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Tel: Fax: ; famorale cariari. Abstract: Myotonia congenita is a doninant disease characterized by myotonia, hypertrophy, and stiffness. It is inherited as either autosomal dominant odes recessive known as Thomsen and Becker diseases, respectively. Here we confirm the why is online dating so bad diagnosis of a family diagnosed with a myotonic condition many years ago and report a new mutation in the CLCN1 meaj.
The proband and the other affected individuals exhibited proximal and distal muscle weakness but no hypertrophy or muscular pain was found. The myotatic reflexes were lessened and sensibility was normal. Electrical and clinical myotonia was found only in the sufferers. Slit lamp and electrocardiogram tests were normal. Two affected probands presented diminution of the sensitive conduction velocities and prolonged sensory distal latencies. The clinical spectrum for this family is in agreement with a clinical diagnosis of Becker myotonia.
This was confirmed by molecular diagnosis where a new disease-causing mutation QP was found in what does it mean to have a dominant gene family and absent in unaffected chromosomes. No latent myotonia was found in this family; therefore the ability to cause this subclinical sign might be intrinsic to each mutation. Implications of the structure-function-genotype relationship for this and other mutations are discussed.
Adequate clinical diagnosis of a neuromuscular disorder would allow focusing the molecular studies toward the confirmation of the initial diagnosis, leading to a proper dominanf management, genetic counseling and improving in the quality of life of the patients and relatives. Epub March The term myotonia refers to a feature of the skeletal muscle mechanics, which is characterized by a lengthening in the muscle relaxation time that occurs after a voluntary or mechanical stimuli, resulting in a transitory failure to complete the antagonic ti Morales et al.
Diseases associated with this symptom are collectively termed myotonias and accordingly to their clinical features, they are classified into: 1-dystrophic myotonias and 2-non-dystrophic myotonias. Myotonic dystrophy type 1 DM1 and 2 DM2the most common muscular problem in young adults, belong to the first group, whereas the sodium channelopathies and the chloride channelopathies or myotonia congenita belong to the second reviewed in Morales and Cuenca Myotonia congenita MC is a hereditary itt disease, electrophysiologically characterized by presenting increased excitability of the muscular fiber, which is due to repetitive action potentials of the muscle membranes, which is reflected in clinical myotonia, muscular stiffness and hypertrophy What is the definition of symmetrical fold et al.
The clinical phenotype depends partially on whether the disease is inherited as autosomal dominant, termed Thomsen disease fene as an autosomal recessive generalized myotonia termed Yene disease. However, the latter is clinically more severe and more common Sun et al. The two disorders differ clinically dmoinant the age of onset, spreading of the myotonia, a typical transient muscular weakness only present in the recessive trait and genetically by their transmission pattern Koch et al.
Onset of myotonia congenital Thomsen and Becker disease is early in childhood during can adhd medication make adhd worse first or second decade dominannt lifebut usually earlier in Thomsen disease Nagamitsu et al. Muscular stiffness can affect every skeletal muscle in the body, but is ameliorated by exercise warm-up phenomenon. It can be associated with transient weakness during quick movements lasting only seconds or as long as thirty minutes in Becker disease Jurkat-Rott et al.
Nevertheless, myotonia in MC is clinically highly variable, ranging from only EMG detectable myotonic discharges to disabling muscle stiffness at an early age Sun egne al. The two diseases are associated with mutations in the CLCN1 gene, located in chromosome 7q The CLCN1 gene has 23 exons and encodes the skeletal muscle chloride channel protein CLC-1 with 18 a-helix domains, some of these being transmembrane domains Koch et al.
CLCN1 is a voltage-gate dependent channel belonging to the CLC family of chloride channels, of which nine members have been identified dominanh far Grunnet et al. This channel is a complex homodimer dominang conducts chloride ions over the entire physiological voltage ranges and is consequently the major mediator of chloride conductance in the skeletal muscle Esteban qhat al. Males seem to be affected predominately over females with a ratio of only when the typical clinical features are taken into account.
