| 1. |
- Darin, Niklas, 1964, et al.
(författare)
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Benign mitochondrial myopathy with exercise intolerance in a large multigeneration family due to a homoplasmic m.3250T>C mutation in MTTL1.
- 2017
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Ingår i: European journal of neurology. - : Wiley. - 1468-1331 .- 1351-5101. ; 24:4, s. 587-593
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Tidskriftsartikel (refereegranskat)abstract
- Most mitochondrial disorders with onset in early childhood are progressive and involve multiple organs. The m.3250T>C mutation in MTTL1 has previously been described in a few individuals with a possibly riboflavin-responsive myopathy and an association with sudden infant death syndrome was suspected. We describe a large family with this mutation and evaluate the effect of riboflavin treatment.Medical data were collected with the help of a standardized data collection form. Sanger sequencing was used to screen for variants in mitochondrial DNA and the proportion of the mutation was analyzed in different tissues. Biochemical and muscle morphological investigations of muscle tissue were performed in two individuals. The effect of riboflavin treatment was evaluated in two individuals.Thirteen family members experienced exercise intolerance with fatigue and weakness. Inheritance was maternal with 100% penetrance. The course was either static or showed improvement over time. There was no evidence of other organ involvement except for a possible mild transient cardiac enlargement in one child. Muscle investigations showed isolated complex I deficiency and mitochondrial proliferation. The level of m.3250T>C was apparently 100%, i.e. homoplasmic, in all examined tissues. Riboflavin treatment showed no effect in any treated family member and there have been no cases of sudden infant death in this family.This study illustrates the importance of considering mitochondrial disorders in the work-up of individuals with exercise intolerance and provides a better understanding of the phenotype associated with the m.3250T>C mutation in MTTL1.
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| 2. |
- Darin, Niklas, 1964, et al.
(författare)
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Inflammation and response to steroid treatment in limb-girdle muscular dystrophy 2I
- 2007
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Ingår i: Eur J Paediatr Neurol. - : Elsevier BV. ; 11:6, s. 353-7
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Tidskriftsartikel (refereegranskat)abstract
- Limb-girdle muscular dystrophy (LGMD) type 2I, caused by mutations in the fukutin-related protein gene (FKRP), is one of the most common forms of LGMD in childhood. We describe two patients with LGMD2I and a Duchenne-like phenotype. In addition to the common L276I mutation, both patients had a new mutation in FKRP, L169P and P89L, respectively. Clinical onset was triggered by viral upper respiratory tract infections. In addition to the common dystrophic pattern with a weak immune histochemical staining for alpha-dystroglycan, muscle biopsy showed inflammatory changes. This was especially striking in one of the patients with up-regulation of MHC class 1 antigen, suggestive of myositis. Both patients showed a good clinical response to treatment with prednisolone, which was initiated at daily dosage of 0.35mg/kg/day. Our results provide evidence for an inflammatory involvement in the pathological expression of LGMD2I and open up the possibility that this disorder could be treatable with corticosteroids.
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| 3. |
- Eek, Meta Nyström, et al.
(författare)
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Isometric muscle torque in children 5 to 15 years of age: normative data.
- 2006
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Ingår i: Archives of physical medicine and rehabilitation. - : Elsevier BV. - 0003-9993. ; 87:8, s. 1091-9
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To establish reference values of arm and leg muscle strength as measured by isometric torque production in healthy children. DESIGN: Measurement of isometric muscle strength in healthy children. SETTING: Public school. PARTICIPANTS: Healthy children (N=149; 76 boys, 73 girls) ages 5 to 15 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Isometric torque values of 12 arm and leg muscle groups of healthy children as measured by a handheld dynamometer. RESULTS: Normative data were obtained for children 5 to 15 years of age. There was an increase in torque with age and weight and a strong correlation with both age and weight. There were few differences between boys and girls. Equations for predicted torque taking into account age, weight, and sex were calculated. The agreement between examiners was excellent. CONCLUSIONS: Studies on growing children require comparison to healthy (normal) children to assess the amount of deviation from normal and to be able to draw conclusions of change over time. The reference values for torque in combination with a predicted value based on the child's age, weight, and sex make it possible to compare over time and between subjects and provide a tool for evaluation of physical status and efficacy of therapy.
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| 4. |
- Eriksson, Britt-Marie, et al.
(författare)
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Evaluation of hand orthoses in Duchenne muscular dystrophy
- 2018
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Ingår i: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 40:23, s. 2824-2832
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purpose of this study was to evaluate whether treatment of boys with Duchenne muscular dystrophy using hand orthoses could benefit joint mobility, grip strength, or fine motor function. Method: Eight boys with Duchenne muscular dystrophy were provided with individually customised rest orthoses. The results were analysed using single-subject design. The study included a baseline and an intervention phase. A follow-up examination was also performed. Results: Boys with less than 50 degrees passive wrist extension mobility were included. Wrist extension of the dominant hand increased in four and was maintained in four. Wrist extension in the non-dominant hand increased in five, was maintained in two and decreased in one. Thumb abduction in the dominant hand increased in six and two remained stable. In the non-dominant hand five increased and three remained stable. Grip strength and fine motor function showed also positive results. Conclusions: This study indicates that the use of hand orthoses in Duchenne muscular dystrophy can delay development of contractures and improve passive wrist extension and thumb abduction. Hand orthoses can therefore be recommended for boys who start to develop contractures in the long finger flexors. Due to small sample size further studies are needed to confirm this result.
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| 5. |
- Eriksson, M., et al.
