malignant Hyperthermia Investigation Unit, University Health Network, University of Toronto, Toronto, Canada
| | - M.M.J. Snoeck
- Malignant Hyperthermia Investigation Unit, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - N.C. Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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van den Bersselaar LR, Riazi S, Snoeck M, Jungbluth H, Voermans NC. 259th ENMC international workshop: Anaesthesia and neuromuscular disorders 11 December, 2020 and 28-29 May, 2021. Neuromuscul Disord 2021; 32:86-97. [PMID: 34916120 DOI: 10.1016/j.nmd.2021.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 02/07/2023]
Affiliation(s)
- L R van den Bersselaar
- Department of Anaesthesiology, Malignant Hyperthermia Investigation Unit, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands; Department of Neurology, Radboud University Medical Center, Reinier Postlaan 4, P.O. Box 9101, 6500 HB, Nijmegen 6525 GC, the Netherlands
| | - S Riazi
- Department of Anesthesiology and Pain Medicine, Malignant Hyperthermia Investigation Unit, University Health Network, University of Toronto, Toronto, Canada
| | - Mmj Snoeck
- Department of Anaesthesiology, Malignant Hyperthermia Investigation Unit, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - H Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom; Randall Centre for Cell and Molecular Biophysics, Muscle Signalling Section, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - N C Voermans
- Department of Neurology, Radboud University Medical Center, Reinier Postlaan 4, P.O. Box 9101, 6500 HB, Nijmegen 6525 GC, the Netherlands.
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Braun F, Reumers S, Spillane J, Bohm J, Pennings M, Schouten M, van der Kooi A, Foley A, Bönnemann C, Kamsteeg E, Erasmus C, Schara-Schmidt U, Jungbluth H, Voermans N. CONGENITAL MYOPATHIES – CENTRONUCLEAR MYOPATHIES. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.056] [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: 11/16/2022]
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Riazi S, van den Bersselaar L, Islander G, Heytens L, Snoeck M, Bjorksten A, Gillies R, Dranitsaris G, Hellblom A, Treves S, Voermans N, Jungbluth H. CLINICAL RESEARCH. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.023] [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: 11/16/2022]
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Bullivant J, Porter B, Murphy L, Render L, Bellgard M, Lennox A, Spring M, Hollander A, Bönnemann C, Jungbluth H, Buj-Bello A, Dowling J, Marini-Bettolo C. CONGENITAL MYOPATHIES – CENTRONUCLEAR MYOPATHIES. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.050] [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: 10/20/2022]
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Bachmann C, Kruijt N, van den Bersselaar L, Bouman K, Fernandez M, Muntoni F, Jungbluth H, Voermans N, Zorzato F, Treves S. CONGENITAL MYOPATHIES. Neuromuscul Disord 2021. [DOI: 10.1016/j.nmd.2021.07.073] [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: 11/16/2022]
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van den Bersselaar LR, Greven T, Bulger T, Voermans NC, van Petegem F, Schiemann AH, Parker R, Burling SM, Jungbluth H, Stowell KM, Kamsteeg EJ, Snoeck MMJ. RYR1 variant c.38T>G, p.Leu13Arg causes hypersensitivity of the ryanodine receptor-1 and is pathogenic for malignant hyperthermia. Br J Anaesth 2021; 127:e63-e65. [PMID: 34127251 DOI: 10.1016/j.bja.2021.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - T Greven
- Department of Anaesthesia, Nijmegen, the Netherlands
| | | | - N C Voermans
- Department of Anaesthesia, Nijmegen, the Netherlands
| | | | | | | | | | | | | | - E J Kamsteeg
- Department of Anaesthesia, Nijmegen, the Netherlands
| | - M M J Snoeck
- Department of Anaesthesia, Nijmegen, the Netherlands.
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Kruijt N, van den Bersselaar LR, Kamsteeg EJ, Verbeeck W, Snoeck MMJ, Everaerd DS, Abdo WF, Jansen DRM, Erasmus CE, Jungbluth H, Voermans NC. The etiology of rhabdomyolysis: an interaction between genetic susceptibility and external triggers. Eur J Neurol 2020; 28:647-659. [PMID: 32978841 PMCID: PMC7821272 DOI: 10.1111/ene.14553] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 05/27/2020] [Accepted: 09/09/2020] [Indexed: 01/04/2023]
Abstract
Background and purpose Rhabdomyolysis is a medical emergency characterized by acute skeletal muscle breakdown with a sudden rise and subsequent fall of serum creatine kinase (CK) levels. Rhabdomyolysis events are provoked by exposure to external triggers, possibly in combination with an increased genetic susceptibility. We aimed to describe comprehensively the external triggers and potentially pathogenic genetic variants possibly implicated in increased rhabdomyolysis susceptibility. Methods We performed a retrospective single‐center study, including a total of 1302 patients with an acute CK level exceeding 2000 IU/l. Results Anoxia was the most frequently reported trigger (40%). A subset of 193 patients were clinically suspected of an underlying genetic disorder (recurrent episodes, a positive family history, very high or persistently increased CK levels). In 72 of these patients, an unequivocal genetic defect was identified. A total of 22 genes with pathogenic variants were identified, including 52 different variants. Of those, 11 genes have been previously associated with rhabdomyolysis (ACADVL, ANO5, CPT2, DMD, DYSF, FKRP, HADHA, PGM1, LPIN1, PYGM, RYR1). Eleven genes are probably implicated in increased susceptibility (including AGL, CAPN3, CNBP, DMPK, MAGT1, ACADM, SCN4A, SGCA, SGCG, SMPD1, TANGO2). Conclusion These findings suggest that the spectrum of genetic susceptibility for rhabdomyolysis has not yet been completely clarified. With the increasing availability of next‐generation sequencing in a diagnostic setting, we expect that in more cases a genetic defect will be identified.
