Presentation
This is supported by the reported cases of myoglobinuria in mitochondrial disorders. 4 A similar but slower mechanism may explain the relatively rapid presentation in our patient, as well as the subacute mode of presentation of other mitochondrial disorders [jnnp.bmj.com]
However, when they present in adolescence or adulthood, they tend to present with myopathic symptoms, cardiomyopathy symptoms, or both. 1 Adults may present with fatigue, proximal muscle weakness and soreness, exercise intolerance, 1 or ptosis. [jaoa.org]
It can present as an idiopathic proximal myopathy with very subtle neuropathic features. Alternately, it can present with ophthalmoplegia with very subtle myopathic changes. [onlinelibrary.wiley.com]
Complementary and alternative medicine Medicine(all) Cite this Apa Standard Harvard Vancouver BIBTEX RIS @article{4ea902ecd7be4c4d90d52ec63baaed35, title = "Mitochondrial myopathy presenting as Rhabdomyolysis", abstract = "A 37-year-old white woman presented [mayoclinic.pure.elsevier.com]
Trial evaluating treatment with elamipretide in rare disease meets efficacy and safety endpoints Data to be presented at Mitochondrial Medicine 2016 on Friday, June 17 at 8:10 a.m. [stealthbt.com]
Entire Body System
- Weakness
These disorders cause progressive weakness and can lead to death. [ninds.nih.gov]
Further evaluation, a year after initiation of therapy, disclosed only very mild proximal limb weakness. [jnnp.bmj.com]
[…] paralysis of the muscles controlling eye movement Muscle weakness in the neck, arms or legs Numbness and weakness in the hands and feet (peripheral neuropathy) Difficulty swallowing Hearing loss Short stature Symptoms usually appear in childhood after [chop.edu]
Speech Therapy Muscle weakness in the throat may make talking or swallowing difficult. Speech therapy may help strengthen the muscles or work around the weakness. Respiratory Therapy Respiratory therapy will help make sure breathing is normal. [lahey.org]
- Fatigue
During physical activity, muscles may become easily fatigued or weak. Muscle cramping is rare, but may occur. [ninds.nih.gov]
Mitochondrial Myopathy in Follow-up of a Patient With Chronic Fatigue Syndrome Fernando Galán, AOPT(1,*), Isabel de Lavera, PhD(2), David Cotán, PhD(2), José A. [meassociation.org.uk]
Introduction Chronic fatigue syndrome (CFS)—also known as myalgic encephalomyelitis (ME)—is characterized by profound fatigue that is not improved by bed rest and that may be worsened by physical or mental activity. [journals.sagepub.com]
- Asymptomatic
The mother was asymptomatic. Two daughters had lactic acidosis and myoclonic epilepsy, mild dementia, ataxia, weakness and sensory neuropathy. The son suffered one acute hemiplegic episode due to an ischemic infarct in the right temporal region. [scielo.br]
In some of the studies including patients with the m.3243A>G mutation, data from mutation carriers who were asymptomatic or paucisymptomatic were included, which could also have affected the results. 9, 12, 15, 24 This illustrates another limitation of [ng.neurology.org]
Family history may be overlooked due to mild or oligosymptomatic disease, variability in clinical manifestations, or because many relatives may be asymptomatic carriers. [journals.sagepub.com]
Respiratoric
- Respiratory Insufficiency
The course of mitochondrial myopathies is usually slowly progressive and only rarely rapidly progressive leading to restriction of mobility and requirement of a wheel chair or even muscular respiratory insufficiency. [thieme-connect.com]
Direct involvement of muscle mitochondria in this disease may interfere with energy metabolism and contribute to the clinical findings of hypotonia, weakness, and respiratory insufficiency. [cambridge.org]
Gastrointestinal
- Vomiting
The symptoms of mitochondrial myopathies include muscle weakness or exercise intolerance, heart failure or rhythm disturbances, dementia, movement disorders, stroke-like episodes, deafness, blindness, droopy eyelids, limited mobility of the eyes, vomiting [ninds.nih.gov]
