myopathy for medical students
DESCRIPTION
Myopathy for studentsTRANSCRIPT
MYOPATHYMYOPATHY
Prof. Ashraf AbdouProf. Ashraf Abdou
Neuropsychiatry deptNeuropsychiatry dept
Faculty of medicineFaculty of medicine
Alexandria univAlexandria univ
Etiological Classification of Etiological Classification of MyopathiesMyopathies
HEREDITARYHEREDITARY Muscular Muscular
DystrophiesDystrophies– Duchenne’s Duchenne’s
MyotoniasMyotonias
ACQUIREDACQUIRED InflammatoryInflammatory EndocrineEndocrine Drug-induced Drug-induced
and toxic and toxic myopathiesmyopathies– EtOH, steroids, EtOH, steroids,
statinsstatins
When you think about When you think about muscle disease?muscle disease?
Weakness:Weakness:– Child: delayed sitting, standing, walkingChild: delayed sitting, standing, walking
– Adult: Adult: going upstairs – walking long distance – walking going upstairs – walking long distance – walking
– standing– standing
Difficulty in carrying heavy objects – difficulty in Difficulty in carrying heavy objects – difficulty in combing haircombing hair
No sensory complaintNo sensory complaint
No sphincters control problemNo sphincters control problem
MayalgiaMayalgia
When you think about When you think about muscle disease?muscle disease?
Clincal examinationClincal examination
– Weakness: Bilateral – Weakness: Bilateral – symmetrical – proximalsymmetrical – proximal
– Muscle atrophyMuscle atrophy
When you think about When you think about muscle disease?muscle disease?
Clincal examinationClincal examination
– No sensory abnormalitiesNo sensory abnormalities
– Skeletal deformitiesSkeletal deformities
INVESTIGATIONSINVESTIGATIONS
InvestigationsInvestigations
Muscle enzymesMuscle enzymes
– Creatinine kinase [CK]Creatinine kinase [CK]
– AldolaseAldolase
ElectromyogramElectromyogram
InvestigationsInvestigations
Muscle biopsy for Muscle biopsy for pathological studypathological study
Muscular DystrophyMuscular Dystrophy
Group of inherited diseases Leads to chronic
progressive muscle atrophy Usually appears in early
childhood Most types result in total
disability and early death
Duchenne’s muscle Duchenne’s muscle dystrophydystrophy
Prevalence of DMDPrevalence of DMD
Affects 1 in Affects 1 in 3500 newborn 3500 newborn malesmales
1/3 of these 1/3 of these with previous with previous family historyfamily history
2/3 sporadic2/3 sporadic
DYSTROPHIN GENEDYSTROPHIN GENE
NORMAL
DUCHENNE
BEKER’s
Muscles that are affectedMuscles that are affected
In the early stages, In the early stages, Duchenne MD Duchenne MD affect the pectoral affect the pectoral muscles , the muscles , the trunk, hamsterings, trunk, hamsterings, calf musclecalf muscle
These weaknesses These weaknesses lead to difficulty in lead to difficulty in rising, climbing rising, climbing stairs and stairs and maintaining maintaining balance.balance.
Symptoms of DMDSymptoms of DMD
Delayed developmental Delayed developmental
milestonesmilestones
Loss of motor skillsLoss of motor skills
Characteristic gaitCharacteristic gait
Calf hypertrophyCalf hypertrophy
Clumsiness/frequent fallsClumsiness/frequent falls
PSEUDOHYPERTROPHY
ATROPHY
Difficulty rising Difficulty rising (Gower’s sign)(Gower’s sign)
PrognosisPrognosis
Prenatal diagnosisPrenatal diagnosis
This is achieved by studying the This is achieved by studying the
foetus’s own DNA on a chorion villus foetus’s own DNA on a chorion villus
biopsy.biopsy.
The test is performed on a tiny piece The test is performed on a tiny piece
of the developing placenta usually at of the developing placenta usually at
the 11the 11thth –12 –12th th week of pregnancy.week of pregnancy.
Treatment optionsTreatment options
FutureFuture