Spinal muscular atrophies

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Spinal muscular atrophies
Polio spinal diagram-en.svg
Location of neurons affected in spinal muscular atrophies
Specialty Neurology
Symptoms Loss of motor neurons resulting in muscle wasting

Spinal muscular atrophies (SMAs) are a genetically and clinically heterogeneous group of rare debilitating disorders characterised by the degeneration of lower motor neurons (neuronal cells situated in the anterior horn of the spinal cord) and subsequent atrophy (wasting) of various muscle groups in the body. [1] While some SMAs lead to early infant death, other diseases of this group permit normal adult life with only mild weakness.

Contents

Classification

Based on the type of muscles affected, spinal muscular atrophies can be divided into:[ citation needed ]

When taking into account prevalence, spinal muscular atrophies are traditionally divided into:[ citation needed ]

A more detailed classification is based on the gene associated with the condition (where identified) and is presented in table below.

GroupName
Alternative names
OMIM Gene Locus Mode of
inheritance
Characteristics
SMA Spinal muscular atrophy (SMA)
  • 5q spinal muscular atrophy
  • Autosomal recessive proximal spinal muscular atrophy
  • Werdnig–Hoffmann disease / Kugelberg–Welander disease
253300
253550
253400
271150
SMN1 5q13.2 Autosomal recessive Affects primarily proximal muscles in people of all ages, progressive, relatively common
XLSMA X-linked spinal muscular atrophy type 1 (SMAX1)
  • Spinal and bulbar muscular atrophy (SBMA)
  • Kennedy's disease (KD)
313200 NR3C4 Xq12 X-linked recessive Affects primarily bulbar muscles as well as sensory nerves mainly in adult men, progressive
X-linked spinal muscular atrophy type 2 (SMAX2)
  • Arthrogryposis multiplex congenita – X-linked type 1 (AMCX1)
301830 UBA1 Xp11.23 X-linked recessive Characterised by bone fractures, affects mainly distal muscles in newborn boys, usually fatal in infancy
X-linked spinal muscular atrophy type 3 (SMAX3)
  • Distal spinal muscular atrophy – X-linked (DSMAX)
300489 ATP7A Xq21.1 X-linked recessive Affects distal muscles of all extremities mainly in boys, slowly progressive
DSMA Distal spinal muscular atrophy type 1 (DSMA1)
  • Spinal muscular atrophy with respiratory distress type 1 (SMARD1)
  • Distal hereditary motor neuronopathy type 6 (DHMN6)
604320 IGHMBP2 11q13.3 Autosomal recessive Affects mainly infant boys, similar to SMA type 1 but with diaphragmatic paralysis
Distal spinal muscular atrophy type 2 (DSMA2)
  • Distal hereditary motor neuronopathy – Jerash type (DHMN-J)
605726 SIGMAR1 19p13.3 Autosomal recessive Slowly progressive
Distal spinal muscular atrophy type 3 (DSMA3)
  • Distal hereditary motor neuronopathy types 3 & 4 (DHMN3/DHMN4)
607088  ? 11q13.3 Autosomal recessive Slowly progressive
Distal spinal muscular atrophy type 4 (DSMA4) 611067 PLEKHG5 1p36.31 Autosomal recessive Slowly progressive, described only in one family
Distal spinal muscular atrophy type 5 (DSMA5) 614881 DNAJB2 2q35 Autosomal recessive Young adult onset, slowly progressive
Distal spinal muscular atrophy type VA (DSMAVA)
  • Distal hereditary motor neuronopathy type 5A (DHMN5A)
600794 GARS 7p14.3 Autosomal dominant With upper limb predominance; allelic and overlapping with CMT2D, phenotype overlapping with Silver syndrome
Distal spinal muscular atrophy type VB (DSMAVB)
  • Distal hereditary motor neuronopathy type 5B (DHMN5B)
614751 REEP1 2p11 Autosomal dominant With upper limb predominance; allelic and overlapping with HSP-31
Distal spinal muscular atrophy with calf predominance
  • Distal hereditary motor neuronopathy type 2D (DHMN2D)
