The findings about the medication mexiletine – a chemical cousin of lidocaine – were published May 4 in the journal Neurology, a publication of the American Academy of Neurology.
Currently there is no drug approved to treat myotonic dystrophy, an inherited disease that is marked by progressive muscle weakness. While the course of the disease can vary dramatically from patient to patient, symptoms besides weakness can include muscle stiffness, difficulty speaking and swallowing, problems walking, and in some patients, heart problems and cataracts. Physicians estimate that approximately 40,000 Americans have the condition.
The researchers at the University of Rochester Medical Center found that mexiletine is effective at treating the myotonia – muscle stiffness – that is at the center of the disease. Turning a key in a lock, writing with a pen or pencil, picking up and setting down a pitcher of water – all are formidable tasks for patients with myotonia. Sometimes the symptom first occurs when a patient shakes someone’s hand, then cannot relax his or her grip for several seconds.
While several doctors have suspected that mexiletene helps relieve myotonia, this is the first placebo-controlled, double-blind study to show that it actually does so, said neurologist Richard Moxley III, M.D., an author of the study and an international expert on muscular dystrophy.
“It’s important for physicians who treat patients to know that mexiletine is an option,” said Moxley, who is director of the University’s Neuromuscular Disease Center and professor of Neurology. “Several physicians who specialize in treating patients with myotonic dystrophy have found it to be effective for their patients, but we really wanted to study the issue closely. The medication really addresses myotonia quite well, with no additional risk.”
The findings come from one of the world’s premier groups focusing on research and new treatments for muscular dystrophy. Ten years ago Moxley began the world’s first muscular dystrophy registry, which now includes more than 1,500 patients with either myotonic dystrophy or facioscapulohumeral dystrophy.
Moxley also heads the University’s Senator Paul D. Wellstone Muscular Dystrophy Cooperative Research Center, one of three research centers originally created in 2003 by the National Institutes of Health. The Rochester center is now one of six NIH Wellstone centers and most recently received $5 million in additional funding in September 2008 to continue its work for five more years.
In the trial of mexiletine, evaluators measured the amount of time it took patients to relax their grip after squeezing the handles of a computerized device that measures force. For most healthy people, that relaxation takes one-third of a second or less. But for people with myotonic dystrophy, that relaxation can take many seconds.
Scientists studied two groups of 20 patients who had myotonic dystrophy, all confirmed through genetic analysis. Each participant received either placebo, or 150 or 200 milligrams of mexiletine three times a day, for seven weeks. Then, after a period of several weeks where they received no drug, participants were switched to the other treatment for another seven weeks.
The team found that mexiletine at three daily doses of either 150 or 200 milligrams per dose does a great deal to alleviate myotonia. In their test of relaxation after grip, the team found that mexiletine reduces the abnormally long relaxation by 38 percent at the lower dose and 59 percent at the higher dose. No benefit at all was seen for participants on placebo.
Because the drug can affect the heart, participants in the study were admitted as inpatients and stayed several nights at the University’s Clinical Research Center, where their heart health could be monitored closely. The team found no adverse effects of mexiletine, including no effects on normal cardiac rhythms.
Mexiletine acts to help the muscle compensate for the ion channel abnormality that is at the core of the myotonia in this disease. The myotonia is caused by a sort of molecular stutter that causes electrical signaling in muscle cells to go awry, in effect making muscle stick in the “on” position. The mutation markedly reduces the number of functioning muscle chloride channels and causes decreased movement of the chloride ion across the muscle membrane, leading to excessive muscle irritability and repeated spontaneous activation of muscle fibers. This results in muscle stiffness and delayed relaxation after contraction. Mexiletine works through the sodium channel, which is functioning normally, to decrease muscle irritability.
The new research findings on the effectiveness of mexiletine come amid several exciting research finds by Moxley’s colleagues. In one line of research, led by Charles Thornton, M.D., researchers have discovered precisely how a faulty gene actually causes myotonic dystrophy by preventing normal proteins from doing their jobs. Thornton’s group then used experimental compounds to break up abnormal cellular deposits of toxic RNA in the nuclei of cells, eliminating myotonia in mice with myotonic dystrophy. Down the hall, a team led by Rabi Tawil, M.D., is part of an international study examining the genetic roots of the second most common form of muscular dystrophy in adults, facioscapulohumeral muscular dystrophy.
In addition to Moxley, authors of the paper include Neurology faculty members Eric Logigian, M.D., and Charles Thornton, M.D., and Biostatistics faculty member Michael McDermott, Ph.D. Also taking part from Rochester were William Martens, Richard Moxley IV, Nuran Dilek, A. T. Pearson, Cheryl Barbieri, and Christine Annis. Allen W. Wiegner, Ph.D., of Harvard also contributed.
The work was funded by the Senator Paul D. Wellstone Muscular Dystrophy Cooperative Research Center, the U.S. Food and Drug Administration, the National Institutes of Health, the Muscular Dystrophy Association of America, and the Saunders Family Neuromuscular Research Fund.For Media Inquiries:
Tom Rickey | EurekAlert!
Speed data for the brain’s navigation system
06.12.2016 | Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE)
Study suggests possible new target for treating and preventing Alzheimer's
02.12.2016 | Oregon Health & Science University
In recent years, lasers with ultrashort pulses (USP) down to the femtosecond range have become established on an industrial scale. They could advance some applications with the much-lauded “cold ablation” – if that meant they would then achieve more throughput. A new generation of process engineering that will address this issue in particular will be discussed at the “4th UKP Workshop – Ultrafast Laser Technology” in April 2017.
Even back in the 1990s, scientists were comparing materials processing with nanosecond, picosecond and femtosesecond pulses. The result was surprising:...
Have you ever wondered how you see the world? Vision is about photons of light, which are packets of energy, interacting with the atoms or molecules in what...
A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.
Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...
In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.
“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...
The Max Planck Institute for Physics (MPP) is opening up a new research field. A workshop from November 21 - 22, 2016 will mark the start of activities for an innovative axion experiment. Axions are still only purely hypothetical particles. Their detection could solve two fundamental problems in particle physics: What dark matter consists of and why it has not yet been possible to directly observe a CP violation for the strong interaction.
The “MADMAX” project is the MPP’s commitment to axion research. Axions are so far only a theoretical prediction and are difficult to detect: on the one hand,...
16.11.2016 | Event News
01.11.2016 | Event News
14.10.2016 | Event News
07.12.2016 | Earth Sciences
07.12.2016 | Earth Sciences
07.12.2016 | Materials Sciences