Congenital muscular dystrophies (central nervous system manifestations)

Last revised by Dalia Ibrahim on 20 Oct 2020

Congenital muscular dystrophies are a heterogeneous group of autosomal recessive myopathies presenting at birth with hypotonia, delayed motor development, and early onset of progressive muscle weakness, confirmed with a dystrophic pattern on muscle biopsy. 

There is a wide spectrum of clinical manifestations in the different types of congenital muscular dystrophies, from a severe and often early fatal infant syndrome with feeding and respiratory troubles to a moderate motor delay and mild or moderate limb-girdle involvement during childhood compatible with survival into adult life 3,5. Common symptoms are:

  • hypotonia (floppy baby)
  • developmental delay
  • seizures
  • poor vision

Congenital muscular dystrophies are diagnosed by the analysis of the clinical severity and progression and confirmed by a muscle biopsy showing the presence of a dystrophic process without histological evidence of another neuromuscular disease 4,5

  • mutations in molecules with roles in cell migration and connection or proteins involved in their processing, such as α-dystroglycan (a part of the dystrophin-glycoprotein complex) or its ligand, merosin/laminin α2
  • autosomal recessive
  • muscle biopsy: mild to moderate dystrophic changes, +/- inflammatory infiltrate, +/- absent staining laminin α2
  • CMD 1: abnormal white matter varies from mild (CMD1 merosin positive) to moderate-severe (CMD 1 merosin negative)
  • CMD 2: Fukuyama congenital muscular dystrophy (FCMD), moderate dysplasia of cerebral neocortex and cerebellum, abnormal white matter
  • CMD 3: Santavuori muscle-eye-brain (MEB) Finnish-type, less severe than CMD 4, with ventriculomegaly, vermian hypogenesis, dysplastic cortex, patchy abnormal white matter +/- callosal dysgenesis
  • CMD 4: Walker-Warburg syndrome, most severe, with cobblestone brain, massive ventriculomegaly with absent/abnormal callosum, no myelin, kinked pons midbrain, vermian hypoplasia +/- cephalocele

The latter types, CMD 2-4, belong to the group of dystroglycanopathies, which frequently have brain involvement.

Described features in general include:

The condition was first described by the English neurologist Frederick Eustace Batten (1865-1918) in his publications in 1903 and 1904 5,6.

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