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Late-onset distal muscle weakness

MedGen UID:
871100
Concept ID:
C4025565
Finding
HPO: HP:0003810

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVLate-onset distal muscle weakness

Conditions with this feature

Nemaline myopathy 2
MedGen UID:
342534
Concept ID:
C1850569
Disease or Syndrome
Nemaline myopathy-2 (NEM2) is an autosomal recessive skeletal muscle disorder with a wide range of severity. The most common clinical presentation is early-onset (in infancy or childhood) muscle weakness predominantly affecting proximal limb muscles. Muscle biopsy shows accumulation of Z-disc and thin filament proteins into aggregates named 'nemaline bodies' or 'nemaline rods,' usually accompanied by disorganization of the muscle Z discs. The clinical and histologic spectrum of entities caused by variants in the NEB gene is a continuum, ranging in severity. The distribution of weakness can vary from generalized muscle weakness, more pronounced in proximal limb muscles, to distal-only involvement, although neck flexor weakness appears to be rather consistent. Histologic patterns range from a severe usually nondystrophic disturbance of the myofibrillar pattern to an almost normal pattern, with or without nemaline bodies, sometimes combined with cores (summary by Lehtokari et al., 2014). Genetic Heterogeneity of Nemaline Myopathy See also NEM1 (255310), caused by mutation in the tropomyosin-3 gene (TPM3; 191030) on chromosome 1q22; NEM3 (161800), caused by mutation in the alpha-actin-1 gene (ACTA1; 102610) on chromosome 1q42; NEM4 (609285), caused by mutation in the beta-tropomyosin gene (TPM2; 190990) on chromosome 9p13; NEM5A (605355), also known as Amish nemaline myopathy, NEM5B (620386), and NEM5C (620389), all caused by mutation in the troponin T1 gene (TNNT1; 191041) on chromosome 19q13; NEM6 (609273), caused by mutation in the KBTBD13 gene (613727) on chromosome 15q22; NEM7 (610687), caused by mutation in the cofilin-2 gene (CFL2; 601443) on chromosome 14q13; NEM8 (615348), caused by mutation in the KLHL40 gene (615340), on chromosome 3p22; NEM9 (615731), caused by mutation in the KLHL41 gene (607701) on chromosome 2q31; NEM10 (616165), caused by mutation in the LMOD3 gene (616112) on chromosome 3p14; and NEM11 (617336), caused by mutation in the MYPN gene (608517) on chromosome 10q21. Several of the genes encode components of skeletal muscle sarcomeric thin filaments (Sanoudou and Beggs, 2001). Mutations in the NEB gene are the most common cause of nemaline myopathy (Lehtokari et al., 2006).
Actin accumulation myopathy
MedGen UID:
777997
Concept ID:
C3711389
Disease or Syndrome
Congenital myopathy-2A (CMYO2A) is an autosomal dominant disorder of the skeletal muscle characterized by infantile- or childhood-onset myopathy with delayed motor milestones and nonprogressive muscle weakness. Of the patients with congenital myopathy caused by mutation in the ACTA1 gene, about 90% carry heterozygous mutations that are usually de novo and cause the severe infantile phenotype (CMYO2C; 620278). Some patients with de novo mutations have a more typical and milder disease course with delayed motor development and proximal muscle weakness, but are able to achieve independent ambulation. Less frequently, autosomal dominant transmission of the disorder within a family may occur when the ACTA1 mutation produces a phenotype compatible with adult life. Of note, intrafamilial variability has also been reported: a severely affected proband may be identified and then mildly affected or even asymptomatic relatives are found to carry the same mutation. The severity of the disease most likely depends on the detrimental effect of the mutation, although there are probably additional modifying factors (Ryan et al., 2001; Laing et al., 2009; Sanoudou and Beggs, 2001; Agrawal et al., 2004; Nowak et al., 2013; Sewry et al., 2019; Laitila and Wallgren-Pettersson, 2021). The most common histologic finding on muscle biopsy in patients with ACTA1 mutations is the presence of 'nemaline rods,' which represent abnormal thread- or rod-like structures ('nema' is Greek for 'thread'). However, skeletal muscle biopsy from patients with mutations in the ACTA1 gene can show a range of pathologic phenotypes. These include classic rods, intranuclear rods, clumped filaments, cores, or fiber-type disproportion, all of which are nonspecific pathologic findings and not pathognomonic of a specific congenital myopathy. Most patients have clinically severe disease, regardless of the histopathologic phenotype (Nowak et al., 2007; Sewry et al., 2019). ACTA1 mutations are the second most common cause of congenital myopathies classified histologically as 'nemaline myopathy' after mutations in the NEB gene (161650). ACTA1 mutations are overrepresented in the severe phenotype with early death (Laing et al., 2009). For a discussion of genetic heterogeneity of congenital myopathy, see CMYO1A (117000). For a discussion of genetic heterogeneity of nemaline myopathy, see NEM2 (256030).

