Central core disease

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Central core disease
Synonyms	Central core myopathy
Pronounce
Specialty	Neurology, Genetics
Symptoms	Muscle weakness, Hypotonia, Delayed motor development
Complications	N/A
Onset	Infancy or early childhood
Duration	Lifelong
Types	N/A
Causes	Mutations in the RYR1 gene
Risks
Diagnosis	Muscle biopsy, Genetic testing
Differential diagnosis	Other congenital myopathies
Prevention	N/A
Treatment	Physical therapy, Occupational therapy, Orthopedic surgery
Medication
Prognosis	Variable, generally stable
Frequency	Rare
Deaths

A congenital myopathy characterized by muscle weakness

Central core disease (CCD) is a rare congenital myopathy that primarily affects skeletal muscles, leading to muscle weakness and other associated symptoms. It is named for the characteristic appearance of "cores" or areas of disorganized structure within the muscle fibers, which can be observed under a microscope.

Presentation

Individuals with central core disease typically present with muscle weakness that is most pronounced in the proximal muscles of the body, such as those in the hips, thighs, and shoulders. This weakness can lead to difficulties with motor skills such as walking, running, and climbing stairs. In some cases, affected individuals may also experience hypotonia, or decreased muscle tone, which can contribute to delayed motor development in infants and young children.

Genetics

Central core disease is most commonly inherited in an autosomal dominant pattern, meaning that a single copy of the altered gene in each cell is sufficient to cause the disorder. The condition is often associated with mutations in the RYR1 gene, which encodes the ryanodine receptor 1, a protein that plays a critical role in calcium ion release from the sarcoplasmic reticulum in muscle cells. This release is essential for muscle contraction.

Pathophysiology

The "cores" seen in muscle biopsies of individuals with central core disease are areas where the normal structure of the muscle fiber is disrupted. These cores lack mitochondria and other essential components, leading to impaired muscle function. The exact mechanism by which RYR1 mutations lead to core formation is not fully understood, but it is believed to involve abnormal calcium handling within the muscle cells.

Diagnosis

Diagnosis of central core disease is typically based on a combination of clinical evaluation, muscle biopsy, and genetic testing. Muscle biopsy reveals the characteristic central cores, while genetic testing can identify mutations in the RYR1 gene. Electromyography (EMG) and other tests may also be used to assess muscle function.

Management

There is currently no cure for central core disease, and treatment is primarily supportive. Physical therapy and occupational therapy can help improve muscle strength and function, while orthopedic interventions may be necessary to address skeletal abnormalities. Individuals with central core disease should be monitored for potential complications, such as malignant hyperthermia, a life-threatening reaction to certain anesthetics.

Prognosis

The prognosis for individuals with central core disease varies widely. Some individuals experience only mild muscle weakness and lead relatively normal lives, while others may have more significant impairments. The risk of malignant hyperthermia is a serious concern and requires careful management during surgical procedures.

See also

• Congenital myopathy
• RYR1 gene
• Malignant hyperthermia
• Muscle biopsy