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Entry
- #600334 - TIBIAL MUSCULAR DYSTROPHY, TARDIVE; TMD
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<span class="h4">#600334</span>
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<a href="#phenotypeMap"><strong>Phenotype-Gene Relationships</strong></a>
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<a href="/clinicalSynopsis/600334"><strong>Clinical Synopsis</strong></a>
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<a href="#clinicalFeatures">Clinical Features</a>
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<a href="#mapping">Mapping</a>
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<a href="#heterogeneity">Heterogeneity</a>
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<a href="#molecularGenetics">Molecular Genetics</a>
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<a href="#references"><strong>References</strong></a>
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<a href="#contributors"><strong>Contributors</strong></a>
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<a href="#creationDate"><strong>Creation Date</strong></a>
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<div><a href="https://clinicaltrials.gov/search?cond=TIBIAL MUSCULAR DYSTROPHY, TARDIVE" class="mim-tip-hint" title="A registry of federally and privately supported clinical trials conducted in the United States and around the world." target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'Clinical Trials', 'domain': 'clinicaltrials.gov'})">Clinical Trials</a></div>
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<a href="#" class="mim-tip-icd" qtip_title="<strong>ICD+</strong>" qtip_text="
<strong>SNOMEDCT:</strong> 698846009<br />
<strong>ORPHA:</strong> 609<br />
<strong>DO:</strong> 0111078<br />
">ICD+</a>
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<span class="mim-font mim-tip-hint" title="Phenotype description, molecular basis known">
<span class="text-danger"><strong>#</strong></span>
600334
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<h3>
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TIBIAL MUSCULAR DYSTROPHY, TARDIVE; TMD
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<em>Alternative titles; symbols</em>
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<h4>
<span class="mim-font">
TARDIVE TIBIAL MUSCULAR DYSTROPHY<br />
UDD MYOPATHY
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<strong>Phenotype-Gene Relationships</strong>
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Location
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Phenotype
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Phenotype <br /> MIM number
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Inheritance
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Phenotype <br /> mapping key
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Gene/Locus
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Gene/Locus <br /> MIM number
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<td>
<span class="mim-font">
<a href="/geneMap/2/823?start=-3&limit=10&highlight=823">
2q31.2
</a>
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<td>
<span class="mim-font">
Tibial muscular dystrophy, tardive
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<td>
<span class="mim-font">
<a href="/entry/600334"> 600334 </a>
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<td>
<span class="mim-font">
<abbr class="mim-tip-hint" title="Autosomal dominant">AD</abbr>
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<span class="mim-font">
<abbr class="mim-tip-hint" title="3 - The molecular basis of the disorder is known"> 3 </abbr>
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<span class="mim-font">
TTN
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<span class="mim-font">
<a href="/entry/188840"> 188840 </a>
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<span class="glyphicon glyphicon-question-sign mim-tip-hint" title="OMIM PheneGene graphics depict relationships between phenotypes, groups of related phenotypes (Phenotypic Series), and genes.<br /><a href='/static/omim/pdf/OMIM_Graphics.pdf' target='_blank'>A quick reference overview and guide (PDF)</a>"></span>
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<span class="h5 mim-font">
<strong> INHERITANCE </strong>
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<div style="margin-left: 2em;">
<div>
<span class="mim-font">
- Autosomal dominant <span class="mim-feature-ids hidden">[SNOMEDCT: <a href="https://purl.bioontology.org/ontology/SNOMEDCT/263681008" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'SNOMEDCT\', \'domain\': \'bioontology.org\'})">263681008</a>, <a href="https://purl.bioontology.org/ontology/SNOMEDCT/771269000" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'SNOMEDCT\', \'domain\': \'bioontology.org\'})">771269000</a>]</span> <span class="mim-feature-ids hidden">[UMLS: <a href="https://bioportal.bioontology.org/search?q=C0443147&searchproperties=true" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'UMLS\', \'domain\': \'bioontology.org\'})">C0443147</a>, <a href="https://bioportal.bioontology.org/search?q=C1867440&searchproperties=true" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'UMLS\', \'domain\': \'bioontology.org\'})">C1867440</a> HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0000006" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0000006</a>]</span> <span class="mim-feature-ids hidden">[HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0000006" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0000006</a>]</span><br />
</span>
</div>
</div>
</div>
<div>
<div>
<span class="h5 mim-font">
<strong> MUSCLE, SOFT TISSUES </strong>