Professional guidelines

PubMed

Montagnese F, Barca E, Musumeci O, Mondello S, Migliorato A, Ciranni A, Rodolico C, De Filippi P, Danesino C, Toscano A
J Neurol 2015;262(4):968-78. Epub 2015 Feb 12 doi: 10.1007/s00415-015-7664-0. PMID: 25673129

Recent clinical studies

Etiology

Ranta-Aho J, Johari M, Udd B
Curr Opin Neurol 2024 Oct 1;37(5):515-522. Epub 2024 Jul 16 doi: 10.1097/WCO.0000000000001299. PMID: 39017652Free PMC Article
Lillback V, Savarese M, Sandholm N, Hackman P, Udd B
Eur J Neurol 2023 Apr;30(4):1080-1088. Epub 2023 Feb 8 doi: 10.1111/ene.15688. PMID: 36692225
van den Dorpel JJA, Poelman E, Harlaar L, van Kooten HA, van der Giessen LJ, van Doorn PA, van der Ploeg AT, van den Hout JMP, van der Beek NAME
Orphanet J Rare Dis 2020 Sep 14;15(1):247. doi: 10.1186/s13023-020-01482-w. PMID: 32928284Free PMC Article
Udd B
Handb Clin Neurol 2011;101:239-62. doi: 10.1016/B978-0-08-045031-5.00016-5. PMID: 21496636
Griggs RC, Udd BA
Neuromolecular Med 2011 Mar;13(1):27-30. Epub 2010 Aug 31 doi: 10.1007/s12017-010-8134-6. PMID: 20809097

Diagnosis

Ranta-Aho J, Johari M, Udd B
Curr Opin Neurol 2024 Oct 1;37(5):515-522. Epub 2024 Jul 16 doi: 10.1097/WCO.0000000000001299. PMID: 39017652Free PMC Article
Zibold J, Lessard LER, Picard F, da Silva LG, Zadorozhna Y, Streichenberger N, Belotti E, Osseni A, Emerit A, Errazuriz-Cerda E, Michel-Calemard L, Menassa R, Coudert L, Wiessner M, Stucka R, Klopstock T, Simonetti F, Hutten S, Nonaka T, Hasegawa M, Strom TM, Bernard E, Ollagnon E, Urtizberea A, Dormann D, Petiot P, Schaeffer L, Senderek J, Leblanc P
Brain 2024 May 3;147(5):1768-1783. doi: 10.1093/brain/awad410. PMID: 38079474Free PMC Article
de Visser M
Acta Myol 2020 Dec;39(4):235-244. Epub 2020 Dec 1 doi: 10.36185/2532-1900-027. PMID: 33458579Free PMC Article
Verschueren A
Rev Neurol (Paris) 2017 May;173(5):320-325. Epub 2017 Apr 20 doi: 10.1016/j.neurol.2017.03.018. PMID: 28434507
Udd B
Handb Clin Neurol 2011;101:239-62. doi: 10.1016/B978-0-08-045031-5.00016-5. PMID: 21496636

