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Scoliosis in Spinal Muscular Atrophy Type 1 in the Nusinersen Era.
Al Amrani, Fatima; Amin, Reshma; Chiang, Jackie; Xiao, Lena; Boyd, Jennifer; Law, Eugenia; Nigro, Elisa; Weinstock, Lauren; Stosic, Ana; Gonorazky, Hernan D.
Affiliation
  • Al Amrani F; Department of Pediatrics (FAA, JB, EL, EN-P, HDG), Division of Neurology, Hospital for Sick Children, University of Toronto; Department of Pediatrics (RA, JC, LX), Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto; Department of Rehabilitation Services (LW), Hospita
  • Amin R; Department of Pediatrics (FAA, JB, EL, EN-P, HDG), Division of Neurology, Hospital for Sick Children, University of Toronto; Department of Pediatrics (RA, JC, LX), Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto; Department of Rehabilitation Services (LW), Hospita
  • Chiang J; Department of Pediatrics (FAA, JB, EL, EN-P, HDG), Division of Neurology, Hospital for Sick Children, University of Toronto; Department of Pediatrics (RA, JC, LX), Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto; Department of Rehabilitation Services (LW), Hospita
  • Xiao L; Department of Pediatrics (FAA, JB, EL, EN-P, HDG), Division of Neurology, Hospital for Sick Children, University of Toronto; Department of Pediatrics (RA, JC, LX), Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto; Department of Rehabilitation Services (LW), Hospita
  • Boyd J; Department of Pediatrics (FAA, JB, EL, EN-P, HDG), Division of Neurology, Hospital for Sick Children, University of Toronto; Department of Pediatrics (RA, JC, LX), Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto; Department of Rehabilitation Services (LW), Hospita
  • Law E; Department of Pediatrics (FAA, JB, EL, EN-P, HDG), Division of Neurology, Hospital for Sick Children, University of Toronto; Department of Pediatrics (RA, JC, LX), Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto; Department of Rehabilitation Services (LW), Hospita
  • Nigro E; Department of Pediatrics (FAA, JB, EL, EN-P, HDG), Division of Neurology, Hospital for Sick Children, University of Toronto; Department of Pediatrics (RA, JC, LX), Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto; Department of Rehabilitation Services (LW), Hospita
  • Weinstock L; Department of Pediatrics (FAA, JB, EL, EN-P, HDG), Division of Neurology, Hospital for Sick Children, University of Toronto; Department of Pediatrics (RA, JC, LX), Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto; Department of Rehabilitation Services (LW), Hospita
  • Stosic A; Department of Pediatrics (FAA, JB, EL, EN-P, HDG), Division of Neurology, Hospital for Sick Children, University of Toronto; Department of Pediatrics (RA, JC, LX), Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto; Department of Rehabilitation Services (LW), Hospita
  • Gonorazky HD; Department of Pediatrics (FAA, JB, EL, EN-P, HDG), Division of Neurology, Hospital for Sick Children, University of Toronto; Department of Pediatrics (RA, JC, LX), Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto; Department of Rehabilitation Services (LW), Hospita
Neurol Clin Pract ; 12(4): 279-287, 2022 Aug.
Article in En | MEDLINE | ID: mdl-36382115
Background and Objectives: The introduction of spinal muscular dystrophy (SMA)-modifying therapies, such as antisense oligonucleotide therapy, has changed the natural history of SMA. Most reports on treatment outcomes have focused on motor scores and respiratory function. The objective of this study is to document the development and progression of scoliosis in patients with SMA1 treated with nusinersen. Methods: A descriptive single-center study was conducted in patients with SMA1 who were treated with nusinersen before 6 months of age. Data were collected on patients who met criteria, including age at the first nusinersen dose, number of nusinersen doses, degree of scoliosis, respiratory parameters, feeding route, and motor scores at baseline and follow-up. The Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND) was subanalyzed using axial (AxS) and appendicular motor (ApS) scores to evaluate a possible correlation between scoliosis and axial muscle strength. Results: From our cohort, 31 percent (11/35) of patients had a diagnosis of SMA1. Sixty-three percent (7/11) met the inclusion criteria. All patients (7/7) showed initial improvement in their CHOP-INTEND scores in correlation with improvement on the ApS. Despite this, most patients did not show improvement in the AxS. Subsequently, all patients developed scoliosis in the first year of life with Cobb angles that ranged between 18° and 60°. Furthermore, total CHOP-INTEND scores had dropped in 2 patients alongside the development of a Cobb angle of >40°. Discussion: Despite the significant improvement in functional motor assessment in patients with SMA1, there is a progression of significant scoliosis despite treatment. Subsequently, lack or minimal improvement on the axial CHOP-INTEND scores may predict worsening on the total motor scores.

Full text: 1 Collection: 01-internacional Database: MEDLINE Type of study: Prognostic_studies Language: En Journal: Neurol Clin Pract Year: 2022 Document type: Article Country of publication: United States

Full text: 1 Collection: 01-internacional Database: MEDLINE Type of study: Prognostic_studies Language: En Journal: Neurol Clin Pract Year: 2022 Document type: Article Country of publication: United States