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PubMed1991

[Benign, focal amyotrophy].

Benign focal amyotrophy is a usually asymmetrical motor neuron disease affecting young people. Its favourable prognosis differentiates it from progressive motor neuron diseases such as the much more frequent and most severe form, amyotrophic lateral sclerosis (ALS). We report on one patient with "juvenile muscular atrophy of unilateral upper extremity" of the Hirayama type and two patients with selective amyotrophy of one calf ("wasted leg-syndrome"). In addition, we have observed three young women with selective muscle atrophy in the scapula region which has appeared stable for many years and might represent another entity of so-called benign focal amyotrophy.

Adult↗
PubMed1989

[A case of amyotrophic lateral sclerosis associated with clinical features of progressive supranuclear palsy].

A 64-year-old male patient of amyotrophic lateral sclerosis (ALS) with frozen gait, axial rigidity and supranuclear upper gaze palsy was reported. We have followed this patient more than four years. He was well until November 1982, when he noticed weakness of left arm. In March 1983, he noticed hypogeusia and in July, he developed dysarthria and frozen gait. On admission, he was alert and oriented. Neurological examination revealed dysarthria, dysphagia and muscular weakness and atrophy in bilateral upper extremities, dominantly in left side. He showed remarkable frozen gait, retropulsion and could not walk. Brain CT showed mild dilatation of the third ventricle. In August 1988, he showed tongue atrophy, and weakness and atrophy of the extremities progressed during these four years. He also showed axial rigidity and frozen gait. Brain CT showed severe third ventricular dilatation and atrophy of tegmentum of the midbrain and cerebellum that were compatible with progressive supranuclear palsy (PSP). Six months later, he developed upper gaze palsy. From these findings, we concluded that this patient had a quite unique clinical features of both ALS and PSP.

Amyotrophic Lateral Sclerosis↗
PubMed1996

Testosterone therapy and the pathogenesis of Kennedy's disease (X-linked bulbospinal muscular atrophy).

The mutation in X-linked bulbospinal muscular atrophy (XBSMA) is an increased CAG triplet repeat coding for a polyglutamine domain in the gene for the androgen receptor. This might impair the effect of testosterone on motor neurons, leading to their progressive degeneration. We report a trial of high-dose oral testosterone therapy in two brothers with XBSMA. Patient 1 received 37.5 mg of testosterone daily for more than 18 months, and Patient 2 received 25 mg per day for six months, both in combination with exercise therapy. Patient 1 showed improvement of up to 300% in muscle work output. Patient 2, who did less exercise, had no symptomatic improvement. These results indicate that exogenous testosterone therapy is not harmful, and may produce functional improvement when combined with exercise. We hypothesize that high-dose testosterone may reduce a toxic gain of function that the mutation produces, perhaps by inhibiting glutamate neurotoxicity.

Aged↗
PubMed2004

Sleep disordered breathing in spinal muscular atrophy.

Sleep disordered breathing is a common but under-diagnosed complication causing sleep disturbance and daytime symptoms in children with spinal muscular atrophy. Non-invasive (positive pressure) ventilation is an established treatment of respiratory failure; its role in treatment of sleep disordered breathing though remains controversial. Aim of this study was to verify the hypothesis that nocturnal non-invasive ventilation has beneficial impact on breathing during sleep, sleep quality and daytime complaints in children with spinal muscular atrophy. Twelve children with spinal muscular atrophy type I or II (7.8+/-1.9 years) underwent polysomnography and were asked to fill out a symptom questionnaire. Seven patients (six with spinal muscular atrophy I and one with spinal muscular atrophy II) had sleep disordered breathing and received non-invasive ventilation during sleep. Five less severely affected patients (one with spinal muscular atrophy I and four with spinal muscular atrophy II) had no sleep disordered breathing and served as reference group. Patients were restudied after 6-12 months. In patients with sleep disordered breathing both sleep architecture and disease related symptoms were significantly worse than in the reference-group. Non-invasive ventilation during sleep completely eliminated disordered breathing, normalized sleep architecture and improved symptoms (P<0.05 for all). In children with spinal muscular atrophy sleep disordered breathing may cause relevant impairment of sleep and well-being. Both can be highly improved by nocturnal non-invasive ventilation.

Child↗
PubMed1993

[Infantile spinal amyotrophy with atypical course: report of 2 cases].

The authors report two cases of infantile spinal muscular atrophy with atypical evolution diagnosed by means of EMG findings. The first one is a 10 years-old female child who has showed a distal predominium of the muscle weakness and atrophy. The second patient, a 7 year-old female child, has manifested within a period of 4 months a rapidly progressive tetraparesis that culminated in death after 10 months. The authors present the most accepted classifications of the illness and discuss the clinical manifestations of the two patients aiming to characterize the clinical forms, in accordance to the literature.

