[Contribution of Japanese researchers to progress in the field of neurology in the last 100 years: Hirayama's disease].
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History, 20th Century↗
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[Klippel-Trenaunay-Weber's syndrome with many malformations and with progressive lipodystrophy in a 6-year-old boy].
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Abnormalities, Multiple↗
Pathogenesis of pes cavus in Charcot-Marie-Tooth disease.
Of 22 persons from a single kinship of known Charcot-Marie-Tooth (CMT) disease, 12 were found to be affected. All 12 had a pes cavus deformity. The insidious atrophy of the intrinsic musculature of the foot progressed to a fixed soft tissue and bony cavus deformity.
Adolescent↗
Nemaline myopathy: comparative muscle histochemistry in the severe neonatal, moderate congenital, and adult-onset forms.
A histochemical study of biopsied muscle specimens from patients with the 3 forms of nemaline myopathy (i.e., severe neonatal, moderate congenital, and adult-onset), classified on the basis of clinical symptoms, was conducted. A close relationship could not be found between the number of rods and the severity of weakness in any form. Type 1 fiber atrophy and predominance or type 2B fiber deficiency was the usual finding in all forms. In the moderate congenital form, type 1 fiber atrophy and predominance became more apparent in patients with a protracted course, suggesting that the histochemical abnormalities are progressive. The abnormal fiber type distribution is assumed to be related to the pathogenetic mechanism of nemaline myopathy in all forms. Because acid phosphatase activity was increased in muscle fibers of patients with rapid progression, an autodegenerative process inducing lysosomal enzyme activation may be responsible for the acute clinical progression and muscle fiber loss in this disorder.
Adolescent↗
Immunoblot analysis of sarcoplasmic calcium binding proteins in Duchenne muscular dystrophy.
The Western blotting technique was used to detect parvalbumin and S-100 protein in muscles from 10 Duchenne muscular dystrophy (DD) patients, 13 patients with other muscle diseases and 5 age-matched healthy subjects. DD muscles were found to contain decreased amounts of parvalbumin and the S-100 protein. The parvalbumin level did not relate to the age of the patients and the stage of the disease. The S-100 protein decreased progressively with the age of the patients. In a very advanced DD case the S-100 protein was present in trace amounts. In other primary myopathies, including Becker dystrophy, and neurogenic muscular atrophy both parvalbumin and S-100 protein levels were similar to that observed in healthy subjects. The decrease in the amount of both calcium binding proteins may contribute to the elevation of free intracellular Ca2+ level in the sarcoplasm of dystrophic muscle and would result in abnormalities in processes regulated by these proteins. The mechanism(s) responsible for the decrease of parvalbumin and S-100 protein in DD muscles are discussed.
Adolescent↗
Severe infantile neuropathy with diaphragmatic weakness and its relationship to SMARD1.
A group of 13 patients with early onset diaphragmatic palsy in association with a progressive neuropathy is presented. All eight of those tested were found to have mutations in the same gene encoding the immunoglobulin mu-binding protein 2 (IGHMBP2) in patients with spinal muscular atrophy (SMA) with respiratory distress type 1. Six out of these eight patients had either homozygous or compound heterozygous mutations, and two had only a single heterozygous mutation. Detailed analysis of the clinical picture and the neurophysiological and histopathological findings indicated that these patients shared similar characteristics, which were further developed as a set of diagnostic criteria. Some of the most striking of these were early onset of respiratory compromise, a markedly low birth weight, very slow motor nerve conduction velocities and a general decrease in the size of myelinated fibres on sural nerve biopsy. Extensive histological examination of the spinal cord in one patient failed to find any evidence of an SMA. Four out of the five not tested genetically were positive for all diagnostic criteria. None of the cases of early onset neuropathies or spinal muscular atrophies with early respiratory failure reviewed in the literature shares the exact characteristics, but many do have very close similarities. Their classification varies, but the discovery of mutations in IGHMBP2 in cases that are variously classified as SMA plus or severe infantile neuropathy with respiratory distress points to a need for the search for this genetic defect to be widened to include both groups. The fact that we identified other, similar cases of neuropathy and early respiratory failure with and without IGHMBP2 mutations suggests genetic as well as clinical heterogeneity in these infants. It is possible that infants that do not have mutations in the IGHMBP2 gene will be found to have mutations in a similar functioning gene.