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Affiliation(s)
- N Kruijt
- Department of Neurology, Radboudumc, Nijmegen, The Netherlands
| | - L R van den Bersselaar
- Department of Neurology, Radboudumc, Nijmegen, The Netherlands.,Malignant Hyperthermia Investigation Unit, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - E J Kamsteeg
- Department of Human Genetics, Radboud Institute for Health Sciences, Radboudumc, Nijmegen, The Netherlands
| | - W Verbeeck
- Department of Pharmacology and Toxicology, Radboudumc, Nijmegen, The Netherlands.,Vincent van Gogh Institute for Psychiatry, Venlo, Venray, The Netherlands
| | - M M J Snoeck
- Malignant Hyperthermia Investigation Unit, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - D S Everaerd
- Department of Psychiatry, Radboudumc, Nijmegen, The Netherlands
| | - W F Abdo
- Department of Intensive Care Medicine, Radboudumc, Nijmegen, The Netherlands
| | - D R M Jansen
- Department of Geriatrics, Radboudumc, Nijmegen, The Netherlands
| | - C E Erasmus
- Department of Neurology, Radboudumc, Nijmegen, The Netherlands.,Department of Paediatrics, Radboudumc, Nijmegen, The Netherlands
| | - H Jungbluth
- Randall Division for Cell and Molecular Biophysics, Muscle Signalling Section, King's College, London, UK.,Department of Basic and Clinical Neuroscience, IoPPN, King's College, London, UK.,Department of Paediatric Neurology, Neuromuscular Service, Guy's and St Thomas' Hospital NHS Foundation Trust, Evelina Children's Hospital, London, UK
| | - N C Voermans
- Department of Neurology, Radboudumc, Nijmegen, The Netherlands
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Sa M, Ridout D, Distefano M, Fernandez-Garcia M, Main M, Mein R, Phadke R, Jungbluth H, Muntoni F, Sarkozy A. CONGENITAL MYOPATHIES 2. Neuromuscul Disord 2020. [DOI: 10.1016/j.nmd.2020.08.100] [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: 10/23/2022]
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O'Rahelly M, Fernandez-Garcia M, Hahn A, Nguyen C, Kim D, Byun S, Koelbel H, Schara U, Henrich M, Leslie J, Eymard B, Chouchane M, Roefke K, Thieme A, van den Bergh P, Paquay S, Schneider-Gold C, Vincent A, Allen N, Jungbluth H. P.379Fetal Acetylcholine Receptor Inactivation Syndrome (FARIS): A potentially treatable autoimmune disorder mimicking a wide range of genetic neuromuscular conditions. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.541] [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: 10/25/2022]
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Sarkozy A, Fernandez-Garcia M, Manzur A, Mein R, Bodi I, Phadke R, Wraige E, Deshpande C, Holder S, Hurst J, Gautel M, Jungbluth H, Muntoni F. P.109Congenital myopathy in patients with Kabuki and Au-Kline syndromes - Double trouble or expansion of the phenotypes? Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.165] [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: 10/25/2022]
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Sarkozy A, Mein R, Oates E, Zaharieva I, Jungbluth H, Manzur A, Robb S, Munot P, Feng L, Sewry C, Phadke R, Muntoni F. P.238The Dubowitz neuromuscular centre experience in TTN gene analysis in UK patients with congenital myopathies. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.352] [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: 11/25/2022]
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Phadke R, Sarkozy A, Oates E, Mein R, Bodi I, Feng L, Manzur A, Thomas N, Illingworth M, Mazanti I, Ellard S, Sewry C, Gautel M, Jungbluth H, Muntoni F. P.236Myofibres with subsarcolemmal rims and/or central aggregates of mitochondria (SRCAM) are prevalent in congenital titinopathies. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.350] [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: 11/24/2022]
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Knuiman GJ, Küsters B, Eshuis L, Snoeck M, Lammens M, Heytens L, De Ridder W, Baets J, Scalco RS, Quinlivan R, Holton J, Bodi I, Wraige E, Radunovic A, von Landenberg C, Reimann J, Kamsteeg EJ, Sewry C, Jungbluth H, Voermans NC. The histopathological spectrum of malignant hyperthermia and rhabdomyolysis due to RYR1 mutations. J Neurol 2019; 266:876-887. [PMID: 30788618 PMCID: PMC6420893 DOI: 10.1007/s00415-019-09209-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/16/2019] [Accepted: 01/19/2019] [Indexed: 12/22/2022]
Abstract
Objective The histopathological features of malignant hyperthermia (MH) and non-anaesthetic (mostly exertional) rhabdomyolysis (RM) due to RYR1 mutations have only been reported in a few cases. Methods We performed a retrospective multi-centre cohort study focussing on the histopathological features of patients with MH or RM due to RYR1 mutations (1987–2017). All muscle biopsies were reviewed by a neuromuscular pathologist. Additional morphometric and electron microscopic analysis were performed where possible. Results Through the six participating centres we identified 50 patients from 46 families, including patients with MH (n = 31) and RM (n = 19). Overall, the biopsy of 90% of patients showed one or more myopathic features including: increased fibre size variability (n = 44), increase in the number of fibres with internal nuclei (n = 30), and type I fibre predominance (n = 13). Abnormalities on oxidative staining, generally considered to be more specifically associated with RYR1-related congenital myopathies, were observed in 52%, and included unevenness (n = 24), central cores (n = 7) and multi-minicores (n = 3). Apart from oxidative staining abnormalities more frequently observed in MH patients, the histopathological spectrum was similar between the two groups. There was no correlation between the presence of cores and the occurrence of clinically detectable weakness or presence of (likely) pathogenic variants. Conclusions Patients with RYR1-related MH and RM exhibit a similar histopathological spectrum, ranging from mild myopathic changes to cores and other features typical of RYR1-related congenital myopathies. Suggestive histopathological features may support RYR1 involvement, also in cases where the in vitro contracture test is not informative. Electronic supplementary material The online version of this article (10.1007/s00415-019-09209-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- G J Knuiman
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - B Küsters
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - L Eshuis
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M Snoeck
- National MH Investigation Unit, Department of Anaesthesiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - M Lammens
- Department of Pathology, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - L Heytens
- Malignant Hyperthermia Research Unit, University of Antwerp, Antwerp, Belgium
| | - W De Ridder
- Neurogenetics Group, Center for Molecular Neurology, VIB, Antwerp, Belgium
- Laboratory of Neuromuscular Pathology, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
- Department of Neurology, Neuromuscular Reference Centre, Antwerp University Hospital, Antwerp, Belgium
| | - J Baets
- Neurogenetics Group, Center for Molecular Neurology, VIB, Antwerp, Belgium
- Laboratory of Neuromuscular Pathology, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
- Department of Neurology, Neuromuscular Reference Centre, Antwerp University Hospital, Antwerp, Belgium
| | - R S Scalco
- MRC Centre for Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - R Quinlivan
- MRC Centre for Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - J Holton
- MRC Centre for Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - I Bodi
- Department of Paediatric Neurology, Neuromuscular Service, Evelina Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - E Wraige
- Department of Paediatric Neurology, Neuromuscular Service, Evelina Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - A Radunovic
- Barts Neuromuscular Diseases Centre, Royal London Hospital, London, UK
| | - C von Landenberg
- Muscle Lab, Department of Neurology, University of Bonn Medical Centre, Bonn, Germany
| | - J Reimann
- Muscle Lab, Department of Neurology, University of Bonn Medical Centre, Bonn, Germany
| | - E-J Kamsteeg
- Department of Human Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - C Sewry
- Dubowitz Neuromuscular Centre, UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
| | - H Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
- Muscle Signalling Section, Randall Division for Cell and Molecular Biophysics, King's College, London, UK
- Department of Basic and Clinical Neuroscience, King's College, IoPPN, London, UK
| | - N C Voermans
- Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands.