Symptoms may include: Seizures Recurring headaches Loss of appetite Recurring vomiting Stomach pain Muscle weakness and/or cramping Exercise intolerance Extreme fatigue Difficulty breathing Recurrent stroke-like episodes (the distinguishing symptom of [chop.edu]
Aside from muscle weakness and exercise intolerance, the symptoms of mitochondrial myopathy may include nausea, vomiting, headache, seizures, stroke-like episodes, and dementia ; droopy eyelids, limited mobility of the eyes, blindness, and deafness ; [medicinenet.com]
[…] syndrome Infancy Muscle weakness and liver failure, floppiness, feeding difficulties, and developmental delay Mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) Childhood to adulthood Stroke-like episodes, migraine headaches, vomiting [lahey.org]
- Nausea
Nausea, headache, and breathlessness are also associated with these disorders. [ninds.nih.gov]
Aside from muscle weakness and exercise intolerance, the symptoms of mitochondrial myopathy may include nausea, vomiting, headache, seizures, stroke-like episodes, and dementia ; droopy eyelids, limited mobility of the eyes, blindness, and deafness ; [medicinenet.com]
- Recurrent Vomiting
Symptoms may include: Seizures Recurring headaches Loss of appetite Recurring vomiting Stomach pain Muscle weakness and/or cramping Exercise intolerance Extreme fatigue Difficulty breathing Recurrent stroke-like episodes (the distinguishing symptom of [chop.edu]
Musculoskeletal
- Myopathy
Emery–Dreifuss Other structural collagen disease Bethlem myopathy PTP disease X-linked MTM adaptor protein disease BIN1-linked centronuclear myopathy cytoskeleton disease Nemaline myopathy Zaspopathy Channelopathy Myotonia Myotonia congenita Thomsen [en.wikipedia.org]
Treatment Although there is no specific treatment for any of the mitochondrial myopathies, physical therapy may extend the range of movement of muscles and improve dexterity. [ninds.nih.gov]
Is mitochondrial myopathy inherited? A proportion of cases of mitochondrial myopathy are not inherited from the parents. Instead changes to the mitochondrial DNA occur spontaneously after conception. [mda.org.au]
We conclude that long-term therapy with zidovudine can cause a toxic mitochondrial myopathy, which coexists with a T-cell—mediated inflammatory myopathy that is restricted to MHC-I antigen, and is indistinguishable from the myopathy associated with primary [nejm.org]
- Proximal Muscle Weakness
In our case, bilateral symmetric proximal muscle weakness of the extremities was the only symptom. [ommegaonline.org]
[…] cramps caused by exercise to muscle weakness in a predominantly proximal distribution. [journals.sagepub.com]
However, when they present in adolescence or adulthood, they tend to present with myopathic symptoms, cardiomyopathy symptoms, or both. 1 Adults may present with fatigue, proximal muscle weakness and soreness, exercise intolerance, 1 or ptosis. [jaoa.org]
A 39‐year‐old man presented with a 7‐year history of progressive muscle weakness, pain and spasms in his muscles with exertion, and decreased stamina. [onlinelibrary.wiley.com]
The myopathy was rated mild if the patient had only myalgia and minimal muscle weakness, moderate if proximal muscle strength was rated 4+/5 on the Medical Research Council (MRC) scale (the scale ranges from 0 to 5, with 5 denoting normal strength) 21 [nejm.org]
- Muscular Atrophy
I was in … READ MORE Alberta Fourth Province to Expand Access to Spinraza™ for Patients Impacted with Spinal Muscular Atrophy July 5, 2019 Alberta fourth province to expand access to SPINRAZA™ for patients impacted with Spinal Muscular Atrophy. [muscle.ca]
MDA addresses the muscular dystrophies, spinal muscular atrophy, ALS, Charcot-Marie-Tooth disease, myasthenia gravis, Friedreich's ataxia, metabolic diseases of muscle, and inflammatory diseases of muscle, for a total of more than 40 neuromuscular diseases [brainfacts.org]
Dobkin BH, Verity MA - Familial progressive bulbar and spinal muscular atrophy: juvenile onset and late morbidity with ragged-red fibers. Neurology 26:754, 1976. [ Links ] 11. [scielo.br]
Neurologic
- Seizure
