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2.1
Emery-Dreifuss Muscular Dystrophy Type 2
Autosomal Dominant Emery-Dreifuss Muscular Dystrophy Type 2

Presentation

This report presents the cases of two brothers with this dystrophy in whom bilateral hypomyelination of the deep periatrial white matter was noted. [ajnr.org]

Springer Science & Business Media, ٢٧‏/١١‏/٢٠١٣ - 208 من الصفحات The main themes presented in this volume are exercise intolerance and muscle contracture. These two topics could seem different at first sight but share common clinical features. [books.google.com]

Diffuse white matter changes on brain MRI is invariably present after 6 months of age. [vdocuments.us]

Cardiac imaging revealed dilated cardiomyopathy in two of the individuals, one of whom was presented with heart failure. The second patient presented with no significant abnormalities in cardiac structure or function. [spandidos-publications.com]

It presents slowly progressive muscle weakness and atrophy (initially and generally with a humeroperoneal distribution but later becoming more diffuse). [orpha.net]

Musculoskeletal

  • Winged Scapula

    Proband clinical features: winged scapulae and combination of thigh atrophy and calf pseudo-hypertrophy. Figure 2. [frontiersin.org]

Psychiatrical

  • Suggestibility

    However, our results suggest an important role for the laminin st2 chain gene in brain development. [vdocuments.us]

    Distrifia fact that both sons of apparently healthy musculad parents were affected suggests X-linked recessive transmission, in which the mother must be a carrier. [olox.pro]

    Around 45% of patients do not carry mutations in these genes suggesting other causative genes that remain to be identified. [orpha.net]

Neurologic

  • Stroke

    Disabling consequences occurred in 3 patients; these were namely hemiparesis (patient 4, stroke at 54 years) residual hemiplegia (patient 11, stroke at 26 years), and ataxia (patient 18, cerebellar stroke at 43 years, with recurrence 1 year later). [ahajournals.org]

    Clinical Relevance of Atrial Fibrillation/Flutter, Stroke, Pacemaker Implant, and Heart Failure in Emery-Dreifuss Muscular Dystrophy: A Long-Term Longitudinal Study. Stroke. 2003;34 (4 ):901–908. [physio-pedia.com]

    Congenital Myasthenic Syndromes Spinal Muscular Atrophies & Motor Neuron Diseases Hereditary Ataxias Hereditary Cardiomyopathies Hereditary Motor and Sensory Neuropathies Neurodegenerative Lysosomal Storage Diseases Disorders of Neuronal Migration Hereditary Stroke [meduniwien.ac.at]

    Merlini et al., “Clinical relevance of atrial fibrillation/flutter, stroke, pacemaker implant, and heart failure in Emery-Dreifuss muscular dystrophy: a long-term longitudinal study,” Stroke, vol. 34, no. 4, pp. 901–908, 2003. [ 6 ] N. E. [oalib.com]

    Partial epilepsy [ 6 ] and cardioembolic stroke [ 7 ] were also recently reported in these patients. [omicsonline.org]

  • Waddling Gait

    At age 9 years, he showed Gowers sign, waddling gait, and proximal dominant limb muscle weakness and atrophy. No joint contractures were observed (Figure 1). [mafiadoc.com]

    Signs and symptoms, which typically appear in early childhood, might include: Frequent falls Difficulty rising from a lying or sitting position Trouble running and jumping Waddling gait Walking on the toes Large calf muscles Muscle pain and stiffness [mayoclinic.org]

    At age 7 years, she had generalized hypotonia, waddling gait, and severe limb muscle wasting and weakness. Muscle Nerve, 27pp. Bethlem J, Knobbout CE. [gualdetxumbtt.club]

    The first patient was a 9-year-old boy who developed proximal muscle weakness and atrophy of the lower limbs, waddling gait, and lordotic posture by age 6. He had showed unsteady gait at age 4. [genome.jp]

    Clinical signatures of disease include tiptoe walking, waddling gait, difficulty in running and climbing stairs, scapular winging. [frontiersin.org]

  • Hyporeflexia

    Assessment of the patient's brother, aged 21, revealed an irregular heart beat on cardiac auscultation, and neurological study identified myotatic hyporeflexia, mild atrophy, no upper limb muscle weakness, forearm extension limited to +150/160° and preserved [revportcardiol.org]

