U.S. flag

An official website of the United States government

Format

Send to:

Choose Destination

Central core myopathy(CMYP1A)

MedGen UID:
199773
Concept ID:
C0751951
Disease or Syndrome
Synonyms: Central core disease; Central core disease of muscle; CMYP1A; Muscle core disease; Muscular central core disease; Myopathy, central fibrillar; Shy-Magee syndrome
SNOMED CT: Central core myopathy (43152001); Central core disease (43152001)
Modes of inheritance:
Autosomal dominant inheritance
MedGen UID:
141047
Concept ID:
C0443147
Intellectual Product
Source: Orphanet
A mode of inheritance that is observed for traits related to a gene encoded on one of the autosomes (i.e., the human chromosomes 1-22) in which a trait manifests in heterozygotes. In the context of medical genetics, an autosomal dominant disorder is caused when a single copy of the mutant allele is present. Males and females are affected equally, and can both transmit the disorder with a risk of 50% for each child of inheriting the mutant allele.
 
Gene (location): RYR1 (19q13.2)
 
Monarch Initiative: MONDO:0007294
OMIM®: 117000
Orphanet: ORPHA597

Definition

Congenital myopathy-1A (CMYP1A) with susceptibility to malignant hyperthermia is an autosomal dominant disorder of skeletal muscle characterized by muscle weakness primarily affecting the proximal muscles of the lower limbs beginning in infancy or early childhood, although later onset of symptoms has been reported. There is significant phenotypic variability, even within families, and the wide clinical diversity most likely depends on the severity of the RYR1 mutation. The disorder is static or slowly progressive; affected individuals typically show delayed motor development and usually achieve independent walking, although many have difficulty running or climbing stairs. Additional features often include mild facial weakness, joint laxity, shoulder girdle weakness, and skeletal manifestations, such as dislocation of the hips, foot deformities, scoliosis, and Achilles tendon contractures. Some patients present with orthopedic deformities. Serum creatine kinase is usually not elevated. Respiratory involvement is rare and there is no central nervous system or cardiac involvement. Patients with dominant mutations in the RYR1 gene are at risk for malignant hyperthermia and both disorders may segregate in the same family. Historically, patients with congenital myopathy due to RYR1 mutations were diagnosed based on the finding of pathologic central cores (central core disease; CCD) on muscle biopsy, which represent areas that lack oxidative enzymes and mitochondrial activity in type 1 muscle fibers. However, additional pathologic findings may also be observed, including cores and rods, central nuclei, fiber type disproportion, multiminicores, and uniform type 1 fibers. These histopathologic features are not always specific to RYR1 myopathy and often change over time (Quinlivan et al., 2003; Jungbluth et al., 2007; Klein et al., 2012; Ogasawara and Nishino, 2021). Some patients with RYR1 mutations have pathologic findings on muscle biopsy, but are clinically asymptomatic (Shuaib et al., 1987; Quane et al., 1993). Rare patients with a more severe phenotype have been found to carry a heterozygous mutation in the RYR1 gene inherited from an unaffected parent. However, in these cases, there is a possibility of recessive inheritance (CMYP1B; 255320) with either a missed second RYR1 mutation in trans or a genomic rearrangement on the other allele that is undetectable on routine genomic sequencing, since the RYR1 gene is very large and genetic analysis may be difficult (Klein et al., 2012). Genetic Heterogeneity of Congenital Myopathy See also CMYP1B (255320), caused by mutation in the RYR1 gene (180901) on chromosome 19q13; CMYP2A (161800), CMYP2B (620265), and CMYP2C (620278), caused by mutation in the ACTA1 gene (102610) on chromosome 1q42; CMYP3 (602771), caused by mutation in the SELENON gene (606210) on chromosome 1p36; CMYP4A (255310) and CMYP4B (609284), caused by mutation in the TPM3 gene (191030) on chromosome 1q21; CMYP5 (611705), caused by mutation in the TTN gene (188840) on chromosome 2q31; CMYP6 (605637), caused by mutation in the MYH2 gene (160740) on chromosome 17p13; CMYP7A (608358) and CMYP7B (255160), caused by mutation in the MYH7 gene (160760) on chromosome 14q11; CMYP8 (618654), caused by mutation in the ACTN2 gene (102573) on chromosome 1q43; CMYP9A (618822) and CMYP9B (618823), caused by mutation in the FXR1 gene (600819) on chromosome 3q28; CMYP10A (614399) and CMYP10B (620249), caused by mutation in the MEGF10 gene (612453) on chromosome 5q23; CMYP11 (619967), caused by mutation in the HACD1 gene (610467) on chromosome 10p12; CMYP12 (612540), caused by mutation in the CNTN1 gene (600016) on chromosome 12q12; CMYP13 (255995), caused by mutation in the STAC3 gene (615521) on chromosome 12q13; CMYP14 (618414), caused by mutation in the MYL1 gene (160780) on chromosome 2q34; CMYP15 (620161), caused by mutation in the TNNC2 gene (191039) on chromosome 20q13; CMYP16 (618524), caused by mutation in the MYBPC1 gene (160794) on chromosome 12q23; CMYP17 (618975), caused by mutation in the MYOD1 gene (159970) on chromosome 11p15; CMYP18 (620246), caused by mutation in the CACNA1S gene (114208) on chromosome 1q32; CMYP19 (618578), caused by mutation in the PAX7 gene (167410) on chromosome 1p36; CMYP20 (620310), caused by mutation in the RYR3 gene (180903) on chromosome 15q13; CMYP21 (620326), caused by mutation in the DNAJB4 gene (611327) on chromosome 1p31; CMYP22A (620351) and CMYP22B (620369), both caused by mutation in the SCN4A gene (603967) on chromosome 17q23; CMYP23 (609285), caused by mutation in the TPM2 gene (190990) on chromosome 9p13; and CMYP24 (617336), caused by mutation in the MYPN gene (608517) on chromosome 10q21. [from OMIM]

