Semin Neurol 2012; 32(03): 246-254
DOI: 10.1055/s-0032-1329202
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Myotonic Dystrophy: From Bench to Bedside

Nicholas E. Johnson
1   Department of Neurology, University of Rochester, Rochester, New York
,
Chad R. Heatwole
1   Department of Neurology, University of Rochester, Rochester, New York
› Author Affiliations
Further Information

Publication History

Publication Date:
01 November 2012 (online)

Abstract

Myotonic dystrophy type 1 (DM1) and type 2 (DM2) are autosomal dominant disorders classically characterized by muscle weakness, myotonia, and early-onset cataracts. Patients may also experience dysfunction of the heart, brain, gastrointestinal, endocrine, skin, and respiratory systems. The pathogenesis of myotonic dystrophy is related to trinucleotide (DM1) and tetranucleotide (DM2) repeat expansions that produce toxic mutant mRNA with subsequent interference of RNA-splicing mechanisms. Optimal disease management includes symptomatic care, screens for asymptomatic disease, counseling, and a multidisciplinary approach. The authors review the pathogenesis, clinical features, diagnostic tests, and standard management of DM1 and DM2 and outline promising clinical research for patients with these disorders.

 
  • References

  • 1 Harper PS. Myotonic Dystrophy. London: W.B. Saunders; 2001
  • 2 Day JW, Ricker K, Jacobsen JF , et al. Myotonic dystrophy type 2: molecular, diagnostic and clinical spectrum. Neurology 2003; 60 (4) 657-664
  • 3 López de Munain A, Blanco A, Emparanza JI , et al. Prevalence of myotonic dystrophy in Guipúzcoa (Basque Country, Spain). Neurology 1993; 43 (8) 1573-1576
  • 4 Mathieu J, De Braekeleer M, Prévost C. Genealogical reconstruction of myotonic dystrophy in the Saguenay-Lac-Saint-Jean area (Quebec, Canada). Neurology 1990; 40 (5) 839-842
  • 5 Medica I, Marković D, Peterlin B. Genetic epidemiology of myotonic dystrophy in Istria, Croatia. Acta Neurol Scand 1997; 95 (3) 164-166
  • 6 Suominen T, Bachinski LL, Auvinen S , et al. Population frequency of myotonic dystrophy: higher than expected frequency of myotonic dystrophy type 2 (DM2) mutation in Finland. Eur J Hum Genet 2011; 19 (7) 776-782
  • 7 Brook JD, McCurrach ME, Harley HG , et al. Molecular basis of myotonic dystrophy: expansion of a trinucleotide (CTG) repeat at the 3′ end of a transcript encoding a protein kinase family member. Cell 1992; 68 (4) 799-808
  • 8 Fu YH, Pizzuti A, Fenwick Jr RG , et al. An unstable triplet repeat in a gene related to myotonic muscular dystrophy. Science 1992; 255 (5049) 1256-1258
  • 9 Mahadevan M, Tsilfidis C, Sabourin L , et al. Myotonic dystrophy mutation: an unstable CTG repeat in the 3′ untranslated region of the gene. Science 1992; 255 (5049) 1253-1255
  • 10 De Temmerman N, Sermon K, Seneca S , et al. Intergenerational instability of the expanded CTG repeat in the DMPK gene: studies in human gametes and preimplantation embryos. Am J Hum Genet 2004; 75 (2) 325-329
  • 11 Heatwole CR, Bode R, Johnson NE , et al. Patient-reported impact of symptoms in myotonic dystrophy type 1 (PRISM-1). Neurology 2012; 79 (4) 348-357