(författare)
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Health-related quality of life and orthosis use in a Swedish population with arthrogryposis
- 2018
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Ingår i: Prosthetics and Orthotics International. - : Ovid Technologies (Wolters Kluwer Health). - 0309-3646 .- 1746-1553. ; 42:4, s. 402-409
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Tidskriftsartikel (refereegranskat)abstract
- Background: Joint contractures are the main characteristics for children with arthrogryposis multiplex congenita. Orthoses are often used to enable or facilitate walking. Objectives: To describe health-related quality of life in children with arthrogryposis multiplex congenita and satisfaction with orthoses in those using orthoses. Methods: A total of 33 children with arthrogryposis multiplex congenita participated in the study. Questionnaires were used which measured health-related quality of life (Child Health Questionnaire-Parent Form and EQ-5D youth), mobility and self-care (Paediatric Evaluation of Disability Inventory) and satisfaction with orthoses (Quebec User Evaluation of Satisfaction with Assistive Technology 2.0). Children were divided into groups based on the use of orthoses: Ort-D were dependent on orthoses for walking, Ort-ND used orthoses but were not dependent on them for walking and Non-Ort did not use orthoses. Results: Children with arthrogryposis multiplex congenita had significantly lower Child Health Questionnaire scores in 9 of 12 subscales compared to healthy controls. The children's reported perceived health with EQ-5D youth did not show any difference between children using orthoses or children using only shoes. Paediatric Evaluation of Disability Inventory showed less mobility in Ort-D than in Non-Ort. In total, both orthosis groups were quite satisfied' with their orthoses. Conclusion: Child Health Questionnaire-physical functioning was lowest in children who were dependent on orthoses (Ort-D) for walking. Both Ort-D and Ort-ND were similar satisfied with their orthoses. Clinical relevance This study contributes to knowledge about health-related quality of life in a group of ambulatory children with arthrogryposis multiplex congenita. For children using orthoses, it is relevant to capture their opinion about their orthoses but a questionnaire specifically for children should be developed.
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| 6. |
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| 7. |
- Gillenstrand, Jonas, et al.
(författare)
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Behavioural strengths and difficulties in relation to intellectual functions and age in Swedish boys with Duchenne muscular dystrophy
- 2023
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Ingår i: Child Neuropsychology. - : Informa UK Limited. - 0929-7049 .- 1744-4136. ; 29:6, s. 959-972
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe behavioral strengths and difficulties in relation to intellectual function and age in boys with DMD. In a cross-sectional design, 70 boys with DMD were tested at 5, 8, 11, and 14 years of age (mean age 10y 5 m). Parental ratings of behavioral strengths and difficulties were studied in relation to age, intellectual function, motor function, and family socioeconomic status (SES). Results show a significant relation between behavioral strengths and difficulties and age with parents rating increasingly more difficulties (slightly higher, higher and very high) from 5 years (11.1%) to 9 years (30.8%) and 11 years (78.9%) of age and then fewer difficulties at 14 years (50%) of age. Working Memory Index (WMI) explained significant variance in SDQ-Total-Score (17.5%) and SDQ-Impact-Score (11.2%). WMI together with upper motor function explained 19.5% variance in SDQ-Hyperactivity and 19.7% in SDQ-Peer-Problems. Age and SES explained an 18.9% variance in SDQ-Emotional-Problems. Age is an important factor when analyzing behavioral strengths and difficulties for boys with DMD. The development of boys with DMD needs to be understood in the context of expected developmental trajectory as well as in the decline of psychical functioning. Our study supports that age, cognition, motor function, and family SES all contribute to how behavioral strengths and difficulties evolves in boys with DMD.
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| 8. |
- Goemans, N. M., et al.
(författare)
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Long-Term Efficacy, Safety, and Pharmacokinetics of Drisapersen in Duchenne Muscular Dystrophy: Results from an Open-Label Extension Study
- 2016
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Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 11:9
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Tidskriftsartikel (refereegranskat)abstract
- Background Drisapersen induces exon 51 skipping during dystrophin pre-mRNA splicing and allows synthesis of partially functional dystrophin in Duchenne muscular dystrophy (DMD) patients with amenable mutations. This 188-week open-label extension of the dose-escalation study assessed the long-term efficacy, safety, and pharmacokinetics of drisapersen (PRO051/GSK2402968), 6 mg/kg subcutaneously, in 12 DMD subjects. Dosing was once weekly for 72 weeks. All subjects had a planned treatment interruption (weeks 73-80), followed by intermittent dosing (weeks 81-188). Subjects received a median (range) total dose of 5.93 (5.10 to 6.02) mg/kg drisapersen. After 177 weeks (last efficacy assessment), median (mean [SD]) six-minute walk distance (6MWD) improved by 8 (-24.5 [161]) meters for the 10 subjects able to complete the 6MWD at baseline (mean age [SD]: 9.5 [1.9] years). These statistics include 2 subjects unable to complete the test at later visits and who scored "zero". When only the 8 ambulant subjects at week 177 were taken into account, a median (mean [SD]) increase of 64 (33 [121]) meters in 6MWD was observed. Of 7 subjects walking >= 330 m at extension baseline, 5 walked farther at week 177. Of 3 subjects walking <330 m, 2 lost ambulation, while 1 declined overall but walked farther at some visits. Over the 188 weeks, the most common adverse events were injection-site reactions, raised urinary alpha(1)-microglobulin and proteinuria. Dystrophin expression was detected in all muscle biopsies obtained at week 68 or 72. Drisapersen was generally well tolerated over 188 weeks. Possible renal effects, thrombocytopenia and injection-site reactions warrant continued monitoring. Improvements in the 6MWD at 12 weeks were sustained after 3.4 years of dosing for most patients. For a small, uncontrolled study, the outcomes are encouraging, as natural history studies would anticipate a decline of over 100 meters over a 3-year period in a comparable cohort.
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| 9. |
- Kimber, Eva, 1951, et al.