Clinical features

From HPO
Pes planus
MedGen UID:
42034
Concept ID:
C0016202
Anatomical Abnormality
A foot where the longitudinal arch of the foot is in contact with the ground or floor when the individual is standing; or, in a patient lying supine, a foot where the arch is in contact with the surface of a flat board pressed against the sole of the foot by the examiner with a pressure similar to that expected from weight bearing; or, the height of the arch is reduced.
Talipes
MedGen UID:
220976
Concept ID:
C1301937
Congenital Abnormality
A deformity of foot and ankle that has different subtypes that are talipes equinovarus, talipes equinovalgus, talipes calcaneovarus and talipes calcaneovalgus.
Ankle flexion contracture
MedGen UID:
332440
Concept ID:
C1837407
Anatomical Abnormality
Feeding difficulties
MedGen UID:
65429
Concept ID:
C0232466
Finding
Impaired ability to eat related to problems gathering food and getting ready to suck, chew, or swallow it.
Delayed ability to walk
MedGen UID:
66034
Concept ID:
C0241726
Finding
A failure to achieve the ability to walk at an appropriate developmental stage. Most children learn to walk in a series of stages, and learn to walk short distances independently between 12 and 15 months.
Hyporeflexia
MedGen UID:
195967
Concept ID:
C0700078
Finding
Reduction of neurologic reflexes such as the knee-jerk reaction.
Motor delay
MedGen UID:
381392
Concept ID:
C1854301
Finding
A type of Developmental delay characterized by a delay in acquiring motor skills.
Congenital hip dislocation
MedGen UID:
9258
Concept ID:
C0019555
Disease or Syndrome
Scoliosis
MedGen UID:
11348
Concept ID:
C0036439
Disease or Syndrome
The presence of an abnormal lateral curvature of the spine.
Muscle weakness
MedGen UID:
57735
Concept ID:
C0151786
Finding
Reduced strength of muscles.
Weakness of facial musculature
MedGen UID:
98103
Concept ID:
C0427055
Disease or Syndrome
Reduced strength of one or more muscles innervated by the facial nerve (the seventh cranial nerve).
Muscular atrophy
MedGen UID:
892680
Concept ID:
C0541794
Pathologic Function
The presence of skeletal muscular atrophy (which is also known as amyotrophy).
Generalized muscle weakness
MedGen UID:
155433
Concept ID:
C0746674
Sign or Symptom
Generalized weakness or decreased strength of the muscles, affecting both distal and proximal musculature.
Centrally nucleated skeletal muscle fibers
MedGen UID:
330782
Concept ID:
C1842170
Finding
An abnormality in which the nuclei of sarcomeres take on an abnormally central localization (or in which this feature is found in an increased proportion of muscle cells).
Increased variability in muscle fiber diameter
MedGen UID:
336019
Concept ID:
C1843700
Finding
An abnormally high degree of muscle fiber size variation. This phenotypic feature can be observed upon muscle biopsy.
Type 1 muscle fiber predominance
MedGen UID:
344274
Concept ID:
C1854387
Finding
An abnormal predominance of type I muscle fibers (in general, this feature can only be observed on muscle biopsy).
Neonatal hypotonia
MedGen UID:
412209
Concept ID:
C2267233
Disease or Syndrome
Muscular hypotonia (abnormally low muscle tone) manifesting in the neonatal period.
Nemaline bodies
MedGen UID:
814369
Concept ID:
C3808039
Finding
Nemaline rods are abnormal bodies that can occur in skeletal muscle fibers. The rods can be observed on histological analysis of muscle biopsy tissue or upon electron microscopy, where they appear either as extensions of sarcomeric Z-lines, in random array without obvious attachment to Z-lines (often in areas devoid of sarcomeres) or in large clusters localized at the sarcolemma or intermyofibrillar spaces.
Central core regions in muscle fibers
MedGen UID:
868176
Concept ID:
C4022568
Finding
The presence of disorganized areas called cores in the center of muscle fibers. There is a typical appearance of the biopsy on light microscopy, where the muscle cells have cores that are devoid of mitochondria and specific enzymes. Cores are typically well demarcated and centrally located, but may occasionally be multiple and of eccentric.
Malignant hyperthermia
MedGen UID:
1830388
Concept ID:
C5779784
Pathologic Function
Malignant hyperthermia is characterized by a rapid increase in temperature to 39-42 degrees C. Malignant hyperthermia may occur in response to either inhalational anesthetics such as halothane, to muscle relaxants such as succinylcholine, or to exercise.