  • 12 Nakamori M, Gourdon G, Thornton CA. Stabilization of expanded (CTG)•(CAG) repeats by antisense oligonucleotides. Mol Ther 2011; 19 (12) 2222-2227
  • 13 Gourdon G, Radvanyi F, Lia AS , et al. Moderate intergenerational and somatic instability of a 55-CTG repeat in transgenic mice. Nat Genet 1997; 15 (2) 190-192
  • 14 Joseph JT, Richards CS, Anthony DC, Upton M, Perez-Atayde AR, Greenstein P. Congenital myotonic dystrophy pathology and somatic mosaicism. Neurology 1997; 49 (5) 1457-1460
  • 15 Mankodi A, Takahashi MP, Jiang H , et al. Expanded CUG repeats trigger aberrant splicing of ClC-1 chloride channel pre-mRNA and hyperexcitability of skeletal muscle in myotonic dystrophy. Mol Cell 2002; 10 (1) 35-44
  • 16 Mankodi A, Teng-Umnuay P, Krym M, Henderson D, Swanson M, Thornton CA. Ribonuclear inclusions in skeletal muscle in myotonic dystrophy types 1 and 2. Ann Neurol 2003; 54 (6) 760-768
  • 17 Wheeler TM. Myotonic dystrophy: therapeutic strategies for the future. Neurotherapeutics 2008; 5 (4) 592-600
  • 18 Osborne RJ, Lin X, Welle S , et al. Transcriptional and post-transcriptional impact of toxic RNA in myotonic dystrophy. Hum Mol Genet 2009; 18 (8) 1471-1481
  • 19 Charlet-B N, Savkur RS, Singh G, Philips AV, Grice EA, Cooper TA. Loss of the muscle-specific chloride channel in type 1 myotonic dystrophy due to misregulated alternative splicing. Mol Cell 2002; 10 (1) 45-53
  • 20 Savkur RS, Philips AV, Cooper TA. Aberrant regulation of insulin receptor alternative splicing is associated with insulin resistance in myotonic dystrophy. Nat Genet 2001; 29 (1) 40-47
  • 21 Savkur RS, Philips AV, Cooper TA , et al. Insulin receptor splicing alteration in myotonic dystrophy type 2. Am J Hum Genet 2004; 74 (6) 1309-1313
  • 22 Orengo JP, Chambon P, Metzger D, Mosier DR, Snipes GJ, Cooper TA. Expanded CTG repeats within the DMPK 3′ UTR causes severe skeletal muscle wasting in an inducible mouse model for myotonic dystrophy. Proc Natl Acad Sci U S A 2008; 105 (7) 2646-2651
  • 23 Wang GS, Kuyumcu-Martinez MN, Sarma S, Mathur N, Wehrens XH, Cooper TA. PKC inhibition ameliorates the cardiac phenotype in a mouse model of myotonic dystrophy type 1. J Clin Invest 2009; 119 (12) 3797-3806
  • 24 Bachinski LL, Udd B, Meola G , et al. Confirmation of the type 2 myotonic dystrophy (CCTG)n expansion mutation in patients with proximal myotonic myopathy/proximal myotonic dystrophy of different European origins: a single shared haplotype indicates an ancestral founder effect. Am J Hum Genet 2003; 73 (4) 835-848
  • 25 Liquori CL, Ricker K, Moseley ML , et al. Myotonic dystrophy type 2 caused by a CCTG expansion in intron 1 of ZNF9. Science 2001; 293 (5531) 864-867
  • 26 Ranum LP, Rasmussen PF, Benzow KA, Koob MD, Day JW. Genetic mapping of a second myotonic dystrophy locus. Nat Genet 1998; 19 (2) 196-198
  • 27 Cardani R, Mancinelli E, Giagnacovo M, Sansone V, Meola G. Ribonuclear inclusions as biomarker of myotonic dystrophy type 2, even in improperly frozen or defrozen skeletal muscle biopsies. Eur J Histochem 2009; 53 (2) 107-111
