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      The myotonic dystrophy experience: a North American cross‐sectional study

      research-article
      , PhD 1 , , , MBA 2 , , MD 3 , the Christopher Project Reference Group
      Muscle & Nerve
      John Wiley and Sons Inc.
      caregiver, myotonic dystrophy, neuromuscular disease, patient report, unmet needs

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          ABSTRACT

          Introduction: Myotonic dystrophy (DM) is a chronic, multisystemic, neurological condition. Patients and caregivers are uniquely suited to identify what symptoms are most important and highlight the unmet needs that are most relevant to DM. Methods: We conducted a North American, cross‐sectional study of people with DM type‐1, congenital DM, and DM type‐2 and their family members. We sent patients and caregivers separate surveys to identify and quantitate the issues of greatest importance, examine the differences between groups, and identify the most important challenges experienced by this population. Results: 1,180 people with DM and 402 family members/caregivers responded to the surveys. They reported considerable physical and cognitive symptoms, extensive diagnostic delays, and varying clinical phenotypes on the basis of DM type. Discussion: Marked disease burden and numerous unmet needs exist in DM. These needs vary based on DM type and highlight the complex clinical phenotypes of these neurological disorders. Muscle Nerve 59:457–464, 2019

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          Most cited references18

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          Molecular basis of myotonic dystrophy: expansion of a trinucleotide (CTG) repeat at the 3' end of a transcript encoding a protein kinase family member.

          Using positional cloning strategies, we have identified a CTG triplet repeat that undergoes expansion in myotonic dystrophy patients. This sequence is highly variable in the normal population. PCR analysis of the interval containing this repeat indicates that unaffected individuals have been 5 and 27 copies. Myotonic dystrophy patients who are minimally affected have at least 50 repeats, while more severely affected patients have expansion of the repeat containing segment up to several kilobase pairs. The CTG repeat is transcribed and is located in the 3' untranslated region of an mRNA that is expressed in tissues affected by myotonic dystrophy. This mRNA encodes a polypeptide that is a member of the protein kinase family.
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            Myotonic dystrophy type 2 caused by a CCTG expansion in intron 1 of ZNF9.

            C Liquori (2001)
            Myotonic dystrophy (DM), the most common form of muscular dystrophy in adults, can be caused by a mutation on either chromosome 19q13 (DM1) or 3q21 (DM2/PROMM). DM1 is caused by a CTG expansion in the 3' untranslated region of the dystrophia myotonica-protein kinase gene (DMPK). Several mechanisms have been invoked to explain how this mutation, which does not alter the protein-coding portion of a gene, causes the specific constellation of clinical features characteristic of DM. We now report that DM2 is caused by a CCTG expansion (mean approximately 5000 repeats) located in intron 1 of the zinc finger protein 9 (ZNF9) gene. Parallels between these mutations indicate that microsatellite expansions in RNA can be pathogenic and cause the multisystemic features of DM1 and DM2.
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              A 10-year study of mortality in a cohort of patients with myotonic dystrophy.

              To determine the age and causes of death as well as the predictors of survival in patients with myotonic dystrophy (DM). In a longitudinal study, a cohort of 367 patients with definite DM was followed for 10 years. During the 10-year period, 75 of the 367 DM patients (20%) died. The mean age at death (53.2 years, range 24 to 81) was similar for men and women. Among these 75 patients, 32 (43%) died of a respiratory problem, 15 (20%) of cardiovascular disease, 8 (11%) of a neoplasia, and 8 (11%) died suddenly. The ratio of observed to expected deaths was significantly increased to 56.6 (95% confidence interval [CI] 38.7 to 78.0) for respiratory diseases, 4.9 (95% CI 2.7 to 7.7) for cardiovascular diseases, and 2.5 (95% CI 1.1 to 4.6) for neoplasms. The mean age at death was 44.7 years for the childhood phenotype of DM, 47.8 years for the early-adult, 55.4 years for the adult, and 63.5 years for the mild phenotype (F = 4.8, p = 0.005). The age-adjusted risk of dying was 3.9 (95% CI 1.3 to 11.0) times greater for a patient with a distal weakness and 5.6 (95% CI 2.2 to 14.4) times greater for a patient with proximal weakness as compared with a person without limb weakness. Life expectancy is greatly reduced in DM patients, particularly in those with early onset of the disease and proximal muscular involvement. The high mortality reflects an increase in death rates from respiratory diseases, cardiovascular diseases, neoplasms, and sudden deaths presumably from cardiac arrhythmias.
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                Author and article information

                Contributors
                khagerma@stanford.edu
                Journal
                Muscle Nerve
                Muscle Nerve
                10.1002/(ISSN)1097-4598
                MUS
                Muscle & Nerve
                John Wiley and Sons Inc. (Hoboken )
                0148-639X
                1097-4598
                05 February 2019
                April 2019
                : 59
                : 4 ( doiID: 10.1002/mus.v59.4 )
                : 457-464
                Affiliations
                [ 1 ] Department of Neurology Stanford University 1201 Welch Road, MSLS Room P220, Stanford California, 94305 USA
                [ 2 ] Marigold Foundation Calgary Alberta Canada
                [ 3 ] Department of Neurology University of Rochester Medical Center Rochester New York USA
                Author notes
                [*] [* ] Correspondence to: K. A. Hagerman; e‐mail: khagerma@ 123456stanford.edu
                Article
                MUS26420
                10.1002/mus.26420
                6590656
                30677147
                9fa30566-4264-4b0a-baec-fefe62c6b1db
                © 2019 The Authors. Muscle & Nerve published by Wiley Periodicals, Inc.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 25 July 2018
                : 07 January 2019
                : 20 January 2019
                Page count
                Figures: 2, Tables: 3, Pages: 8, Words: 6350
                Funding
                Funded by: Marigold Foundation
                Categories
                Clinical Research Article
                Clinical Research Articles
                Custom metadata
                2.0
                mus26420
                April 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.4 mode:remove_FC converted:24.06.2019

                Neurosciences
                caregiver,myotonic dystrophy,neuromuscular disease,patient report,unmet needs
                Neurosciences
                caregiver, myotonic dystrophy, neuromuscular disease, patient report, unmet needs

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