The purpose of this study was to evaluate the quality of life (QoL) of patients with Duchenne muscular dystrophy (DMD) in different stages of the disease, by means of the Life Satisfaction Index for Adolescents (LSI-A). The practicality of this scale was also verified. The LSI-A was applied four times to 95 patients with DMD who were undergoing steroid therapy, at three-month intervals. The patients were divided into four groups according to age. The results from the four applications and the inter and intra-examiner concordance were treated statistically. Comparing the different age groups, patients with DMD did not lose QoL, even with disease progression. We concluded that, in spite of the progressive course of the disease, the QoL in patients with DMD does not get worse. The use of a scale that embraces a great diversity of circumstances in patients' lives, without considering clinical aspects excessively, is a good alternative for assessing the QoL of these patients. Key words: quality of life, Duchenne muscular dystrophy, steroid therapy, questionnaire, Life Satisfaction Index for Adolescents. Distrofia muscular de Duchenne: avaliação da qualidade de vida em 95 pacientes através do Life Satisfaction Index for AdolescentsRESUMO O objetivo deste estudo foi de quantificar a qualidade de vida (QV) em crianças com distrofia muscular de Duchenne (DMD) em diferentes idades através do uso do questionário Life Satisfaction Index for Adolescents (LSI-A). Foi também avaliada a praticidade do questionário. O LSI-A foi aplicado a 95 pacientes com distrofia muscular de Duchenne em corticoterapia, em diferentes idades, e por quatro vezes com intervalos de três meses. Os resultados concernentes às quatro avaliações e a concordância inter e intra-observador foram tratados estatisticamente. Comparando diferentes faixas etárias, mesmo ao longo da progressão da doença, não notamos perda da QV. Concluímos que por não valorizar excessivamente os aspectos clínicos e abranger uma diversidade de circunstâncias cotidianas, O LSI-A é útil na avaliação da QV das crianças com DMD, sendo também de fácil aplicação. Palavras-chave: qualidade de vida, distrofia muscular de Duchenne, corticoterapia, questionário, Life Satisfaction Index for Adolescents.

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-We describe five patients with Schwartz-Jampel syndrome (SJS) examined at the outpatient service for neuromuscular disorders at our Institution from 1996 to 1999 with the objective of emphasizing the characteristic dysmorphic phenotype of SJS and its different clinical forms. Two cases presented SJS-type 1A, two had SJS-type 1B and one manifested SJS-type 2. Two boys with 3 and 13 years of age had generalized stiffness and the characteristic facial as well as osteoarticular changes from birth. Other two boys with 11 and 7 years had less marked dysmorphic changes at birth and manifested myotonia, as a limiting factor, during the second year of age. A girl with two months of age had severe myotonia from birth leading to feeding diffuculties. In all cases the diagnosis was based on dysmorphic features, and on electromyographic changes showing continuous electrical activity of muscle fibers. All were treated with carbamazepine, 20-30 mg/Kg since diagnosis. The four boys (all with normal intelligence) improved of myotonia in daily activities, markedly in three, and moderately in one. The girl did not improve and showed global development delay: by the last follow-up (at 20 months of age) she did not sit unsupported, and had mental retardation. Carbamazepine in SJS-type 1 improves general daily performance and psychological status of the patients.KEY WORDS: Schwartz-Jampel syndrome, myotonia, carbamazepine. Síndrome de Schwartz-Jampel: relato de cinco casosRESUMO -Descrevemos cinco pacientes com a síndrome de Schwartz-Jampel (SSJ) avaliados no Ambulatório de Doenças Neuromusculares da Divisão de Neurologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, de 1996 a 1999, com o objetivo de salientar o peculiar fenótipo dismórfico e as diferentes formas clínicas da SSJ. Dois meninos apresentavam SSJ-tipo 1A, mais branda e mais tardia, dois outros meninos apresentavam SSJ-tipo1B, de início mais precoce e dismorfismos mais limitantes, e uma menina apresentava SSJ-tipo 2, forma neonatal, com grave comprometimento, inclusive da sucção. Em todos, o diagnóstico foi baseado nos aspectos clínicos dismórficos, tanto faciais como esqueléticos, e no encontro de anormalidade eletromiográfica caracterizada como atividade elétrica contínua da fibra muscular. Todos receberam carbamazepina, em doses anticonvulsivantes de 20 a 30 mg/Kg, desde a realização da eletromiografia, que foi mantida nas consultas de seguimento, após períodos variando de 15 meses a 4 anos. Os quatro meninos, todos frequentando escola, apresentaram atenuação da síndrome miotônica; esta atenuação foi acentuada em três, notando-se nítida melhora da postura anormal, e moderada em um, que refere menor limitação nas atividades da vida diária. O quadro da menina com SSJ-tipo 2 não se modificou e a paciente manifestou retardo global do desenvolvimento, não tendo adquirido a marcha nem a linguagem por ocasião da última avaliação aos 20 meses de idade. A boa resposta dos sintomas à carbamazepina na SSJ-tipo 1 deve ser enfatizada, poi...

