Abstract
Objective: The aim of our study was to evaluate the long-term efficacy and safety of mexiletine in 112 patients affected by genetically confirmed non-dystrophic myotonias. The study was performed at the Neurophysiologic Division of Fondazione Policlinico Universitario A. Gemelli Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), Rome and the Children's Hospital Bambino Gesù, Rome.Methods: The treatment was accepted by 59 patients according to clinical severity, individual needs, and concerns about a chronic medication. Forty-three patients were affected by recessive congenita myotonia, 11 by sodium channel myotonia, and five by dominant congenital myotonia. They underwent clinical examination before and after starting therapy, and Electromyography (EMG). A number of recessive myotonia patients underwent a protocol of repetitive nerve stimulations, for detecting and quantifying the transitory weakness, and a modified version of the Timed Up and Go test, to document and quantify the gait impairment.Results: Treatment duration ranged from 1 month to 20 years and the daily dosages in adults ranged between 200 and 600 mg. No patient developed cardiac arrhythmias causing drug discontinuation. Mexiletine was suspended in 13 cases (22%); in three patients, affected by Sodium Channel myotonia, because flecainide showed better efficacy; in one patient because of a gastric cancer antecedent treatment; in four patients because of untreatable dyspepsia; and five patients considered the treatment not necessary.Conclusions: In our experience, mexiletine is very useful and not expensive. We did not observe any hazarding cardiac arrhythmias. Dyspepsia was the most frequent dose-limiting side effect.
Highlights
Mexiletine was suspended in 13 cases (22%); in three patients, affected by Sodium Channel myotonia, because flecainide showed better efficacy; in one patient because of a gastric cancer antecedent treatment; in four patients because of untreatable dyspepsia; and five patients considered the treatment not necessary
Non-dystrophic myotonias are due to loss-of-function mutations in the voltage-gated chloride ClC-1 channel, encoded by the CLCN1 gene, or gain-of-function mutations in the voltage-gated sodium Nav1.4 channel, encoded by the SCN4A gene [1,2,3]
Among patients affected by recessive congenital myotonia (RCM), we found several patients carrying the same mutation
Summary
Non-dystrophic myotonias are due to loss-of-function mutations in the voltage-gated chloride ClC-1 channel, encoded by the CLCN1 gene, or gain-of-function mutations in the voltage-gated sodium Nav1.4 channel, encoded by the SCN4A gene [1,2,3]. These are rare disorders, with a prevalence of < 1:100,000, characterized by clinical and electrophysiological myotonia, which is lifelong and impact quality of life. Today the drug of choice for treating myotonia is mexiletine, whatever the culprit gene [4,5,6]. Costs are entirely covered by the Italian National Health System
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