Neurological symptoms in individuals with fibrodysplasia ossificans progressiva

Joseph A. Kitterman, Jonathan B. Strober, Lixin Kan, David M. Rocke, Amanda Cali, Jeannie Peeper, Jennifer Snow, Patricia L R Delai, Rolf Morhart, Robert Pignolo, Eileen M. Shore, Frederick S. Kaplan

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Fibrodysplasia ossificans progressiva (FOP), a rare, disabling condition caused by gain-of-function mutations of a bone morphogenetic protein (BMP) type I receptor, leads to episodes of heterotopic ossification and resultant immobility. Neurological problems have not been associated with FOP, but neurological symptoms are commonly reported by FOP patients. To determine the prevalence of neurological symptoms and their characteristics in individuals with FOP, we conducted a survey of the 470 patient members of the International FOP Association (IFOPA) using a questionnaire about neurological symptoms. There were 168 responses (105 females, 63 males; age 1.5-68 years) from 30 countries representing 36 % of IFOPA members. Chronic neurological symptoms were reported by 86 (51 %). Prevalence of neuropathic pain (NP) was significantly increased (P<0.001) compared to the general population, and tenfold more common in females (15 %) than males (1.6 %). Of those with NP, 94 % reported other sensory abnormalities. Prevalence of recurrent severe headaches (HA) (26 %) was similar to that in the general population, but prevalence in females with FOP (36 %) was almost fourfold greater than in males. Prevalence of NP, HA, and other sensory abnormalities was substantially higher in post-pubertal females; 33 % reported symptoms worsened during menstrual periods. Worsening of neurological symptoms during FOP flare-ups was reported by 23 %. Three patients with FOP (1.8 %) reported myoclonus, a prevalencemuch greater than reported in the general population (P<0.001). Our worldwide survey indicates that neurological symptoms are common in FOP. We speculate that these symptoms are related to effects of dysregulated BMP signaling on the central and/or peripheral nervous systems.

Original languageEnglish (US)
Pages (from-to)2636-2643
Number of pages8
JournalJournal of Neurology
Volume259
Issue number12
DOIs
StatePublished - Dec 1 2012
Externally publishedYes

Fingerprint

Myositis Ossificans
Neuralgia
Headache
Type I Bone Morphogenetic Protein Receptors
Population
Heterotopic Ossification
Bone Morphogenetic Proteins
Myoclonus
Peripheral Nervous System
Central Nervous System

Keywords

  • ACVR1
  • Bone morphogenetic protein 4
  • Substance P

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Kitterman, J. A., Strober, J. B., Kan, L., Rocke, D. M., Cali, A., Peeper, J., ... Kaplan, F. S. (2012). Neurological symptoms in individuals with fibrodysplasia ossificans progressiva. Journal of Neurology, 259(12), 2636-2643. https://doi.org/10.1007/s00415-012-6562-y

Neurological symptoms in individuals with fibrodysplasia ossificans progressiva. / Kitterman, Joseph A.; Strober, Jonathan B.; Kan, Lixin; Rocke, David M.; Cali, Amanda; Peeper, Jeannie; Snow, Jennifer; Delai, Patricia L R; Morhart, Rolf; Pignolo, Robert; Shore, Eileen M.; Kaplan, Frederick S.

In: Journal of Neurology, Vol. 259, No. 12, 01.12.2012, p. 2636-2643.

Research output: Contribution to journalArticle

Kitterman, JA, Strober, JB, Kan, L, Rocke, DM, Cali, A, Peeper, J, Snow, J, Delai, PLR, Morhart, R, Pignolo, R, Shore, EM & Kaplan, FS 2012, 'Neurological symptoms in individuals with fibrodysplasia ossificans progressiva', Journal of Neurology, vol. 259, no. 12, pp. 2636-2643. https://doi.org/10.1007/s00415-012-6562-y
Kitterman JA, Strober JB, Kan L, Rocke DM, Cali A, Peeper J et al. Neurological symptoms in individuals with fibrodysplasia ossificans progressiva. Journal of Neurology. 2012 Dec 1;259(12):2636-2643. https://doi.org/10.1007/s00415-012-6562-y
Kitterman, Joseph A. ; Strober, Jonathan B. ; Kan, Lixin ; Rocke, David M. ; Cali, Amanda ; Peeper, Jeannie ; Snow, Jennifer ; Delai, Patricia L R ; Morhart, Rolf ; Pignolo, Robert ; Shore, Eileen M. ; Kaplan, Frederick S. / Neurological symptoms in individuals with fibrodysplasia ossificans progressiva. In: Journal of Neurology. 2012 ; Vol. 259, No. 12. pp. 2636-2643.
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abstract = "Fibrodysplasia ossificans progressiva (FOP), a rare, disabling condition caused by gain-of-function mutations of a bone morphogenetic protein (BMP) type I receptor, leads to episodes of heterotopic ossification and resultant immobility. Neurological problems have not been associated with FOP, but neurological symptoms are commonly reported by FOP patients. To determine the prevalence of neurological symptoms and their characteristics in individuals with FOP, we conducted a survey of the 470 patient members of the International FOP Association (IFOPA) using a questionnaire about neurological symptoms. There were 168 responses (105 females, 63 males; age 1.5-68 years) from 30 countries representing 36 {\%} of IFOPA members. Chronic neurological symptoms were reported by 86 (51 {\%}). Prevalence of neuropathic pain (NP) was significantly increased (P<0.001) compared to the general population, and tenfold more common in females (15 {\%}) than males (1.6 {\%}). Of those with NP, 94 {\%} reported other sensory abnormalities. Prevalence of recurrent severe headaches (HA) (26 {\%}) was similar to that in the general population, but prevalence in females with FOP (36 {\%}) was almost fourfold greater than in males. Prevalence of NP, HA, and other sensory abnormalities was substantially higher in post-pubertal females; 33 {\%} reported symptoms worsened during menstrual periods. Worsening of neurological symptoms during FOP flare-ups was reported by 23 {\%}. Three patients with FOP (1.8 {\%}) reported myoclonus, a prevalencemuch greater than reported in the general population (P<0.001). Our worldwide survey indicates that neurological symptoms are common in FOP. We speculate that these symptoms are related to effects of dysregulated BMP signaling on the central and/or peripheral nervous systems.",
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