  • 28 Lam SL, Wu F, Yang H, Chi LM. The origin of genetic instability in CCTG repeats. Nucleic Acids Res 2011; 39 (14) 6260-6268
  • 29 Timchenko LT, Tapscott SJ, Cooper TA, Monckton DG. Myotonic dystrophy: discussion of molecular basis. Adv Exp Med Biol 2002; 516: 27-45
  • 30 Ranum LP, Day JW. Myotonic dystrophy: clinical and molecular parallels between myotonic dystrophy type 1 and type 2. Curr Neurol Neurosci Rep 2002; 2 (5) 465-470
  • 31 Huichalaf C, Schoser B, Schneider-Gold C, Jin B, Sarkar P, Timchenko L. Reduction of the rate of protein translation in patients with myotonic dystrophy 2. J Neurosci 2009; 29 (28) 9042-9049
  • 32 Salisbury E, Schoser B, Schneider-Gold C , et al. Expression of RNA CCUG repeats dysregulates translation and degradation of proteins in myotonic dystrophy 2 patients. Am J Pathol 2009; 175 (2) 748-762
  • 33 Logigian EL, Blood CL, Dilek N , et al. Quantitative analysis of the “warm-up” phenomenon in myotonic dystrophy type 1. Muscle Nerve 2005; 32 (1) 35-42
  • 34 Groh WJ, Groh MR, Saha C , et al. Electrocardiographic abnormalities and sudden death in myotonic dystrophy type 1. N Engl J Med 2008; 358 (25) 2688-2697
  • 35 Fung KC, Corbett A, Kritharides L. Myocardial tissue velocity reduction is correlated with clinical neurologic severity in myotonic dystrophy. Am J Cardiol 2003; 92 (2) 177-181
  • 36 Sabovic M, Medica I, Logar N, Mandić E, Zidar J, Peterlin B. Relation of CTG expansion and clinical variables to electrocardiogram conduction abnormalities and sudden death in patients with myotonic dystrophy. Neuromuscul Disord 2003; 13 (10) 822-826
  • 37 Vinereanu D, Bajaj BP, Fenton-May J, Rogers MT, Mädler CF, Fraser AG. Subclinical cardiac involvement in myotonic dystrophy manifesting as decreased myocardial Doppler velocities. Neuromuscul Disord 2004; 14 (3) 188-194
  • 38 Arsenault ME, Prévost C, Lescault A, Laberge C, Puymirat J, Mathieu J. Clinical characteristics of myotonic dystrophy type 1 patients with small CTG expansions. Neurology 2006; 66 (8) 1248-1250
  • 39 Ciafaloni E, Mignot E, Sansone V , et al. The hypocretin neurotransmission system in myotonic dystrophy type 1. Neurology 2008; 70 (3) 226-230
  • 40 Gibbs III JW, Ciafaloni E, Radtke RA. Excessive daytime somnolence and increased rapid eye movement pressure in myotonic dystrophy. Sleep 2002; 25 (6) 662-665
  • 41 Meola G, Sansone V. Cerebral involvement in myotonic dystrophies. Muscle Nerve 2007; 36 (3) 294-306
  • 42 Meola G, Sansone V, Perani D , et al. Executive dysfunction and avoidant personality trait in myotonic dystrophy type 1 (DM-1) and in proximal myotonic myopathy (PROMM/DM-2). Neuromuscul Disord 2003; 13 (10) 813-821
  • 43 Sistiaga A, Urreta I, Jodar M , et al. Cognitive/personality pattern and triplet expansion size in adult myotonic dystrophy type 1 (DM1): CTG repeats, cognition and personality in DM1. Psychol Med 2010; 40 (3) 487-495
  • 44 Gaul C, Schmidt T, Windisch G , et al. Subtle cognitive dysfunction in adult onset myotonic dystrophy type 1 (DM1) and type 2 (DM2). Neurology 2006; 67 (2) 350-352
