Evaluation of muscle strength and motor abilities in children with type II and III spinal muscle atrophy treated with valproic acid.

BACKGROUND: Spinal muscular atrophy (SMA) is an autosomal recessive disorder that affects the motoneurons of the spinal anterior horn, resulting in hypotonia and muscle weakness. The disease is caused by deletion or mutation in the telomeric copy of SMN gene (SMN1) and clinical severity is in part determined by the copy number of the centromeric copy of the SMN gene (SMN2). The SMN2 mRNA lacks exon 7, resulting in a production of lower amounts of the full-length SMN protein. Knowledge of the molecular mechanism of diseases has led to the discovery of drugs capable of increasing SMN protein level through activation of SMN2 gene. One of these drugs is the valproic acid (VPA), a histone deacetylase inhibitor. METHODS: Twenty-two patients with type II and III SMA, aged between 2 and 18 years, were treated with VPA and were evaluated five times during a one-year period using the Manual Muscle Test (Medical Research Council scale-MRC), the Hammersmith Functional Motor Scale (HFMS), and the Barthel Index. RESULTS: After 12 months of therapy, the patients did not gain muscle strength. The group of children with SMA type II presented a significant gain in HFMS scores during the treatment. This improvement was not observed in the group of type III patients. The analysis of the HFMS scores during the treatment period in the groups of patients younger and older than 6 years of age did not show any significant result. There was an improvement of the daily activities at the end of the VPA treatment period. CONCLUSION: Treatment of SMA patients with VPA may be a potential alternative to alleviate the progression of the disease. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01033331.

Frontal foramina, Chiari II malformation, and hydrocephalus in a female.

Reported is a 4-year-old female with Chiari II malformation and congenital hydrocephalus associated with lumbosacral myelomeningocele who also presented with frontal calvarial foramina depicted by head computed tomographic scans with three-dimensional reconstructions. Magnetic resonance demonstrated bilateral and symmetric frontal lobe malformation-separated-lip clefts schizencephaly-adjacent to the bilateral frontal calvarial foramina. Because the different types of malformations evident in this patient do not share the same developmental origin, the association of findings is unusual and suggests the occurrence of an unknown prenatal factor acting along different stages of central nervous system development.