| Neuromuscular involvement in various types of Ehlers-Danlos syndrome. | |
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MedLine Citation:
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PMID: 19557868 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Ehlers-Danlos syndrome (EDS) is a clinically and genetically heterogeneous group of heritable connective tissue disorders characterized by joint hypermobility, skin hyperextensibility, and tissue fragility. Muscle involvement is plausible based on recently discovered interactions between muscle cells and extracellular matrix molecules; however, muscle symptoms are only sporadically reported. We designed a cross-sectional study to find out whether neuromuscular features are part of EDS. METHODS: Standardized questionnaires, physical examination, nerve conduction studies, electromyography, muscle ultrasound, and muscle biopsy were performed in 40 EDS patients with the vascular, classic, tenascin-X (TNX)-deficient type EDS, and hypermobility type of EDS caused by TNXB haploinsufficiency. RESULTS: Muscle weakness, myalgia, and easy fatigability were reported by the majority of patients. Mild-to-moderate muscle weakness (85%) and reduction of vibration sense (60%) were common. Nerve conduction studies demonstrated axonal polyneuropathy in five patients (13%). Needle electromyography myopathic features in nine patients (26%) and a mixed neurogenic-myopathic pattern in most (60%). Muscle ultrasound showed increased echo-intensity (48%) and atrophy (50%). Mild myopathic features were seen on muscle biopsy of five patients (28%). Overall, patients with the hypermobility type EDS caused by TNXB haploinsufficiency were least affected. INTERPRETATION: Mild-to-moderate neuromuscular involvement is common in various types of EDS, with a remarkable relation between residual TNX level and degree of neuromuscular involvement, compatible with a dose-effect relation. The findings of this study should increase awareness of neuromuscular symptoms in EDS patients and improve clinical care. They also point to a role of the extracellular matrix in muscle and peripheral nerve function. |
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Authors:
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Nicol C Voermans; Nens van Alfen; Sigrid Pillen; Martin Lammens; Joost Schalkwijk; Machiel J Zwarts; Iris A van Rooij; Ben C J Hamel; Baiel G van Engelen |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Annals of neurology Volume: 65 ISSN: 1531-8249 ISO Abbreviation: Ann. Neurol. Publication Date: 2009 Jun |
Date Detail:
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Created Date: 2009-07-29 Completed Date: 2009-08-12 Revised Date: 2010-03-09 |
Medline Journal Info:
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Nlm Unique ID: 7707449 Medline TA: Ann Neurol Country: United States |
Other Details:
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Languages: eng Pagination: 687-97 Citation Subset: IM |
Affiliation:
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Department of Neurology, Neuromuscular Centre Nijmegen, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands. n.voermans@neuro.umcn.nl |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Cross-Sectional Studies Ehlers-Danlos Syndrome / classification*, diagnosis, physiopathology* Female Humans Male Middle Aged Muscle Contraction / physiology Muscle Weakness / pathology Muscle, Skeletal / pathology*, physiology Neural Conduction / physiology Neuromuscular Junction / pathology*, physiology Questionnaires Young Adult |
| Comments/Corrections | |
Comment In:
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Ann Neurol. 2010 Jan;67(1):145-6; author reply 146-7
[PMID:
20186845
]
Ann Neurol. 2010 Jan;67(1):147-8 [PMID: 20186851 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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