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!
Penn vet research identifies new target for taming Ebola
12.01.2017 | University of Pennsylvania
The strange double life of Dab2
10.01.2017 | University of Miami Miller School of Medicine
Laser-driving of semimetals allows creating novel quasiparticle states within condensed matter systems and switching between different states on ultrafast time scales
Studying properties of fundamental particles in condensed matter systems is a promising approach to quantum field theory. Quasiparticles offer the opportunity...
Among the general public, solar thermal energy is currently associated with dark blue, rectangular collectors on building roofs. Technologies are needed for aesthetically high quality architecture which offer the architect more room for manoeuvre when it comes to low- and plus-energy buildings. With the “ArKol” project, researchers at Fraunhofer ISE together with partners are currently developing two façade collectors for solar thermal energy generation, which permit a high degree of design flexibility: a strip collector for opaque façade sections and a solar thermal blind for transparent sections. The current state of the two developments will be presented at the BAU 2017 trade fair.
As part of the “ArKol – development of architecturally highly integrated façade collectors with heat pipes” project, Fraunhofer ISE together with its partners...
At TU Wien, an alternative for resource intensive formwork for the construction of concrete domes was developed. It is now used in a test dome for the Austrian Federal Railways Infrastructure (ÖBB Infrastruktur).
Concrete shells are efficient structures, but not very resource efficient. The formwork for the construction of concrete domes alone requires a high amount of...
Many pathogens use certain sugar compounds from their host to help conceal themselves against the immune system. Scientists at the University of Bonn have now, in cooperation with researchers at the University of York in the United Kingdom, analyzed the dynamics of a bacterial molecule that is involved in this process. They demonstrate that the protein grabs onto the sugar molecule with a Pac Man-like chewing motion and holds it until it can be used. Their results could help design therapeutics that could make the protein poorer at grabbing and holding and hence compromise the pathogen in the host. The study has now been published in “Biophysical Journal”.
The cells of the mouth, nose and intestinal mucosa produce large quantities of a chemical called sialic acid. Many bacteria possess a special transport system...
UMD, NOAA collaboration demonstrates suitability of in-orbit datasets for weather satellite calibration
"Traffic and weather, together on the hour!" blasts your local radio station, while your smartphone knows the weather halfway across the world. A network of...
10.01.2017 | Event News
09.01.2017 | Event News
05.01.2017 | Event News
17.01.2017 | Machine Engineering
17.01.2017 | Physics and Astronomy
16.01.2017 | Power and Electrical Engineering