(författare)
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A mutation in the fast skeletal muscle troponin I gene causes myopathy and distal arthrogryposis
- 2006
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Ingår i: Neurology. - : Ovid Technologies (Wolters Kluwer Health). - 1526-632X .- 0028-3878. ; 67:4, s. 597-601
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe a three-generation family with distal arthrogryposis associated with myopathy and caused by a mutation in the gene encoding for sarcomeric thin filament protein troponin I, TNNI2. METHODS: The authors performed clinical investigations and reviewed medical records. Muscle biopsy specimens were obtained for morphologic analysis. Genomic DNA was extracted from blood and analyzed for mutations in TNNI2. RESULTS: The five affected individuals had predominantly distal congenital joint contractures, mild facial involvement (mild micrognathia, narrow palpebral fissures), and no detectable muscle weakness. The four affected adults had slightly increased levels of creatine kinase in blood, and muscle biopsy specimens showed findings of myopathy with changes restricted to type 2 fibers. These included variability of muscle fiber size, internalized nuclei, and increased interstitial connective tissue. Analysis of TNNI2 encoding the troponin I isoform expressed in type 2 muscle fibers disclosed a heterozygous three-base in-frame deletion, 2,918-2,920del, skipping the highly conserved lysine at position 176. The mutation was present in all 5 affected individuals but was not identified in any of the 11 unaffected family members. CONCLUSION: Distal arthrogryposis type 1 is genetically heterogeneous, and myopathy due to sarcomeric protein dysfunction may be one underlying cause of the disease.
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| 10. |
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| 11. |
- Kimber, Eva, 1951-, et al.
(författare)
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Distal arthrogryposis : clinical and genetic findings
- 2012
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Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 101:8, s. 877-887
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Tidskriftsartikel (refereegranskat)abstract
- AIM: Distal arthrogryposis is characterized by congenital contractures predominantly in hands and feet. Mutations in sarcomeric protein genes are involved in several types of distal arthrogryposis. Our aim is to describe clinical and molecular genetic findings in individuals with distal arthrogryposis and evaluate the genotype-phenotype correlation.METHOD: We investigated 39 patients from 21 families. Clinical history, including neonatal findings, joint involvement and motor function, was documented. Clinical examination was performed including evaluation of muscle strength. Molecular genetic investigations were carried out in 19 index cases. Muscle biopsies from 17 patients were analysed.RESULTS: A pathogenic mutation was found in six families with 19 affected family members with autosomal dominant inheritance and in one child with sporadic occurrence. In three families and in one child with sporadic form, the identified mutation was de novo. Muscle weakness was found in 17 patients. Ambulation was affected in four patients and hand function in 28. Fourteen patients reported pain related to muscle and joint affection.CONCLUSION: The clinical findings were highly variable between families and also within families. Mutations in the same gene were found in different syndromes suggesting varying clinical penetrance and expression, and different gene mutations were found in the same clinical syndrome demonstrating genetic heterogeneity.
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| 12. |
- Kroksmark, Anna-Karin, et al.
(författare)
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Long-term follow-up of motor function and muscle strength in the congenital and childhood forms of myotonic dystrophy type 1
- 2017
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Ingår i: Neuromuscular Disorders. - : Elsevier BV. - 0960-8966. ; 27:9, s. 826-835
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Tidskriftsartikel (refereegranskat)abstract
- The aims of this study were to explore how motor function and muscle strength change over time in the congenital and childhood forms of myotonic dystrophy type 1, further to investigate whether sex, age, disease severity or size of the mutation could explain these changes. Motor function and isometric muscle strength were evaluated at three occasions during 1999-2013 in 57 patients aged 0.7-28.9 years. Median time between first and last assessment was 11.5 years ranging from 9.6 to 13.3 years. The study shows that motor function improves during the first decade, is most pronounced during the first six years, reaches a plateau during adolescence and starts to deteriorate in the beginning of the second decade. The most predictive variables for change are age (p < 0.0001) and number of CTG-repeat expansions (p = 0.0018). Sex or disease severity grade do not predict changes in motor function. Deterioration of muscle strength is most pronounced in ankle dorsiflexors. Knowledge of development and deterioration of motor function is important for clinical decision making and for planning of interventions. This knowledge can also be of interest for patient recruitment in drug trials, since treatment effect might be easier to evaluate in the stable phases of this progressive disorder. (C) 2017 Elsevier B.V. All rights reserved.
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| 13. |
- Kroksmark, Anna-Karin, et al.
(författare)
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Low bone mineral density and reduced bone-specific alkaline phosphatase in 5q spinal muscular atrophy type 2 and type 3: A 2-year prospective study of bone health
- 2023
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Ingår i: ACTA PAEDIATRICA. - : WILEY. - 0803-5253 .- 1651-2227. ; 112:12, s. 2589-2600
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Tidskriftsartikel (refereegranskat)abstract
- AimIndividuals with spinal muscular atrophy (SMA) are at risk of developing skeletal problems. This study investigated bone mineral density (BMD), bone turnover markers and motor function in children and adolescents with SMA type 2 and type 3 over a two-year period. The effect of nusinersen was studied in a subgroup.MethodsSingle-centre study, including 20 patients, 2-18 years, of whom ten patients received nusinersen treatment. BMD was measured by dual-energy X-ray absorptiometry.ResultsAll patients had low BMD levels at baseline; mean Z-score -2.3 for total body less head (TBLH) and -2.9 for total hip left (THL). Significant correlations were found both at baseline and for the follow-up change for motor function and Z-scores (TBLH and THL). For the whole study group, reduced bone formation and unchanged bone resorption, assessed by bone-specific alkaline phosphatase (BALP) (p = 0.0006, ES = -0.83) and C-terminal cross-linking telopeptide of type I collagen (CTX), respectively, were found over the study period. However, BALP decreased less in the nusinersen treatment group, which suggests a positive development on bone mass in these patients.ConclusionBone health evaluation is important in follow-up programmes for SMA patients. Further investigations are warranted for individuals on survival motor neuron-targeted treatments.