  • 45 Weber YG, Roebling R, Kassubek J , et al. Comparative analysis of brain structure, metabolism, and cognition in myotonic dystrophy 1 and 2. Neurology 2010; 74 (14) 1108-1117
  • 46 Modoni A, Silvestri G, Vita MG, Quaranta D, Tonali PA, Marra C. Cognitive impairment in myotonic dystrophy type 1 (DM1): a longitudinal follow-up study. J Neurol 2008; 255 (11) 1737-1742
  • 47 Modoni A, Silvestri G, Pomponi MG, Mangiola F, Tonali PA, Marra C. Characterization of the pattern of cognitive impairment in myotonic dystrophy type 1. Arch Neurol 2004; 61 (12) 1943-1947
  • 48 Wozniak JR, Mueller BA, Ward EE, Lim KO, Day JW. White matter abnormalities and neurocognitive correlates in children and adolescents with myotonic dystrophy type 1: a diffusion tensor imaging study. Neuromuscul Disord 2011; 21 (2) 89-96
  • 49 Rönnblom A, Andersson S, Danielsson A. Mechanisms of diarrhoea in myotonic dystrophy. Eur J Gastroenterol Hepatol 1998; 10 (7) 607-610
  • 50 Moxley III RT, Meola G. The myotonic dystrophies. In: Rosenberg RN, DiMauro S, Paulson HL, Ptacek L, Nestler EJ, , eds. The Molecular and Genetic Basis of Neurologic and Psychiatric Disease. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2007: 511-518
  • 51 Heatwole CR, Miller J, Martens B, Moxley III RT. Laboratory abnormalities in ambulatory patients with myotonic dystrophy type 1. Arch Neurol 2006; 63 (8) 1149-1153
  • 52 Zaki M, Boyd PA, Impey L, Roberts A, Chamberlain P. Congenital myotonic dystrophy: prenatal ultrasound findings and pregnancy outcome. Ultrasound Obstet Gynecol 2007; 29 (3) 284-288
  • 53 Campbell C, Sherlock R, Jacob P, Blayney M. Congenital myotonic dystrophy: assisted ventilation duration and outcome. Pediatrics 2004; 113 (4) 811-816
  • 54 Moxley III RT, Meola G, Udd B, Ricker K. Report of the 84th ENMC workshop: PROMM (proximal myotonic myopathy) and other myotonic dystrophy-like syndromes: 2nd workshop. 13-15th October, 2000, Loosdrecht, The Netherlands. Neuromuscul Disord 2002; 12 (3) 306-317
  • 55 Ricker K, Koch MC, Lehmann-Horn F , et al. Proximal myotonic myopathy. Clinical features of a multisystem disorder similar to myotonic dystrophy. Arch Neurol 1995; 52 (1) 25-31
  • 56 Day JW, Roelofs R, Leroy B, Pech I, Benzow K, Ranum LP. Clinical and genetic characteristics of a five-generation family with a novel form of myotonic dystrophy (DM2). Neuromuscul Disord 1999; 9 (1) 19-27
  • 57 Thornton CA, Johnson K, Moxley III RT. Myotonic dystrophy patients have larger CTG expansions in skeletal muscle than in leukocytes. Ann Neurol 1994; 35 (1) 104-107
  • 58 Young NP, Daube JR, Sorenson EJ, Milone M. Absent, unrecognized, and minimal myotonic discharges in myotonic dystrophy type 2. Muscle Nerve 2010; 41 (6) 758-762
  • 59 Logigian EL, Ciafaloni E, Quinn LC , et al. Severity, type, and distribution of myotonic discharges are different in type 1 and type 2 myotonic dystrophy. Muscle Nerve 2007; 35 (4) 479-485
