Psychopharmacological Treatments for Mental Disorders in Patients with Neuromuscular Diseases: A Scoping Review.

Chiara Brusa,Giulio Gadaleta,Federica S Ricci,Rossella D’Alessandro,Benedetto Vitiello,Tiziana E Mongini,Guido Urbano,Chiara Davico,Martina Vacchetti

doi:10.3390/brainsci12020176

Abstract

Mental disorders are observed in neuromuscular diseases, especially now that patients are living longer. Psychiatric symptoms may be severe and psychopharmacological treatments may be required. However, very little is known about pharmacotherapy in these conditions. We aimed to summarize the current knowledge on the use of psychopharmacological treatments for mental disorders in patients living with a neuromuscular disease. A scoping review was performed using the methodology of the Joanna Briggs Institute. Four databases were searched from January 2000 to July 2021. Articles were screened based on titles and abstracts. Full-text papers published in peer-reviewed journals in English were selected. Twenty-six articles met eligibility criteria, all being case reports/series focusing on the psychopharmacological control of psychiatric symptoms for the following conditions: myasthenia gravis (n = 11), Duchenne (n = 5) and Becker (n = 3) muscular dystrophy, mitochondrial disorders (n = 3), glycogen storage disease (n = 1), myotonic dystrophy (n = 1), hyperkalemic periodic paralysis (n = 1), and congenital myasthenic syndrome (n = 1). None of the articles provided details on the decision-making process to choose a specific drug/regimen or on follow-up strategies to monitor safety and efficacy. Larger studies showing real-world data would be required to guide consensus-based recommendations, thus improving current standards of care and, ultimately, the quality of life of patients and their families.

Highlights

Neuromuscular diseases encompass a wide range of disorders due to genetic or acquired etiologies and are characterized by the anatomic localization of the pathology within the motor unit
We searched for articles reporting the use of medications for mental disorders in patients with neuromuscular conditions including spinal muscular atrophies, neuromuscular junction disorders, muscular dystrophies, structural congenital myopathies, non-dystrophic myotonias, mitochondrial myopathies, glycogen storage diseases, and myositis
Myasthenia Gravis (MG) We found 11 articles reporting on the use of psychopharmacological treatments in patients suffering from anxiety, somatic, depressive, psychotic, or bipolar disorder symptoms, or a combination of two or more psychiatric symptoms

Summary

Introduction

Neuromuscular diseases encompass a wide range of disorders due to genetic or acquired etiologies and are characterized by the anatomic localization of the pathology within the motor unit. Each neuromuscular disease is “rare” according to the European Union definition of a disease that affects no more than 1 person in 2000, and some of them are very rare. Collectively, these conditions are quite common [1], and a general pediatrician/practitioner will care for at least one neuromuscular patient on average at any one time. Prevalence rates directly reflect duration of life, and the introduction and adoption of supportive care options for neuromuscular disorders over the last decades [3,4,5,6,7] have contributed to improving the overall survival of these patients. The recent availability of innovative drug therapies for some patients—in particular those with infantile-onset Pompe disease (IOPD) [8] and spinal muscular atrophy (SMA) type 1 [9,10,11]—have further contributed to prolonging their survival

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