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van Ruitenbeek E, Custers JAE, Verhaak C, Snoeck M, Erasmus CE, Kamsteeg EJ, Schouten MI, Coleman C, Treves S, Van Engelen BG, Jungbluth H, Voermans NC. Functional impairments, fatigue and quality of life in RYR1-related myopathies: A questionnaire study. Neuromuscul Disord 2018; 29:30-38. [PMID: 30578099 DOI: 10.1016/j.nmd.2018.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 08/27/2018] [Revised: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 01/01/2023]
Abstract
Mutations in RYR1 are a common genetic cause of non-dystrophic neuromuscular disorders. To obtain baseline data concerning the prevalence of fatigue, the psychological disease burden and quality of life associated with these common conditions, we performed a questionnaire study. Seventy-two patients were included in this study, 33 with a congenital myopathy and 39 with malignant hyperthermia or exertional rhabdomyolysis. Our results showed that patients with RYR1-related myopathies have more functional impairments and significant chronic fatigue compared to healthy controls, with almost half of patients being severely fatigued. Whilst fatigue, pain and associated physical and social difficulties were more pronounced in those with permanent phenotypes, individuals with intermittent phenotypes also scored higher in all relevant categories compared to healthy controls. These findings indicate that RYR1-related myopathies, despite being often considered relatively mild conditions, are nevertheless associated with severe fatigue and functional limitations, resulting in substantial loss of quality of life. Moreover, milder but in essence similar findings in patients with RYR1-related malignant hyperthermia and rhabdomyolysis suggest that those phenotypes are not truly episodic but in fact associated with a substantial permanent disease burden. These preliminary data should help to design more comprehensive quality of life studies to inform standards of care.
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Affiliation(s)
- E van Ruitenbeek
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J A E Custers
- Department of Medical Psychology, Radboudumc, Nijmegen, The Netherlands
| | - C Verhaak
- Department of Medical Psychology, Radboudumc, Nijmegen, The Netherlands
| | - M Snoeck
- Department of Anesthesiology, Canisius Wilhelmina Hospital Nijmegen, The Netherlands
| | - C E Erasmus
- Department of Pediatric Neurology, Radboudumc, Nijmegen, The Netherlands
| | - E J Kamsteeg
- Department of Human Genetics, Radboudumc, Nijmegen, The Netherlands
| | - M I Schouten
- Department of Human Genetics, Radboudumc, Nijmegen, The Netherlands
| | - C Coleman
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK
| | - S Treves
- Basel University, Basel, Switzerland
| | - B G Van Engelen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK; Randall Division for Cell and Molecular Biophysics, Muscle Signaling Section, King's College, London, UK; Department of Basic and Clinical Neuroscience, IoPPN, King's College London, London, UK
| | - N C Voermans
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands.
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17
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Hackman P, Savarese M, Bönnemann C, Ferreiro A, Beggs A, Dawson J, Thompson R, Evangelista T, Lochmüller H, Nikodinovic Glumac J, Jungbluth H, Foye S, Udd B. CONGENITAL MYOPATHIES: NEMALINE AND TITINOPATHIES. Neuromuscul Disord 2018. [DOI: 10.1016/j.nmd.2018.06.286] [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: 10/28/2022]
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18
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Abstract
Over the last two decades, muscle (magnetic resonance) imaging has become an important complementary tool in the diagnosis and differential diagnosis of inherited neuromuscular disorders, particularly in conditions where the pattern of selective muscle involvement is often more predictive of the underlying genetic background than associated clinical and histopathological features. Following an overview of different imaging modalities, the present review will give a concise introduction to systematic image analysis and interpretation in genetic neuromuscular disorders. The pattern of selective muscle involvement will be presented in detail in conditions such as the congenital or myofibrillar myopathies where muscle imaging is particularly useful to inform the (differential) diagnosis, and in disorders such as Duchenne or fascioscapulohumeral muscular dystrophy where the diagnosis is usually made on clinical grounds but where detailed knowledge of disease progression on the muscle imaging level may inform better understanding of the natural history. Utilizing the group of the congenital myopathies as an example, selected case studies will illustrate how muscle MRI can be used to inform the diagnostic process in the clinico-pathological context. Future developments, in particular, concerning the increasing use of whole-body MRI protocols and novel quantitative fat assessments techniques potentially relevant as an outcome measure, will be briefly outlined.
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Affiliation(s)
- H Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK.,Randall Division of Cell and Molecular Biophysics, Muscle Signalling Section, London, UK.,Department of Clinical and Basic Neuroscience, IoPPN, King's College, London, UK
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19
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Marks S, van Ruitenbeek E, Fallon P, Johns P, Phadke R, Mein R, Mohammed S, Jungbluth H. Parental mosaicism in RYR1-related Central Core Disease. Neuromuscul Disord 2018; 28:422-426. [PMID: 29576327 DOI: 10.1016/j.nmd.2018.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 07/29/2017] [Revised: 01/20/2018] [Accepted: 02/20/2018] [Indexed: 11/15/2022]
Abstract
Myopathies due to mutations in the skeletal muscle ryanodine receptor (RYR1) gene are amongst the most common non-dystrophic neuromuscular disorders and have been associated with both dominant and recessive inheritance. Several cases with apparently de novo dominant inheritance have been reported. Here we report two siblings with features of Central Core Disease (CCD) born to unaffected parents. Genetic testing revealed a heterozygous dominant RYR1 c.14582G>A (p. Arg4861His) mutation previously identified in other CCD pedigrees. The variant was absent in blood from the asymptomatic mother but detected at low but variable levels in blood- and saliva-derived DNA from the unaffected father, suggesting that this mutation has arisen as a paternal post-zygotic de novo event. These findings suggest that parental mosaicism should be considered in RYR1-related myopathies, and may provide one possible explanation for the marked intergenerational variability seen in some RYR1 pedigrees.
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Affiliation(s)
- S Marks
- Viapath, Guy's Hospital, London, UK
| | - E van Ruitenbeek
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK; Radboud University Medical School, Nijmegen, The Netherlands
| | - P Fallon
- Department of Paediatric Neurology, St. George's Hospital, London, UK
| | - P Johns
- Department of Cellular Pathology, St. George's Hospital, London, UK
| | - R Phadke
- Dubowitz Neuromuscular Centre, Great Ormond Street Hospital for Children, London, UK
| | - R Mein
- Viapath, Guy's Hospital, London, UK
| | - S Mohammed
- Department of Clinical Genetics, Guy's Hospital, London, UK
| | - H Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK; Randall Division for Cell and Molecular Biophysics, Muscle Signaling Section, King's College, London, UK; Department of Basic and Clinical Neuroscience, IoPPN, King's College London, London, UK.
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20
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Piano Mortari E, Folgiero V, Marcellini V, Romania P, Bellacchio E, D'Alicandro V, Bocci C, Carrozzo R, Martinelli D, Petrini S, Axiotis E, Farroni C, Locatelli F, Schara U, Pilz D, Jungbluth H, Dionisi-Vici C, Carsetti R. The Vici syndrome protein EPG5 regulates intracellular nucleic acid trafficking linking autophagy to innate and adaptive immunity. Autophagy 2018; 14:22-37. [PMID: 29130391 PMCID: PMC5846549 DOI: 10.1080/15548627.2017.1389356] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 12/21/2016] [Revised: 09/19/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022] Open
Abstract
Vici syndrome is a human inherited multi-system disorder caused by recessive mutations in EPG5, encoding the EPG5 protein that mediates the fusion of autophagosomes with lysosomes. Immunodeficiency characterized by lack of memory B cells and increased susceptibility to infection is an integral part of the condition, but the role of EPG5 in the immune system remains unknown. Here we show that EPG5 is indispensable for the transport of the TLR9 ligand CpG to the late endosomal-lysosomal compartment, and for TLR9-initiated signaling, a step essential for the survival of human memory B cells and their ultimate differentiation into plasma cells. Moreover, the predicted structure of EPG5 includes a membrane remodeling domain and a karyopherin-like domain, thus explaining its function as a carrier between separate vesicular compartments. Our findings indicate that EPG5, by controlling nucleic acids intracellular trafficking, links macroautophagy/autophagy to innate and adaptive immunity.
