Skip to main content

Facioscapulohumeral Muscular Dystrophy

  • Chapter
  • First Online:
Principles and Practice of the Muscular Dystrophies

Part of the book series: Current Clinical Neurology ((CCNEU))

Abstract

Facioscapulohumeral muscular dystrophy is the most prevalent dominantly-inherited muscular dystrophy after myotonic dystrophy. The most distinctive clinical features are the characteristic facial weakness and scapular winging. Whereas the pattern of muscle involvement is similar in many patients, the age at onset, rate of progression and overall disease severity is very variable. Symptomatic extra-muscular manifestations such as retinal exudative retinopathy or hearing loss are rare and limited to severely affected, infantile onset disease. The genetic cause of this dystrophy in the majority of cases is the epigenetic activation of the DUX4 gene, a gene normally only expressed in early development but not in somatic cells. The ectopic expression of DUX4, a transcription factor, in myofibers results in the activation of a number of deleterious mechanisms resulting in muscle weakness. No approved targeted treatment exists for facioscapulohumeral muscular dystrophy. However, the underlying disease mechanism is amenable to treatment using targeted antisense oligonucleotides, an approach being actively pursued by several pharmaceutical companies.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Duchenne G. Album de photographies pathologiques complementaire de liver intule de l’electrisation localisee. Paris: JB Bailliere; 1862.

    Google Scholar 

  2. Landouzy LDJ. De la myopathie atrophique progressive. Rev Med Franc. 1885;5:81–253.

    Google Scholar 

  3. Tyler FH, Stephens FE. Studies in disorders of muscle. II clinical manifestations and inheritance of facioscapulohumeral dystrophy in a large family. Ann Intern Med. 1950;32(4):640–60.

    Article  CAS  PubMed  Google Scholar 

  4. Padberg G. Facioscapulohumeral disease. Leiden: University of Leiden; 1982.

    Google Scholar 

  5. Wijmenga C, Frants RR, Brouwer OF, Moerer P, Weber JL, Padberg GW. Location of facioscapulohumeral muscular dystrophy gene on chromosome 4. Lancet. 1990;336(8716):651–3.

    Article  CAS  PubMed  Google Scholar 

  6. Lemmers RJ, van der Vliet PJ, Klooster R, Sacconi S, Camano P, Dauwerse JG, et al. A unifying genetic model for facioscapulohumeral muscular dystrophy. Science. 2010;329(5999):1650–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Deenen JC, Arnts H, van der Maarel SM, Padberg GW, Verschuuren JJ, Bakker E, et al. Population-based incidence and prevalence of facioscapulohumeral dystrophy. Neurology. 2014;83(12):1056–9.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Statland JM, Tawil R. Risk of functional impairment in Facioscapulohumeral muscular dystrophy. Muscle Nerve. 2014;49(4):520–7.

    Article  PubMed  Google Scholar 

  9. Goselink RJ, Schreuder TH, Mul K, Voermans NC, Pelsma M, de Groot IJ, et al. Facioscapulohumeral dystrophy in children: design of a prospective, observational study on natural history, predictors and clinical impact (iFocus FSHD). BMC Neurol. 2016;16:138.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hamel J, Johnson N, Tawil R, Martens WB, Dilek N, McDermott MP, et al. Patient-reported symptoms in Facioscapulohumeral muscular dystrophy (PRISM-FSHD). Neurology. 2019;93(12):e1180–e92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Statland JM, Shah B, Henderson D, Van Der Maarel S, Tapscott SJ, Tawil R. Muscle pathology grade for facioscapulohumeral muscular dystrophy biopsies. Muscle Nerve. 2015;52(4):521–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Padberg GW, van Engelen BG. Facioscapulohumeral muscular dystrophy. Curr Opin Neurol. 2009;22(5):539–42.

    Article  PubMed  Google Scholar 

  13. Moreira S, Wood L, Smith D, Marini-Bettolo C, Guglieri M, McMacken G, et al. Respiratory involvement in ambulant and non-ambulant patients with facioscapulohumeral muscular dystrophy. J Neurol. 2017;264(6):1271–80.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wohlgemuth M, Horlings CGC, van der Kooi EL, Gilhuis HJ, Hendriks JCM, van der Maarel SM, et al. Respiratory function in facioscapulohumeral muscular dystrophy 1. Neuromuscul Disord. 2017;27(6):526–30.

    Article  CAS  PubMed  Google Scholar 

  15. Runte M, Spiesshoefer J, Heidbreder A, Dreher M, Young P, Brix T, et al. Sleep-related breathing disorders in facioscapulohumeral dystrophy. Sleep Breath. 2019;23(3):899–906.

