Congenital myopathies and related disorders

Considerable progress has been made in molecular genetic research and in identifying the underlying pathogenesis of congenital myopathies, with implications for genetic counseling. Therefore an overview of such advances in the last two years is most timely and relevant for a more precise delineation of these disorders. New mutations have been described on the ryanodine receptor gene, including the carboxyl-terminus region, and experimental models developed to explain their role in central core disease. Phenotype-genotype correlations for nemaline myopathy have improved our understanding of those related to gene mutations. In multi-minicore disease, collaborative studies support genetic heterogeneity and autosomal-recessive inheritance. Research on X-linked myotubular myopathies has revealed a high percentage of mothers of sporadic cases as carriers. Although not initially included within the congenital myopathies, desmin-related or myofibrillar myopathies are described here because they are closely related to other congenital myopathies with intracytoplasmic inclusions. Western blot for myotubularin and desmin has been proposed as a useful diagnostic test for both X-linked myotubular myopathy and desmin-related myopathy, and in-vitro and mouse models for the latter have provided insights into its pathogenesis. Several entities still await genetic characterization. Here we focus on clinical features, inheritance, and molecular genetics. Advances in immunohistochemistry and molecular genetics in congenital muscular dystrophies have enriched our knowledge of this heterogeneous group of disorders, leading to more accurate classification and differentiation between the various congenital myopathies.