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Affiliation(s)
- E. Piano Mortari
- B cell Physiopathology Unit, Immunology Research Area, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - V. Folgiero
- Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - V. Marcellini
- B cell Physiopathology Unit, Immunology Research Area, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - P. Romania
- Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - E. Bellacchio
- Division of Metabolism, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - V. D'Alicandro
- Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - C. Bocci
- B cell Physiopathology Unit, Immunology Research Area, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - R. Carrozzo
- Unit for Neuromuscular and Neurodegenerative Diseases, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - D. Martinelli
- Division of Metabolism, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - S. Petrini
- Confocal Microscopy core facility, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - E. Axiotis
- B cell Physiopathology Unit, Immunology Research Area, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - C. Farroni
- B cell Physiopathology Unit, Immunology Research Area, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - F. Locatelli
- Department of Pediatric Hematology and Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
- Department of Pediatric Science, University of Pavia, Pavia, Italy
| | - U. Schara
- 41 Pediatric Neurology, University Childrens Hospital, University of Duisburg-Essen, Essen, Germany
| | - D.T. Pilz
- West of Scotland Genetics Service, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - H. Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK
- Randall Division for Cell and Molecular Biophysics, Muscle Signalling Section, King's College, London, UK
- Department of Basic and Clinical Neuroscience, IoPPN, King's College, London, UK
| | - C. Dionisi-Vici
- Division of Metabolism, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - R. Carsetti
- B cell Physiopathology Unit, Immunology Research Area, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
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21
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Zaharieva I, Sarkozy A, Manzur A, Munot P, Jungbluth H, Feng L, Phadke R, Sewry C, Treves S, Muntoni F. Functional characterisation of p.Trp284Ser STAC3 mutation causing impaired excitation-contraction coupling in congenital myopathy patients. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.480] [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: 10/18/2022]
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22
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Hackman P, Savarese M, Bönneman C, Ferreiro A, Beggs A, Gautel M, Davis M, Evangelista T, Glumac JN, Laporte J, Smith J, Richard I, Granzier H, Schneider R, Jungbluth H, Foye S, Frase AR, Udd B. Establishment of an international database of Titin mutations and their phenotypes – a follow up. Neuromuscul Disord 2017. [DOI: 10.1016/j.nmd.2017.06.519] [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: 11/26/2022]
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23
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Lopez R, Byrne S, Vukcevic M, Sekulic-Jablanovic M, Xu L, Brink M, Alamelu J, Voermans N, Snoeck M, Clement E, Muntoni F, Zhou H, Radunovic A, Mohammed S, Wraige E, Zorzato F, Treves S, Jungbluth H. A novel bleeding disorder associated with RYR1 mutations. Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.019] [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: 10/21/2022]
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24
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Scalco R, Voermans N, Piercy R, Jungbluth H, Quinlivan R. Dantrolene as a treatment option for RYR1-related rhabdomyolysis. Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.185] [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: 11/15/2022]
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25
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Voermans NC, Snoeck M, Jungbluth H. RYR1-related rhabdomyolysis: A common but probably underdiagnosed manifestation of skeletal muscle ryanodine receptor dysfunction. Rev Neurol (Paris) 2016; 172:546-558. [PMID: 27663056 DOI: 10.1016/j.neurol.2016.07.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 06/03/2016] [Accepted: 07/29/2016] [Indexed: 01/04/2023]
Abstract
Mutations in the skeletal muscle ryanodine receptor (RYR1) gene are associated with a wide spectrum of inherited myopathies presenting throughout life. Malignant hyperthermia susceptibility (MHS)-related RYR1 mutations have emerged as a common cause of exertional rhabdomyolysis, accounting for up to 30% of rhabdomyolysis episodes in otherwise healthy individuals. Common triggers are exercise and heat and, less frequently, viral infections, alcohol and drugs. Most subjects are normally strong and have no personal or family history of malignant hyperthermia. Heat intolerance and cold-induced muscle stiffness may be a feature. Recognition of this (probably not uncommon) rhabdomyolysis cause is vital for effective counselling, to identify potentially malignant hyperthermia-susceptible individuals and to adapt training regimes. Studies in various animal models provide insights regarding possible pathophysiological mechanisms and offer therapeutic perspectives.
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Affiliation(s)
- N C Voermans
- Department of Neurology, Radboud University Medical Centre, R. Postlaan 4 (route 935), P.O. Box 9101, 6500 Nijmegen (935), The Netherlands.
| | - M Snoeck
- Department of Anaesthesia, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - H Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK; Randall Division of Cell and Molecular Biophysics, Muscle Signalling Section, London, UK; Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
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26
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Scalco RS, Voermans NC, Piercy RJ, Jungbluth H, Quinlivan R. Dantrolene as a possible prophylactic treatment for RYR1-related rhabdomyolysis. Eur J Neurol 2016; 23:e56-7. [PMID: 27431030 DOI: 10.1111/ene.13051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 04/21/2016] [Indexed: 11/28/2022]
Affiliation(s)
- R S Scalco
- MRC Centre for Neuromuscular Diseases, UCL, London, UK
| | - N C Voermans
- Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - R J Piercy
- Comparative Neuromuscular Diseases Laboratory, Royal Veterinary College, London
| | - H Jungbluth
- Department of Clinical and Basic Neuroscience, IoPPN, King's College, UK
| | - R Quinlivan
- MRC Centre for Neuromuscular Diseases, UCL, London, UK
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27
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Snoeck M, Treves S, Molenaar JP, Kamsteeg EJ, Jungbluth H, Voermans NC. "Human Stress Syndrome" and the Expanding Spectrum of RYR1-Related Myopathies. Cell Biochem Biophys 2016; 74:85-7. [PMID: 26972305 DOI: 10.1007/s12013-015-0704-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- M Snoeck
- National MH Investigation Unit, Department of Anesthesiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - S Treves
- Departments of Biomedicine and Anesthesia, University Hospital Basel, Basel, Switzerland
| | - J P Molenaar
- Department of Neurology, Radboud University Medical Centre, 935, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - E J Kamsteeg
- Department of Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - H Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK.,Randall Division for Cell and Molecular Biophysics, Muscle Signalling Section, King's College, London, UK
| | - N C Voermans
- Department of Neurology, Radboud University Medical Centre, 935, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
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28