</span>
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<div style="margin-left: 2em;">
<div>
<span class="mim-font">
- Weakness of the muscles in the anterior compartment of the lower leg (particularly the tibialis anterior muscle) <span class="mim-feature-ids hidden">[UMLS: <a href="https://bioportal.bioontology.org/search?q=C1838245&searchproperties=true" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'UMLS\', \'domain\': \'bioontology.org\'})">C1838245</a>]</span><br /> -
Atrophy of the muscles in the anterior compartment of the lower leg <span class="mim-feature-ids hidden">[UMLS: <a href="https://bioportal.bioontology.org/search?q=C1838246&searchproperties=true" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'UMLS\', \'domain\': \'bioontology.org\'})">C1838246</a>]</span><br /> -
'Steppage' gait <span class="mim-feature-ids hidden">[SNOMEDCT: <a href="https://purl.bioontology.org/ontology/SNOMEDCT/27253007" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'SNOMEDCT\', \'domain\': \'bioontology.org\'})">27253007</a>]</span> <span class="mim-feature-ids hidden">[UMLS: <a href="https://bioportal.bioontology.org/search?q=C0427149&searchproperties=true" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'UMLS\', \'domain\': \'bioontology.org\'})">C0427149</a> HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0003376" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0003376</a>]</span><br /> -
Reduced ankle dorsiflexion <span class="mim-feature-ids hidden">[UMLS: <a href="https://bioportal.bioontology.org/search?q=C1838247&searchproperties=true" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'UMLS\', \'domain\': \'bioontology.org\'})">C1838247</a>]</span><br /> -
Replacement of affected muscle tissue with fatty tissue <span class="mim-feature-ids hidden">[UMLS: <a href="https://bioportal.bioontology.org/search?q=C1838248&searchproperties=true" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'UMLS\', \'domain\': \'bioontology.org\'})">C1838248</a>]</span><br /> -
Biopsy shows rimmed vacuoles, central nuclei, and variation in fiber size <span class="mim-feature-ids hidden">[UMLS: <a href="https://bioportal.bioontology.org/search?q=C1838249&searchproperties=true" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'UMLS\', \'domain\': \'bioontology.org\'})">C1838249</a>]</span><br /> -
Myopathy seen on EMG <span class="mim-feature-ids hidden">[UMLS: <a href="https://bioportal.bioontology.org/search?q=C4230767&searchproperties=true" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'UMLS\', \'domain\': \'bioontology.org\'})">C4230767</a>]</span> <span class="mim-feature-ids hidden">[SNOMEDCT: <a href="https://purl.bioontology.org/ontology/SNOMEDCT/129565002" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'SNOMEDCT\', \'domain\': \'bioontology.org\'})">129565002</a>]</span> <span class="mim-feature-ids hidden">[ICD10CM: <a href="https://purl.bioontology.org/ontology/ICD10CM/G72.9" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'ICD10CM\', \'domain\': \'bioontology.org\'})">G72.9</a>, <a href="https://purl.bioontology.org/ontology/ICD10CM/M62.9" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'ICD10CM\', \'domain\': \'bioontology.org\'})">M62.9</a>, <a href="https://purl.bioontology.org/ontology/ICD10CM/M60-M63" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'ICD10CM\', \'domain\': \'bioontology.org\'})">M60-M63</a>]</span> <span class="mim-feature-ids hidden">[ICD9CM: <a href="https://purl.bioontology.org/ontology/ICD9CM/359.9" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'ICD9CM\', \'domain\': \'bioontology.org\'})">359.9</a>]</span> <span class="mim-feature-ids hidden">[HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0003198" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0003198</a>]</span><br />
</span>
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<div>
<span class="h5 mim-font">
<strong> MISCELLANEOUS </strong>
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<div style="margin-left: 2em;">
<div>
<span class="mim-font">
- Adult onset (after age 35 years) <span class="mim-feature-ids hidden">[UMLS: <a href="https://bioportal.bioontology.org/search?q=C1853562&searchproperties=true" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'UMLS\', \'domain\': \'bioontology.org\'})">C1853562</a> HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0003581" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0003581</a>]</span> <span class="mim-feature-ids hidden">[HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0003581" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0003581</a>]</span><br /> -
Slow progression without marked disability<br /> -
Incomplete penetrance <span class="mim-feature-ids hidden">[UMLS: <a href="https://bioportal.bioontology.org/search?q=C1836598&searchproperties=true" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'UMLS\', \'domain\': \'bioontology.org\'})">C1836598</a> HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0003829" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0003829</a>]</span> <span class="mim-feature-ids hidden">[HPO: <a href="https://hpo.jax.org/app/browse/term/HP:0003829" target="_blank" onclick="gtag(\'event\', \'mim_outbound\', {\'name\': \'HPO\', \'domain\': \'hpo.jax.org\'})">HP:0003829</a>]</span><br /> -
Cardiomyopathy is not a feature<br />
</span>
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<div>
<span class="h5 mim-font">
<strong> MOLECULAR BASIS </strong>
</span>
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<div style="margin-left: 2em;">
<div>
<span class="mim-font">
- Caused by heterozygous mutation in the titin gene (TTN, <a href="/entry/188840#0004">188840.0004</a>)<br />
