Ptose miogênica na distrofia muscular oculofaríngea / Miogenic ptosis in oculopharyngeal muscular dystrophy

RESUMO Relato de caso de distrofia muscular oculofaríngea, doença genética de herança autossômica dominante e uma das causas de ptose miogênica adquirida. A paciente apresentou quadro de ptose palpebral bilateral e disfagia, achados clínicos típicos da doença, foi submetida a tratamento cirúrgico da ptose, com bom resultado estético e funcional.

ABSTRACT The authors report a case of oculopharyngeal muscular dystrophy, an autosomal dominant genetic disease, which leads to miogenic ptosis. This patient presented bilateral palpebral ptosis and dysphagia and underwent ptosis surgical treatment, with a good functional and aesthetic result.

Distrofia muscular oculofaríngea. Presentación de un caso particular e importancia de los hallazgos electromiográficos / Oculopharyngeal muscular dystrophy. Presentation of a peculiar case and importance of electromyographic findings

La distrofia muscular oculofaríngea es un raro trastorno genético caracterizado clínicamente por ptosis palpebral y dificultades deglutorias. Con este trabajo se pretende hacer una descripción detallada de un caso particular, poniendo de manifiesto la relevancia de los hallazgos electromiográficos, además se propone realizar una exhaustiva revisión bibliográfica sobre el tema. Fue un estudio clínico, neurofisiológico y molecular de una paciente de 82 años remitida a la Unidad de Neurofisiología Clínica por ptosis palpebral bilateral y disfagia progresiva. El estudio electromiográfico objetivó la existencia de una miopatía de predominio facial y el estudio molecular confirmó la existencia de una expansión patológica de 12 repeticiones en el tracto poli-alanina del gen PABPN1. La distrofia muscular oculofaríngea es una enfermedad infradiagnosticada que puede pasar desapercibida, simulando otros procesos patológicos. Un riguroso estudio neurofisiológico es fundamental para llevar a cabo un diagnóstico de sospecha así como para orientar el posterior diagnóstico molecular.

Oculopharyngeal Muscular Dystrophy is a rare genetic disorder characterized clinically by ptosis and deglutition difficulties. This work aims to give a detailed description of a particular case highlighting the relevance of the electromyographic findings in addition to a comprehensive literature review on the topic. Clinical, neurophysiological and molecular study of 82 years old patient referred to Clinical Neurophysiology Unit for progressive bilateral ptosis and dysphagia. The electromyographic study aimed the existence of a facial myopathy prevalence and molecular study confirmed the existence of a pathological expansion of 12 repetitions in the poly-alanine tract PABPN1 gene. Conclusions: Oculopharyngeal Muscular Dystrophy is an underdiagnosed disease that may go unnoticed by simulating other pathological processes. A rigorous neurophysiological study is essential to conduct a suspected diagnosis and to guide further molecular diagnostics.

Conduta fonoaudiológica em um caso de disfagia neurogênica por distrofia muscular oculofaríngea / Speech-language clinical pattern in a neurogenic dysphagia case through oculo-pharyngeal muscular dystrophy

Resumo:A Distrofia Muscular Oculofaríngea é uma miopatia hereditária de transmissão autossômica dominante, de início tardio, com sinais clínicos de ptose palpebral e disfagia orofaríngea, essa podendo estar associada à fraqueza muscular proximal. O presente estudo analisa a conduta fonoaudiológica em um caso de distrofia oculofaríngea. O sujeito atendido no ambulatório de Fonoaudiologia, desde março de 2013, com sessões quinzenais, frequência essa modificada para sessões semanais a partir de julho do mesmo ano. A terapia constituiu-se com os objetivos de: aprimorar a mobilidade das estruturas orofaciais; organizar a coordenação pneumofonoarticulatória; reavaliar frequentemente a disfagia, por meio do registro dos episódios de sinais e sintomas de disfagia na alimentação habitual, assim como, da verificação das consistências da dieta usual com manobra de segurança (queixo no peito); verificar o peso; utilizar o diário de distúrbios da deglutição, e orientar a realização dos exercícios orofaciais em casa. Houve estabilização do quadro clinico e do peso corporal durante o ano de atendimento, com posterior retomada de progressão da doença. O direcionamento clínico sugerido é de uma abordagem interdisciplinar, cuja contribuição da fonoaudiologia é do favorecimento para uma alimentação segura, a facilitação da comunicação oral e melhoria da qualidade de vida.