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| 14. |
- Kroksmark, Anna-Karin, et al.
(författare)
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Muscle involvement and motor function in amyoplasia
- 2006
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Ingår i: Am J Med Genet A. - : Wiley. - 1552-4825 .- 1552-4833. ; 140:16, s. 1757-67
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Tidskriftsartikel (refereegranskat)abstract
- The most common form of arthrogryposis multiplex congenita (AMC) is amyoplasia. Diagnostic criteria are highly specific, with decreased muscle mass, typical contractures and limb positioning at birth. Intellectual development is normal. The aims of this study were to investigate how muscle strength and contractures affect motor function in amyoplasia, and to relate current functional status to joint positions at birth. Medical records were reviewed and a clinical examination was performed, with investigation of muscle strength, range of motion, and motor function. Thirty-five patients with amyoplasia participated and were divided into three functional groups: 11 community ambulators, 11 household ambulators, and 7 non-ambulators. Six children less than 2 years old were not categorized. Community ambulators had the best muscle strength and none had knee flexion contractures extending 20 degrees. Household ambulators had severe contractures in the lower limbs, but good muscle strength in the upper limbs. Non-ambulators had most severe contractures and most severely reduced muscle strength. Most of the non-ambulators were born with hips in severe abduction, flexion and external rotation. Good and very good correlations were found between muscle strength and motor function, and only moderate correlations between range of motion and motor function. We conclude that more attention should be paid to developing muscle strength, with early stimulation of active movement, and that periods of immobilization should be minimized. Further, ultrasound or MRI of muscle tissue in the newborn period would be useful to evaluate prerequisites for future development of muscle strength and thereby anticipate response to therapy.
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| 15. |
- Kroksmark, Anna-Karin, et al.
(författare)
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Muscle strength and motor function in children and adolescents with spinal muscular atrophy II and III.
- 2001
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Ingår i: European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society. - : Elsevier BV. - 1090-3798. ; 5:5, s. 191-8
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to quantify isometric muscle strength and motor function in children and adolescents with spinal muscular atrophy (SMA) and to analyse the impact of reduced muscle strength on motor function. Six children and adolescents with SMA II and eight with SMA IlI were assessed regarding isometric muscle strength and motor function. Isometric muscle strength was tested with a myometer and the values obtained were compared with normative data. Motor function was videotaped and 20 movements were scored according to a three-point scale. All of the assessed children and adolescents with SMA II and SMA III showed reduced muscle strength, but there were great differences within the group. The typical pattern of muscle weakness in SMA, with proximal weakness greater than distal and the lower limbs more affected than the upper, was also seen in these children. The muscle weakness affected motor function in all assessed children. Walking, transfer from lying or sitting to the standing position and stair-climbing were possible in some of the children, despite marked reduction of muscle strength. The study increases our knowledge concerning the degree of muscle weakness in children with SMA and the impact of muscle weakness on motor function. The results increase our possibilities of understanding the prerequisites for everyday life in these children and planning therapeutic interventions. Repeated assessments with the methods used in this study may be used to monitor the course of the disease and to evaluate the efficacy of treatment.
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| 16. |
- Kroksmark, Anna-Karin
(författare)
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Muscle strength and motor function in neuromuscular disorders. A clinical study of children and adolescents with spinal muscular atrophy, myotonic dystrophy, Duchenne muscular dystrophy and amyoplasia
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The aims of this study were to investigate muscle strength and motor function in children and adolescents with four neuromuscular disorders; 1) spinal muscular atrophy (SMA), 2) myotonic dystrophy (DM), 3) Duchenne muscular dystrophy (DMD and 4) the amyoplasia form of arthrogryposis multiplex congenita. Further: 1) to analyze compensatory maneuvers due to muscle weakness in individuals with SMA, 2) to correlate motor function in individuals with DM with the size of the mutation, 3) to evaluate the long-term side effects and effects on muscle strength, motor function, vital capacity and development of scoliosis in boys with DMD treated with low-dose prednisone, and 4) to investigate how muscle strength and joint contractures affect motor function in individuals with amyoplasia and to relate current status to joint position at birth. Methods: 14 children and adolescents from western part of Sweden with SMA, 42 children and adolescents from western and southern Sweden with DM, 37 boys from western Sweden with DMD and 35 individuals from Sweden with amyoplasia participated in this study. In study 2, a control group of 42 age and gender-matched healthy children and adolescents was investigated. Medical records were reviewed and a clinical examination was performed. Isometric muscle strength was measured with an electronic hand-held dynamometer, contractures with an ordinary goniometer and motor function was assessed according to a scale designed for children with neuromuscular disorders. Results: 1) In children and adolescents with SMA profound muscle weakness was found in all assessed muscle groups compared to normal strength. Proximal weakness was greater than distal and lower limbs were more affected than upper limbs. Walking, transfer from lying or sitting to the standing position, and climbing stairs were possible in some of the individuals, despite marked reduction of muscle strength. Compensatory maneuvers described were reinforcement by using stronger upper limbs or distal muscle groups. 2) Children and adolescents with DM were significantly weaker than healthy controls in a majority of the assessed muscle groups. There was a great variation where some of the individuals had normal muscle strength. A strong correlation was found between motor function score and size of the mutation (rho=-0.743). Jumping, heel-standing and head-lifting in supine were difficult to perform, but few had difficulty in walking, running and stair-climbing. 3) Low-dose prednisolone treatment in boys with DMD delayed the time of loss of ambulation by at least 1.7 years and postponed development of scoliosis and contractures. There were also beneficial effects on muscle strength, motor function and vital capacity. The side effects were mild and long-term treatment was possible.4) In individuals with amyoplasia muscle strength affected motor function to a greater extent than joint contractures, although the joint contractures and joint position at birth also had an impact. Muscle strength was reduced in most of the investigated individuals. There was, however, heterogeneity and some of the patients had normal muscle strength in some of the investigated muscle groups. More attention should be paid at developing muscle strength, with early stimulation of active movement, and periods of immobilization should be minimized. Conclusions: SMA, DM, DMD and amyoplasia are heterogeneous conditions with a wide spectrum of muscle involvement. This investigation of muscle strength and motor function increases our knowledge concerning pattern and degree of muscle weakness in the different disorders, but also the impact of muscle weakness on motor function. The results have enhanced the possibilities of planning therapeutic interventions and the understanding of the prerequisites for everyday life in the children and adolescents with neuromuscular disorders.
