However, a new study out this month in the journal Neurology reveals that there is often a disconnect between the two groups over which symptoms are more important, a phenomenon that not only impacts care but also the direction of research into new therapies.
"In order to design better therapies we must first develop a clear understanding of what patients think are the key mental and physical burdens of this disease," said University of Rochester Medical Center (URMC) neurologist Chad Heatwole, M.D., lead author of the study. "It is clear from this study that, in the case of myotonic dystrophy, researchers have not always been concentrating on the symptoms that are most important to the patient."
Myotonic dystrophy has been characterized as one of the most diverse and complex genetic diseases with a wide range of symptoms ranging from fatigue, muscle weakness, cognitive impairment, depression, difficulty sleeping, impaired vision, pain, difficulty swallowing, gastrointestinal problems, and myotonia, the inability to relax muscles after contraction – such as when clenching a fist – that is the hallmark of the disease. The severity and onset of these symptoms can vary from patient to patient.
As a result, physicians and patients are often confronted with a bewildering array of treatment options and researchers have previously had no comprehensive method to measure the meaningful impact of experimental therapies. Further impetus for a patient-centered approach has come from a recent push by the federal Food and Drug Administration to require that new drugs take into account what outcomes patients feel are important.
Using a national database of muscular dystrophy patients developed by URMC, Heatwole and his colleagues surveyed 278 people with myotonic dystrophy type-1. They asked them not only which symptoms they were experiencing, but which ones have the most impact on their lives. Answers were cross referenced with the respondent's age and a genetic measure – called CTG repeat length – that roughly correlates with the severity of the disease.
The study revealed that certain symptoms like myotonia which are experienced by more than 90 percent of individuals with the disease are less important to patients than symptoms such as such as fatigue, limited mobility, and sleep problems. Respondents also identified specific symptoms that have the greatest impact on their lives. These included difficulty having children, not being able to stay in the standing position, and difficulty holding down a job.
"One of the more surprising results is that myotonia – the condition that gives the disease its name – is down the list of things that patients feel most affect their daily lives," said Heatwole. "These insights will not only have important implications for how patients are treated, but also how new therapies for the disease are evaluated by building better outcome measures."
Using this data, Heatwole and his colleagues have developed a questionnaire for myotonic dystrophy patients that weights patient responses based on their study findings. The questionnaire, called a disease-specific patient reported outcome measure is one of many which is being developed for neuromuscular diseases at the URMC by Heatwole and his team and will enable researchers to more precisely measure whether the impact of experimental therapies is meaningful to patients. The myotonic dystrophy outcome measure is already being used in two clinical trials at the University of Rochester.
Additional co-authors include Nicholas Johnson, M.D., Christine Quinn, M.S., William Martens, Michael McDermott, Ph.D., Charles Thornton, M.D., and Richard Moxley, M.D. with URMC, Rita Bode, Ph.D., Nan Rothrock, Ph.D., and David Victorson, Ph.D. with Northwestern University and Barbara Vickrey, Ph.D. with the University of California Los Angeles. Funding for the study was provided by the National Institute of Arthritics and Muskuloskeletal and Skin Disorders, the Wellstone Muscular Dystrophy Cooperative Research Center, the Muscular Dystrophy Association, the New York State Empire Clinical Research Investigator Program, the Saunders Family Fund, and the University of Rochester Clinical and Translational Science Institute.
Mark Michaud | EurekAlert!
Purdue cancer identity technology makes it easier to find a tumor's 'address'
16.11.2018 | Purdue University
Microgel powder fights infection and helps wounds heal
14.11.2018 | Michigan Technological University
Researchers at the University of New Hampshire have captured a difficult-to-view singular event involving "magnetic reconnection"--the process by which sparse particles and energy around Earth collide producing a quick but mighty explosion--in the Earth's magnetotail, the magnetic environment that trails behind the planet.
Magnetic reconnection has remained a bit of a mystery to scientists. They know it exists and have documented the effects that the energy explosions can...
Biochips have been developed at TU Wien (Vienna), on which tissue can be produced and examined. This allows supplying the tissue with different substances in a very controlled way.
Cultivating human cells in the Petri dish is not a big challenge today. Producing artificial tissue, however, permeated by fine blood vessels, is a much more...
Faster and secure data communication: This is the goal of a new joint project involving physicists from the University of Würzburg. The German Federal Ministry of Education and Research funds the project with 14.8 million euro.
In our digital world data security and secure communication are becoming more and more important. Quantum communication is a promising approach to achieve...
On Saturday, 10 November 2018, the research icebreaker Polarstern will leave its homeport of Bremerhaven, bound for Cape Town, South Africa.
When choosing materials to make something, trade-offs need to be made between a host of properties, such as thickness, stiffness and weight. Depending on the application in question, finding just the right balance is the difference between success and failure
Now, a team of Penn Engineers has demonstrated a new material they call "nanocardboard," an ultrathin equivalent of corrugated paper cardboard. A square...
09.11.2018 | Event News
06.11.2018 | Event News
23.10.2018 | Event News
16.11.2018 | Health and Medicine
16.11.2018 | Life Sciences
16.11.2018 | Life Sciences