Duchenne Muscular Dystrophy Complicating Pregnancy: Case Report and Review of the literature
Keywords:
Management, Diagnosis, Dystrophin Gene, Muscle Degeneration, Genetic Disorder, Review, Case Report, Duchenne Muscular DystrophyAbstract
Duchenne muscular dystrophy (DMD) represents a severe genetic disorder characterized by progressive muscle weakness and wasting. We present a case of a healthy male offspring coming from a mother carrier with the mutation c.9568c>T, p.Arg3190, depicting an extremely rare case. At the same time, it will provide a comprehensive review of the current understanding of the disease, including its etiology, pathophysiology, clinical features, diagnostic methods, and management strategies. The review section highlights the genetic basis of DMD, emphasizing mutations in the dystrophin gene and its consequences on muscle structure and function. Additionally, the pathophysiological mechanisms leading to muscle degeneration, such as impaired calcium homeostasis and increased oxidative stress, are discussed. Diagnostic methods, including genetic testing, muscle biopsy, and imaging techniques, are outlined, along with their respective limitations and benefits. Lastly, various management approaches are examined, ranging from symptomatic treatment, physical therapy, and assistive devices to emerging therapeutic strategies such as gene therapy and exon skipping. Through this case report and review, we aim to enhance the understanding of DMD and facilitate improved diagnosis and management of affected individuals.
References
Aartsma-Rus, A. et al. (2019) ‘EvidenceBased Consensus and Systematic Review on Reducing the Time to Diagnosis of Duchenne Muscular Dystrophy’, Journal of Pediatrics. J
Pediatr, pp. 305-313.e14. Available at: https://doi.org/10.1016/j.jpeds.2018.10.043
Aartsma-Rus, A., Ginjaar, I.B. and Bushby, K. (2016) ‘The importance of genetic diagnosis for Duchenne muscular dystrophy’, Journal of Medical Genetics, 53(3), pp. 145–151.
Available at: https://doi.org/10.1136/jmedgenet-2015-103387
Alghamdi, F. et al. (2021) ‘Case Report: The Genetic Diagnosis of Duchenne Muscular Dystrophy in the Middle East’, Frontiers in Pediatrics, 9, p. 716424. Available at:
https://doi.org/10.3389/fped.2021.716424
Andrews, J.G. et al. (2018) ‘Diagnostic accuracy of phenotype classification in duchenne and becker muscular dystrophy using medical record data’, Journal of Neuromuscular Diseases, 5(4), pp. 481–495. Available at: https://doi.org/10.3233/JND180306
Andrews, J.G. and Wahl, R.A. (2018) ‘Duchenne and Becker muscular dystrophy in adolescents: current perspectives’, Adolescent Health, Medicine and Therapeutics, Volume 9, pp. 53–63. Available at: https://doi.org/10.2147/ahmt.s125739
Beksac, M.S. et al. (2018) ‘Gestational Outcomes of Pregnant Women Who Have Had Invasive Prenatal Testing for the Prenatal Diagnosis of Duchenne Muscular Dystrophy’,
Journal of Pregnancy, 2018. Available at: https://doi.org/10.1155/2018/9718316
Birelliwar, A. et al. (2020) ‘Early gait training program and proprioceptive neuromuscular facilitation in the patient with post debridement amputation - A rare case report’,
MEDICAL SCIENCE, 24(105), pp. 3421–3426. Available at: http://www.discoveryjournals.org/medicalscience/current_issue/v24/n105/A80.htm?fbclid=IwAR3-
xgX1yD8UtglaxhgzggCC_vFx4qoJhd1dS8_aJ4kiuShdQksxmxtu544 (Accessed: 10 June 2023)
Birnkrant, D.J., Bushby, K., Bann, C.M., Apkon, S.D., et al. (2018) ‘Diagnosis and management of Duchenne muscular dystrophy, part 1: diagnosis, and neuromuscular, rehabilitation, endocrine, and gastrointestinal and nutritional management’, The Lancet Neurology. NIH Public Access, pp. 251–267. Available at: https://doi.org/10.1016/S1474-