615575 FBXO38 5q32 Autosomal dominant Juvenile- or adult-onset, slowly progressive, affects both proximal and distal muscles, initially manifests with calf weakness which progresses to hands
Distal spinal muscular atrophy with vocal cord paralysis
  • Distal hereditary motor neuronopathy type 7A (DHMN7A)
  • Harper–Young myopathy
158580 SLC5A7 2q12.3 Autosomal dominant Adult-onset with vocal cord paralysis, very rare
Congenital distal spinal muscular atrophy
  • Distal hereditary motor neuronopathy type 8 (DHMN8)
600175 TRPV4 12q24.11 Autosomal dominant Affects primarily distal muscles of lower limbs, non-progressive, rare, allelic with SPSMA and CMT2C
Scapuloperoneal spinal muscular atrophy (SPSMA)
  • Scapuloperoneal neurogenic amyotrophy
181405 TRPV4 12q24.11 Autosomal dominant
or X-linked dominant
Affects muscles of lower limbs, non-progressive, rare, allelic with congenital distal spinal muscular atrophy and CMT2C
Autosomal dominant distal spinal muscular atrophy
  • Distal hereditary motor neuronopathy type 2A (DHMN2A)
158590 HSPB8 12q24.23 Autosomal dominant Adult-onset. Allelic with Charcot–Marie–Tooth disease type 2L (CMT2L)
Autosomal dominant juvenile distal spinal muscular atrophy
  • Distal hereditary motor neuronopathy type 1 (DHMN1)
182960  ? 7q34–q36 Autosomal dominant Juvenile-onset
Juvenile segmental spinal muscular atrophy (JSSMA) 183020  ? 18q21.3  ?Juvenile-onset, progressive with stabilisation after 2–4 years, affects primarily hands, very rare
Finkel type proximal spinal muscular atrophy (SMAFK) 182980 VAPB 20q13.32 Autosomal dominant Late-onset, affects proximal muscles in adults
James type infantile spinal muscular atrophy (SMAJI) 619042 GARS1 7p14.3 Autosomal dominantInfantile-onset hypotonia, slowly progressive, resulting in delayed motor milestones and loss of previous motor skills. Children never walk. Milder disorders caused by GARS1 mutations are CMT2D and HMN5A.
Jokela type spinal muscular atrophy (SMAJ) 615048 CHCHD10 22q11.2–q13.2 Autosomal dominant Late-onset, slowly progressive, affects both proximal and distal muscles in adults
Spinal muscular atrophy with lower extremity predominance 1 (SMALED1) 158600 DYNC1H1 14q32 Autosomal dominant Affects proximal muscles in infants
Spinal muscular atrophy with lower extremity predominance 2A (SMALED2A) 615290 BICD2 9q22.31 Autosomal dominant Early-onset, primarily affecting lower limbs, slowly progressive, non-life-limiting, very rare
Spinal muscular atrophy with lower extremity predominance 2B (SMALED2B) 618291 BICD2 9q22.31 Autosomal dominant Presents with hypotonia, contractures and respiratory involvement at birth, frequently fatal in early childhood, very rare
Spinal muscular atrophy with progressive myoclonic epilepsy (SMAPME) 159950 ASAH1 8p22 Autosomal recessive
Spinal muscular atrophy with congenital bone fractures 1 (SMABF1) 616866 TRIP4 15q22.31 Autosomal recessive Prenatal onset, characterised by severe muscle wasting, respiratory and feeding failure, and bone fractures at birth as in arthrogryposis multiplex congenita, usually fatal in infancy
Spinal muscular atrophy with congenital bone fractures 2 (SMABF2) 616867 ASCC1 10q22.1 Autosomal recessive Prenatal onset, characterised by severe muscle wasting, respiratory and feeding failure, and bone fractures at birth as in arthrogryposis multiplex congenita, usually fatal in infancy [2] [3] [4]
PCH Spinal muscular atrophy with pontocerebellar hypoplasia (SMA-PCH)
  • Pontocerebellar hypoplasia type 1A (PCH1A)
607596 VRK1 14q32 Autosomal dominant → see Pontocerebellar hypoplasia
MMA Juvenile asymmetric segmental spinal muscular atrophy (JASSMA)
  • Monomelic amyotrophy
  • Hirayama disease
  • Sobue disease
602440  ? ? ?→ see Monomelic amyotrophy
PMAProgressive spinal muscular atrophy
  • Progressive muscular atrophy
  • Duchenne-Aran muscular atrophy
 ? ? ? ?→ see Progressive muscular atrophy

In all forms of SMA (with an exception of X-linked spinal muscular atrophy type 1), only motor neurons, located at the anterior horn of spinal cord, are affected; sensory neurons, which are located at the posterior horn of spinal cord, are not affected. By contrast, hereditary disorders that cause both weakness due to motor denervation along with sensory impairment due to sensory denervation are known as hereditary motor and sensory neuropathies (HMSN).[ citation needed ]

See also

Related Research Articles

<span class="mw-page-title-main">Motor neuron diseases</span> Group of neurological disorders affecting motor neurons

Motor neuron diseases or motor neurone diseases (MNDs) are a group of rare neurodegenerative disorders that selectively affect motor neurons, the cells which control voluntary muscles of the body. They include amyotrophic lateral sclerosis (ALS), progressive bulbar palsy (PBP), pseudobulbar palsy, progressive muscular atrophy (PMA), primary lateral sclerosis (PLS), spinal muscular atrophy (SMA) and monomelic amyotrophy (MMA), as well as some rarer variants resembling ALS.

<span class="mw-page-title-main">Charcot–Marie–Tooth disease</span> Neuromuscular disease

Charcot–Marie–Tooth disease (CMT) is a hereditary motor and sensory neuropathy of the peripheral nervous system characterized by progressive loss of muscle tissue and touch sensation across various parts of the body. This disease is the most commonly inherited neurological disorder, affecting about one in 2,500 people. It is named after those who classically described it: the Frenchman Jean-Martin Charcot (1825–1893), his pupil Pierre Marie (1853–1940), and the Briton Howard Henry Tooth (1856–1925).

<span class="mw-page-title-main">Spinal and bulbar muscular atrophy</span> Medical condition

Spinal and bulbar muscular atrophy (SBMA), popularly known as Kennedy's disease, is a rare, adult-onset, X-linked recessive lower motor neuron disease caused by trinucleotide CAG repeat expansions in exon 1 of the androgen receptor (AR) gene, which results in both loss of AR function and toxic gain of function.

<span class="mw-page-title-main">Progressive muscular atrophy</span> Medical condition

Progressive muscular atrophy (PMA), also called Duchenne–Aran disease and Duchenne–Aran muscular atrophy, is a disorder characterised by the degeneration of lower motor neurons, resulting in generalised, progressive loss of muscle function.

<span class="mw-page-title-main">Spinal muscular atrophy</span> Rare congenital neuromuscular disorder

Spinal muscular atrophy (SMA) is a rare neuromuscular disorder that results in the loss of motor neurons and progressive muscle wasting. It is usually diagnosed in infancy or early childhood and if left untreated it is the most common genetic cause of infant death. It may also appear later in life and then have a milder course of the disease. The common feature is progressive weakness of voluntary muscles, with arm, leg and respiratory muscles being affected first. Associated problems may include poor head control, difficulties swallowing, scoliosis, and joint contractures.

<i>SMN1</i> Protein-coding gene in the species Homo sapiens

Survival of motor neuron 1 (SMN1), also known as component of gems 1 or GEMIN1, is a gene that encodes the SMN protein in humans.

<span class="mw-page-title-main">Hereditary motor and sensory neuropathy</span> Medical condition

Hereditary motor and sensory neuropathies (HMSN) is a name sometimes given to a group of different neuropathies which are all characterized by their impact upon both afferent and efferent neural communication. HMSN are characterised by atypical neural development and degradation of neural tissue. The two common forms of HMSN are either hypertrophic demyelinated nerves or complete atrophy of neural tissue. Hypertrophic condition causes neural stiffness and a demyelination of nerves in the peripheral nervous system, and atrophy causes the breakdown of axons and neural cell bodies. In these disorders, a patient experiences progressive muscle atrophy and sensory neuropathy of the extremities.

Hereditary sensory and autonomic neuropathy (HSAN) or hereditary sensory neuropathy (HSN) is a condition used to describe any of the types of this disease which inhibit sensation.

<span class="mw-page-title-main">X-linked spinal muscular atrophy type 2</span> Medical condition

X-linked spinal muscular atrophy type 2, also known as arthrogryposis multiplex congenita X-linked type 1 (AMCX1), is a rare neurological disorder involving death of motor neurons in the anterior horn of spinal cord resulting in generalised muscle wasting (atrophy). The disease is caused by a mutation in UBA1 gene and is passed in an X-linked recessive manner by carrier mothers to affected sons.

<span class="mw-page-title-main">Distal spinal muscular atrophy type 1</span> Medical condition

Distal spinal muscular atrophy type 1 (DSMA1), also known as spinal muscular atrophy with respiratory distress type 1 (SMARD1), is a rare neuromuscular disorder involving death of motor neurons in the spinal cord which leads to a generalised progressive atrophy of body muscles.

<i>SMN2</i> Protein-coding gene in the species Homo sapiens

Survival of motor neuron 2 (SMN2) is a gene that encodes the SMN protein in humans.

Distal hereditary motor neuronopathies, sometimes also called distal hereditary motor neuropathies, are a genetically and clinically heterogeneous group of motor neuron diseases that result from genetic mutations in various genes and are characterized by degeneration and loss of motor neuron cells in the anterior horn of the spinal cord and subsequent muscle atrophy.

<span class="mw-page-title-main">Spinal muscular atrophy with progressive myoclonic epilepsy</span> Rare neurodegenerative disease whose symptoms include slowly progressive muscle wasting

Spinal muscular atrophy with progressive myoclonic epilepsy (SMA-PME), sometimes called Jankovic–Rivera syndrome, is a very rare neurodegenerative disease whose symptoms include slowly progressive muscle (atrophy), predominantly affecting proximal muscles, combined with denervation and myoclonic seizures. Only 12 known human families are described in scientific literature to have SMA-PME.

Congenital distal spinal muscular atrophy (cDSMA), also known as distal hereditary motor neuropathytype VIII (dHMN8), is a hereditary medical condition characterized by muscle wasting (atrophy), particularly of distal muscles in legs and hands, and by early-onset contractures of the hip, knee, and ankle. Affected individuals often have shorter lower limbs relative to the trunk and upper limbs. The condition is a result of a loss of anterior horn cells localized to lumbar and cervical regions of the spinal cord early in infancy, which in turn is caused by a mutation of the TRPV4 gene. The disorder is inherited in an autosomal dominant manner. Arm muscle and function, as well as cardiac and respiratory functions are typically well preserved.

<span class="mw-page-title-main">Hereditary motor and sensory neuropathy with proximal dominance</span> Medical condition

Hereditary motor and sensory neuropathy with proximal dominance (HMSN-P) is an autosomal dominant neurodegenerative disorder that is defined by extensive involuntary and spontaneous muscle contractions, asthenia, and atrophy with distal sensory involvement following. The disease starts presenting typically in the 40s and is succeeded by a slow and continuous onslaught. Muscle spasms and muscle contractions large in number are noted, especially in the earliest stages. The presentation of HMSN-P is quite similar to amyotrophic lateral sclerosis and has common neuropathological findings. Sensory loss happens as the disease progresses, but the amount of sensation lost varies from case to case. There have been other symptoms of HMSN-P reported such as urinary disturbances and a dry cough.

<span class="mw-page-title-main">Distal spinal muscular atrophy type 2</span> Medical condition

Distal spinal muscular atrophy type 2 (DSMA2), also known as Jerash type distal hereditary motor neuropathy (HMNJ), is a very rare childhood-onset genetic disorder characterised by progressive muscle wasting affecting lower and subsequently upper limbs. The disorder has been described in Arab inhabitants of Jerash region in Jordan as well as in a Chinese family.

Hereditary sensory and autonomic neuropathy type I or hereditary sensory neuropathy type I is a group of autosomal dominant inherited neurological diseases that affect the peripheral nervous system particularly on the sensory and autonomic functions. The hallmark of the disease is the marked loss of pain and temperature sensation in the distal parts of the lower limbs. The autonomic disturbances, if present, manifest as sweating abnormalities.

<span class="mw-page-title-main">Monomelic amyotrophy</span> Medical condition

Monomelic amyotrophy (MMA) is a rare motor neuron disease first described in 1959 in Japan. Its symptoms usually appear about two years after adolescent growth spurt and is significantly more common in males, with an average age of onset between 15 and 25 years. MMA is reported most frequently in Asia but has a global distribution. It is typically marked by insidious onset of muscle atrophy of an upper limb, which plateaus after two to five years from which it neither improves nor worsens. There is no pain or sensory loss associated with MMA. MMA is not believed to be hereditary.

Distal hereditary motor neuropathy type V is a particular type of neuropathic disorder. In general, distal hereditary motor neuropathies affect the axons of distal motor neurons and are characterized by progressive weakness and atrophy of muscles of the extremities. It is common for them to be called "spinal forms of Charcot-Marie-Tooth disease (CMT)", because the diseases are closely related in symptoms and genetic cause. The diagnostic difference in these diseases is the presence of sensory loss in the extremities. There are seven classifications of dHMNs, each defined by patterns of inheritance, age of onset, severity, and muscle groups involved. Type V is a disorder characterized by autosomal dominance, weakness of the upper limbs that is progressive and symmetrical, and atrophy of the small muscles of the hands.

References

  1. "Spinal muscular atrophy". Genetics Home Reference. 2016-03-21. Retrieved 2016-03-26.
  2. Knierim E, Hirata H, Wolf NI, Morales-Gonzalez S, Schottmann G, Tanaka Y, et al. (March 2016). "Mutations in Subunits of the Activating Signal Cointegrator 1 Complex Are Associated with Prenatal Spinal Muscular Atrophy and Congenital Bone Fractures". American Journal of Human Genetics. 98 (3): 473–489. doi:10.1016/j.ajhg.2016.01.006. PMC   4800037 . PMID   26924529.
  3. Oliveira J, Martins M, Pinto Leite R, Sousa M, Santos R (October 2017). "The new neuromuscular disease related with defects in the ASC-1 complex: report of a second case confirms ASCC1 involvement". Clinical Genetics. 92 (4): 434–439. doi:10.1111/cge.12997. PMID   28218388. S2CID   28768062.
  4. Giuffrida MG, Mastromoro G, Guida V, Truglio M, Fabbretti M, Torres B, et al. (December 2019). "A new case of SMABF2 diagnosed in stillbirth expands the prenatal presentation and mutational spectrum of ASCC1". American Journal of Medical Genetics. Part A. 182 (3): 508–512. doi:10.1002/ajmg.a.61431. PMID   31880396. S2CID   209490732.

Further reading