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Donkervoort S, Bönnemann CG, Loeys B, Jungbluth H, Voermans NC. The neuromuscular differential diagnosis of joint hypermobility; S. Donkervoort, C. G. Bönnemann, B. Loeys, H. Jungbluth, and N. C. Voermans; Am J Med Genet C Semin Med Genet. 2015 Mar;169(1):23-42. Am J Med Genet A 2015. [DOI: 10.1002/ajmg.a.37244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- S. Donkervoort
- National Institutes of Health; National Institute of Neurological Disorders and Stroke; Neurogenetics Branch; Neuromuscular and Neurogenetic Disorders of Childhood Section; Bethesda Maryland
| | - C. G. Bönnemann
- National Institutes of Health; National Institute of Neurological Disorders and Stroke; Neurogenetics Branch; Neuromuscular and Neurogenetic Disorders of Childhood Section; Bethesda Maryland
| | - B. Loeys
- Department of Human Genetics; Radboud University Nijmegen Medical Centre; The Netherlands and center for medical genetics; Antwerp University Hospital and University of Antwerp; Antwerp Belgium
| | - H. Jungbluth
- Department of Paediatric Neurology - Neuromuscular Service; Evelina Children's Hospital; Guy's & St Thomas' NHS Foundation Trust; London UK
- Randall Division of Cell and Molecular Biophysics; Muscle Signalling Section; King's College London; London UK
- Department of Basic and Clinical Neuroscience; Institute of Psychiatry; Psychology and Neuroscience (IoPPN); King's College London; London UK
| | - N. C. Voermans
- Department of Neurology; Radboud University Nijmegen Medical Centre; The Netherlands
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29
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Gardiner A, Scalco R, Parton M, Hanna M, Pitceathly R, Zanoteli E, Murphy E, Treves S, Houlden H, Wilmshurst J, Straub V, Hilton-Jones D, Voermans N, Manzur A, Oflazer P, Reed U, Lachmann R, Quinlivan R, Jungbluth H. RYR1-related exertional rhabdomyolysis: Expanding spectrum and diagnostic challenges. Neuromuscul Disord 2015. [DOI: 10.1016/j.nmd.2015.06.263] [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: 10/23/2022]
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30
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Snoeck M, van Engelen BGM, Küsters B, Lammens M, Meijer R, Molenaar JPF, Raaphorst J, Verschuuren-Bemelmans CC, Straathof CSM, Sie LTL, de Coo IF, van der Pol WL, de Visser M, Scheffer H, Treves S, Jungbluth H, Voermans NC, Kamsteeg EJ. RYR1-related myopathies: a wide spectrum of phenotypes throughout life. Eur J Neurol 2015; 22:1094-112. [PMID: 25960145 DOI: 10.1111/ene.12713] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 02/06/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Although several recent studies have implicated RYR1 mutations as a common cause of various myopathies and the malignant hyperthermia susceptibility (MHS) trait, many of these studies have been limited to certain age groups, confined geographical regions or specific conditions. The aim of the present study was to investigate the full spectrum of RYR1-related disorders throughout life and to use this knowledge to increase vigilance concerning malignant hyperthermia. METHODS A retrospective cohort study was performed on the clinical, genetic and histopathological features of all paediatric and adult patients in whom an RYR1 mutation was detected in a national referral centre for both malignant hyperthermia and inherited myopathies (2008-2012). RESULTS The cohort of 77 non-related patients (detection rate 28%) included both congenital myopathies with permanent weakness and 'induced' myopathies such as MHS and non-anaesthesia-related episodes of rhabdomyolysis or hyperCKemia, manifested throughout life and triggered by various stimuli. Sixty-one different mutations were detected, of which 24 were novel. Some mutations are present in both dominant (MHS) and recessive modes (congenital myopathy) of inheritance, even within families. Histopathological features included an equally wide spectrum, ranging from only subtle abnormalities to prominent cores. CONCLUSIONS This broad range of RYR1-related disorders often presents to the general paediatric and adult neurologist. Its recognition is essential for genetic counselling and improving patients' safety during anaesthesia. Future research should focus on in vitro testing by the in vitro contracture test and functional characterization of the large number of RYR1 variants whose precise effects currently remain uncertain.
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Affiliation(s)
- M Snoeck
- National MH Investigation Unit, Department of Anesthesiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - B G M van Engelen
- Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - B Küsters
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Pathology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M Lammens
- Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Pathology, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - R Meijer
- Department of Human Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J P F Molenaar
- Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J Raaphorst
- Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands.,Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands
| | - C C Verschuuren-Bemelmans
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - C S M Straathof
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - L T L Sie
- Department of Neuropediatrics, Juliana Children's Hospital/Haga Hospital, The Hague, Nijmegen, The Netherlands
| | - I F de Coo
- Department of Neurology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - W L van der Pol
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M de Visser
- Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands
| | - H Scheffer
- Department of Human Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - S Treves
- Departments of Anesthesia and Biomedicine, University Hospital Basel, Basel, Switzerland
| | - H Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK.,Randall Division for Cell and Molecular Biophysics, Muscle Signalling Section, King's College, London, UK.,Department of Basic and Clinical Neuroscience, IoPPN, King's College, London, UK
| | - N C Voermans
- Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - E-J Kamsteeg
- Department of Human Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
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31
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Kropp R, Jungbluth H, Radenbach KL. Influence of capreomycin on renal function. (Preliminary results). Antibiot Chemother 2015; 16:59-68. [PMID: 4108898 DOI: 10.1159/000386804] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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32
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Donkervoort S, Bonnemann C, Loeys B, Jungbluth H, Voermans N. The neuromuscular differential diagnosis of joint hypermobility. Am J Med Genet 2015; 169C:23-42. [DOI: 10.1002/ajmg.c.31433] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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33
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Singh R, Jayapal S, Goyal S, Jungbluth H, Lascelles K. Early-onset movement disorder and epileptic encephalopathy due to de novo dominant SCN8A mutation. Seizure 2015; 26:69-71. [PMID: 25799905 DOI: 10.1016/j.seizure.2015.01.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 01/27/2015] [Accepted: 01/29/2015] [Indexed: 10/24/2022] Open
Affiliation(s)
- R Singh
- Department of Paediatric Neurology, Evelina Children's Hospital, Guys and St Thomas' NHS Foundation Trust, United Kingdom
| | - S Jayapal
- Department of Paediatric Neurology, Evelina Children's Hospital, Guys and St Thomas' NHS Foundation Trust, United Kingdom
| | - S Goyal
- Neurophysiology Department, Evelina Children's Hospital, Guys and St Thomas' NHS Foundation Trust, United Kingdom
| | - H Jungbluth
- Department of Paediatric Neurology, Evelina Children's Hospital, Guys and St Thomas' NHS Foundation Trust, United Kingdom; Randall Division of Cell and Molecular Biophysics, King's College London, United Kingdom; Department of Basic and Clinical Neuroscience, IoPPN, King's College London, United Kingdom
| | - K Lascelles
- Department of Paediatric Neurology, Evelina Children's Hospital, Guys and St Thomas' NHS Foundation Trust, United Kingdom.