Child↗
PubMed1988

[An experimental study on denervated muscle atrophy--effect of electrostimulation and comparison with immobilization muscle atrophy].

The efficacy of causing muscle atrophy was compared among denervation, arthrodesis and tenotomy in rat anterior tibial muscle. Reduction of wet weight was most pronounced in denervated muscle and least in arthrodesed muscle. Histochemical investigation by ATPase stain revealed that atrophy of Type 1 and Type 2 fiber was more severe in denervated muscle group than in the other two groups. Type 2 fiber atrophy was dominant in denervated muscle and in arthrodesed muscle. Type 1 fiber atrophy was dominant in tenotomized muscle. The effect of electrostimulation on denervated muscle was investigated. Electrostimulation significantly reduced the degree of denervation atrophy. Four weeks after severance of peroneal nerve, tibial nerve-crossing was done and electrostimulation was continued for eight weeks. Recovery of wet weight of re-innervated muscle with electrostimulation was significantly better than that without electrostimulation. Electrostimulation applied to denervated muscle reduced the progress of atrophy and improved the recovery after nerve repair.

Animals↗
PubMed1975

X-linked spinal and bulbar muscular atrophy of late onset. A separate type of motor neuron disease?

The clinical, electrophysiological and muscle biopsy findings of 7 cases with a peculiar form of X-linked hereditary degenerative motor neuron disease are presented. It is suggested that the disease might be a separate clinical entity with the following characteristics: (1) sex-linked recessive inheritance, (2) unusual but not invariable late onset, (3) slow progression, (4) facial-bulbar and proximal spinal muscle involvement, (5) consistent fasciculations, sometimes massive and more pronounced about the lips, chin and tongue, (6) fine tremor of the hands, (7) muscle cramps usually preceding the other symptoms, and (8) gynaecomastia as a frequent but not a constant feature.

Action Potentials↗
PubMed1996

Trinucleotide repeats in neurogenetic disorders.

Trinucleotide repeat expansion is increasingly recognized as a cause of neurogenetic diseases. To date, seven diseases have been identified as expanded repeat disorders: the fragile X syndrome of mental retardation both FRAXA and FRAXE loci), myotonic dystrophy, X-linked spinal and bulbar muscular atrophy, Huntington's disease, spinocerebellar ataxia type I, dentatorubral-pallidoluysian atrophy, and Machado-Joseph disease. All are neurologic disorders, affecting one or more regions of the neuraxis. Moreover, five of the seven (the last five above) are progressive neurodegenerative disorders whose strikingly similar mutations suggest a common mechanism of neuronal degeneration. In this article we discuss specific characteristics of each trinucleotide repeat disease, review their shared clinical and genetic features, and address possible molecular mechanisms underlying the neuropathology in each disease. Particular attention is paid to the neurodegenerative diseases, all of which are caused by CAG repeats encoding polyglutamine tracts in the disease gene protein.

Central Nervous System Diseases↗
PubMed1988

A follow-up study of 60 cases of chronic spinal muscular atrophy.

60 cases of chronic spinal muscular atrophy (CSMA) were followed-up for a period varying from 5 to 40 years. The neuromuscular impairment was evaluated by Norris' ALS score, both at the time of last examination and retrospectively at the time of diagnosis. Age at onset of symptoms was the most important factor in the progression of the neuromuscular damage. Monomelic or asymmetric location of symptoms at the time of diagnosis and duration of the disease were not significantly correlated to the worsening of ALS score.

Adult↗
PubMed2004

Long-term observations of patients with infantile spinal muscular atrophy with respiratory distress type 1 (SMARD1).

We describe 6 unrelated patients affected by infantile spinal muscular atrophy with respiratory distress type 1 (SMARD1) with prolonged survival upon mechanical ventilation (4.5-11 years), which has not been reported before. Biallelic mutations in the IGHMBP2 gene proved the diagnosis of SMARD1 in all patients. Disease onset was in the first 2 months in the described patients, starting with generalised hypotonia, failure to thrive, and early breathing difficulties. Diaphragmatic palsy was diagnosed and permanent ventilation was initiated 2-8 months after onset. Within months a more distal muscular atrophy became evident associated with joint contractures (talipes), hand drops, and fatty finger pads. Motor development remained minimal, loss of function was observed within the first year after which no further progression was recorded. Voiding dysfunction with reflux nephropathy was observed in 3 patients and has not been reported before. Further evidence of autonomic nerve dysfunction resulting in cardiac arrhythmia, hypertension, and excessive sweating was given in 2 patients. Investigative results were largely compatible with those obtained in classic SMA. However, neurogenic atrophy muscle was more pronounced in distal muscles, if examined, and there was evidence of peripheral nerve involvement at least in some patients.