(18)30024-3
Birnkrant, D.J., Bushby, K., Bann, C.M., Alman, B.A., et al. (2018) ‘Diagnosis and management of Duchenne muscular dystrophy, part 2: respiratory, cardiac, bone
health, and orthopaedic management’, The Lancet Neurology. NIH Public Access, pp. 347–361. Available at: https://doi.org/10.1016/S1474-4422(18)30025-5
Chung, J. et al. (2016) ‘Twenty-year follow-up of newborn screening for patients with muscular dystrophy’, Muscle and Nerve, 53(4), pp. 570–578. Available at: https://doi.org/10.1002/mus.24880
Crisafulli, S. et al. (2020) ‘Global epidemiology of Duchenne muscular dystrophy: An updated systematic review and meta-analysis’, Orphanet Journal of Rare Diseases. BioMed Central. Available at: https://doi.org/10.1186/s13023-020-01430-8
Dennis Lo, Y.M. et al. (1997) ‘Presence of fetal DNA in maternal plasma and serum’, Lancet, 350(9076), pp. 485–487. Available at: https://doi.org/10.1016/S0140-
(97)02174-0
Devaney, S.A. et al. (2011) ‘Noninvasive fetal sex determination using cell-free fetal DNA: A systematic review and meta-analysis’, JAMA. American Medical Association, pp. 627–636. Available at: https://doi.org/10.1001/jama.2011.1114
Duan, D. et al. (2021) ‘Duchenne muscular dystrophy’, Nature Reviews Disease Primers. Nat Rev Dis Primers. Available at: https://doi.org/10.1038/s41572-021-00248-3
Evans, N.P. et al. (2009) ‘Dysregulated intracellular signaling and inflammatory gene expression during initial disease onset in duchenne muscular dystrophy’, American
Journal of Physical Medicine and Rehabilitation. Am J Phys Med Rehabil, pp. 502–522. Available at: https://doi.org/10.1097/PHM.0b013e3181a5a24f
Falzarano, M.S. et al. (2015) ‘Duchenne muscular dystrophy: From diagnosis to therapy’, Molecules, 20(10), pp. 18168–18184. Available at:
https://doi.org/10.3390/molecules201018168
Feingold, B. et al. (2017) ‘Management of cardiac involvement associated with neuromuscular diseases: A scientific statement from the American Heart Association’, Circulation. Circulation, pp. e200–e231. Available at: https://doi.org/10.1161/CIR.0000000000000526
Freeman, K., Szczepura, A. and Osipenko, L. (2009) ‘Non-invasive fetal RHD genotyping tests: A systematic review of the quality of reporting of diagnostic accuracy in published studies’, European Journal of Obstetrics and Gynecology and Reproductive Biology. Elsevier, pp. 91–98. Available at: https://doi.org/10.1016/j.ejogrb.2008.10.010
Jansen, M. et al. (2010) ‘Physical training in boys with Duchenne Muscular Dystrophy: The protocol of the No Use is Disuse study’, BMC Pediatrics, 10, p. 55. Available at:
https://doi.org/10.1186/1471-2431-10-55
Jawade, S. et al. (2020) ‘Efficacy of strength training program on muscle performance by determining 1 repetition maximum in adults’, European journal of molecular and clinical medicine, 7(2), p. 1946‐1954. Available at: https://ejmcm.com/article_2404 (Accessed: 10 June 2023)
Khatib, M.N. et al. (2017) ‘Yoga for improving functional capacity, quality of life and cardiovascular outcomes in people with heart failure’, Cochrane Database of Systematic
Reviews, 2017(7). Available at: https://doi.org/10.1002/14651858.CD012015.pub2
Kim, J. et al. (2021) ‘Case Report: Cooccurrence of Duchenne Muscular Dystrophy and Frontometaphyseal Dysplasia 1’, Frontiers in Pediatrics, 9, p. 628190. Available
at: https://doi.org/10.3389/fped.2021.628190
Kumar Adlakha, V. et al. (2015) ‘A Rare CaseReport of Neurodegenerative Disease: Duchenne Muscular Dystrophy in Two Male Siblings’, International Journal of Clinical
Pediatric Dentistry, 8(2), pp. 163–165. Available at: https://doi.org/10.5005/jpjournals-10005-1306
Kwon, J.M. et al. (2016) ‘Clinical Follow-Up for Duchenne Muscular Dystrophy Newborn Screening: A Proposal’, Muscle and Nerve, 54(2), pp. 186–191. Available at:
https://doi.org/10.1002/mus.25185
Lai, Y. et al. (2009) ‘Dystrophins carrying spectrin-like repeats 16 and 17 anchor nNOS to the sarcolemma and enhance exercise performance in a mouse model of muscular
dystrophy’, Journal of Clinical Investigation, 119(3), pp. 624–635. Available at: https://doi.org/10.1172/JCI36612
Lee, S.H. and Song, W.J. (2017) ‘Chromosomal Microarray Testing in 42 Korean Patients with Unexplained Developmental Delay, Intellectual Disability, Autism Spectrum Disorders, and Multiple Congenital Anomalies’, Genomics & Informatics, 15(3), pp. 82–86. Available at: https://doi.org/10.5808/gi.2017.15.3.82
Liu, X. et al. (2022) ‘Duchenne muscular dystrophy involves the myocardium and causes arrhythmia: Case report’, Frontiers in Cardiovascular Medicine, 9. Available at:
https://doi.org/10.3389/fcvm.2022.974843
Lo, Y.M.D. (2003) ‘Fetal DNA in Maternal Plasma/Serum: The First 5 Years: Commentary on the article by Jimenez and Tarantal on page 18’, Pediatric Research, 53(1), pp. 16–17. Available at: https://doi.org/10.1203/00006450-200301000-00006
Lun, F.M.F. et al. (2008) ‘Microfluidics digital PCR reveals a higher than expected fraction of fetal DNA in maternal plasma’, Clinical Chemistry, 54(10), pp. 1664–1672. Available at: https://doi.org/10.1373/clinchem.2008.111385
McDonald, C.M. et al. (2018) ‘Long-term effects of glucocorticoids on function, quality of life, and survival in patients with Duchenne muscular dystrophy: a prospective cohort study’, The Lancet, 391(10119), pp. 451–461. Available at: https://doi.org/10.1016/S0140-6736(17)32160-8
Mersy, E. et al. (2013) ‘Noninvasive detection of fetal trisomy 21: Systematic review and report of quality and outcomes of diagnostic accuracy studies performed between 1997 and 2012’, Human Reproduction Update, 19(4), pp. 318–329. Available at: https://doi.org/10.1093/humupd/dmt001
Mitropoulou, P. et al. (2022) ‘ST-elevationmyocardial infarction in a young patient with Duchenne’s muscular dystrophy: A case report’, European Heart Journal CaseReports, 6(5). Available at: https://doi.org/10.1093/ehjcr/ytac184
Mujezinovic, F. and Alfirevic, Z. (2007)
‘Procedure-related complications of
amniocentesis and chorionic villous sampling:
A systematic review’, Obstetrics and
Gynecology, 110(3), pp. 687–694. Available
at:
https://doi.org/10.1097/01.AOG.0000278820.
e3
Nassoro, D.D. et al. (2020) ‘A child with
duchenne muscular dystrophy: A case report
of a rare diagnosis among Africans’, Clinical
Case Reports, 8(12), pp. 2654–2660.
Available at:
https://doi.org/10.1002/ccr3.3254
Niesche, R. and Haase, M. (2012) ‘Emotions
and Ethics: A Foucauldian framework for
becoming an ethical educator’, Educational
Philosophy and Theory, 44(3), pp. 276–288.
Available at: https://doi.org/10.1111/j.1469-
2010.00655.x
Nowak, K.J. and Davies, K.E. (2004)
‘Duchenne muscular dystrophy and
dystrophin: Pathogenesis and opportunities
for treatment: Third in molecular medicine
review series’, EMBO Reports. EMBO Rep,
pp. 872–876. Available at:
https://doi.org/10.1038/sj.embor.7400221
Palladino, A. et al. (2016) ‘Management of
cardiac involvement in muscular dystrophies:
Paediatric versus adult forms’, Acta
Myologica, 35(3), pp. 128–134. Available at:
/pmc/articles/PMC5416740/ (Accessed: 10
June 2023).
Papageorgiou, E.A. and Patsalis, P.C. (2012)
‘Non-invasive prenatal diagnosis of
aneuploidies: New technologies and clinical
applications’, Genome Medicine. BioMed
Central, pp. 1–12. Available at:
Passamano, L. et al. (2012) ‘Improvement of
survival in Duchenne Muscular Dystrophy:
Retrospective analysis of 835 patients’, Acta
Myologica. Pacini Editore, pp. 121–125.
Available at: /pmc/articles/PMC3476854/
(Accessed: 10 June 2023).
Pegoraro, E. et al. (1995) ‘Genetic and
biochemical normalization in female carriers
of duchenne muscular dystrophy: Evidence
for failure of dystrophin production in
dystrophin-competent myonuclei’, Neurology,
(4), pp. 677–690. Available at:
https://doi.org/10.1212/WNL.45.4.677
Percival, J.M. et al. (2008) ‘Functional deficits
in nNOSμ-deficient skeletal muscle:
Myopathy in nNOS knockout mice’, PLoS
ONE, 3(10), p. 3387. Available at:
https://doi.org/10.1371/journal.pone.0003387
Rivera, S.R. et al. (2020) ‘Medical
management of muscle weakness in
Duchenne muscular dystrophy’, PLoS ONE,
(10 October). Available at:
https://doi.org/10.1371/journal.pone.0240687
Van Ruiten, H.J.A. et al. (2014) ‘Improving
recognition of Duchenne muscular dystrophy:
a retrospective case note review’, Archives of
Disease in Childhood, 99(12), pp. 1074–1077.
Available at:
https://doi.org/10.1136/archdischild-2014-
Salmaninejad, A. et al. (2018) ‘Duchenne
muscular dystrophy: an updated review of
common available therapies’, International
Journal of Neuroscience. Int J Neurosci, pp.
–864. Available at:
https://doi.org/10.1080/00207454.2018.1430
Sander, M. et al. (2000) ‘Functional muscle
ischemia in neuronal nitric oxide synthasedeficient skeletal muscle of children with
Duchenne muscular dystrophy’, Proceedings
of the National Academy of Sciences of the
United States of America, 97(25), pp. 13818–
Available at:
https://doi.org/10.1073/pnas.250379497
Shahade, P.S., Mundada, P.H. and Samal,
S.S. (2022) ‘Perks of Rehabilitation in
Improving Motor Function in a Nine-Year-Old
Male With Duchenne Muscular Dystrophy: A
Case Report’, Cureus, 14(10). Available at:
https://doi.org/10.7759/cureus.30162
Shvetsova, E. et al. (2019) ‘Skewed Xinactivation is common in the general female
population’, European Journal of Human
Genetics, 27(3), pp. 455–465. Available at:
https://doi.org/10.1038/s41431-018-0291-3
Sienkiewicz, D. et al. (2015) ‘Duchenne
muscular dystrophy: Current cell therapies’,
Therapeutic Advances in Neurological
Disorders. SAGE Publications, pp. 166–177.
Available at:
https://doi.org/10.1177/1756285615586123
Trippe, H. et al. (2014) ‘Xp21/A translocation:
A rarely considered genetic cause for
manifesting carriers of Duchenne muscular
dystrophy’, Neuropediatrics, 45(5), pp. 333–
Available at: https://doi.org/10.1055/s0034-1383824
Ward, L.M. and Birnkrant, D.J. (2018) ‘An
introduction to the Duchenne muscular
dystrophy care considerations’, Pediatrics,
(Suppl 2), pp. S1–S4. Available at:
https://doi.org/10.1542/peds.2018-0333B
Winerdal, M. et al. (2020) ‘Confined placental
mosaicism of Duchenne muscular dystrophy:
a case report’, Molecular Cytogenetics, 13(1).
Available at: https://doi.org/10.1186/s13039-
-00520-3
Wright, M.A. et al. (2012) ‘Consider muscle
disease in children with elevated
transaminase’, Journal of the American Board
of Family Medicine, 25(4), pp. 536–540.
Available at:
https://doi.org/10.3122/jabfm.2012.04.11018
Wu, L. et al. (2018) ‘Next-Generation
Sequencing to Diagnose Muscular Dystrophy,
Rhabdomyolysis, and HyperCKemia’,
Canadian Journal of Neurological Sciences,
(3), pp. 262–268. Available at:
https://doi.org/10.1017/cjn.2017.286
Zhang, K. et al. (2019) ‘Molecular genetic
testing and diagnosis strategies for
dystrophinopathies in the era of next
generation sequencing’, Clinica Chimica Acta. Clin Chim Acta, pp. 66–73. Available at: https://doi.org/10.1016/j.cca.2019.01.014
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