DMDDuchenne muscular dystrophy AIM To investigate tactile perception and manual dexterity, with or without visual feedback, in males with Duchenne muscular dystrophy (DMD).METHOD Forty males with DMD (mean age 9y 8mo, SD 2y 3mo; range 5-14y), recruited from the teaching hospital of the School of Medicine of the University of São Paulo, with disease severity graded as '1' to '6' on the Vignos Scale and '1' on Brooke's Scale, and 49 healthy males (mean age 8y 2mo; range 5-11y; SD 1y 11mo), recruited from a local education center, participated in the study. We assessed tactile perception using two-point discrimination and stereognosis tests, and manual dexterity using the Pick-Up test with the eyes either open or closed. Analysis of variance was used to compare groups; a p value of less than 0.05 was considered statistically significant. RESULTSMales with DMD exhibited no impairment in tactile perception, as measured by the two-point discrimination test and the number of objects correctly named in the stereognosis test. Manipulation during stereognosis was statistically slower with both hands (p<0.001), and manual dexterity was much worse in males with DMD when there was no visual feedback (p<0.001).INTERPRETATION Males with DMD exhibited disturbances in manipulation during stereognosis and dexterity tests. Hand control was highly dependent on visual information rather than on tactile perception. Motor dysfunction in males with DMD, therefore, might be related to altered neural control.Duchenne muscular dystrophy (DMD) is the most common and severe neuromuscular disease and the second most prevalent genetic disorder in children. Dystrophin synthesis impairment causes progressive and irreversible muscular weakness, leading to loss of ambulation by adolescence. New treatment approaches have enhanced the survival of individuals with DMD to the third decade of life. 1 This has increased the need to identify functional outcomes in DMD in order to evaluate the efficacy of existing therapeutic interventions.As a result of the proximal-to-distal progression of muscular weakness, upper limb assessment is possible in almost all patients and may represent an important functional outcome at different stages of the disease.2 However, as has been described in the past few years, reach and grasp control can also be affected by altered brain function. 3,4 Morphological and functional changes in sensorimotor areas of the cerebral cortex 3,5 seem to be related to diminished manual dexterity in children with DMD. In addition, reductions in glucose metabolism in the post-central gyrus and cerebellum 3 have also been reported in these patients. The hypometabolism in these brain regions may interfere with the integration of somatosensory inputs, particularly the tactile afferent inputs of the hands, which are required for adjusting prehension force, 6,7 velocity, and dexterity. 8 Color vision impairment 9 or other visual problems, caused by lack of dystrophin in the retina 10 and decreased visual-spatial attention, 11 could also have an...

-We report on two boys aged 2 and 6 years-old respectively with dysmorphic face, ptosis, downslanting palpebral fissures, hypertelorism, epicanthic folds, low-set ears, malar hypoplasia, micrognathia, high-arched palate, clinodactyly, palmar simian line, pectus excavatum, winging of the scapulae, lumbar lordosis and mild thoracic scoliosis who present congenital hypotonia, slightly delayed motor development, diffuse joint hyperextensibility and mild proximal weakness. The muscle biopsy revealed minimal but identifiable changes represented by size fiber variability, type I fiber predominance and atrophy, perimysial fibrous infiltration and some disarray of the intermyofibrillary network. These cases correspond to the first Brazilian reports of the King-Denborough syndrome and our objective is increasing the awareness of this disorder as these patients are predisposed to developing malignant hyperthermia.KEY WORDS: King-Denborough syndrome, congenital myopathy, malignant hyperthermia. Síndrome de King-Denborough: relato de dois casosRESUMO -Relatamos dois meninos de 2 e 6 anos de idade que apresentam aspectos dismórficos caracterizados por facies alongada, ptose e fenda palpebral anti-mongólica, hipertelorismo, epicanto bilateral, orelhas de implantação baixa, hipoplasia malar, micrognatia, pálato ogival, clinodactilia, prega palmar única, "pectus excavatum", escápulas aladas, lordose lombar e escoliose torácica. Apresentam hipotonia congênita, hiperextensibilidade articular, fraqueza muscular e retardo do desenvolvimento motor. A biópsia muscular revelou em ambos alterações mínimas: variabilidade do tamanho das fibras, predomínio e atrofia de fibras tipo I, discreta infiltração perimisial e desarranjo intermiofibrilar. Os aspectos dismórficos associados à miopatia congênita configuram a síndrome de King-Denborough, da qual acreditamos serem estes os primeiros casos descritos no Brasil. Como a síndrome se acompanha de alto risco de desenvolver hipertermia maligna na indução anestésica, o objetivo deste relato é chamar a atenção para a necessidade do diagnóstico pré-operatório, a fim de evitar esta gravíssima intercorrência. PALAVRAS-CHAVE: síndrome de King-Denborough, miopatia congênita, hipertermia maligna.

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