  • 60 Suokas KI, Haanpää M, Kautiainen H, Udd B, Hietaharju AJ. Pain in patients with myotonic dystrophy type 2: a postal survey in Finland. Muscle Nerve 2012; 45 (1) 70-74
  • 61 George A, Schneider-Gold C, Zier S, Reiners K, Sommer C. Musculoskeletal pain in patients with myotonic dystrophy type 2. Arch Neurol 2004; 61 (12) 1938-1942
  • 62 Meola G, Sansone V, Marinou K , et al. Proximal myotonic myopathy: a syndrome with a favourable prognosis?. J Neurol Sci 2002; 193 (2) 89-96
  • 63 Akiguchi I, Nakano S, Shiino A , et al. Brain proton magnetic resonance spectroscopy and brain atrophy in myotonic dystrophy. Arch Neurol 1999; 56 (3) 325-330
  • 64 Chang L, Ernst T, Osborn D, Seltzer W, Leonido-Yee M, Poland RE. Proton spectroscopy in myotonic dystrophy: correlations with CTG repeats. Arch Neurol 1998; 55 (3) 305-311
  • 65 Tieleman AA, Knoop H, van de Logt AE, Bleijenberg G, van Engelen BG, Overeem S. Poor sleep quality and fatigue but no excessive daytime sleepiness in myotonic dystrophy type 2. J Neurol Neurosurg Psychiatry 2010; 81 (9) 963-967
  • 66 Schoser BG, Ricker K, Schneider-Gold C , et al. Sudden cardiac death in myotonic dystrophy type 2. Neurology 2004; 63 (12) 2402-2404
  • 67 Heatwole C, Johnson N, Goldberg B, Martens W, Moxley III R. Laboratory abnormalities in patients with myotonic dystrophy type 2. Arch Neurol 2011; 68 (9) 1180-1184
  • 68 Johnson N, Heatwole CR. Myotonic dystrophies. In: Tawil RN, Venance S, , eds. Neuromuscular Disorders. Oxford, UK: Wiley-Blackwell; 2011: 80-86
  • 69 Vihola A, Bassez G, Meola G , et al. Histopathological differences of myotonic dystrophy type 1 (DM1) and PROMM/DM2. Neurology 2003; 60 (11) 1854-1857
  • 70 Schoser BG, Schneider-Gold C, Kress W , et al. Muscle pathology in 57 patients with myotonic dystrophy type 2. Muscle Nerve 2004; 29 (2) 275-281
  • 71 Pisani V, Panico MB, Terracciano C , et al. Preferential central nucleation of type 2 myofibers is an invariable feature of myotonic dystrophy type 2. Muscle Nerve 2008; 38 (5) 1405-1411
  • 72 Orngreen MC, Olsen DB, Vissing J. Aerobic training in patients with myotonic dystrophy type 1. Ann Neurol 2005; 57 (5) 754-757
  • 73 Kilmer DD, McCrory MA, Wright NC, Aitkens SG, Bernauer EM. The effect of a high resistance exercise program in slowly progressive neuromuscular disease. Arch Phys Med Rehabil 1994; 75 (5) 560-563
  • 74 Logigian EL, Martens WB, Moxley IV RT , et al. Mexiletine is an effective antimyotonia treatment in myotonic dystrophy type 1. Neurology 2010; 74 (18) 1441-1448
  • 75 Desaphy JF, De Luca A, Didonna MP, George Jr AL, Camerino Conte D. Different flecainide sensitivity of hNav1.4 channels and myotonic mutants explained by state-dependent block. J Physiol 2004; 554 (Pt 2) 321-334
  • 76 Trip J, Drost G, van Engelen BG, Faber CG. Drug treatment for myotonia. Cochrane Database Syst Rev 2006; (1) CD004762
  • 77 Damian MS, Gerlach A, Schmidt F, Lehmann E, Reichmann H. Modafinil for excessive daytime sleepiness in myotonic dystrophy. Neurology 2001; 56 (6) 794-796
  • 78 MacDonald JR, Hill JD, Tarnopolsky MA. Modafinil reduces excessive somnolence and enhances mood in patients with myotonic dystrophy. Neurology 2002; 59 (12) 1876-1880