Axons↗
Nuclear inclusions of the androgen receptor protein in spinal and bulbar muscular atrophy.
Spinal and bulbar muscular atrophy (SBMA) is an X-linked motor neuronopathy caused by the expansion of an unstable CAG repeat in the coding region of the androgen receptor (AR) gene. To study AR protein expression in normal and SBMA individuals, we used several antibodies that recognize AR protein, and analyzed neural and nonneural tissues by immunohistochemistry and western blotting. Both the normal and the mutant AR proteins were widely distributed, predominantly, but not exclusively, in the cytoplasm of neurons regardless of the pathological involvement, and predominantly in the nuclei of the nonneural tissues in both normal and SBMA individuals, with different expression levels of AR protein among different tissues. In the motor neurons of SBMA patients, there were AR-immunoreactive ubiquitinated nuclear inclusions that were detected by antibodies that recognize a small portion of the N terminus of the AR protein. Absence of other immunoreactive AR epitopes within the inclusion may be due to altered AR configuration, or masking of AR epitopes by other proteins, or proteolytic cleavage of the AR. Our data show that, in addition to the normal cellular distribution of the AR protein, mutant AR-bearing nuclear inclusions are present in SBMA.
Aged↗
Further aspects of muscular dystrophy in mdx mice.
The histopathological aspects of leg muscles in young, adult and old mdx mice were compared. Before 1 yr of age, the mutant showed a vigorous regeneration, following the fibre necrosis, which led to hypertrophic muscles. Hypertrophy resulted from a mixture of hypertrophic and small fibres but not from fibrosis. From the age of 15 months, the muscles progressively atrophied and the fibres were atrophic or split. An important degree of fibrosis occurred particularly in soleus and plantaris muscles. These aspects in old mdx mice are similar to those described in other dystrophinopathies in animals and humans.
Aging↗
Clinical and genetic studies of muscular dystrophy in young girls.
During the years 1971-81, we treated 7 girls with clinical features suggestive of Duchenne dystrophy. Muscle weakness developed at 1.5 or at 5-8 years and progressed rapidly. Two girls were in wheel-chairs in their teens. Muscle atrophy began in the proximal parts of the lower extremities and pseudohypertrophy of the calf occurred in all patients. Serum creatine phosphokinase (CPK) activity was moderately to highly elevated in all cases and EMG showed a moderate to marked myopathic pattern. Chromosomal studies showed normal finding in the five examined. Mental retardation (IQ 37-73) was present in four. Consanguinity was present in 3 out of the 7 cases. Two mothers showed elevated levels of CPK and myopathic patterns on EMG. In addition, one mother had slight muscle weakness at the age of 42 and another had prominent pseudohypertrophy of the calf. Sex-linked recessive inheritance might be considered here, because carriers of autosomal recessive type never showed elevated levels of CPK or mild myopathic symptoms. The other five of our seven might be cases of autosomal recessive inheritance, because the mothers had normal serum CPK levels and in 2 families there was a consanguinity.
Adolescent↗
Amyotrophic cerebellar hypoplasia: a specific form of infantile spinal atrophy.
Lower motor neuron degeneration, cerebellar hypoplasia, atrophy of pons, olives, and cerebellum, sclerosis of thalamus and pallidum, and deficient myelination were found in a 2-months-old baby with laryngeal paralysis, mental retardation, progressive amyotrophy, and slow nerve conduction velocity. Such changes seem characteristic of an unusual syndrome previously referred to as "cerebellar hypoplasia in Werdnig-Hoffmann disease", or "anterior horn cell disease with pontocerebellar hypoplasia". Although the pathologic changes in lower motor neurons are indistinguishable from those in other cases of infantile spinal muscular atrophy, the consistent reproducibility of a complex pathologic pattern suggests that this is probably a manifestation of a separate disease process. The term "amyotrophic cerebellar hypoplasia" (ACH) is a convenient designation for the syndrome.