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| 17. |
- Kroksmark, Anna-Karin, et al.
(författare)
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Myotonic dystrophy: muscle involvement in relation to disease type and size of expanded CTG-repeat sequence
- 2005
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Ingår i: Dev Med Child Neurol. - 0012-1622. ; 47:7, s. 478-85
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Tidskriftsartikel (refereegranskat)abstract
- This study aimed to: classify a cohort of children and adolescents with myotonic dystrophy (dystrophia myotonica: DM) into congenital and childhood onset forms; estimate CTG expansion size; and quantify muscle strength, contractures, and motor function in children with DM and compare results with those of controls. Participants were clinically examined, medical records were reviewed, and isometric muscle strength, contractures, and motor function were measured. Participants were: 42 children with DM (18 females, 24 males; mean age 8y 9mo [SD 4y 7mo], range 10mo to 17y) and 42 age- and sex-matched, healthy controls. Children with DM were divided into three groups: severe congenital (n=13), mild congenital (n=15), and childhood (n=14). Children with childhood DM were significantly weaker than controls (wrist and ankle dorsiflexors [p=0.0044, p=0.0044 respectively]; hip abductors and flexors [p=0.0464, p=0.0217]; and knee flexors and extensors: [p=0.0382, p=0.0033]). Children with mild congenital DM were significantly weaker than controls in all assessed muscle groups. Contractures and skeletal deformities were more frequent at time of investigation than at birth, suggesting that foot and spine deformities in particular increase over time. Motor function score was significantly lower for children with DM than for controls. Children with severe congenital DM had the lowest motor function, with correlation between motor function and size of CTG repeat (p=-0.743). Children found jumping, heel standing, and head lifting the most difficult items to perform but few had difficulty walking, running, or stair climbing. DM in children is a heterogeneous disorder with a wide spectrum of muscle involvement, and owing to increased risk of contractures and skeletal deformities, regular follow-ups are recommended.
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| 18. |
- Lager, C., et al.
(författare)
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Pain in adolescents with spinal muscular atrophy and Duchenne and Becker muscular dystrophy
- 2015
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Ingår i: European journal of paediatric neurology. - : Elsevier BV. - 1090-3798. ; 19:5, s. 537-546
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Tidskriftsartikel (refereegranskat)abstract
- Background/purpose: The purpose of this study was to explore the prevalence, nature and scope of pain in adolescents with spinal muscular atrophy and Duchenne and Becker muscular dystrophy and whether the pain differs between diagnostic groups or between adolescents with different ambulation status. Furthermore to study the consequences of pain and to identify pain-exacerbating and pain-relieving factors. Methods: In a national survey, fifty-five adolescents with spinal muscular atrophy and dystrophinopathy completed a questionnaire assessing pain frequency, duration, location using a body map, intensity and discomfort using visual analogue scales, pain interference using a modified version of Brief Pain Inventory and factors exacerbating and relieving pain. Results: Sixty-nine per cent of the adolescents reported pain during the past three months and 50% reported chronic pain. The pain prevalence did not differ significantly between diagnostic groups or between ambulators and non-ambulators. The average pain intensity was graded as mild and the worst pain as moderate. The pain typically occurred weekly, most frequently in the neck/back or legs. General activity and mood were the areas that were most affected by pain. Common pain-exacerbating factors were sitting, too much movement/activity and being lifted or transferred. Conclusion: Pain is a frequent problem in adolescents with spinal muscular atrophy and dystrophinopathy. The assessments used enable an understanding both of the nature and scope of pain and of the impact of pain in everyday life. The study highlights the importance of assessing pain in a systematic manner and offering an individual approach to interventions designed to reduce pain in this population. (C) 2015 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.
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| 19. |
- Lindeblad, G., et al.
(författare)
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Cognitive and adaptive functioning in congenital and childhood forms of myotonic dystrophy type 1: a longitudinal study
- 2019
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Ingår i: Developmental Medicine and Child Neurology. - : Wiley. - 0012-1622 .- 1469-8749. ; 61:10, s. 1214-1220
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To conduct a longitudinal follow-up of the development of global cognitive abilities and adaptive skills in individuals with congenital and childhood forms of myotonic dystrophy type 1 (DM1). Method: Fifty-one participants (29 males, 22 females, mean age 19y 5mo, SD 4y 11mo, range 10y 10mo–28y 11mo) were divided into severe congenital (n=16), mild congenital (n=17), and childhood DM1 (n=18) subgroups. The average time between the first and second assessments was 7years 8months. Adaptive skills were evaluated using the Vineland Adaptive Behavior Scales and global cognitive functioning using Wechsler scales. Results: There was no statistically significant decline in cognitive abilities and adaptive behaviour. A tendency of decline regarding the level of intellectual disability was found in the congenital DM1 groups but not in the childhood group. In the congenital DM1 groups, the gap in relation to typically developing peers in cognitive and adaptive functioning increased. Predictors of change over time in adaptive skills were age and current level of intellectual disability: individuals with severe intellectual disability and younger individuals deteriorated the most. However, when raw scores were compared, no actual regression in adaptive functioning was found. Interpretation: The participants had not lost any important adaptive skills. Greater cognitive and adaptive development was found in the childhood group than in the congenital groups. What this paper adds: There is no absolute decline in cognitive and adaptive abilities in individuals with congenital and childhood myotonic dystrophy type 1. Pace of development is slow in comparison with normative data. The childhood group tended to show greater cognitive and adaptive development than the congenital groups. © 2019 Mac Keith Press
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| 20. |
- Michael, Eva, et al.