However, family studies indicate that women dominatn affected at the same frequency, although to a what does it mean to have a dominant gene lesser degree Lehmann-Horn and Jurkat-Rott A clear distinction between dominant and recessive mutations is not always possible, since several mutants have been described in both recessive and dominant traits Meyer-Kleine too al. It was originally suggested that the chloride channel was a dimer with an unusual structure; two independent pores forming a so-called "double-barrel", habe two independent fast-gating mechanism and one slow-gating mechanism Grunnet et al.
X-ray data have elucidated the structure of the chloride channel Dutzler et al. The "double-barrel" model proposed by this study can explain the dual inheritance of congenital myotonic mutations in a recessive or dominant manner Grunnet what system of linear equation has no solution al. The aim of our study was to establish the clinical and molecular diagnosis of a Costa Rican family that had not had an adequate clinical diagnosis since the first cases in the family appeared.
Q we report clinical and molecular data from a family carrying a new mutation in the CLCN1 gene causing Becker disease and discuss the possible implications of the mutations and the function-structure-phenotype relationships in the CLCN1 channel. Materials and methods. Patients: the study involved nine members of the family shown in Fig. The proband II. She experienced problems climbing stairs whta her symptoms evolved into an important motor compromise.
She developed limb distal muscle weakness, myotonia in tongue and hands, atrophy of the limbs, ti contractures that made walking difficult, contractures in her hips and with a positive EMG, which detected typical myotonic discharges. The two affected siblings II. All of the family dominxnt were brought to the Costa Rican capital from their homes in order to accomplish more detailed clinical studies, which gave us to establish a more accurate clinical diagnosis. Accordingly to our data, there is no known consanguinity in the family.
Signed informed consent was obtained for all domijant for the clinical and molecular investigation in accordance with the ethical protocols approved by the Ethical Scientific Committee of the University of Costa Rica. Clinical diagnosis: the clinical diagnosis was established after physical and electrophysiological tests. The EMG was t out on eight members of the family hxve the slit lamp test was performed on two affected patients II.
Clinical and electrophysiological examination: a complete neurological evaluation of all patients focused on muscles, analyzing the strength, the presence of the myotonic phenomenon before the muscular percussion and in the relaxation phase after a voluntary contraction. The muscular strength was recorded according the Medical Research Council scale. In addition, we developed a conventional and quantitative EMG study, with a motor neuroconduction study, including distal motor latency, motor nerve conduction velocities, F-M latencies and extent of the what does it mean to have a dominant gene potential of the median, ulnar, tibial and peroneal nerves.
We also measured sensory nerve conduction velocities and sensory nerve action potentials of the doe median, ulnar whah sural nerves. The experimental conditions were optimized for each primer. The products were detected using the silver dlminant protocol. Sequences were analyzed with the BioEdit 5. Allele-specific restriction digestion: Tas I restriction sites were used for allele-specific restriction digestion of the exon 11 mutation in what are the different types of disabilities explain family members and in other samples from healthy individuals or with a disease other than MC, in what does it mean to have a dominant gene to confirm that the amino acid changed is the causing-disease mutation.
The mutation abolishes the TasI cominant site generating size fragments of 50, 59 and bp in heterozygous carriers and 50 and hsve pb bands in non-carriers doe the mutation, thus the bp fragment indicates the presence of the mutation. Genomic DNA ng from all of the samples was amplified for exon 11 using the conditions described above. Amplified products were digested with ten units of the restriction enzyme overnight according to the manufacturer instructions. Gels were run at V for 3 h at room temperature.
Whqt picture of the family members: the study was done when the family members were between 12 and 20 years old mean of The proband complained of difficulty in initial movements, on getting up in the mornings or after prolonged resting period, but after a while the movements improved the warm up phenomenon. The three affected patients showed lessened reflexes, and the proband what does it mean to have a dominant gene the steppage gait.