Professional guidelines

PubMed

Murayama T, Kurebayashi N, Ogawa H, Yamazawa T, Oyamada H, Suzuki J, Kanemaru K, Oguchi K, Iino M, Sakurai T
Hum Mutat 2016 Nov;37(11):1231-1241. Epub 2016 Sep 19 doi: 10.1002/humu.23072. PMID: 27586648
Amburgey K, Bailey A, Hwang JH, Tarnopolsky MA, Bonnemann CG, Medne L, Mathews KD, Collins J, Daube JR, Wellman GP, Callaghan B, Clarke NF, Dowling JJ
Orphanet J Rare Dis 2013 Aug 6;8:117. doi: 10.1186/1750-1172-8-117. PMID: 23919265Free PMC Article
Voermans NC, Bonnemann CG, Hamel BC, Jungbluth H, van Engelen BG
J Neurol 2009 Jan;256(1):13-27. Epub 2009 Feb 9 doi: 10.1007/s00415-009-0105-1. PMID: 19221853

Curated

Lillis S, Abbs S, Ferreiro A, Muntoni F, Jungbluth H
Eur J Hum Genet 2012 Feb;20(2) Epub 2011 Oct 19 doi: 10.1038/ejhg.2011.180. PMID: 22009146Free PMC Article
Lillis S, Abbs S, Mueller CR, Muntoni F, Jungbluth H
Eur J Hum Genet 2012 Feb;20(2) Epub 2011 Oct 12 doi: 10.1038/ejhg.2011.179. PMID: 21989361Free PMC Article

Recent clinical studies

Etiology

Topaloglu H
Acta Myol 2020 Dec;39(4):266-273. Epub 2020 Dec 1 doi: 10.36185/2532-1900-029. PMID: 33458581Free PMC Article
D'Amico A, Bertini E
Curr Neurol Neurosci Rep 2008 Jan;8(1):73-9. doi: 10.1007/s11910-008-0012-3. PMID: 18367042
Jungbluth H
Orphanet J Rare Dis 2007 Jul 13;2:31. doi: 10.1186/1750-1172-2-31. PMID: 17631035Free PMC Article
Rosenberg H, Davis M, James D, Pollock N, Stowell K
Orphanet J Rare Dis 2007 Apr 24;2:21. doi: 10.1186/1750-1172-2-21. PMID: 17456235Free PMC Article
Bruno C, Minetti C
Curr Neurol Neurosci Rep 2004 Jan;4(1):68-73. doi: 10.1007/s11910-004-0015-7. PMID: 14683632

Diagnosis

Ogasawara M, Nishino I
Neuromuscul Disord 2021 Oct;31(10):968-977. Epub 2021 Sep 17 doi: 10.1016/j.nmd.2021.08.015. PMID: 34627702
Jungbluth H, Sewry CA, Muntoni F
Semin Pediatr Neurol 2011 Dec;18(4):239-49. doi: 10.1016/j.spen.2011.10.005. PMID: 22172419
D'Amico A, Bertini E
Curr Neurol Neurosci Rep 2008 Jan;8(1):73-9. doi: 10.1007/s11910-008-0012-3. PMID: 18367042
Jungbluth H
Orphanet J Rare Dis 2007 May 15;2:25. doi: 10.1186/1750-1172-2-25. PMID: 17504518Free PMC Article
Robinson R, Carpenter D, Shaw MA, Halsall J, Hopkins P
Hum Mutat 2006 Oct;27(10):977-89. doi: 10.1002/humu.20356. PMID: 16917943

