What is myotonic dystrophy? Myotonic dystrophy is part of a group of inherited disorders called muscular dystrophies. It is the most common form of muscular dystrophy that begins in adulthood. Myotonic dystrophy is characterized by progressive muscle wasting and weakness. People with this disorder often have prolonged muscle contractions (myotonia) and are not able to relax certain muscles after use. For example, a person may have difficulty releasing their grip on a doorknob or handle. Also, affected people may have slurred speech or temporary locking of their jaw.

signs and symptoms of myotonic dystrophy Other signs and symptoms of myotonic dystrophy include clouding of the lens of the eye (cataracts) and abnormalities of the electrical signals that control the heartbeat (cardiac conduction defects). In affected men, hormonal changes may lead to early balding and an inability to father a child (infertility). The features of this disorder often develop during a person's twenties or thirties, although they can occur at any age. The severity of the condition varies widely among affected people, even among members of the same family.

What genes are related to myotonic dystrophy? Myotonic dystrophy is a genetic condition which is inherited in an autosomal dominant pattern and thus will be passed along to 50% of a carrier's offspring, on average.geneticautosomal dominant Myotonic dystrophy is one of several known trinucleotide repeat disorders. Certain areas of DNA have repeated sequences of two or three nucleotides. trinucleotide repeat disorders DNA nucleotides DM1 In DM1, the affected gene is called DMPK, which codes for myotonic dystrophy protein kinase, a protein expressed predominantly in skeletal muscle. The gene is located on the long arm of chromosome 19.DMPKmyotonic dystrophy protein kinase chromosome 19

In DM1, there is an expansion of the cytosine-thymine-guanine (CTG) triplet repeat in the DMPK gene. Between 5 and 37 repeats is considered normal, while individuals with between 38 and 49 repeats are considered to have a pre-mutation and are at risk of having children with further expanded repeats and, therefore, symptomatic disease.Individuals with greater than 50 repeats are almost invariably symptomatic, with some noted exceptions.[ref] Longer repeats are usually associated with earlier onset and more severe disease. cytosinethymineguanine DMPK alleles with greater than 37 repeats are unstable and additional trinucleotide repeats may be inserted during cell division in mitosis and meiosis. Consequently, the children of individuals with premutations or mutations inherit DMPK alleles which are longer than their parents and therefore are more likely to be affected or display an earlier onset and greater severity of the condition, a phenomenon known as anticipation.alleles mitosismeiosis phenomenonanticipation

Myotonic dystrophy subtypes TypeGeneRepeat Anticipati on Severity DM1DMPKCTGYes Moderate -severe DM2ZNF9CCTG Minimal/n one Mild- moderate

Clinical Diagnosis Myotonic dystrophy type 1 (DM1) is suspected in adults with the following: Muscle weakness, especially of the distal leg, hand, neck, and face Myotonia (sustained muscle contraction), which often manifests as the inability to quickly release a hand grip (grip myotonia) and which can be demonstrated by tapping a muscle (e.g., the thenar muscles) with a reflex hammer (percussion myotonia) Posterior subcapsular cataracts detectable as red and green iridescent opacities on slit lamp examination

DM1 is suspected in neonates with some combination of the following: Hypotonia Facial muscle weakness Generalized weakness Positional malformations including club foot Respiratory insufficiency

Testing Electromyography (EMG). Serum CK concentration.. Muscle biopsy.

Management There is currently no cure for or treatment specific to myotonic dystrophy. Therefore, the focus is on managing the complications of the disease, particularly those relating to the cardiopulmonary system as these account for 70% of deaths due to DM1. Pacemaker insertion may be required for individuals with cardiac conduction abnormalities. Central sleep apnoea or obstructive sleep apnoea may cause excessive daytime sleepiness, and these individuals should undergo a sleep study. Otherwise, there is evidence for the use of modafinil as a central nervous system stimulant.Central sleep apnoeaobstructive sleep apnoeamodafinil Some small studies have suggested that imipramine, clomipramine and taurine may be useful in the treatment of myotonia. However, due to the weak evidence and potential side effects such as cardiac arrhythmias, these treatments are rarely used. imipramineclomipraminetaurine

Treatment Currently, researchers are looking for a treatment on the molecular level, a molecule capable of releasing and enabling trapped proteins. It has shown promise, but it still in its infancy. In the meantime, medical professionals are left to treat and mask the symptoms. Many doctors must be involved in this effort: Primary care physicians Gastrointestinal specialists Eye surgeons Ear nose and throat surgeons Orthopedic surgeons, neurologists Pain management doctors Under normal circumstances, each of these doctors should be visited at least once, if not twice, a year. In addition, Type 1 patients whose condition is progressing rapidly (which usually begins to happen about ten years after the onset of symptoms) should have both an EKG and ECG done every three months.

By Faeze heidari medical91