    Article  PubMed  Google Scholar 

  16. van der Kooi EL, Kalkman JS, Lindeman E, Hendriks JC, van Engelen BG, Bleijenberg G, et al. Effects of training and albuterol on pain and fatigue in facioscapulohumeral muscular dystrophy. J Neurol. 2007;254(7):931–40.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Statland JM, Sacconi S, Farmakidis C, Donlin-Smith CM, Chung M, Tawil R. Coats syndrome in facioscapulohumeral dystrophy type 1: frequency and D4Z4 contraction size. Neurology. 2013;80(13):1247–50.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Lutz KL, Holte L, Kliethermes SA, Stephan C, Mathews KD. Clinical and genetic features of hearing loss in facioscapulohumeral muscular dystrophy. Neurology. 2013;81(16):1374–7.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Labombarda F, Maurice M, Simon JP, Legallois D, Guyant-Marechal L, Bedat-Millet AL, et al. Cardiac abnormalities in type 1 Facioscapulohumeral muscular dystrophy. J Clin Neuromuscul Dis. 2017;18(4):199–206.

    Article  PubMed  Google Scholar 

  20. van der Kooi AJ, Visser MC, Rosenberg N, van den Berg-Vos R, Wokke JH, Bakker E, et al. Extension of the clinical range of facioscapulohumeral dystrophy: report of six cases. J Neurol Neurosurg Psychiatry. 2000;69(1):114–6.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Wang LH, Friedman SD, Shaw D, Snider L, Wong CJ, Budech CB, et al. MRI-informed muscle biopsies correlate MRI with pathology and DUX4 target gene expression in FSHD. Hum Mol Genet. 2019;28(3):476–86.

    Article  PubMed  Google Scholar 

  22. Wang LH, Shaw DWW, Faino A, Budech CB, Lewis LM, Statland J, et al. Longitudinal study of MRI and functional outcome measures in facioscapulohumeral muscular dystrophy. BMC Musculoskelet Disord. 2021;22(1):262.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Monforte M, Laschena F, Ottaviani P, Bagnato MR, Pichiecchio A, Tasca G, et al. Tracking muscle wasting and disease activity in facioscapulohumeral muscular dystrophy by qualitative longitudinal imaging. J Cachexia Sarcopenia Muscle. 2019;10(6):1258–65.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Mul K, Vincenten SCC, Voermans NC, Lemmers R, van der Vliet PJ, van der Maarel SM, et al. Adding quantitative muscle MRI to the FSHD clinical trial toolbox. Neurology. 2017;89(20):2057–65.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Friedman SD, Poliachik SL, Otto RK, Carter GT, Budech CB, Bird TD, et al. Longitudinal features of STIR bright signal in FSHD. Muscle Nerve. 2014;49(2):257–60.

    Article  CAS  PubMed  Google Scholar 

  26. Ghosh PS, Milone M. Camptocormia as presenting manifestation of a spectrum of myopathic disorders. Muscle Nerve. 2015;52(6):1008–12.

    Article  PubMed  Google Scholar 

  27. Jordan B, Eger K, Koesling S, Zierz S. Camptocormia phenotype of FSHD: a clinical and MRI study on six patients. J Neurol. 2011;258(5):866–73.

    Article  PubMed  Google Scholar 

  28. Dumbovic G, Forcales SV, Perucho M. Emerging roles of macrosatellite repeats in genome organization and disease development. Epigenetics. 2017;12(7):515–26.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Lemmers RJ, Tawil R, Petek LM, Balog J, Block GJ, Santen GW, et al. Digenic inheritance of an SMCHD1 mutation and an FSHD-permissive D4Z4 allele causes facioscapulohumeral muscular dystrophy type 2. Nat Genet. 2012;44(12):1370–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Mason AG, Slieker RC, Balog J, Lemmers R, Wong CJ, Yao Z, et al. SMCHD1 regulates a limited set of gene clusters on autosomal chromosomes. Skelet Muscle. 2017;7(1):12.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Hamanaka K, Sikrova D, Mitsuhashi S, Masuda H, Sekiguchi Y, Sugiyama A, et al. Homozygous nonsense variant in LRIF1 associated with facioscapulohumeral muscular dystrophy. Neurology. 2020;94(23):e2441–e7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. van den Boogaard ML, Lemmers R, Balog J, Wohlgemuth M, Auranen M, Mitsuhashi S, et al. Mutations in DNMT3B modify epigenetic repression of the D4Z4 repeat and the penetrance of Facioscapulohumeral dystrophy. Am J Hum Genet. 2016;98(5):1020–9.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Rickard AM, Petek LM, Miller DG. Endogenous DUX4 expression in FSHD myotubes is sufficient to cause cell death and disrupts RNA splicing and cell migration pathways. Hum Mol Genet. 2015;24(20):5901–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Geng LN, Yao Z, Snider L, Fong AP, Cech JN, Young JM, et al. DUX4 activates germline genes, retroelements, and immune mediators: implications for facioscapulohumeral dystrophy. Dev Cell. 2012;22(1):38–51.