Medications Medications may be needed for symptoms such as irregular heartbeat, seizures or pain. Prevention There are no current guidelines to prevent mitochondrial myopathies. [lahey.org]
[…] symptoms of mitochondrial myopathies include muscle weakness or exercise intolerance, heart failure or rhythm disturbances, dementia, movement disorders, stroke-like episodes, deafness, blindness, droopy eyelids, limited mobility of the eyes, vomiting, and seizures [ninds.nih.gov]
Mitochondrial Myopathy Symptoms Generally, mitochondrial myopathies cause: Muscle weakness or exercise intolerance Lack of balance or coordination Arrhythmias of the heart or heart failure Problems with eye movements Seizures Stroke-like episodes Vomiting [uvahealth.com]
Years later, her daughter, Rose, began suffering seizures. Tom is full of laughter and smiles, yet he has had a complicated medical history and has undergone over 35 medical procedures. [mito.org.au]
- Chronic Progressive External Ophthalmoplegia
The most common MD are Leber's Hereditary Optic Neuropathy (LHON), Chronic Progressive External Ophthalmoplegia (CPEO), Kearns-Sayre Syndrome (KSS), Mitochondrial Myopathy (MM) and Mitochondrial Encephalomyopathy, Lactic Acidosis and Strokelike episodes [ncbi.nlm.nih.gov]
[…] in muscle fibers and appear as "ragged-red fibers" when muscle is stained with modified Gömöri trichrome stain Short stature Kearns-Sayre syndrome (KSS) External ophthalmoplegia Cardiac conduction defects Sensorineural hearing loss Chronic progressive [en.wikipedia.org]
There are several different types, including: Kearns-Sayre syndrome (KSS) chronic progressive external ophthalmoplegia (CPEO) Leber hereditary optic neuropathy (LHON) mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS) myoclonus [musculardystrophyuk.org]
progressive external ophthalmoplegia [CPEO] or other phenotypes of MM). [ng.neurology.org]
- Limb Weakness
Further evaluation, a year after initiation of therapy, disclosed only very mild proximal limb weakness. [jnnp.bmj.com]
[…] movement (ataxia) Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE): Occurs before age 20 Causes eye movement problems (PEO), drooping eyelid, limb weakness, digestive problems and peripheral neuropathy Neuropathy, ataxia, and retinitis pigmentosa [uvahealth.com]
[…] neurogastrointestinal encephalomyopathy (MNGIE) Before age 20 Eye movement problems (PEO), drooping eyelid, limb weakness, digestive problems, peripheral neuropathy Neuropathy, ataxia, and retinitis pigmentosa (NARP) Early childhood to adulthood Uncoordinated [lahey.org]
Inheritance pattern: maternal Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) Onset: usually before age 20 Features:This disorder is characterized by PEO, ptosis, limb weakness, and gastrointestinal (digestive) problems, including vomiting [ninds.nih.gov]
- Convulsions
He had experienced a generalized convulsion at age 3 years and was diagnosed as having hypertension and hyperlipidemia at age 35 years. [ajnr.org]
Focal and general convulsions may occur in association with these episodes. Other abnormalities that may be observed are ventricular dilatation, cortical atrophy, and basal ganglia calcification. [emedicine.medscape.com]
For examples, seizures may be treated with anti-seizure medications called anti-epileptics or anti-convulsants. Eyelid drooping can be treated with eye crutches or surgery. Hearing loss can be treated with hearing aids called cochlear implants. [rarediseases.org]
Workup
The diagnostic workup requires a complex approach that includes routine and special laboratory tests. [rarediseases.org]
Treatment
There is a major unmet medical need for new and effective treatment options for mitochondrial myopathies since there is no specific treatment for these serious diseases. [neurovive.com]
Treatment Although there is no specific treatment for any of the mitochondrial myopathies, physical therapy may extend the range of movement of muscles and improve dexterity. [ninds.nih.gov]
To better elucidate the treatment landscape for PMM, NeurologyLive spoke with Bruce H. [neurologylive.com]
Prognosis
Prognosis The prognosis for patients with mitochondrial myopathies varies greatly, depending largely on the type of disease and the degree of involvement of various organs. [ninds.nih.gov]