Atrophy↗
Migrating atelectasis in Werdnig-Hoffmann disease: pulmonary manifestations in two cases of spinal muscular atrophy type 1.
Spinal muscular atrophy (SMA) or Werdnig-Hoffmann disease is the second most common neuromuscular disease, with 25% of cases presenting in infancy. Deletions in the survival motor neuron gene are believed responsible for autosomal-recessive SMA. SMA affects about 1 in 10,000 births. Symptomatic newborns have severe hypotonia, may have respiratory distress, may be unable to feed, and rapidly progress to death early in infancy. This paper describes another early pulmonary manifestation of SMA, i.e., migrating or rotating atelectasis, in 2 patients with infantile SMA. Migrating or rotating atelectasis may suggest the diagnosis of SMA.
Humans↗
Phenotypic variability in Kennedy's disease: implication of the early diagnostic features.
OBJECTIVES: The clinical diagnosis of Kennedy's disease (KD) is not easy when the typical manifestations are lacking, especially in early stage of the disease. In our study, we tried to identify the relative frequency of common clinical features and early symptoms in KD. METHOD: Eighteen Korean patients with KD were included. Clinical findings were subdivided into two parts: the age at onset of each clinical symptoms and characteristic signs on investigations. With detailed clinical examinations, the serum creatine kinase (CK) level, electrophysiologic study and DNA analysis were performed and analyzed in detail. RESULTS: In KD, the most consistent clinical findings at evaluations included perioral fasciculation with variable bulbar paresis, limb weakness with wasting, hyporeflexia, hand tremor, and elevated CK level. Some distinguishing features, such as X-linked family history, gynecomastia, and sensory abnormalities were absent in a half of cases. Frequent initial clinical findings include tremor (50%) and symptoms other than weakness, such as cramps and fatigability (33.3%). CONCLUSION: We conclude that KD shows variable clinical and electrophysiological features. Our description on the onset and subsequent progression of each clinical finding might help to identify KD in early stage and avoid misdiagnosis.
Adult↗
Spastic syndrome in a Holstein bull: a histologic study.
A 4-year-old Canadian holstein bull developed the spastic syndrome, an episodic but progressive disorder causing pelvic limb muscular spasms. A post-mortem study, including morphometry of skeletal muscles and teased peripheral nerve fibers of the pelvic limb, revealed mild type II skeletal muscle fiber atrophy and minimal, focal segmental demyelination with remyelination, and axonal degeneration in peripheral nerves. Such alterations are probably incidental or age-associated. Idiopathic muscular cramps is the most probable explanation of the clinical disease and is consistent with the absence of significant morphologic pathologic lesions.
Animals↗
Serum lactate dehydrogenase isoenzymes in neuromuscular diseases.
Serum LDH isozymes render qualitative information which may be more specific than the quantitative changes of total serum LDH and total serum CPK in neuromuscular diseases. Muscle LDH isozymes vary with age, muscle, and species. Temporal study of serum LDH isozymes in experimental neurogenic atrophy demonstrated a temporary rise of serum LDH 5. In acute and progressive neurogenic diseases, a high serum LDH 5 was noted. Isozyme patterns were normal in chronic and non-progressive diseases. In Duchenne dystrophy, serum LDH 5 was low and stayed low until the final stages of the disease. This abnormality persisted long after serum total LDH and CPK returned to normal. This may reflect the leakage of genetically abnormal isozymes from the muscles to serum. It is concluded that the serum LDH isozyme pattern is a reliable qualitative test in the diagnosis of a genetic myopathy, and in differentiating progressive from static neurogenic atrophies.
Adolescent↗
Spinal muscular atrophy.