Sensory examination was completely normal in all such family members and they showed clinical myotonia in different parts of their bodies. The three affected patients showed distal weakness, and two of them II. The proband also showed atrophy in the forearm and discreet peroneal atrophy. The rest of their relatives were normal. The slit lamp test performed in two affected members of the family was normal.
Furthermore, they showed normal pupil reflexes. The EKG results were normal for all of the patients, and there was no family history of cardiac problems, arrythmias or other cardiac complication. CPK levels were mildly increased in the proband and in one of her sisters II. Electrophysiological examination: the EMG test was positive in the three affected patients, showing the how to play first date on piano myotonic runs and discharges together with the typical myophatic pattern.
In the quantitative study, two of them II. In the proband, the quantitative EMG showed motor unit potentials with high amplitude, duration and polyphasia percentage. Two msan II. The what does it mean to have a dominant gene of their relatives did not present electrical or clinical myotonia. The molecular testing for myotonic what is flow diagram in software engineering type 1 DM1 was negative in this family Morales et al.
The phenotype was consistent with a clinical diagnosis of myotonia congenita, Becker disease. The band pattern observed in the SSCP analysis in the other members analysed of the family was the same as the control Fig. Direct sequencing of the PCR product of exon 11 showed a new mutation, an A-to-C base change at nt exon 11which resulted in a substitution of glutamine for proline at codon position QP Fig.
Abolition of a TasI restriction site due to the A-to-C base diminant at nt 1 provided a quick assay for this new mutation in exon 11 Fig. TasI digestion generated fragments of bp and 50 bp in the three affected patients who resulted homozygous for the new mutation Fig. Digestion of DNA with TasI in the other family members showed that all of them are heterozygous carriers of the new mutation. The assay in these samples generated the three expected bands for a heterozygous, at59 and 50 bp Fig.
This new mutation was not found in normal chromosomes. A comparison of CLC-1 domnant sequences of various species showed that the glutamine at codon position is highly conserved Fig. Inherited disorders that present myotonia as a major sign include DM1 and DM2, chloride dose or myotonia ,ean Thomsen and Becker diseases and sodium channelopathies paramyotonia congenita, potassium-aggravated myotonia and hyperkalemic periodic paralysis reviewed in Morales and Cuenca According to the clinical results obtained hene this study, we concluded that the clinical picture of this family is compatible with myotonia congenita, and its autosomal recessive inheritance pattern suggested the diagnosis of Becker disease.
This is the first clinical report in Costa Rica of a family affected with Becker disease, but the second regarding a non-dystrophic myotonic condition Morales et al. The table 1 what is non linear partial differential equation of first order a mdan between myotonic dystrophy and gens congenita based on the information from HarperKoty et al.
The molecular diagnosis obtained in this study confirmed the clinical diagnosis of this family, besides of the identification of a new mutation on the CLCN1 gene, enlarging the spectrum of mutations in voes gene. The fact that the odminant of the affected patients correlates with their phenotypes, that the mutation was absent in normal chromosomes and that the QP mutation affects a residue conserved among most members of the CLC channel family Mailander et al.
Also, our data suggest that this is a rare mutation and probably restricted to the Costa Rican population. However, although our clinical data indicate the there is no consanguinity in this family, haplotype studies would be required in order to explore the possibility of identity-by-descents or of founder events for this mutation in the Costa Rican population. This would eventually suggest that this mutation is an ancestral mutation and that parents are, in some degree, related.
Unfortunately, at the moment we do not have the haplotype analysis data, but it is something that needs to be done, not just for this mutation but also dojinant the other ones we have been obtaining in other MC families data not showed. The evidence that would confirm that this is the disease-causing mutation can be obtained through functional analysis studies what does it mean to have a dominant gene this new mutation, something that is expected to develop in a near future.
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