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      Enfermedad de Pompe como diagnóstico diferencial de enfermedad de motoneurona: reporte de casos y revisión de la literatura Translated title: Pompe disease as a differential diagnosis of motor neuron disease: report of a case and review of the literature

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          Abstract

          A través del presente estudio se pretende demostrar la importancia de la evaluación de la enfermedad de Pompe como diagnóstico diferencial de la enfermedad de motoneurona. En el siguiente trabajo presentamos dos casos clínicos en los que inicialmente se consideró enfermedad de motoneurona, y en donde finalmente se documentó un déficit de alfa glucosidasa como causal de la sintomatología.

          Translated abstract

          Through this study we aim to demonstrate the importance of the evaluation of pompe disease as a differential diagnosis of motor neuron disease. Here we present two cases in which the initial approach was of a motor neuron disease, but with a more comprehensive assessment it was documented an alpha glucosidase deficiency.

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          Most cited references12

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          Study of 962 patients indicates progressive muscular atrophy is a form of ALS.

          Progressive muscular atrophy (PMA) is clinically characterized by signs of lower motor neuron dysfunction and may evolve into amyotrophic lateral sclerosis (ALS). Whether PMA is actually a form of ALS has important consequences clinically and for therapeutic trials. We compared the survival of patients with PMA or ALS to analyze the clinical features that influence survival in PMA. We reviewed the medical records of patients with PMA (n = 91) or ALS (n = 871) from our ALS Center and verified survival by telephoning the families or using the National Death Index. In PMA, patients were more likely to be male (p < 0.001), older (p = 0.007), and lived longer (p = 0.01) than in ALS. Cox model analysis suggested that the risk of death increased with age at onset in both patient groups (p < 0.005). Upper motor neuron (UMN) signs developed in 22% of patients with PMA within 61 months after diagnosis. Demographic and other clinical variables did not differ at diagnosis between those who did or did not develop UMN signs. In PMA, the factors present at diagnosis that predicted shorter survival were greater number of body regions affected, lower forced vital capacity, and lower ALS Functional Rating Scale-Revised score. Noninvasive ventilation and gastrostomy were used frequently in PMA. Although patients with progressive muscular atrophy (PMA) tended to live longer than those with amyotrophic lateral sclerosis (ALS), shorter survival in PMA is associated with the same risk factors that predict poor survival in ALS. Additionally, PMA is relentlessly progressive, and UMN involvement can occur, as also reported in imaging and postmortem studies. For these reasons, PMA should be considered a form of ALS.
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            Pompe disease: a neuromuscular disease with respiratory muscle involvement.

            Pompe disease is a single disease continuum that includes variable neuromuscular symptoms and rates of progression. However, specific clinical features, such as an early onset of respiratory problems preceding limb muscular weakness, distinguish Pompe disease from other neuromuscular diseases in which respiratory insufficiency occurs after loss of ambulation. The management of Pompe disease also differs from other neuromuscular diseases in that specific treatment is now available, making early recognition of the disease a priority. The results from clinical trials with recombinant human acid alpha-glucosidase have been published, and they show promising results with regards to the improvement of respiratory function in patients with Pompe disease. This review aims to give an overview of Pompe disease and to describe the current concepts of the disease. A focus is placed on the pathophysiology and clinical presentation of respiratory muscle involvement in adults. Additionally, new approaches and therapies available for the management of respiratory complications observed in Pompe disease are discussed in detail.
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              Patterns of Weakness, Classification of Motor Neuron Disease, and Clinical Diagnosis of Sporadic Amyotrophic Lateral Sclerosis.

              When approaching a patient with suspected motor neuron disease (MND), the pattern of weakness on examination helps distinguish MND from other diseases of peripheral nerves, the neuromuscular junction, or muscle. MND is a clinical diagnosis supported by findings on electrodiagnostic testing. MNDs exist on a spectrum, from a pure lower motor neuron to mixed upper and lower motor neuron to a pure upper motor neuron variant. Amyotrophic lateral sclerosis (ALS) is a progressive mixed upper and lower motor neuron disorder, most commonly sporadic, which is invariably fatal. This article describes a pattern approach to identifying MND and clinical features of sporadic ALS.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                anco
                Acta Neurológica Colombiana
                Acta Neurol Colomb.
                Asociación Colombiana de Neurología (Bogotá, Distrito Capital, Colombia )
                0120-8748
                September 2016
                : 32
                : 3
                : 212-215
                Affiliations
                [02] Bogotá orgnameUniversidad del Rosario Colombia
                [03] Bogotá orgnameClínica VIP Colombia
                [04] Bogotá orgnameFundación Cardioinfantil Colombia
                [01] Bogotá orgnameUniversidad del Rosario Colombia
                Article
                S0120-87482016000300006
                ac479b41-cb8d-47b6-8ab3-d2992bd7bbef

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 12 April 2016
                : 25 May 2016
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 18, Pages: 4
                Product

                SciELO Colombia


                Pompe,Motor neuron disease,Differential diagnosis,Motoneurona,Diagnóstico diferencial

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