The history of the spinal muscular atrophies (SMA) began in the 1890s with Guido Werdnig and Johann Hoffmann. Together, their papers present a rather complete picture of the clinical and pathologic aspects of infantile SMA: onset during the first year of life, occurrence in siblings with normal parents, progressive floppiness and weakness, hand tremor, and death from pneumonia in early childhood. Based on the work of an international collaboration, the following is current nomenclature: SMA type 1 (or I) for onset of symptoms before age 6 months, SMA type 2 (II) for onset between 6 and 18 months, and SMA type 3 (III) for onset after age 18 months. Linkage of autosomal recessive SMA to chromosome 5q11.2-13.3 was reported by Gilliam et al in 1990. A novel gene, whose function remains unknown, called the survival motor neuron gene (SMN) at 5q13, contains deletions in more than 98% of SMA patients. Some patients with atypical forms of SMA have been shown to have mutations in SMN. Because there is no effective therapy for SMA, management consists of preventing or treating the complications of severe weakness, such as restrictive lung disease, poor nutrition, orthopedic deformities, immobility, and psychosocial problems.
Child↗
mdx mice show progressive weakness and muscle deterioration with age.
The time-course of degeneration/regeneration was investigated in leg muscles throughout the life of the mdx mutant mouse, which is a biochemical homologue of Duchenne muscular dystrophy (DMD). In young and adult mice (up to 52 weeks old), muscle fibre necrosis was compensated by a vigorous regeneration, but in old mdx mice (65-104 weeks) this regeneration slightly declined, while the necrotic process persisted. Body and muscles weights declined strikingly after 52 weeks. Life span of mdx mutants was reduced in comparison with the control C57BL/10 animals. Immunostaining of old mdx muscles showed clusters of dystrophin-positive fibres. Muscle fibres in old mdx mice showed great variation in size, many being atrophied or split. Endomysial fibrosis became increasingly conspicuous, and there was some accumulation of adipose tissue. These progressive degenerative changes of old mdx mice resemble those found in DMD and imply that basic pathological similarities between the murine and human diseases previously observed in diaphragm of mdx mice may be extended to other skeletal muscles.
Aging↗
Idiopathic lactic acidemia with developmental delay and type 1 muscle fiber atrophy: report of two patients.
Two infants with generalized muscle hypotonia with mild muscle weakness and markedly delayed developmental milestones, had high lactate levels in serum and cerebrospinal fluid from early infancy. Biochemical and morphologic studies of biopsied muscles disclosed no abnormality except for type 1 fiber atrophy, which was quite different from patients with central nervous involvement with type 2 fiber atrophy. In both patients, the disease was not progressive and lactate levels gradually decreased. Although no metabolic defect was found, these patients probably shared common pathogenetic mechanism.
Acidosis, Lactic↗
[Striated muscle in protein malnutrition: an experimental study in albino rats].
The effects of undernutrition on the "gastrocnemius plantaris" muscle of young albino rats were observed with light and electronmicroscopy and were compared with controls. Pregnant rats received a diet containing 6.7% protein and the neonates had a 3.2% protein diet after weaning. A total number of 40 animals were distributed in two groups: one hypoproteic and one control. Half of the animals of each group were killed 15 days after birth and the remaining ones at 30 days. We could observe important reduction in the weight of the undernourished rats reaching about 50% when compared with the control animals. An important reduction in the diameter of muscle fibers was noted in undernourished rats. Histochemical reactions showed that not only the type I but also the type II fibers were involved, the latter being more severely reduced in size. Type II fibers os small diameter, resembling F (fetal) fiber were found in animals at 15 days indicating a delay in maturation. Ultrastructural evaluation of the muscle did not show specific changes except for a severe reduction in the caliber of fibers when compared with control animals. We concluded that there was hypoplasia and not atrophy of the muscular tissue in animals submitted to pre- and post-natal undernutrition. The present study, associated with others in which the spinal motor cells and peripheral nerves of undernourished rats were analysed, allow us to consider that with protein deprivation there is a delay in the development, a hypoplasia of the motor unit. We think that in infantile progressive spinal amyotrophy (Werdnig-Hoffmann disease) there is possibly hypoplasia and not atrophy of the type II fibers and we postulate that a metabolic proteic problem is involved in this disease.
Animals↗