Limb-girdle dystrophy is a muscular dystrophy that has numerous subtypes; some are autosomal recessive and some are autosomal dominant. Time of onset is determined by the mode of inheritance, but the disease often begins in childhood. Symptoms are slowly progressive, impacting the proximal muscles. Diagnosis is by DNA analysis and muscle biopsy. Treatment is focused on maintenance of function and prevention of contractures.
Muscular dystrophies are inherited, progressive muscle disorders resulting from defects in one or more genes needed for normal muscle structure and function; dystrophic changes (eg, muscle fiber necrosis and regeneration) are seen on biopsy specimens.
As a group, limb-girdle dystrophies are the fourth most common inherited muscle disease. The overall prevalence varies depending on the specific subtype and population studied, with estimates ranging from 2 to 10/100,000 (1). Males and females are affected equally.
Insights from molecular biology have redefined the way these disorders are classified, and the nomenclature is in transition (2). Autosomal dominant forms were classified as limb-girdle muscular dystrophy (LGMD) 1A, -1B, -1C, and so on, and recessive forms were classified as LGMD 2A, -2B, -2C, and so on. However, after the letter Z was used in 2016 to name a recessive form of LGMD, no letters were left to name the next form to be discovered. Henceforth, the nomenclature would begin with the letter D for dominant and R for recessive, followed by a number, indicating the order in which the locus was delineated, followed by the protein product of the disorder. For example, the previously termed LGMD1F is now LGMD D2 transportin 3.
Limb-girdle dystrophy, under the new nomenclature, has 29 known subtypes, 24 autosomal recessive and 5 autosomal dominant.
References
1. Johnson NE, Statland JM: The Limb-Girdle Muscular Dystrophies. Continuum (Minneap Minn) 28(6):1698-1714, 2022. doi: 10.1212/CON.0000000000001178
2. Wicklund MP: The Limb-Girdle Muscular Dystrophies. Continuum (Minneap Minn) 25(6):1599-1618, 2019. doi: 10.1212/CON.0000000000000809
Symptoms and Signs of Limb-Girdle Dystrophy
Patients typically present with slowly progressive, symmetric, proximal muscle weakness with or without facial involvement and diminished or absent tendon reflexes. The pelvic or shoulder girdle muscles can be affected first.
Onset of symptoms for autosomal dominant types ranges from early childhood to adulthood. Onset of symptoms for autosomal recessive types tends to be during childhood, and these types primarily have a pelvic-girdle distribution.
Diagnosis of Limb-Girdle Dystrophy
DNA mutation analysis
Sometimes muscle biopsy
Diagnosis of limb-girdle dystrophy is indicated by characteristic clinical findings, age at onset, and family history and requires mutation analysis of DNA from peripheral blood leukocytes as the primary confirmatory test.
Muscle histology, immunocytochemistry, and Western blot analysis can be done.
Treatment of Limb-Girdle Dystrophy
Maintenance of function and prevention of contractures
Treatment of limb-girdle dystrophy is focused on maintaining function and preventing contractures.
Guidelines issued by the American Academy of Neurology recommend that patients who are newly diagnosed with LGMD who are at high risk of cardiac complications be referred for cardiac evaluation, even in the absence of cardiac symptoms (1). Those at high risk of respiratory failure should undergo pulmonary function testing. All patients with LGMD should ideally be referred to a multispecialty clinic with expertise in neuromuscular disorders.
There is currently no role for gene therapy, myoblast transplantation, neutralizing antibody to myostatin, or growth hormone other than in a research study (1).
Treatment reference
1. Narayanaswami P, Weiss M, Selcen D, et al: Evidence-based guideline summary: Diagnosis and treatment of limb-girdle and distal dystrophies: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the Practice Issues Review Panel of the American Association of Neuromuscular & Electrodiagnostic Medicine. Neurology 83:1453–1463, 2014. doi: 10.1212/WNL.0000000000000892
More Information
The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
Muscular Dystrophy Association: Information on research, treatment, technology, and support for patients living with limb-girdle dystrophy
Muscular Dystrophy News Today: A news and information web site about muscular dystrophy