    Generalized Ascending/Descending/Systemic Unilateral (UL) or Bilateral (BL) or No Lateralization (NL) Onset Lab or Imaging Findings Specific test Adult Botulism + - + + Generalized Descending BL Sudden Toxin test Blood, Wound, or Stool culture Diplopia, Hyporeflexia [wikidoc.org]

Workup

This was even more so since the introduction of imaging—and especially MRI—into routine diagnostic workup and research in inherited muscle disease. [scinapse.io]

[…] genetic analysis; the LMNA and STA genes were analyzed by polymerase chain reaction, single-strand conformation polymorphism (SSSP), and sequencing. 13 At the time of initial diagnosis (or suspicion) of EDMD, all of the subjects received a cardiological workup [ahajournals.org]

Rhythm

  • Sinus Arrest

    Cardiologic evaluation performed at our heart Institute (INCOR) showed significant depression of left ventricle function associated with complex arrhythmia as sinus arrest (episodes with escape junctional rhythm resulting in bradycardias at rates of 35 [scielo.br]

    Initial- ly, we interpreted it as a nodal rhythm of 42/min and sinus arrest or complete atrioventricular block. No atrial electrical activity (6) EDMD is a congenital myopathy. [9lib.org]

    In particular, 3 of the 4 patients in sinus rhythm (1 patient had atrial flutter) had sinoatrial dysfunction (expressed by a pathological corrected sinus node recovery time, ie, >525 ms). [ahajournals.org]

    Serial tracings from one family member (Panel A) show progressive atrioventricular block (from 33 to 37 years of age), paroxysmal atrial fibrillation (at the age of 34 years), and sinus arrest with infrequent junctional escape beats (at the age of 37) [nejm.org]

  • Premature Atrial Contractions

    M — male; PACs — premature atrial contractions; PAF — paroxysmal atrial fibrillation; PVCs — premature ventricular contraction/complexes; SAB — sinoatrial block; SF — sporadic form; SR — sinus rhythm; SVT — supraventricular tachycardia; WP — +Wenckebach [9lib.org]

Blocks

  • Right Bundle Branch Block

    bundle branch block; VA: ventricular arrhythmias. [academic.oup.com]

    Nearly 30% of ECG tracings showed intraventricular conduction anomalies: left anterior fascicular block or incomplete right bundle branch block. [9lib.org]

  • Left Anterior Fascicular Block

    Nearly 30% of ECG tracings showed intraventricular conduction anomalies: left anterior fascicular block or incomplete right bundle branch block. [9lib.org]

  • Incomplete Right Bundle Branch Block

    Nearly 30% of ECG tracings showed intraventricular conduction anomalies: left anterior fascicular block or incomplete right bundle branch block. [9lib.org]

Other Pathologies

  • Myocardial Fibrosis

    Nucleus (Austin, Tex.), 2018, 9, 1, p 276 Clinical aspects of Emery-Dreifuss muscular dystrophy Madej-Pilarczyk A Nucleus (Austin, Tex.), 2018, 9, 1, p 268 ACE inhibition to slow progression of myocardial fibrosis in muscular dystrophies Russo V, Papa [myobase.org]

    Autopsy findings revealed progressive myocardial fibrosis with early and severe atrial involvement. [scielo.br]

    Severe myocardial fibrosis caused by a deletion of the 5’ end of the lamin A/C gene. J Am Coll Cardiol, 2007; 49: 2430–2439. 14. Parmar MS, Parmar KS. Emery-Dreifuss humeroperoneal mus- cular dystrophy: cardiac manifestations. [9lib.org]

Treatment

Treatment of the cardiac disease: anti-arrhythmic agents including beta-blockers, diuretics, ACE inhibitors, cardiac devices (pacemaker, implantable cardiac defibrillator) when required, heart transplantation in case of end-stage heart failure, and treatment [orpha.net]

Treatment of Dunnigan Lipodystrophy FPLD2 treatment must be based on an interdisciplinary approach that includes an endocrinologist, nutritionist, and psychologist. [scirp.org]

Make informed clinical choices for each patient, from diagnosis and treatment selection through post-treatment strategies and management of complications, with new evidence-based criteria throughout. [books.google.de]

