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Axonal Neuropathy and Predominance of Type II Myofibers in Infantile Spinal Muscular Atrophy

Department of Neuropediatrics and Muscular Diseases Albert-Ludwigs-Universität, Freiburg, Germany

Uwe-Peter Ketelsen, MD

Department of Neuropediatrics and Muscular Diseases Albert-Ludwigs-Universität, Freiburg, Germany

Florian Heinen, MD

Department of Neuropediatrics and Muscular Diseases Albert-Ludwigs-Universität, Freiburg, Germany

Manfred Sauer, MD

Department of Neuropediatrics and Muscular Diseases Albert-Ludwigs-Universität, Freiburg, Germany

Sabine Rudnik-Schönebom, MD

Institute of Human Genetics Friedhelm-Wilhelms-Universitat, Bonn, Germany

Brunhilde Wirth, PhD

Institute of Human Genetics Friedhelm-Wilhelms-Universitat, Bonn, Germany

Klaus Zerres, MD

Institute of Human Genetics Friedhelm-Wilhelms-Universitat, Bonn, Germany

Wilfried Kratzer, MD

Children's Hospital Konstanz Konstanz, Germany

Rudolf Korinthenberg, MD

Department of Neuropediatrics and Muscular Diseases Albert-Ludwigs-Universität, Freiburg, Germany

Two affected siblings with infantile spinal muscular atrophy (SMA I) presented with generalized muscular hypotonia, which progressed to early death. Quadriceps muscle biopsy did not show the typical neurogenic pattern of spinal muscular atrophy. The histochemical fiber type determination revealed a predominance of type II fibers without type I hypertrophy, an unprecedented finding in spinal muscular atrophy. Sural nerve biopsy exhibited findings typical for axonal neuropathy. In one patient, electrical stimulation of peripheral nerves showed an inexcitability of motor and sensory nerves. Genetic studies revealed homozygous deletions of the telomeric survival motor neuron (SMN) gene and the neuronal apoptosis inhibitory protein (NAIP) gene in the affected children. This is the second case report of molecular genetically proven spinal muscular atrophy associated with axonal neuropathy. We conclude atypical findings on muscle biopsy and evidence of axonal neuropathy are compatible with the diagnosis of infantile spinal muscular atrophy. (J Child Neurol 1998;13:327-331).

Journal of Child Neurology, Vol. 13, No. 7, 327-331 (1998)
DOI: 10.1177/088307389801300704


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