    Article  CAS  PubMed  Google Scholar 

  35. Knopp P, Krom YD, Banerji CR, Panamarova M, Moyle LA, den Hamer B, et al. DUX4 induces a transcriptome more characteristic of a less-differentiated cell state and inhibits myogenesis. J Cell Sci. 2016;129(20):3816–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Yao Z, Snider L, Balog J, Lemmers RJ, Van Der Maarel SM, Tawil R, et al. DUX4-induced gene expression is the major molecular signature in FSHD skeletal muscle. Hum Mol Genet. 2014;23(20):5342–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Tawil R, Kissel JT, Heatwole C, Pandya S, Gronseth G, Benatar M, et al. Evidence-based guideline summary: evaluation, diagnosis, and management of facioscapulohumeral muscular dystrophy: report of the guideline development, dissemination, and implementation Subcommittee of the American Academy of neurology and the practice issues review panel of the American Association of Neuromuscular & Electrodiagnostic medicine. Neurology. 2015;85(4):357–64.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Dai Y, Li P, Wang Z, Liang F, Yang F, Fang L, et al. Single-molecule optical mapping enables quantitative measurement of D4Z4 repeats in facioscapulohumeral muscular dystrophy (FSHD). J Med Genet. 2020;57(2):109–20.

    Article  CAS  PubMed  Google Scholar 

  39. Sharim H, Grunwald A, Gabrieli T, Michaeli Y, Margalit S, Torchinsky D, et al. Long-read single-molecule maps of the functional methylome. Genome Res. 2019;29(4):646–56.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Tawil R, McDermott MP, Pandya S, King W, Kissel J, Mendell JR, et al. A pilot trial of prednisone in facioscapulohumeral muscular dystrophy. FSH-DY Group Neurology. 1997;48(1):46–9.

    CAS  PubMed  Google Scholar 

  41. Mellion ML, Ronco L, Berends CL, Pagan L, Brooks S, van Esdonk MJ, et al. Phase 1 clinical trial of losmapimod in facioscapulohumeral dystrophy: safety, tolerability, pharmacokinetics, and target engagement. Br J Clin Pharmacol. 2021;87:4658–69.

    Article  CAS  PubMed  Google Scholar 

  42. Tawil R. Statland J, Wang L, et al. A Phase 2, Randomized, Double-Blind, Placebo-Controlled, 48 week study of the efficacy and safety of Losmapimod in subjects with FSHD:ReDUX4 (S23.007) Neurology. 2022;98(18 Supplement):2824.

    Google Scholar 

  43. van der Kooi EL, Vogels OJ, van Asseldonk RJ, Lindeman E, Hendriks JC, Wohlgemuth M, et al. Strength training and albuterol in facioscapulohumeral muscular dystrophy. Neurology. 2004;63(4):702–8.

    Article  PubMed  Google Scholar 

  44. Olsen DB, Orngreen MC, Vissing J. Aerobic training improves exercise performance in facioscapulohumeral muscular dystrophy. Neurology. 2005;64(6):1064–6.

    Article  PubMed  Google Scholar 

  45. Voet N, Bleijenberg G, Hendriks J, de Groot I, Padberg G, van Engelen B, et al. Both aerobic exercise and cognitive-behavioral therapy reduce chronic fatigue in FSHD: an RCT. Neurology. 2014;83(21):1914–22.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Johanna Hamel .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Hamel, J., Tawil, R. (2023). Facioscapulohumeral Muscular Dystrophy. In: Narayanaswami, P., Liewluck, T. (eds) Principles and Practice of the Muscular Dystrophies. Current Clinical Neurology. Humana, Cham. https://doi.org/10.1007/978-3-031-44009-0_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-44009-0_4

  • Published:

  • Publisher Name: Humana, Cham

  • Print ISBN: 978-3-031-44008-3

  • Online ISBN: 978-3-031-44009-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics