Different clinical aspects of debrancher deficiency myopathy. Issue 3 (1st September 1999)

• Record Type: Journal Article
• Authors: Kiechl, Stefan; Kohlendorfer, Ursula; Thaler, Claudia; Skladal, Daniela; Jaksch, Michaela; Obermaier-Kusser, Bert; Willeit, Johann
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 67:Issue 3(1999)
• Page Start: 364
• Page End: 368
• Publication Date: 1999-09-01
• Subjects: glycogenosis -- glycogen storage disease -- debrancher deficiency -- myopathy; Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp.67.3.364
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : OBJECTIVE: To characterise the main clinical phenotypes of debrancher deficiency myopathy and to increase awareness for this probably underdiagnosed disorder. METHODS: The diagnosis of debrancher deficiency was established by laboratory tests, EMG, and muscle and liver biopsy. RESULTS: Four patients with debrancher deficiency myopathy were identified in the Tyrol, a federal state of Austria with half a million inhabitants. Clinical appearance was highly variable. The following phenotypes were differentiated: (1) adult onset distal myopathy; (2) subacute myopathy of the respiratory muscles; (3) severe generalised myopathy; and (4) minimal variant myopathy. Exercise intolerance was uncommon. The clinical course was complicated by advanced liver dysfunction in two patients and by severe cardiomyopathy in one. All had raised creatine kinase concentrations (263 to 810 U/l), myogenic and neurogenic features on EMG, and markedly decreased debrancher enzyme activities in muscle or liver biopsy specimens. The findings were substantiated by a review of 79 previously published cases with neuromuscular debrancher deficiency. CONCLUSIONS: This study illustrates the heterogeneity of neuromuscular manifestations in debrancher deficiency. Based on the clinical appearance, age at onset, and course of disease four phenotypes may be defined which differ in prognosis, frequency of complications, and response to therapy.