Abstract:The Muscular Dystrophy Oculo-pharyngeal myopathology is a hereditary autosomal dominant, late-onset, with clinical signs of ptosis and oral pharyngeal dysphagia, this may be associated to the proximal muscle weakness. This study examines the speech therapy conduct in a case of oculus-pharyngeal dystrophy. The subject was treated in the speech-language therapy outpatient since March 2013, with biweekly sessions, being changed to weekly sessions from July of the same year. The therapy consists of improving mobility of oral facial structures; organization of the pneumonic articulatory coordination; frequent revaluations of the swallowing disorders, with the register of the episodes of signals and symptoms of swallowing disorders in the habitual feeding, as well as, by the verification of the usual diet consistencies with security maneuver (chin-chest); weight check; using the habitual daily swallowing disorders diary, and orientation for the accomplishment of the daily oral facials exercises at home. She had stabilization of the clinical picture and the corporal weight during the year of attendance, with posterior retaken of disease progression. The suggested clinical aiming is of interdisciplinary boarding, having as contribution from speech and language therapy, the aiding of a safe feeding, the facilitation of the verbal communication and improvement of the quality of life.

Clinical and molecular genetic studies of a Chinese family with oculopharyngeal muscular dystrophy / 中国神经精神疾病杂志

Objective To investigate the clinical and molecular genetic changes in a Chinese family with oculopha?ryngeal muscular dystrophy(OPMD). Methods We collected the clinical data of the familial members and blood sam?ples from all available 16 familial members, including the proband. The samples were analyzed using modified poly?merase chain reaction amplification and direct sequence analysis. Results Male OPMD patients initially presented with ptosis, followed by pronunciation difficulty, dysphagia and limb weakness whereas female OPMD patients initially pre?sented with swallowing difficulty. Genetic test revealed the abnormal expansions of the GCG trinucleotide repeat from GCG6 to GCG10 in PABPN1 gene in 10 familial members. Conclusions The genetic test and prenatal diagnosis is the key for the prevention treatment of oculopharyngeal muscular dystrophy. The ptosis of eyelid may be the initial symptom for the male patients of oculopharyngeal muscular dystrophy with (GCG)10 mutation.

Clinical and pathological analysis of 11 cases of extraocular muscle paralysis was misdiagnosed as muscular disease myasthenia gravis / 重庆医学

Objective To analyse the clinical and pathological characteristics of patients with myopathies that were misdiag-nosed as myasthenia gravis because of external ophthalmoplegia ,widen the thoughts for differential diagnosis of extraocular muscle paralysis .Methods The clinical and pathological features of 11 myopathy cases with ptosis and diplopia admitted to the neurology department of the First Affiliated Hospital of Chongqing Medical University between October 2010 and May 2014 were retrospec-tively reviewed and analyzed .Results Among the 11 patients ,6 male and 5 female ,aged 16-66 years old .All had paralysis of ex-traocular muscle manifestations ,including oculopharyngeal muscular dystrophy(OPMD) in 3 cases ,oculopharyngeal distal myopa-thy in 2 cases ,chronic progressive external ophthalmoplegia(CPEO) in 6 cases .Muscle biopsy showed the characteristic pathologi-cal changes .Statistical analysis showed that the age of onset in OPMD patients was older(P0 .05) .Conclusion Certain rare myopa-thy should be considered for patients with external ophthalmoplegia seemingly myasthenia gravis .Muscle biopsy can provide clue for differential diagnosis .

Clinical, pathological and molecular study of two Chinese families with oculopharyngodistal myopathy / 中华神经科杂志

ObjectiveTo investigate the clinical,myopathological and molecular changes in two Chinese families with oculopharyngodistal myopathy ( OPDM).MethodsWe performed muscle biopsy and histopathologic study on the probands of two families,and further examined molecular genetic testing on PABPN1 and GNE gene. Results Family 1 included 3 affected brothers in the same generation and family 2 involved 4 patients in 2 generations. Dysarthria rather than external ophthalmoplegia was the prominent oculopharyngeal symptoms for Chinese patients. No intranuclear inclusions were observed in ultrastructural examination.The number of GCG repeats in the PABPN1 gene was within normal range and no mutations were identified in the GNE gene.ConclusionsFamily 1 is the first publication on autosomal recessive OPDM in China.The age of onset of two families was comparable with Japanese patients and the pattern of muscle involvement was different. OPDM is a distinct phenotypical,histological,and genetic entity.

Phenotypic and genotypic studies in 6 Chinese Han families with oculopharyngeal muscular dystrophy / 中华神经科杂志

