title: Severity, type, and distribution of myotonic discharges are different in type 1 and type 2 myotonic dystrophy.
abstract: To characterize and compare electrical myotonia in myotonic dystrophy type 1 (DM1) and type 2 (DM2), 16 patients with genetically confirmed DM1 and 17 patients with DM2 underwent standardized concentric needle electromyography of deltoid, biceps, extensor digitorum communis, first dorsal interosseous, tensor fascia lata (TFL), vastus lateralis (VL), tibialis anterior, and thoracic paraspinal muscles. Eight needle insertions per muscle were made by electromyographers blinded to DM type who recorded the presence and type of myotonia (e.g., classic waxing-waning or less specific waning discharges). Manual muscle testing was performed by a physical therapist. Overall, myotonia was more elicitable in DM1 than DM2; only in VL and TFL was myotonia more elicitable in DM2 than DM1. The major type of myotonia was waxing-waning in DM1, and waning in DM2. Four DM2 (24%), but no DM1 patients had only waning myotonia. In the arms, myotonia was distally predominant in both DM1 and DM2. In the legs, it was distally predominant in DM1, but both proximal and distal in DM2. The severity of myotonia was positively correlated with muscle weakness and with the presence of waxing and waning discharges in DM1, but with neither in DM2. Thus, myotonia is qualitatively and quantitatively different in DM1 than DM2. Except for proximal leg muscles, myotonia is more evocable in DM1 than DM2. It tends to be waxing-waning in DM1 but waning in DM2, thus making electrodiagnosis of DM2 more challenging. Its severity correlates with muscle weakness and the presence of waxing-waning discharges in DM1 but not DM2.
authors.affiliation: Neuromuscular Division, Department of Neurology, Box 673, 601 Elmwood Avenue, University of Rochester Medical Center, Rochester, New York 14642, USA. eric_logigian@urmc.rochester.edu
authors.forename: Eric L
authors.initials: EL
authors.lastname: Logigian
authors.forename: Emma
authors.initials: E
authors.lastname: Ciafaloni
authors.forename: L Christine
authors.initials: LC
authors.lastname: Quinn
authors.forename: Nuran
authors.initials: N
authors.lastname: Dilek
authors.forename: Shree
authors.initials: S
authors.lastname: Pandya
authors.forename: Richard T
authors.initials: RT
authors.lastname: Moxley
authors.forename: Charles A
authors.initials: CA
authors.lastname: Thornton
mesh_terms: D000200:Action Potentials; D000328:Adult; D000368:Aged; D001132:Arm / Q000503:physiopathology; D003937:Diagnosis, Differential; D004568:Electrodiagnosis / Q000295:instrumentation / Q000379:methods*; D004576:Electromyography / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D007866:Leg / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction; D018908:Muscle Weakness / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D018482:Muscle, Skeletal / Q000503:physiopathology*; D009223:Myotonic Dystrophy / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology*; D009339:Needles; D011237:Predictive Value of Tests; D011446:Prospective Studies