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34
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Schottmann G, Jungbluth H, Schara U, Knierim E, Morales Gonzalez S, Gill E, Seifert F, Norwood F, Deshpande C, von Au K, Schuelke M, Senderek J. Recessive truncating IGHMBP2 mutations presenting as axonal sensorimotor neuropathy. Neurology 2015; 84:523-31. [DOI: 10.1212/wnl.0000000000001220] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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35
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Scalco R, Pitceathly R, Gardiner A, Woodward C, Polke J, Sweeney M, Olpin S, Kirk R, Murphy E, Hilton-Jones D, Jungbluth H, Houlden H, Hanna M, Quinlivan R. G.P.22. Neuromuscul Disord 2014. [DOI: 10.1016/j.nmd.2014.06.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Whyte T, Cullup T, Robb S, Sewry C, Jungbluth H, Muntoni F. P75 Exome sequencing identifies EPG5 mutations in two siblings with a childhood onset vacuolar myopathy. Neuromuscul Disord 2014. [DOI: 10.1016/s0960-8966(14)70091-4] [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: 10/25/2022]
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Heng HS, Lim M, Absoud M, Austin C, Clarke D, Wraige E, Reid C, Robb SA, Jungbluth H. Outcome of children with acetylcholine receptor (AChR) antibody positive juvenile myasthenia gravis following thymectomy. Neuromuscul Disord 2013; 24:25-30. [PMID: 24239058 DOI: 10.1016/j.nmd.2013.09.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [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: 06/08/2013] [Revised: 09/16/2013] [Accepted: 09/23/2013] [Indexed: 11/18/2022]
Abstract
Most evidence supporting the benefit of thymectomy in juvenile myasthenia gravis (JMG) is extrapolated from adult studies, with only little data concerning paediatric populations. Here we evaluate the outcome of children with generalized JMG who underwent thymectomy between 1996 and 2010 at 2 tertiary paediatric neurology referral centres in the United Kingdom. Twenty patients (15 female, 5 male), aged 13months to 15.5years (median 10.4years) at disease onset, were identified. Prior to thymectomy, disease severity was graded as IIb in 3, III in 11, and IV in 6 patients according to the Osserman classification. All demonstrated positive anti-acetylcholine receptor (AChR) antibody titres. All patients received pyridostigmine and 14 received additional steroid therapy. Transternal thymectomy was performed at the age of 2.7-16.6years (median 11.1years). At the last follow-up (10months to 10.9years, median 2.7years, after thymectomy), the majority of children demonstrated substantial improvement, although some had required additional immune-modulatory therapies. About one third achieved complete remission. The postoperative morbidity was low. No benefit was observed in one patient with thymoma. We conclude that thymectomy should be considered as a treatment option early in the course of generalised AChR antibody-positive JMG.
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Affiliation(s)
- H S Heng
- Department of Paediatric Neurology, Evelina Children's Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK; Paediatric Neurology Unit, Institute of Paediatrics, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - M Lim
- Department of Paediatric Neurology, Evelina Children's Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK
| | - M Absoud
- Department of Paediatric Neurology, Evelina Children's Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK
| | - C Austin
- Department of Cardiothoracic Surgery, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK
| | - D Clarke
- Department of Paediatric Neurology, Evelina Children's Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK
| | - E Wraige
- Department of Paediatric Neurology, Evelina Children's Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK
| | - C Reid
- Department of Paediatric Nephrology, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK
| | - S A Robb
- Dubowitz Neuromuscular Centre, Great Ormond Street Hospital for Children, London, UK
| | - H Jungbluth
- Department of Paediatric Neurology, Evelina Children's Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK; Randall Division for Cell and Molecular Biophysics, Muscle Signalling Section, King's College, London, UK; Clinical Neuroscience Division, IoP, King's College, London, UK.
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Ricotti V, Ridout DA, Scott E, Quinlivan R, Robb SA, Manzur AY, Muntoni F, Muntoni F, Robb S, Quinlivan R, Ricotti V, Main M, Bushby K, Straub V, Sarkozy A, Guglieri M, Strehle E, Eagle M, Mayhew A, Roper H, McMurchie H, Childs A, Pysden K, Pallant L, Spinty S, Peachey G, Shillington A, Wraige E, Jungbluth H, Sheehan J, Spahr R, Hughes I, Bateman E, Cammiss C, Willis T, Groves L, Emery N, Baxter P, Senior M, Hartley L, Parsons B, Majumdar A, Jenkins L, Naismith K, Keddie A, Horrocks I, Di Marco M, Chow G, Miah A, de Goede C, Thomas N, Geary M, Palmer J, White C, Greenfield K, Scott E. Long-term benefits and adverse effects of intermittent versus daily glucocorticoids in boys with Duchenne muscular dystrophy. J Neurol Neurosurg Psychiatry 2013; 84:698-705. [PMID: 23250964 DOI: 10.1136/jnnp-2012-303902] [Citation(s) in RCA: 163] [Impact Index Per Article: 14.8] [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] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the current use of glucocorticoids (GCs) in Duchenne muscular dystrophy in the UK, and compare the benefits and the adverse events of daily versus intermittent prednisolone regimens. DESIGN A prospective longitudinal observational study across 17 neuromuscular centres in the UK of 360 boys aged 3-15 years with confirmed Duchenne muscular dystrophy who were treated with daily or intermittent (10 days on/10 days off) prednisolone for a mean duration of treatment of 4 years. RESULTS The median loss of ambulation was 12 years in intermittent and 14.5 years in daily treatment; the HR for intermittent treatment was 1.57 (95% CI 0.87 to 2.82). A fitted multilevel model comparing the intermittent and daily regiments for the NorthStar Ambulatory Assessment demonstrated a divergence after 7 years of age, with boys on an intermittent regimen declining faster (p<0.001). Moderate to severe side effects were more commonly reported and observed in the daily regimen, including Cushingoid features, adverse behavioural events and hypertension. Body mass index mean z score was higher in the daily regimen (1.99, 95% CI 1.79 to 2.19) than in the intermittent regimen (1.51, 95% CI 1.27 to 1.75). Height restriction was more severe in the daily regimen (mean z score -1.77, 95% CI -1.79 to -2.19) than in the intermittent regimen (mean z score -0.70, 95% CI -0.90 to -0.49). CONCLUSIONS Our study provides a framework for providing information to patients with Duchenne muscular dystrophy and their families when introducing GC therapy. The study also highlights the importance of collecting longitudinal natural history data on patients treated according to standardised protocols, and clearly identifies the benefits and the side-effect profile of two treatment regimens, which will help with informed choices and implementation of targeted surveillance.
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Affiliation(s)
- Valeria Ricotti
- Dubowitz Neuromuscular Centre, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
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Dlamini N, Voermans NC, Lillis S, Stewart K, Kamsteeg EJ, Drost G, Quinlivan R, Snoeck M, Norwood F, Radunovic A, Straub V, Roberts M, Vrancken AFJE, van der Pol WL, de Coo RIFM, Manzur AY, Yau S, Abbs S, King A, Lammens M, Hopkins PM, Mohammed S, Treves S, Muntoni F, Wraige E, Davis MR, van Engelen B, Jungbluth H. Mutations in RYR1 are a common cause of exertional myalgia and rhabdomyolysis. Neuromuscul Disord 2013; 23:540-8. [PMID: 23628358 DOI: 10.1016/j.nmd.2013.03.008] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 03/08/2013] [Accepted: 03/12/2013] [Indexed: 12/23/2022]
Abstract
Mutations in the skeletal muscle ryanodine receptor (RYR1) gene are a common cause of neuromuscular disease, ranging from various congenital myopathies to the malignant hyperthermia (MH) susceptibility trait without associated weakness. We sequenced RYR1 in 39 unrelated families with rhabdomyolysis and/or exertional myalgia, frequent presentations in the neuromuscular clinic that often remain unexplained despite extensive investigations. We identified 9 heterozygous RYR1 mutations/variants in 14 families, 5 of them (p.Lys1393Arg; p.Gly2434Arg; p.Thr4288_Ala4290dup; p.Ala4295Val; and p.Arg4737Gln) previously associated with MH. Index cases presented from 3 to 45 years with rhabdomyolysis, with or without exertional myalgia (n=12), or isolated exertional myalgia (n=2). Rhabdomyolysis was commonly triggered by exercise and heat and, less frequently, viral infections, alcohol and drugs. Most cases were normally strong and had no personal MH history. Inconsistent additional features included heat intolerance, and cold-induced muscle stiffness. Muscle biopsies showed mainly subtle changes. Familial RYR1 mutations were confirmed in relatives with similar or no symptoms. These findings suggest that RYR1 mutations may account for a substantial proportion of patients presenting with unexplained rhabdomyolysis and/or exertional myalgia. Associated clinico-pathological features may be subtle and require a high degree of suspicion. Additional family studies are paramount in order to identify potentially MH susceptible relatives.