Objective To explore phenotypes and genotypes in 6 Chinese Han families with oculopharyngeal muscular dystrophy (OPMD).Methods There were 28 OPMD patients in 6 Chinese Han families, aged between 32 and 70 years old.The initial symptom was dysphagia in 13 patients, ptosis in 4 patients,lower limb weakness in 1 patient.Most OPMD patients displayed dysphagia and ptosis in 3-20 years after the initial symptom appeared.Biceps brachii biopsies were made in the 6 OPMD probands.The specimens were examined with histological, histochemical stainings and ultrastructural examination.The exon 1 of PABPN1 gene was sequenced in all probands of OPMD and some of their family members.Haplotype analysis was executed in the 6OPMD probands.Results Mild hypertrophy and hypotrophy of fibers and rimmed vacuoles were found in each probands of OPMD muscle biopsies.Intranuclear palisading filamentous inclusions only appeared in 4OPMD probands.Gene analysis identified (GCG)9 in exon 1 of PA BPN 1 gene was detected in 3OPMD families, while (GCG) 6 (GCA) 1 (GCG) 3, (GCG) 10 and (GCG) 8were in one family respectively.Two families with (GCG) 9 expansion shared a common rs2239579 (C) -(GCG) 9-SNP2622 (C) haplotype.Conclusions Dysphagia and ptosis may be the common initial symptoms in Chinese Han OPMD patients.Rimmed vacuoles and intranuclear inclusions may be the common pathological feature in the muscle fibers.Both (GCG) expansions and (GCA) insertion of PABPN1 gene could be detected in Chinese patients.The genetic heterogeneity and the haplotype of three (GCG)9 families in our patients indicate that OPMD arises from different origin within the Han population.Some families with the same (GCG)9 expansions probably come from a common ancestor.

Oculopharyngeal muscular dystrophy,the clinical,electrophysiologic,myopathological and genetic study in a family / 中华神经科杂志

Objective To report clinical,myopathological and genetic features in a family with oculopharyngeal muscular dystrophy(OPMD).Methods The proband,a 60 year-old man,presented proximal weakness of both lower limbs since 50 years old.He developed dysphagia and dysarthria after 53 years old and mild exophthalmos with ptosis after 57 years old.The serum creatine kinase was mildly elevated.Electromyography showed neurogenic involvement and the nerve conduction velocity decreased 20%-143%.Other 5 members in 3 generations developed also dysathria after 45 years old.followed by ptosis 4-20 years afterwards.Three of them showed mild limb weakness.Muscle was biopsied in the proband and specimen was examined with histological,enzymhistochemical,immunohistochemical stainings (first antibody were anti.desmin and ubiquitin antibedies) and ultrastructural examination.PABPN1 gene was sequenced in the proband and 18 family members.Results Rimmed vacuoles with ubiquitin positive material appeared in the muscle fibers.Additionally.there were a few angular atrophic fibers in small groups,COX negative fibers and desmin positive regenerative fibers.Intranuclear palisading filamentous inclusions were observed electromicroscopically in 3% of the nuclears.(GCG)6in PABPN1 was expanded to (GCG)9 in the proband and 11 members.Conclusions The onset symptoms is pharyngeal weakness in OPMD due to heterozygous expanding of PABPNl(GCG)9,accompanied with demyelinating neuropathy.Intranuclear inclusions are also identified in Chinese patient.

Pathological and molecular genetic studies on oculopharyngeal muscular dystrophy / 中华神经科杂志

Objective To study the pathologic and molecular genetic characteristics of Chinese patients with oculopharyngeal muscular dystrophy(OPMD).Methods The ultrastructural muscle biopsies in 6 patients were carried out by using transmission electron microscopy.The DNA was obtained through blood samples from patients(n=11) and the at-risk individuals(n=16).Amplification of the PABPN1 gene mutation region was performed by polymerase chain reaction(PCR).The sequences were obtained and compared with the genomic sequence of the human PABPN1 gene.Results Intranuclear inclusions(INIs) were found by electron microscopy in 4 patients,and the rate of appearance was 18%,20%,34% and 40%.Sequence analysis of exon 1 of PABPN1 gene showed abnormal expansions of the GCG-repeat—(GCG)_8 and(GCG)_(10) in 9 patients.Conclusions INIs might be found by electron microscopy in muscle biopsies of OPMD patients.The rate of appearance of INIs should have positive relationship with the amount of the GCG-repeat.PABPN1 gene mutations might be present among Chinese patients with OPMD,and should have a negative relationship with the age of onset.

A Case of Oculopharyngeal Muscular Dystrophy Due to a Novel Mutation of the PABPN1 Gene

We recently encountered a Korean patient with oculopharyngeal muscular dystrophy (OPMD). His major clinical manifestations were late onset bilateral ptosis, dysarthria, and dysphagia. Direct sequencing analysis of the PABPN1 gene demonstrated a heterozygous insertion of 9 bp sequence [(GCG)(GCA)(GCA); c.28insGCGGCA GCA], resulting in an in-frame insertion of 3 alanines (p. A10insAAA). To our knowledge, this is the first report of a genetically confirmed case of OPMD in Korea.

A Case of Oculopharyngeal Muscular Dystrophy

Oculopharyngeal muscular dystrophy, one of the variants of chronic progressive external ophthalmoplegia, is a disorder characterized by progressive bilateral ptosis, immobility of the eyes and dysphagia. We have experienced a 46-year-old woman complaining of bilateral ptosis, mild dysphagia and immobility of the eyes. Oculopharyngeal muscular dystrophy was confirmed by clinical, electromyographic and histopathologic examination. Therefore, we report a case of oculopharyngeal muscular dystrophy with review of literatures.