(författare)
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Long term treatment with ataluren-the Swedish experience
- 2021
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Ingår i: Bmc Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Ataluren is a relatively new treatment for male patients with Duchenne muscular dystrophy (DMD) due to a premature stop codon. Long-term longitudinal data as well as efficacy data on non-ambulant patients are still lacking. Here we present the results from a long-term follow-up study of all DMD patients treated with ataluren and followed at the Queen Silvia Children's Hospital in Gothenburg, Sweden, with focus on the evolution of patients' upper motor and respiratory function over time. Methods This is a retrospective longitudinal case-series study of all male DMD patients treated with ataluren and followed at the Queen Silvia Children's Hospital in Gothenburg, Sweden, since 2008. Results Our eleven patients had a median exposure to ataluren of 2312 days which is almost a fourfold higher than previous studies. Loss of ambulation occurred at a median age of 13.2 years. Patients who lost ambulation prior to 13.2 years of age had received ataluren for 5 years, whereas patients who continued to be ambulatory after 13.2 years of age had received ataluren for 6.5 years until loss of ambulation or last follow-up if still ambulatory. Four of six non ambulatory patients had Performance of the Upper Limb scores above the expected mean values over time. All but one patient maintained a pulmonary decline above the expected over time. All ambulatory patients increased in their predicted forced vital capacity (FVC) with 2.8 to 8.2% annually. Following loss of ambulation, 5 of 6 patients declined in predicted FVC (%), with annual rate of decline varying from 1.8 to 21.1%. The treatment was safe and well tolerated throughout the follow-up period. Conclusions This is the first study to present long-term cumulative treatment outcomes over a median period of 6.3 years on ataluren treatment. Our results indicate a delay in loss of ambulation, as well as a slower decline in FVC and upper limb motor function even after loss of ambulation. We suggest that treatment with ataluren should be initiated as soon as the diagnosis is confirmed, closely monitored and, in case of sustainable benefit, continued even after loss of ambulation.
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| 21. |
- Olsson, Bob, 1969, et al.
(författare)
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NFL is a marker of treatment response in children with SMA treated with nusinersen
- 2019
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Ingår i: Journal of Neurology. - : Springer Science and Business Media LLC. - 0340-5354 .- 1432-1459. ; 266:9, s. 2129-2136
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Tidskriftsartikel (refereegranskat)abstract
- Background Recently, the anti-sense oligonucleotide drug nusinersen was approved for spinal muscular atrophy (SMA) and our aim was to find a response marker for this treatment. Methods Twelve children with SMA type 1 and two copies of the SMN2 gene were included in a consecutive single-center study. The children were sampled for CSF at baseline and every time nusinersen was given intrathecally. The neuronal biomarkers NFL and tau and the glial biomarker GFAP were measured. Motor function was assessed using CHOP INTEND. Eleven similarly aged children, who were investigated to rule out neurological or infectious disease, were used as controls. Results Baseline levels of NFL (4598 +/- 981 vs 148 +/- 39, P = 0.001), tau (939 +/- 159 vs 404 +/- 86, P = 0.02), and GFAP (236 +/- 44 vs 108 +/- 26, P = 0.02) were significantly higher in SMA children than controls. Motor function improved by nusinersen treatment in median 13 points corresponding to 5.4 points per month of treatment (P = 0.001). NFL levels typically normalized ( < 380 pg/ml) between the fourth and fifth doses [- 879.5 pg/mL/dose, 95% CI (- 1243.4, - 415.6), P = 0.0001], tau levels decreased [- 112.6 pg/mL/dose, 95% CI (- 206-7, - 18.6), P = 0.01], and minor decreases in GFAP were observed [- 16.9 pg/mL/dose, 95% CI (- 22.8, - 11.2), P = 0.02] by nusinersen treatment. Improvement in motor function correlated with reduced concentrations of NFL (rho = - 0.64, P = 0.03) and tau (rho = - 0.85, P = 0.0008) but not GFAP. Conclusions Nusinersen normalized the axonal damage marker NFL and correlated with motor improvement in children with SMA. NFL may, therefore, be a novel biomarker to monitor treatment response early in the disease course.
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| 22. |
- Pegoraro, E, et al.
(författare)
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SPP1 genotype is a determinant of disease severity in Duchenne muscular dystrophy.
- 2011
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Ingår i: Neurology. - 0028-3878. ; 76:3, s. 219-26
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Tidskriftsartikel (refereegranskat)abstract
- Duchenne muscular dystrophy (DMD) is the most common single-gene lethal disorder. Substantial patient-patient variability in disease onset and progression and response to glucocorticoids is seen, suggesting genetic or environmental modifiers.
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| 23. |
- Sejersen, Thomas, et al.
(författare)
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Healthcare resource utilisation and direct medical cost for individuals with 5q spinal muscular atrophy in Sweden
- 2024
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Ingår i: EUROPEAN JOURNAL OF HEALTH ECONOMICS. - 1618-7598 .- 1618-7601.
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Tidskriftsartikel (refereegranskat)abstract
- Background Spinal muscular atrophy (SMA) is a rare, progressive, neuromuscular disorder. Recent advances in treatment require an updated assessment of burden to inform reimbursement decisions.Objectives To quantify healthcare resource utilisation (HCRU) and cost of care for patients with SMA.Methods Cohort study of patients with SMA identified in the Swedish National Patient Registry (2007-2018), matched to a reference cohort grouped into four SMA types (1, 2, 3, unspecified adult onset [UAO]). HCRU included inpatient admissions, outpatient visits, procedures, and dispensed medications. Direct medical costs were estimated by multiplying HCRU by respective unit costs. Average annual HCRU and medical costs were modelled for SMA versus reference cohorts to estimate differences attributable to the disease (i.e., average treatment effect estimand). The trajectory of direct costs over time were assessed using synthetic cohorts.Results We identified 290 SMA patients. Annualised HCRU was higher in SMA patients compared with reference cohorts. Highest risk ratios were observed for inpatient overnight stays for type 1 (risk ratio [RR]: 29.2; 95% confidence interval [CI]: 16.0, 53.5) and type 2 (RR: 23.3; 95% CI: 16.4,33.1). Mean annual direct medical costs per patient for each year since first diagnosis were greatest for type 1 (euro114,185 and SMA-attributable: euro113,380), type 2 (euro61,876 and SMA-attributable: euro61,237), type 3 (euro45,518 and SMA-attributable: euro44,556), and UAO (euro4046 and SMA-attributable: euro2098). Costs were greatest in the 2-3 years after the first diagnosis for all types.Discussion and conclusion The economic burden attributable to SMA is significant. Further research is needed to understand the burden in other European countries and the impact of new treatments.
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| 24. |
- Stridh, Marie Louise, et al.
(författare)
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Postural control in the congenital and childhood forms of myotonic dystrophy type 1
- 2017
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Ingår i: European Journal of Physiotherapy. - : Informa UK Limited. - 2167-9169 .- 2167-9177. ; 19, s. 24-31
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Tidskriftsartikel (refereegranskat)abstract
- © 2016 Informa UK Limited, trading as Taylor & Francis Group. Aims: To increase knowledge regarding postural control in congenital (CDM1) and childhood (ChDM1) forms of myotonic dystrophy type 1 and to analyze whether variations can be explained by age, joint motion, muscle strength and molecular findings. Methodology: In a cross-sectional study, postural control was measured with the Bruininks-Oseretsky test, sub-test balance, range of motion (ROM) in ankle dorsiflexion and muscle strength in ankle dorsiflexors. Simple linear regression analysis was used to investigate the association between postural control, molecular findings, muscle strength, age and ROM. Major findings: Forty-four individuals participated in the study. All individuals with CDM1 and 80% with ChDM1 had reduced postural control. Simple linear regression analysis shows a negative association between z-BOT2 and CTG repeat expansion (R2=.342, p =.000), a negative association with age (R2=.148, p =.006), a positive association with muscle strength in ankle dorsiflexors (R2=.205, p =.001) and a positive association with ROM in ankle dorsiflexion (R2=.078, p =.037). Principal conclusion: Reduced postural control is common in CDM1 and ChDM1. Size of CTG repeat expansion, muscle strength in ankle dorsiflexors, age and ROM in ankle dorsiflexion all contribute to variations in postural control. These findings provide a better understanding of the disease and contribute to improved health care for the patient group.
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| 25. |
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| 26. |
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| 27. |
- Söderpalm, Ann-Charlott, 1961, et al.
(författare)
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Bone mass development in patients with Duchenne and Becker muscular dystrophies: a 4-year clinical follow-up
- 2012
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Ingår i: Acta Paediatrica. - : Wiley-Blackwell. - 0803-5253 .- 1651-2227. ; 101:4, s. 424-432
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To investigate the longitudinal development of bone mass in patients with Duchenne and Becker muscular dystrophies and to study the impact of muscle strength and motor function on bone mass in these patients. less thanbrgreater than less thanbrgreater thanMethods: Eighteen patients with Duchenne muscular dystrophy (2.3-19.7 years at baseline) and six patients with the milder Becker muscular dystrophy (10.8-18.9 years at baseline) were followed during a 4-year period with respect to areal bone mineral density (BMD), motor function and muscle strength. less thanbrgreater than less thanbrgreater thanResults: Greater bone mineral accretion was observed in the Becker patient group compared with the age-related Duchenne group above 10 years of age, and the older patients with Duchenne experienced decreased femoral neck BMD during the study period. In the study group, significant correlations were found between BMD in the lower extremities and muscle function parameters. less thanbrgreater than less thanbrgreater thanConclusions: The differences in BMD between patients with Duchenne and Becker as well as between different bone measurement sites demonstrated in the present study point out the importance of preserving muscle strength and motor function in patients with muscular dystrophy. Moreover; it highlights the value of performing region-specific analysis of the bone quality in these patients.
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| 28. |
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| 29. |
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| 30. |
- Söderpalm, Ann-Charlott, 1961, et al.
(författare)
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Low bone mineral density and decreased bone turnover in Duchenne muscular dystrophy
- 2007
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Ingår i: Neuromuscular Disorders. - : Elsevier BV. - 0960-8966 .- 1873-2364. ; 17:11-12, s. 919-928
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Tidskriftsartikel (refereegranskat)abstract
- This cross-sectional study examined bone mineral density, bone turnover, body composition and calciotropic hormones in 24 boys with Duchenne muscular dystrophy (DMD) (2.3-19.7 years), most of whom were being treated with prednisolone, and 24 age-matched healthy boys. Our study demonstrated lower bone mineral density in the DMD group for total body, spine, hip, heel and forearm measurements. These differences between DMD patients and controls increased with increasing age. Biochemical markers of both bone formation and resorption revealed reduced bone turnover in DMD patients. The fracture rate was not higher in DMD patients. The DMD group had low vitamin D levels but high leptin levels in comparison with the control group. Muscle strength correlated with bone mineral density assessed at the hip and heel in the DMD group. Interventions that increase bone formation should be considered, as DMD patients have reduced bone turnover in addition to their low bone mineral density. © 2007 Elsevier B.V. All rights reserved.
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| 31. |
- Söderpalm, Ann-Charlott, 1961, et al.
(författare)
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Whole body vibration therapy in patients with Duchenne muscular dystrophy - A prospective observational study
- 2013
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Ingår i: Journal of Musculoskeletal and Neuronal Interactions - JMNI. - : International Society of Musculoskeletal and Neuronal Interactions. - 1108-7161. ; 13:1, s. 13-18
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES:To study the tolerability of whole body vibration (WBV) exercise in patients with Duchenne muscular dystrophy (DMD) and its effects on muscle and bone.METHODS:WBV was performed two to three times a week for three months. Motor function, muscle strength, bone mass and biochemical markers of bone and mineral metabolism were analyzed before and after the WBV period at 0, 3, 6 and 12 months.RESULTS:Six ambulatory patients with DMD aged 5.7-12.5 years completed the study. No changes in creatine kinase activity were found, indicating that the WBV exercise did not further damage the skeletal muscle. No significant changes in bone mass, muscle strength or bone markers were found. However, there was a non-significant trend for the bone formation marker, bone-specific alkaline phosphate, to increase from a mean of 59 U/L to 73 U/L after three months of WBV. The bone formation marker levels returned to baseline three months after discontinuing WBV and were still at that level after nine months.CONCLUSIONS:WBV therapy appears to be safe and well tolerated among ambulatory DMD patients. The potential benefits of WBV on bone and muscle in DMD remain to be elucidated.
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| 32. |
- Tajsharghi, Homa, 1968, et al.
(författare)
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Embryonic myosin heavy-chain mutations cause distal arthrogryposis and developmental myosin myopathy that persists postnatally.
- 2008
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Ingår i: Archives of neurology. - : American Medical Association (AMA). - 1538-3687 .- 0003-9942. ; 65:8, s. 1083-90
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Myosin is a molecular motor and the essential part of the thick filament of striated muscle. The expression of myosin heavy-chain (MyHC) isoforms is developmentally regulated. The embryonic isoform encoded from MYH3 (OMIM *160720) is expressed during fetal life. Recently, mutations in MYH3 were demonstrated to be associated with congenital joint contractures, that is, Freeman-Sheldon and Sheldon-Hall syndromes, which are both distal arthrogryposis syndromes. Mutations in other MyHC isoforms cause myopathy. It is unknown whether MYH3 mutations cause myopathy because muscle tissue has not been studied. OBJECTIVES: To determine whether novel MYH3 mutations are associated with distal arthrogryposis and to demonstrate myopathic changes in muscle biopsy specimens from 4 patients with distal arthrogryposis and MYH3 mutations. DESIGN: In a cohort of patients with distal arthrogryposis, we analyzed the entire coding sequence of MYH3. Muscle biopsy specimens were obtained, and in addition to morphologic analysis, the expression of MyHC isoforms was investigated at the protein and transcript levels. RESULTS: We identified patients from 3 families with novel MYH3 mutations. These mutations affect developmentally conserved residues that are located in different regions of the adenosine triphosphate-binding pocket of the MyHC head. The embryonic (MYH3) isoform was not detected in any of the muscle biopsy samples, indicating a normal developmental downregulation of MYH3 in these patients. However, morphologic analysis of muscle biopsy specimens from the 4 patients revealed mild and variable myopathic features and a pathologic upregulation of the fetal MyHC isoform (MYH8) in 1 patient. CONCLUSIONS: Distal arthrogryposis associated with MYH3 mutations is secondary to myosin myopathy, and postnatal muscle manifestations are variable.
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| 33. |
- Wahlgren, Lisa, 1980, et al.
(författare)
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One in five patients with Duchenne muscular dystrophy dies from other causes than cardiac or respiratory failure
- 2022
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Ingår i: European Journal of Epidemiology. - : Springer Science and Business Media LLC. - 0393-2990 .- 1573-7284. ; 37:2, s. 147-156
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Tidskriftsartikel (refereegranskat)abstract
- Duchenne muscular dystrophy (DMD) is a severe neuromuscular disorder with increasing life expectancy from late teens to over 30 years of age. The aim of this nationwide study was to explore the prevalence, life expectancy and leading causes of death in patients with DMD in Sweden. Patients with DMD were identified through the National Quality Registry for Neuromuscular Diseases in Sweden, the Swedish Registry of Respiratory Failure, pathology laboratories, neurology and respiratory clinics, and the national network for neuromuscular diseases. Age and cause of death were retrieved from the Cause of Death Registry and cross-checked with medical records. 373 DMD patients born 1970-2019 were identified, of whom 129 patients deceased during the study period. Point prevalence of adult patients with DMD on December 31st 2019 was 3.2 per 100,000 adult males. Birth prevalence was 19.2 per 100,000 male births. Median survival was 29.9 years, the leading cause of death being cardiopulmonary in 79.9% of patients. Non-cardiopulmonary causes of death (20.1% of patients) mainly pertained to injury-related pulmonary embolism (1.3 per 1000 person-years), gastrointestinal complications (1.0 per 1000 person-years), stroke (0.6 per 1000 person-years) and unnatural deaths (1.6 per 1000 person-years). Death from non-cardiopulmonary causes occurred at younger ages (mean 21.0 years, SD 8.2; p = 0.004). Age at loss of independent ambulation did not have significant impact on overall survival (p = 0.26). We found that non-cardiopulmonary causes contribute to higher mortality among younger patients with DMD. We present novel epidemiological data on the increasing population of adult patients with DMD.
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| 34. |
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