It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. [musculardystrophynews.com]

Prognosis

Prognosis Prognosis depends on the severity of muscle weakness, joint contractures, and of the cardiac and respiratory involvement. Patients with severe forms of the disease may lose the capacity to walk or require intermittent nasal ventilation. [orpha.net]

Thus these therapies are not likely to be an available for many years, Prognosis Most forms of muscular dystrophy are chronic and progressive and persist throughout life. [brainfoundation.org.au]

Natural History, Complications and Prognosis Prognosis The severity of disability depends on the type of muscular dystrophy. All types of muscular dystrophy slowly get worse, but how fast this happens varies widely. [wikidoc.org]

Therefore, prognosis for subjects carrying or at risk of carrying D4Z4 reduced alleles h ... [5wo.tatter.us]

Etiology

The two sections are introduced by a didactic and general overview, describ ing the main symptoms, classification and classical etiology. [books.google.com]

Etiology Several causative genes have been identified encoding ubiquitous proteins including emerin ( EMD ; Xq28 and FHL1 ; Xq26.3) for X-linked EDMD and lamin A/C ( LMNA ; 1q21.2) for EDMD with autosomal transmission. [orpha.net]

The arrhythmogenic ventricular dysplasia, whose etiology has not yet been established and is more rare than EDMD, may appear as an atrial arrhythmia similar to EDMD, but there is no neurologic commitment 10. [scielo.br]

Both genetic and environmental factors have been implicated in BD etiology, but the biological underpinnings remain elusive. [scinapse.io]

Epidemiology

Human Gene Mutation Database (HGMD) - Cardiff European Bioinformatics Institute (EBI) - mutations Locus Specific DataBases (LSDB's) Human Genome Variation Society (HGVS) nomenclature used to describe mutations Links to diagnostic services diagnosis/epidemiology [dmd.nl]

Summary Epidemiology Emery-Dreifuss muscular dystrophy (EDMD) prevalence is estimated at 1 in 400,000. [orpha.net]

Myology (14-18 March 2016; Centre convention, Lyon, France) 2016, p. 178-181 DMED : 15e réunion annuelle du réseau français Cukierman L 2016 Un nouveau phénotype pour les titinopathies Urtizberea JA 2016 A Systematic Review and Meta-analysis on the Epidemiology [myobase.org]

Few relevant investigations have been reported on its epidemiology and were essentially based on clinical diagnosis, having been performed before recognition of the molecular mutation. [5wo.tatter.us]

Pathophysiology

Pathophysiology and classification of persistent con tractures are described as well as therapy. Each chapter is thoroughly referenced, representing important progress in research in the field. [books.google.com]

In light of the pathophysiology of Emery-Dreifuss muscular dystrophy, there may be prominence of the macromolecular region as a result of more basic myelin components in the periventricular areas of signal intensity abnormality, and the prominent peak [ajnr.org]

Pathophysiology In 5 of 6 gene mutations that have been shown to cause EDMD, the affected protein is present in the LINC (linker of nucleoskeleton and cytoskeleton) complex. [emedicine.medscape.com]

Defining how lamin mutations alter cardiac-cell biology should ultimately increase our understanding of the pathophysiology of dilated cardiomyopathy. [nejm.org]

The second model proposes that mutations in lamin A/C cause change in gene expression, which promote the pathophysiology of the various diseases (14). [thefreelibrary.com]

Prevention

Resources Education about muscular dystrophy is the most important tool with which to manage and prevent complications. [clevelandclinic.org]

Knowledge of the pathogenesis, genetics, and molecular biology of neuromuscular disorders is essential both in developing and applying new therapies and preventive measures, and in formulating genetic and prognostic advice. [books.google.de]

Further muscle atrophy around the shoulder girdle prevents patients from being able to hold their arms extended or up in the air. Cardiomyopathy, or atrophy of the heart muscle, affects some forms of LGMD. [musculardystrophynews.com]

Ankle and foot braces are used to prevent leg deformity. Surgery may be necessary to release contractures. Exercise can help maintain muscle use and overall good health. [mda.org.au]

This decision was made according to the SCD primary prevention guidelines. Five patients died (three had EDMD type 1, two had EDMD type 2). Autopsies were not performed. [9lib.org]

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2.1
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