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Affiliation(s)
- N Dlamini
- Department of Paediatric Neurology, Neuromuscular Service, Evelina's Children Hospital, Guy's & St. Thomas' Hospital NHS Foundation Trust, London, UK
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Maggi L, Scoto M, Cirak S, Robb SA, Klein A, Lillis S, Cullup T, Feng L, Manzur AY, Sewry CA, Abbs S, Jungbluth H, Muntoni F. Congenital myopathies--clinical features and frequency of individual subtypes diagnosed over a 5-year period in the United Kingdom. Neuromuscul Disord 2013; 23:195-205. [PMID: 23394784 DOI: 10.1016/j.nmd.2013.01.004] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 11/15/2012] [Accepted: 01/03/2013] [Indexed: 12/14/2022]
Abstract
The congenital myopathies are a group of inherited neuromuscular disorders mainly defined on the basis of characteristic histopathological features. We analysed 66 patients assessed at a single centre over a 5 year period. Of the 54 patients where muscle biopsy was available, 29 (54%) had a core myopathy (central core disease, multi-minicore disease), 9 (17%) had nemaline myopathy, 7 (13%) had myotubular/centronuclear myopathy, 2 (4%) had congenital fibre type disproportion, 6 (11%) had isolated type 1 predominance and 1 (2%) had a mixed core-rod myopathy. Of the 44 patients with a genetic diagnosis, RYR1 was mutated in 26 (59%), ACTA1 in 7 (16%), SEPN1 in 7 (16%), MTM1 in 2 (5%), NEB in 1 (2%) and TPM3 in 1 (2%). Clinically, 77% of patients older than 18 months could walk independently. 35% of all patients required ventilatory support and/or enteral feeding. Clinical course was stable or improved in 57/66 (86%) patients, whilst 4 (6%) got worse and 5 (8%) died. These findings indicate that core myopathies are the most common form of congenital myopathies and that more than half can be attributed to RYR1 mutations. The underlying genetic defect remains to be identified in 1/3 of congenital myopathies cases.
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Affiliation(s)
- L Maggi
- Dubowitz Neuromuscular Centre, UCL Institute of Child Health & Great Ormond Street Hospital for Children Foundation Trust, London, UK
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Voermans N, Jungbluth H, Aronica E, Monnier N, Lunardi J, Swash M, de Visser M. Congenital myopathy with focal loss of cross-striations revisited. Neuromuscul Disord 2013; 23:160-4. [DOI: 10.1016/j.nmd.2012.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 08/11/2012] [Accepted: 08/28/2012] [Indexed: 10/27/2022]
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Cullup T, Lamont PJ, Cirak S, Damian MS, Wallefeld W, Gooding R, Tan SV, Sheehan J, Muntoni F, Abbs S, Sewry CA, Dubowitz V, Laing NG, Jungbluth H. Mutations in MYH7 cause Multi-minicore Disease (MmD) with variable cardiac involvement. Neuromuscul Disord 2012. [PMID: 22784669 DOI: 10.1016/j.nmd.2012.06.00] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Central Core Disease (CCD) and Multi-minicore Disease (MmD) (the "core myopathies") have been mainly associated with mutations in the skeletal muscle ryanodine receptor (RYR1) and the selenoprotein N (SEPN1) gene. A proportion of cases remain unresolved. Mutations in MYH7 encoding the beta myosin heavy chain protein have been implicated in cardiac and, less frequently, skeletal muscle disorders. Here we report four patients from two families with a histopathological diagnosis of MmD, presenting in childhood with slowly progressive muscle weakness, more proximal in Family 1 and more distal in Family 2, and variable degrees of cardiorespiratory impairment evolving later in life. There was also a strong family history of sudden death in the first family. Muscle biopsies obtained in early childhood showed multiple minicores as the most prominent feature. Sequencing of the MYH7 gene revealed heterozygous missense mutations, c.4399C>G; p.Leu1467Val (exon 32) in Family 1 and c.4763G>C; p.Arg1588Pro (exon 34) in Family 2. These findings suggest MYH7 mutations as another cause of a myopathy with multiple cores, in particular if associated with dominant inheritance and cardiac involvement. However, clinical features previously associated with this genetic background, namely a more distal distribution of weakness and an associated cardiomyopathy, may only evolve over time.
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Affiliation(s)
- T Cullup
- DNA Laboratory, GSTS Pathology, Guy's Hospital, London, UK
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43
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Voermans N, Jungbluth H, Raaphorst J, Snoeck M, Straathof C, Schelhaas H, Sie L, de Coo R, van de Pol W, de Visser M, Scheffer H, Kamsteeg E, van Engelen B. C.P.3 Genetic and clinical heterogeneity of RYR1-related myopathies in a cohort of 60 Dutch families with identification of 40 novel mutations. Neuromuscul Disord 2012. [DOI: 10.1016/j.nmd.2012.06.131] [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: 11/26/2022]
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Cullup T, Lamont PJ, Cirak S, Damian MS, Wallefeld W, Gooding R, Tan SV, Sheehan J, Muntoni F, Abbs S, Sewry CA, Dubowitz V, Laing NG, Jungbluth H. Mutations in MYH7 cause Multi-minicore Disease (MmD) with variable cardiac involvement. Neuromuscul Disord 2012; 22:1096-104. [PMID: 22784669 DOI: 10.1016/j.nmd.2012.06.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Revised: 05/28/2012] [Accepted: 06/12/2012] [Indexed: 10/28/2022]
Abstract
Central Core Disease (CCD) and Multi-minicore Disease (MmD) (the "core myopathies") have been mainly associated with mutations in the skeletal muscle ryanodine receptor (RYR1) and the selenoprotein N (SEPN1) gene. A proportion of cases remain unresolved. Mutations in MYH7 encoding the beta myosin heavy chain protein have been implicated in cardiac and, less frequently, skeletal muscle disorders. Here we report four patients from two families with a histopathological diagnosis of MmD, presenting in childhood with slowly progressive muscle weakness, more proximal in Family 1 and more distal in Family 2, and variable degrees of cardiorespiratory impairment evolving later in life. There was also a strong family history of sudden death in the first family. Muscle biopsies obtained in early childhood showed multiple minicores as the most prominent feature. Sequencing of the MYH7 gene revealed heterozygous missense mutations, c.4399C>G; p.Leu1467Val (exon 32) in Family 1 and c.4763G>C; p.Arg1588Pro (exon 34) in Family 2. These findings suggest MYH7 mutations as another cause of a myopathy with multiple cores, in particular if associated with dominant inheritance and cardiac involvement. However, clinical features previously associated with this genetic background, namely a more distal distribution of weakness and an associated cardiomyopathy, may only evolve over time.
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Affiliation(s)
- T Cullup
- DNA Laboratory, GSTS Pathology, Guy's Hospital, London, UK
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45
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Jain RK, Jayawant S, Squier W, Muntoni F, Sewry CA, Manzur A, Quinlivan R, Lillis S, Jungbluth H, Sparrow JC, Ravenscroft G, Nowak KJ, Memo M, Marston SB, Laing NG. Nemaline myopathy with stiffness and hypertonia associated with an ACTA1 mutation. Neurology 2012; 78:1100-3. [DOI: 10.1212/wnl.0b013e31824e8ebe] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Uusimaa J, Jungbluth H, Fratter C, Crisponi G, Feng L, Zeviani M, Hughes I, Treacy EP, Birks J, Brown GK, Sewry CA, McDermott M, Muntoni F, Poulton J. Reversible infantile respiratory chain deficiency is a unique, genetically heterogenous mitochondrial disease. J Med Genet 2012; 48:660-668. [PMID: 21931168 DOI: 10.1136/jmg.2011.089995] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Homoplasmic maternally inherited, m.14674T>C or m. 14674T>G mt-tRNA(Glu) mutations have recently been identified in reversible infantile cytochrome c oxidase deficiency (or 'benign COX deficiency'). This study sought other genetic defects that may give rise to similar presentations. PATIENTS Eight patients from seven families with clinicopathological features of infantile reversible cytochrome c oxidase deficiency were investigated. METHODS The study reviewed the diagnostic features and performed molecular genetic analyses of mitochondrial DNA and nuclear encoded candidate genes. RESULTS Patients presented with subacute onset of profound hypotonia, feeding difficulties and lactic acidosis within the first months of life. Although recovery was remarkable, a mild myopathy persisted into adulthood. Histopathological findings in muscle included increased lipid and/or glycogen content, ragged-red and COX negative fibres. Biochemical studies suggested more generalised abnormalities than pure COX deficiency. Clinical improvement was reflected by normalisation of lactic acidosis and histopathological abnormalities. The m.14674T>C mt-tRNA(Glu) mutation was identified in four families, but none had the m. 14674T>G mutation. Furthermore, in two families pathogenic mutations were also found in the nuclear TRMU gene which has not previously been associated with this phenotype. In one family, the genetic aetiology still remains unknown. CONCLUSIONS Benign COX deficiency is better described as 'reversible infantile respiratory chain deficiency'. It is genetically heterogeneous, and patients not carrying the m.14674T>C or T>G mt-tRNA(Glu) mutations may have mutations in the TRMU gene. Diagnosing this disorder at the molecular level is a significant advance for paediatric neurologists and intensive care paediatricians, enabling them to select children with an excellent prognosis for continuing respiratory support from those with severe mitochondrial presentation in infancy.
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Affiliation(s)
- J Uusimaa
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, The Women's Centre, John Radcliffe Hospital, Oxford, UK
| | - H Jungbluth
- Department of Clinical Neuroscience, King's College Hospital, London, UK.,Department of Paediatric Neurology - Neuromuscular Service, Evelina Children's Hospital, St Thomas' Hospital, London, UK
| | - C Fratter
- Oxford Medical Genetics Lab, Churchill Hospital, Oxford, UK
| | - G Crisponi
- Servizio di Puericultura, Universita' di Cagliari, Italy
| | - L Feng
- Dubowitz Neuromuscular Centre, UCL Institute of Child Health, London, UK
| | - M Zeviani
- Unit of Molecular Neurogenetics, "C. Besta" Neurological Institute - IRCCS Foundation, Milan, Italy
| | - I Hughes
- Department of Paediatric Neurology, Manchester Children's Hospital, Manchester, UK
| | - E P Treacy
- National Centre for Inherited Metabolic Disease, Children's University Hospital, Dublin Republic of Ireland
| | - J Birks
- Centre for Statistics in Medicine, University of Oxford, UK
| | - G K Brown
- Department of Biochemistry, University of Oxford, UK
| | - C A Sewry
- Dubowitz Neuromuscular Centre, UCL Institute of Child Health, London, UK
| | - M McDermott
- Our Lady's Hospital for Sick Children, Dublin, Ireland
| | - F Muntoni
- Dubowitz Neuromuscular Centre, UCL Institute of Child Health, London, UK
| | - J Poulton
- Nuffield Department of Obstetrics and Gynaecology, University of Oxford, The Women's Centre, John Radcliffe Hospital, Oxford, UK
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Scoto M, Cullup T, Cirak S, Yau M, Feng L, Manzur A, Jungbluth H, Abbs S, Sewry C, Muntoni F. P87 Nebulin mutations in a childhood onset distal myopathy with rods and cores uncovered by next generation sequencing. Neuromuscul Disord 2012. [DOI: 10.1016/s0960-8966(12)70095-0] [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: 10/28/2022]
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Zhou H, Feng L, Munteanu I, Duchen M, Treves S, Jungbluth H, Muntoni F. P91 RyR1 deficiency in congenital myopathies disrupts excitation-contraction coupling and induces the second calcium release system via IP3R. Neuromuscul Disord 2012. [DOI: 10.1016/s0960-8966(12)70099-8] [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: 11/29/2022]
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Trump N, Cullup T, Verheij JBGM, Manzur A, Muntoni F, Abbs S, Jungbluth H. X-linked myotubular myopathy due to a complex rearrangement involving a duplication of MTM1 exon 10. Neuromuscul Disord 2011; 22:384-8. [PMID: 22153990 DOI: 10.1016/j.nmd.2011.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 11/11/2011] [Accepted: 11/16/2011] [Indexed: 11/18/2022]
Abstract
X-linked myotubular myopathy is a predominantly severe congenital myopathy with central nuclei on muscle biopsy due to mutations in the MTM1 gene encoding myotubularin. We report a boy with typical features of X-linked myotubular myopathy. Sequencing of the MTM1 gene did not reveal any causative mutations. Subsequent MLPA analysis identified a duplication of MTM1 exon 10 both in the patient and his mother. Additional quantitative fluorescent PCR and long-range PCR revealed an additional large deletion (2536bp) within intron 10, 143bp downstream of exon 10, and confirmed the duplication of exon 10. Our findings suggest that complex rearrangements have to be considered in typically affected males with X-linked myotubular myopathy.
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Affiliation(s)
- N Trump
- DNA Laboratory, GSTS Pathology, Guy's Hospital, London, UK.
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50
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Klein A, Lillis S, Oprea I, Scoto M, Robb S, Manzur A, Straub V, Roper H, Jeannet P, Kingston H, Jensen U, Wraige E, Trump N, Rakowicz W, M. Roberts, Longman C, Lochmuller H, Bushby K, Hughes M, Abbs S, Jungbluth H, Muntoni F. P3.41. Clinical and genetic findings in a large cohort of patients with congenital myopathies due to mutations in the skeletal muscle ryanodine receptor (RYR1) gene. Neuromuscul Disord 2011. [DOI: 10.1016/j.nmd.2011.06.935] [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: 11/27/2022]
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