Prognosis The prognosis for patients with mitochondrial myopathies varies greatly, depending largely on the type of disease and the degree of involvement of various organs. These disorders cause progressive weakness and can lead to death. [brainfacts.org]
The prognosis for these disorders ranges in severity from progressive weakness to death. CONTINUE SCROLLING OR CLICK HERE FOR RELATED ARTICLE SLIDESHOW Heart Disease: Causes of a Heart Attack See Slideshow [medicinenet.com]
Etiology
Other etiologies such as deconditioning, obesity, malignancy, anemia, and sleep apnea are described less frequently ( 1-4 ), and often the cause remains elusive after an aggressive evaluation ( 3 ). [atsjournals.org]
Research over the years has identified many underlying biological abnormalities, mitochondrial dysfunction among them, but the etiology remains uncertain. 2 No intervention has been proven effective in restoring the ability to work. 3 Primary mitochondrial [journals.sagepub.com]
Epidemiology
International The first assessment of the epidemiology of mitochondrial disorders found a prevalence of more than 10.2 per 100,000 for the m.3243A → G mutation in the adult Finnish population. [emedicine.medscape.com]
Chinnery PF, Johnson MA, Wardell TM, Singh-Kler R, Hayes C, Brown DT, Taylor RW, Bindoff LA, Turnbull DM: The epidemiology of pathogenic mitochondrial DNA mutations. Ann Neurol. 2000, 48: 188-193. 10.1002/1531-8249(200008)48:2 3.0.CO;2-P. 11. [jmedicalcasereports.biomedcentral.com]
Within the mitochondrial diseases, PMM are very common but real epidemiological studies are not available yet. This is also because PMM often go misdiagnosed or undiagnosed so determining their true frequency in the general population is difficult. [rarediseases.org]
ENMC workshop on “Genetic Epidemiology and Clinical Trial Readiness in Encephalomyopathy of Leigh Syndrome”, 16 Octobre et 20 Décembre 2020, 9 Juillet 2021. Agnès Rötig. [maladiesrares-necker.aphp.fr]
Pathophysiology
[…] inflammatory myopathies, including polymyositis, dermatomyositis, and inclusion body myositis, 2 3 and mitochondrial DNA abnormalities were recently described in patients with inclusion body myositis. 3 However, these changes are considered secondary and their pathophysiological [jnnp.bmj.com]
This makes sense from a pathophysiological point of view, because small fiber neuropathy affects small somatic fibers and autonomic fibers, being able to give sensory and autonomic symptoms. [journals.sagepub.com]
Post operative CNS dysfunction is likely in MM and pathophysiology is directly attributable to the patient’s primary pathology of dysfunctional mitochondria. [mhaus.org]
A tool for diagnostic purposes and pathophysiological insights in muscle diseases. Reumatismo. 2004; 56 9-14 18 Möller H E, Kurlemann G, Pützler M. et al. Magnetic resonance spectroscopy in patients with MELAS. [thieme-connect.com]
Wallace DL, Zheng X, Lott MT - Familial mitochondrial encephalomyopathy (MERRF): genetic, pathophysiological, and biochemical characterization of a mitochondrial DNA disease. Cell 55:601, 1988. [ Links ] 51. [scielo.br]
Prevention
Moreover, strict anti-epileptic therapy and treatment or prevention of stroke-like episodes are very important to prevent complications. [ncbi.nlm.nih.gov]
The goal is to develop a treatment that protects the mitochondria in the muscles from disturbed calcium handling and subsequent muscular dystrophy, thus preventing the muscle weakness associated with these diseases. [neurovive.com]
Prevention There are no current guidelines to prevent mitochondrial myopathies. If you have a family history of the disorder, you can talk to a genetic counselor when deciding whether to have children. References DiMauro S. [lahey.org]
Research is ongoing to develop a way to prevent the transmission of mitochondrial DNA mutations to future children. [mda.org.au]
The energetics from mitochondria maintain healthy physiology and prevent disease. This mitochondria-targeted candidate is being developed for both rare and common diseases. [stealthbt.com]