Myopathies


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Myopathies

 

Definition

Myopathies are diseases of skeletal muscle which are not caused by nerve disorders. These diseases cause the skeletal or voluntary muscles to become weak or wasted.

Description

There are many different types of myopathies, some of which are inherited, some inflammatory, and some caused by endocrine problems. Myopathies are rare and not usually fatal. Typically, effects are mild, largely causing muscle weakness and movement problems, and many are transitory. Only rarely will patients become dependent on a wheelchair. However, muscular dystrophy (which is technically a form of myopathy) is far more severe. Some types of this disease are fatal in early adulthood.

Causes and symptoms

Myopathies are usually degenerative, but they are sometimes caused by drug side effects, chemical poisoning, or a chronic disorder of the immune system.

Genetic myopathies

Among their many functions, genes are responsible for overseeing the production of proteins important in maintaining healthy cells. Muscle cells produce thousands of proteins. With each of the inherited myopathies, a genetic defect is linked to a lack of, or problem with, one of the proteins needed for normal muscle cell function.
There are several different kinds of myopathy caused by defective genes:
  • Central core disease
  • Centronuclear (myotubular) myopathy
  • Myotonia congenita
  • Nemaline myopathy
  • Paramyotonia congenita
  • Periodic paralysis (hypokalemic and hyperkalemic forms)
  • Mitochondrial myopathies.
Most of these genetic myopathies are dominant, which means that a child needs to inherit only one copy of the defective gene from one parent in order to have the disease. The parent with the defective gene also has the disorder, and each of this parent's children has a 50% chance of also inheriting the disease. Male and female children are equally at risk.
However, one form of myotonia congenita and some forms of nemaline myopathy must be inherited from both parents, each of whom carry a recessive defective gene but who do not have symptoms of the disease. Each child of such parents has a 25% chance of inheriting both genes and showing signs of the disease, and a 50% chance of inheriting one defective gene from only one parent. If the child inherited just one defective gene, he or she would be a carrier but would not show signs of the disease.
A few forms of centronuclear myopathy develop primarily in males. Females who inherit the defective gene are usually carriers without symptoms, like their mothers, but they can pass on the disease to their sons. Mitochondrial myopathies are inherited through the mother, since sperm do not contain mitochondria. (Mitochondria play a key role in energy production in the body's cells.)
The major symptoms associated with the genetic myopathies include:
  • Central core disease: mild weakness of voluntary muscles, especially in the hips and legs; hip displacement; delays in reaching developmental motor milestones; problems with running, jumping, and climbing stairs develop in childhood
  • Centronuclear myopathy: weakness of voluntary muscles including those on the face, arms, legs, and trunk; drooping upper eyelids; facial weakness; foot drop; affected muscles almost always lack reflexes
  • Myotonia congenita: voluntary muscles of the arms, legs, and face are stiff or slow to relax after contracting (myotonia); stiffness triggered by fatigue, stress, cold, or long rest periods, such as a night's sleep; stiffness can be relieved by repeated movement of the affected muscles
  • Nemaline myopathy: moderate weakness of voluntary muscles in the arms, legs, and trunk; mild weakness of facial muscles; delays in reaching developmental motor milestones; decreased or absent reflexes in affected muscles; long, narrow face; high-arched palate; jaw projects beyond upper part of the face
  • Paramyotonia congenita: stiffness (myotonia) of voluntary muscles in the face, hands, and forearms; attacks spontaneous or triggered by cold temperatures; stiffness made worse by repeated movement; episodes of stiffness last longer than those seen in myotonia congenita
  • Periodic paralysis: attacks of temporary muscle weakness (muscles work normally between attacks); in the hypokalemic (low calcium) form, attacks triggered by vigorous exercise, heavy meals (high in carbohydrates), insulin, stress, alcohol, infection, pregnancy; in the hyperkalemic (normal/high calcium) form, attacks triggered by vigorous exercise, stress, pregnancy, missing a meal, steroid drugs, high potassium intake
  • Mitochondrial myopathies: symptoms vary quite widely with the form of the disease and may include progressive weakness of the eye muscles (ocular myopathy), weakness of the arms and legs, or multisystem problems primarily involving the brain and muscles.

Endocrine-related myopathies

In some cases, myopathies can be caused by a malfunctioning gland (or glands), which produces either too much or too little of the chemical messengers called hormones. Hormones are carried by the blood and one of their many functions is to regulate muscle activity. Problems in producing hormones can lead to muscle weakness.
Hyperthyroid myopathy and hypothyroid myopathy affect different muscles in different ways. Hyperthyroid myopathy occurs when the thyroid gland produces too much thyroxine, leading to muscle weakness, some muscle wasting in hips and shoulders, and, sometimes, problems with eye muscles. The hypothyroid type occurs when too little hormone is produced, leading to stiffness, cramps, and weakness of arm and leg muscles.