  • 79 White RJ, Bass SP. Myotonic dystrophy and paediatric anaesthesia. Paediatr Anaesth 2003; 13 (2) 94-102
  • 80 Weingarten TN, Hofer RE, Milone M, Sprung J. Anesthesia and myotonic dystrophy type 2: a case series. Can J Anaesth 2010; 57 (3) 248-255
  • 81 Rudnik-Schöneborn S, Zerres K. Outcome in pregnancies complicated by myotonic dystrophy: a study of 31 patients and review of the literature. Eur J Obstet Gynecol Reprod Biol 2004; 114 (1) 44-53
  • 82 Rudnik-Schöneborn S, Schneider-Gold C, Raabe U, Kress W, Zerres K, Schoser BG. Outcome and effect of pregnancy in myotonic dystrophy type 2. Neurology 2006; 66 (4) 579-580
  • 83 Newman B, Meola G, O'Donovan DG, Schapira AH, Kingston H. Proximal myotonic myopathy (PROMM) presenting as myotonia during pregnancy. Neuromuscul Disord 1999; 9 (3) 144-149
  • 84 Gadalla SM, Lund M, Pfeiffer RM , et al. Cancer risk among patients with myotonic muscular dystrophy. JAMA 2011; 306 (22) 2480-2486
  • 85 Foff EP, Mahadevan MS. Therapeutics development in myotonic dystrophy type 1. Muscle Nerve 2011; 44 (2) 160-169
  • 86 Mulders SA, van den Broek WJ, Wheeler TM , et al. Triplet-repeat oligonucleotide-mediated reversal of RNA toxicity in myotonic dystrophy. Proc Natl Acad Sci U S A 2009; 106 (33) 13915-13920
  • 87 Wheeler TM, Sobczak K, Lueck JD , et al. Reversal of RNA dominance by displacement of protein sequestered on triplet repeat RNA. Science 2009; 325 (5938) 336-339
  • 88 Goemans NM, Tulinius M, van den Akker JT , et al. Systemic administration of PRO051 in Duchenne's muscular dystrophy. N Engl J Med 2011; 364 (16) 1513-1522
  • 89 Cirak S, Arechavala-Gomeza V, Guglieri M , et al. Exon skipping and dystrophin restoration in patients with Duchenne muscular dystrophy after systemic phosphorodiamidate morpholino oligomer treatment: an open-label, phase 2, dose-escalation study. Lancet 2011; 378 (9791) 595-605
  • 90 Langlois MA, Lee NS, Rossi JJ, Puymirat J. Hammerhead ribozyme-mediated destruction of nuclear foci in myotonic dystrophy myoblasts. Mol Ther 2003; 7 (5 Pt 1) 670-680
  • 91 Langlois MA, Boniface C, Wang G , et al. Cytoplasmic and nuclear retained DMPK mRNAs are targets for RNA interference in myotonic dystrophy cells. J Biol Chem 2005; 280 (17) 16949-16954
  • 92 Soifer HS, Rossi JJ, Saetrom P. MicroRNAs in disease and potential therapeutic applications. Mol Ther 2007; 15 (12) 2070-2079
  • 93 Warf MB, Nakamori M, Matthys CM, Thornton CA, Berglund JA. Pentamidine reverses the splicing defects associated with myotonic dystrophy. Proc Natl Acad Sci U S A 2009; 106 (44) 18551-18556
  • 94 Ward AJ, Rimer M, Killian JM, Dowling JJ, Cooper TA. CUGBP1 overexpression in mouse skeletal muscle reproduces features of myotonic dystrophy type 1. Hum Mol Genet 2010; 19 (18) 3614-3622
  • 95 Wheeler TM, Lueck JD, Swanson MS, Dirksen RT, Thornton CA. Correction of ClC-1 splicing eliminates chloride channelopathy and myotonia in mouse models of myotonic dystrophy. J Clin Invest 2007; 117 (12) 3952-3957