Age Factors↗
PubMed1989

Proteins of muscle subcellular fractions in Duchenne progressive muscular dystrophy stained with "stains-all" cationic carbocyanine dye and with Coomassie Blue.

The protein compositions of subcellular fractions of muscle obtained from 17 Duchenne dystrophy patients, 15 disease controls (10 different primary myopathies, 5 spinal muscular atrophy patients), and 10 normals were examined by polyacrylamide gel electrophoresis. The gels were stained with Coomassie Brilliant Blue and with "Stains-all," which stains calcium-binding proteins, sialic acid-rich glycoproteins, and phosphoproteins. In muscle membrane fractions of Duchenne dystrophy patients there was a marked reduction in the concentrations of calsequestrin and a 39 kDa protein that stained blue with "Stains-all." There were changes in the proteins of all subcellular fractions of Duchenne's patients; some of these changes appear to be specific for Duchenne dystrophy (DD). There was no apparent correlation between the protein changes observed on acrylamide gels and the age of the patients, the duration of the disease, the degree of disability, or activity of creatine kinase. A decreased level of calsequestrin in DD sarcoplasmic reticulum may contribute to an increased level of free calcium seen in muscle from these patients.

Calcium-Binding Proteins↗
PubMedDate not supplied

Oculopharyngeal muscular dystrophy: clinical and CT findings.

A family affected with oculopharygeal muscular dystrophy (OPMD) is reported. This is an uncommon progressive myopathy. The proband presented for evaluation of secretory otitis media with effusion, as a result of tubal dysfunction. CT examination of the father revealed prominent muscular atrophy, and widespread fatty degeneration of the psoas, paraspinal, gluteal and femoral muscles.

Adult↗
PubMed2003

Pontocerebellar hypoplasia type 1: new leads for an earlier diagnosis.

Pontocerebellar hypoplasia type 1 is a rare disease characterized by pontocerebellar hypoplasia and anterior horn cell degeneration. The oldest reported child died at the age of 26 months. Two siblings were diagnosed with pontocerebellar hypoplasia type 1 after the death of the second sibling at 40 months of age from respiratory failure and the unexpected finding of anterior horn cell degeneration on her autopsy. The older sibling was a boy who was labeled as having cerebral palsy. He died at 14 months of age from pneumonia following a clinical course similar to his sister's, who was born 5 years after his death. Both siblings had significant global developmental delay with axial and peripheral hypotonia initially. Peripheral hypertonia with brisk reflexes developed later but were absent prior to death. Extensive investigations in the second sibling ruled out known metabolic (including congenital disorders of glycosylation) and mitochondrial diseases using skin fibroblast cultures and enzyme analysis. Genetic testing for Friedreich's ataxia; neuropathy, ataxia, and retinitis pigmentosa (NARP); spinal muscular atrophy; and spinocerebellar ataxia type 1, 2, 3, 6, 7, and 8 gene abnormalities was negative. The elecroretinogram showed a previously unreported finding of abnormal and progressive rod/cone response. Our cases provide clinical and previously unreported electroretinographic evidence for neurodegeneration in pontocerebellar hypoplasia type 1 and call for the expansion of the disease phenotype.

Atrophy↗
PubMed1989

[A case of Kennedy-Alter-Sung syndrome associated with external ophthalmoplegia--therapeutic efficacy of fluoxymesterone].

We reported a case with Kennedy-Alter-Sung syndrome (KAS) associated with bilateral external ophthalmoplegia. The patient had movement disturbance of bilateral infra-oblique muscles. The doll's eye phenomenon was not noted. It was suggested that the external ophthalmoplegia was due to the involvement of the oculomotor nucleus that innervated infra-oblique muscle. The serum levels of testosterone and gonadotropin were high, suggesting that the feminization of KAS patients was caused by androgen insensitivity. The feminization of KAS patients is similar to the incomplete form of testicular feminization syndrome except that they do not have feminization of genitals. Therefore, we proposed that abnormalities of androgen receptors might play a role in the pathogenesis of KAS. Fluoxymesterone therapy significantly improved the muscle weakness of the extremities of the patient, even though the therapeutic efficacy was shown temporarily. The therapeutic efficacy of fluoxymesterone for muscle weakness supports our hypothesis.

Androgen-Insensitivity Syndrome↗