Inflammatory myopathies

Some myopathies are inflammatory, leading to inflamed, weakened muscles. Inflammation is a protective response of injured tissues characterized by redness, increased heat, swelling, and/or pain in the affected area. Examples of this type include polymyositis, dermatomyositis, and myositis ossificans.
Dermatomyositis is a disease of the connective tissue that also involves weak, tender, inflamed muscles. In fact, muscle tissue loss may be so severe that the person may be unable to walk. Skin inflammation is also present. The cause is unknown, but viral infection and antibiotics are associated with the condition. In some cases, dermatomyositis is associated with rheumatologic disease or cancer. Polymyositis involves inflammation of many muscles usually accompanied by deformity, swelling, sleeplessness, pain, sweating, and tension. It, too, may be associated with cancer. Myositis ossificans is a rare inherited disease in which muscle tissue is replaced by bone, beginning in childhood.

Muscular dystrophy

While considered to be a separate group of diseases, the muscular dystrophies also technically involve muscle wasting and can be described as myopathies. These relatively rare diseases appear during childhood and adolescence, and are caused by muscle destruction or degeneration. They are a group of genetic disorders caused by problems in the production of key proteins.
The forms of muscular dystrophy (MD) differ according to the way they are inherited, the age of onset, the muscles they affect, and how fast they progress. The most common type is Duchenne MD, affecting one or two in every 10,000 boys. Other types of MD include Becker's, myotonic dystrophy, limb-girdle MD, and facioscapulohumeral MD.

Diagnosis

Early diagnosis of myopathy is important so that the best possible care can be provided as soon as possible. An experienced physician can diagnose a myopathy by evaluating a person's medical history and by performing a thorough physical exam. Diagnostic tests can help differentiate between the different types of myopathy, as well as between myopathy and other neuromuscular disorders. If the doctor suspects a genetic myopathy, a thorough family history will also be taken.
Diagnostic tests the doctor may order include:
  • Measurements of potassium in the blood
  • Muscle biopsy
  • Electromyogram (EMG).

Treatment

Treatment depends on the specific type of myopathy the person has:
  • Periodic paralysis: medication and dietary changes
  • Hyperthyroid or hypothyroid myopathy: treatment of the underlying thyroid abnormality
  • Myositis ossificans: medication may prevent abnormal bone formation, but there is no cure following onset
  • Central core disease: no treatment
  • Nemaline myopathy: no treatment
  • Centronuclear (myotubular) myopathy: no treatment
  • Paramyotonia congenita: treatment often unnecessary
  • Myotonia congenita: drug treatment (if necessary), but drugs do not affect the underlying disease, and attacks may still occur.

Prognosis

The prognosis for patients with myopathy depends on the type and severity of the individual disease. In most cases, the myopathy can be successfully treated and the patient returned to normal life.
Muscular dystrophy, however, is generally a much more serious condition. Duchenne's MD is usually fatal by the late teens; Becker's MD is less serious and may not be fatal until the 50s.

Resources

Organizations

Muscular Dystrophy Association. 3300 East Sunrise Drive, Tucson, AZ 85718. (800) 572-1717. http://www.mdausa.org.

Key terms

Electromyogram (EMG) — A diagnostic test that records the electrical activity of muscles. In the test, small electrodes are placed on or in the skin; the patterns of electrical activity are projected on a screen or over a loudspeaker. This procedure is used to test for muscle disorders, including muscular dystrophy.
Inflammation — A protective response of injured tissues characterized by redness, increased heat, swelling, and/or pain in the affected area.
Voluntary muscles — Muscles producing voluntary movement.
References in periodicals archive ?
119th ENMC international workshop: Trial design in adult idiopathic inflammatory myopathies, with the exception of inclusion body myositis, 10-12 October 2003, Naarden, The Netherlands.
For this prospective study, 49 adult patients with idiopathic inflammatory myopathies (13 males, 36 females) were recruited in West China Hospital of Sichuan University, China, from August 2014 to December 2014.
Rheumatologists are from Venus: Differences in approach to classifying the idiopathic inflammatory myopathies.
Some of the common drugs causing myopathies by different mechanisms are as follows:
This could therefore have an impact on the treatment of muscular diseases, including myopathies and muscular dystrophies.
He drew attention to a genetic mutation study conducted by investigators at the State University of New York, Buffalo, in 110 patients with lipid-lowering drug-induced myopathies and 248 controls.
Consider muscle biopsy by a specialist who knows the proper laboratory tests for these myopathies.
Clinically, drug-induced myopathies range from benign processes that cause asymptomatic elevations in serum creatine phosphokinase (CK) levels (asymptomatic hyper-CK-emia) to mild-to-severe myalgias, cramps, exercise intolerance, or various degrees of muscle weakness.
In future, the same technique could be used to rid human embryos of bad mitochondria, and the disorders they cause, which include muscle-wasting mitochondrial myopathies, Leber's Hereditary Optic Neuropathy which leads to blindness, and nerve illnesses similar to multiple sclerosis.
The association between inflammatory myopathies and malignancy is greatest in dermatomyositis, with a 3-fold increase in malignancy.
Among the categories covered are: spinal muscular atrophies, poliomyelitis, Charcot-Marie-Tooth disease and related disorders, vasculitic neuropathies, neuropathies associated with infections, muscular dystrophies, congenital myopathies, myotonic dystrophies, and toxic myopathies, among others.