Therapy

Zullo A, Perrotta G, D'Angelo R, Ruggiero L, Gravino E, Del Vecchio L, Santoro L, Salvatore F, Carsana A
Biomed Res Int 2019;2019:7638946. Epub 2019 Apr 21 doi: 10.1155/2019/7638946. PMID: 31165076Free PMC Article
Brislin RP, Theroux MC
Paediatr Anaesth 2013 Sep;23(9):834-41. Epub 2013 Apr 25 doi: 10.1111/pan.12175. PMID: 23617272
Klingler W, Rueffert H, Lehmann-Horn F, Girard T, Hopkins PM
Anesth Analg 2009 Oct;109(4):1167-73. doi: 10.1213/ANE.0b013e3181b5ae2d. PMID: 19762745
Rosenberg H, Davis M, James D, Pollock N, Stowell K
Orphanet J Rare Dis 2007 Apr 24;2:21. doi: 10.1186/1750-1172-2-21. PMID: 17456235Free PMC Article
Messina S, Hartley L, Main M, Kinali M, Jungbluth H, Muntoni F, Mercuri E
Neuropediatrics 2004 Oct;35(5):262-6. doi: 10.1055/s-2004-821173. PMID: 15534757

Prognosis

Bodkin C, Comer A, Felker M, Gutmann L, Jones KA, Kincaid J, Payne KK, Skinner B
Semin Neurol 2022 Dec;42(6):716-722. Epub 2022 Nov 23 doi: 10.1055/a-1985-0230. PMID: 36417990
Duarte ST, Oliveira J, Santos R, Pereira P, Barroso C, Conceição I, Evangelista T
Muscle Nerve 2011 Jul;44(1):102-8. doi: 10.1002/mus.22009. PMID: 21674524
Jungbluth H
Orphanet J Rare Dis 2007 Jul 13;2:31. doi: 10.1186/1750-1172-2-31. PMID: 17631035Free PMC Article
Jungbluth H
Orphanet J Rare Dis 2007 May 15;2:25. doi: 10.1186/1750-1172-2-25. PMID: 17504518Free PMC Article
Gulati S, Salhotra A, Sharma MC, Sarkar C, Kalra V
Indian J Pediatr 2004 Nov;71(11):1021-4. doi: 10.1007/BF02828119. PMID: 15572824

Clinical prediction guides

Fusto A, Cassandrini D, Fiorillo C, Codemo V, Astrea G, D'Amico A, Maggi L, Magri F, Pane M, Tasca G, Sabbatini D, Bello L, Battini R, Bernasconi P, Fattori F, Bertini ES, Comi G, Messina S, Mongini T, Moroni I, Panicucci C, Berardinelli A, Donati A, Nigro V, Pini A, Giannotta M, Dosi C, Ricci E, Mercuri E, Minervini G, Tosatto S, Santorelli F, Bruno C, Pegoraro E
Acta Neuropathol Commun 2022 Apr 15;10(1):54. doi: 10.1186/s40478-022-01357-0. PMID: 35428369Free PMC Article
Lawal TA, Patankar A, Todd JJ, Razaqyar MS, Chrismer IC, Zhang X, Waite MR, Jain MS, Emile-Backer M, Witherspoon JW, Liu CY, Grunseich C, Meilleur KG
J Neuromuscul Dis 2021;8(4):657-668. doi: 10.3233/JND-200549. PMID: 33646171Free PMC Article
Witherspoon JW, Vuillerot C, Vasavada RP, Waite MR, Shelton M, Chrismer IC, Jain MS, Meilleur KG
Muscle Nerve 2019 Jul;60(1):80-87. doi: 10.1002/mus.26491. PMID: 31004442Free PMC Article
Vainzof M, Ayub-Guerrieri D, Onofre PC, Martins PC, Lopes VF, Zilberztajn D, Maia LS, Sell K, Yamamoto LU
J Mol Neurosci 2008 Mar;34(3):241-8. Epub 2008 Jan 18 doi: 10.1007/s12031-007-9023-9. PMID: 18202836
Messina S, Hartley L, Main M, Kinali M, Jungbluth H, Muntoni F, Mercuri E
Neuropediatrics 2004 Oct;35(5):262-6. doi: 10.1055/s-2004-821173. PMID: 15534757

Supplemental Content

Table of contents

    Clinical resources

    Practice guidelines

    • PubMed
      See practice and clinical guidelines in PubMed. The search results may include broader topics and may not capture all published guidelines. See the FAQ for details.
    • Bookshelf
      See practice and clinical guidelines in NCBI Bookshelf. The search results may include broader topics and may not capture all published guidelines. See the FAQ for details.

    Curated

    Recent activity

    Your browsing activity is empty.

    Activity recording is turned off.

    Turn recording back on

    See more...