Therapy

van den Dorpel JJA, Poelman E, Harlaar L, van Kooten HA, van der Giessen LJ, van Doorn PA, van der Ploeg AT, van den Hout JMP, van der Beek NAME
Orphanet J Rare Dis 2020 Sep 14;15(1):247. doi: 10.1186/s13023-020-01482-w. PMID: 32928284Free PMC Article
Wang J, Wu JC, Yu XE, Han YZ, Yang RM
Medicine (Baltimore) 2018 Nov;97(48):e13153. doi: 10.1097/MD.0000000000013153. PMID: 30508893Free PMC Article
Oktenli C
Am J Nephrol 2000 Sep-Oct;20(5):412-7. doi: 10.1159/000013628. PMID: 11093001

Prognosis

Lillback V, Savarese M, Sandholm N, Hackman P, Udd B
Eur J Neurol 2023 Apr;30(4):1080-1088. Epub 2023 Feb 8 doi: 10.1111/ene.15688. PMID: 36692225
Carroll LS, Walker M, Allen D, Marini-Bettolo C, Ditchfield A, Pinto AA, Hammans SR
Neuromuscul Disord 2021 Mar;31(3):249-252. Epub 2021 Jan 8 doi: 10.1016/j.nmd.2020.12.013. PMID: 33546848
Verschueren A
Rev Neurol (Paris) 2017 May;173(5):320-325. Epub 2017 Apr 20 doi: 10.1016/j.neurol.2017.03.018. PMID: 28434507
Pareyson D, Scaioli V, Laurà M
Neuromolecular Med 2006;8(1-2):3-22. doi: 10.1385/nmm:8:1-2:3. PMID: 16775364
Chahin N, Selcen D, Engel AG
Neurology 2005 Oct 25;65(8):1158-64. Epub 2005 Sep 7 doi: 10.1212/01.wnl.0000180362.90078.dc. PMID: 16148261

Clinical prediction guides

Xi J, Wang X, Yue D, Dou T, Wu Q, Lu J, Liu Y, Yu W, Qiao K, Lin J, Luo S, Li J, Du A, Dong J, Chen Y, Luo L, Yang J, Niu Z, Liang Z, Zhao C, Lu J, Zhu W, Zhou Y
Brain 2021 Mar 3;144(2):601-614. doi: 10.1093/brain/awaa426. PMID: 33374016
Hong DJ, Zhu M, Zhu ZJ, Cong L, Zhong SS, Liu L, Zhang J
Chin Med J (Engl) 2019 Feb 5;132(3):275-284. doi: 10.1097/CM9.0000000000000032. PMID: 30681493Free PMC Article
Montagnese F, Barca E, Musumeci O, Mondello S, Migliorato A, Ciranni A, Rodolico C, De Filippi P, Danesino C, Toscano A
J Neurol 2015;262(4):968-78. Epub 2015 Feb 12 doi: 10.1007/s00415-015-7664-0. PMID: 25673129
Takahashi T, Aoki M, Suzuki N, Tateyama M, Yaginuma C, Sato H, Hayasaka M, Sugawara H, Ito M, Abe-Kondo E, Shimakura N, Ibi T, Kuru S, Wakayama T, Sobue G, Fujii N, Saito T, Matsumura T, Funakawa I, Mukai E, Kawanami T, Morita M, Yamazaki M, Hasegawa T, Shimizu J, Tsuji S, Kuzuhara S, Tanaka H, Yoshioka M, Konno H, Onodera H, Itoyama Y
J Neurol Neurosurg Psychiatry 2013 Apr;84(4):433-40. Epub 2012 Dec 15 doi: 10.1136/jnnp-2011-301339. PMID: 23243261Free PMC Article
Nakamura K, Yoshida K, Yoshinaga T, Kodaira M, Shimojima Y, Takei Y, Morita H, Kayanuma K, Ikeda S
J Neurol Sci 2010 Oct 15;297(1-2):85-8. Epub 2010 Aug 1 doi: 10.1016/j.jns.2010.07.006. PMID: 20674935

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