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<p>A number sign (#) is used with this entry because of evidence that tibial muscular dystrophy (TMD) is caused by heterozygous mutation in the gene encoding the giant skeletal muscle protein titin (TTN; <a href="/entry/188840">188840</a>) on chromosome 2q31.</p><p>Homozygous mutation in the titin gene causes the more severe limb-girdle muscular dystrophy type 2J (LGMD2J; <a href="/entry/608807">608807</a>).</p>
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<strong>Description</strong>
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<p>Tardive tibial muscular dystrophy (TMD) is an autosomal dominant late-onset myopathy in which weakness and atrophy are usually confined to the anterior compartment of the lower leg, in particular, the tibialis anterior muscle. Onset usually occurs at ages 35 to 45 years, but can be later (summary by <a href="#3" class="mim-tip-reference" title="Hackman, P., Vihola, A., Haravuori, H., Marchand, S., Sarparanta, J., de Seze, J., Labeit, S., Witt, C., Peltonen, L., Richard, I., Udd, B. &lt;strong&gt;Tibial muscular dystrophy is a titinopathy caused by mutations in TTN, the gene encoding the giant skeletal-muscle protein titin.&lt;/strong&gt; Am. J. Hum. Genet. 71: 492-500, 2002.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/12145747/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;12145747&lt;/a&gt;, &lt;a href=&quot;https://www.ncbi.nlm.nih.gov/pmc/?term=12145747[PMID]&amp;report=imagesdocsum&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed Image&#x27;, &#x27;domain&#x27;: &#x27;ncbi.nlm.nih.gov&#x27;})&quot;&gt;images&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1086/342380&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="12145747">Hackman et al., 2002</a>). <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=12145747" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})"><span class="glyphicon glyphicon-plus-sign mim-tip-hint" title="Click this 'reference-plus' icon to see articles related to this paragraph in PubMed."></span></a></p>
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<strong>Clinical Features</strong>
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<p><a href="#13" class="mim-tip-reference" title="Udd, B. &lt;strong&gt;Limb-girdle type muscular dystrophy in a large family with distal myopathy: homozygous manifestation of a dominant gene?&lt;/strong&gt; J. Med. Genet. 29: 383-389, 1992.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/1619633/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;1619633&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1136/jmg.29.6.383&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="1619633">Udd (1992)</a> reported a large consanguineous Finnish pedigree with 2 separate muscle disease phenotypes: mild late-onset distal myopathy inherited in an autosomal dominant pattern and severe limb-girdle muscular dystrophy (see LGMD2J) inherited in an autosomal recessive pattern. Segregation analysis showed that the corrected proportion of affected persons with the severe proximal type was 0.246 and the proportion of affected persons with the distal myopathy was 0.58. The findings were compatible with the hypothesis that the severe LGMD phenotype was the homozygous manifestation of a dominant gene that in the heterozygous state caused the milder distal myopathy. <a href="#12" class="mim-tip-reference" title="Udd, B., Rapola, J., Nokelainen, P., Arikawa, E., Somer, H. &lt;strong&gt;Nonvacuolar myopathy in a large family with both late adult onset distal myopathy and severe proximal muscular dystrophy.&lt;/strong&gt; J. Neurol. Sci. 113: 214-221, 1992.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/1487757/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;1487757&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1016/0022-510x(92)90249-k&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="1487757">Udd et al. (1992)</a>, who referred to the distal myopathy as 'tibial muscular dystrophy,' reported follow-up on the large affected Finnish pedigree. <a href="https://pubmed.ncbi.nlm.nih.gov/?term=1487757+1619633" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})"><span class="glyphicon glyphicon-plus-sign mim-tip-hint" title="Click this 'reference-plus' icon to see articles related to this paragraph in PubMed."></span></a></p><p><a href="#7" class="mim-tip-reference" title="Partanen, J., Laulumaa, V., Paljarvi, L., Partanen, K., Naukkarinen, A. &lt;strong&gt;Late onset foot-drop muscular dystrophy with rimmed vacuoles.&lt;/strong&gt; J. Neurol. Sci. 125: 158-167, 1994.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/7807161/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;7807161&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1016/0022-510x(94)90029-9&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="7807161">Partanen et al. (1994)</a> studied a family with very late-onset (fifth or sixth decade) or asymptomatic hereditary myopathy of the anterior tibial muscle. The muscles of the upper extremity were spared. The anterior tibial muscles had a characteristic myopathic alteration with rimmed vacuoles. Twelve persons, both male and female, were affected, and male-to-male transmission was demonstrated. <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=7807161" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})"><span class="glyphicon glyphicon-plus-sign mim-tip-hint" title="Click this 'reference-plus' icon to see articles related to this paragraph in PubMed."></span></a></p><p><a href="#7" class="mim-tip-reference" title="Partanen, J., Laulumaa, V., Paljarvi, L., Partanen, K., Naukkarinen, A. &lt;strong&gt;Late onset foot-drop muscular dystrophy with rimmed vacuoles.&lt;/strong&gt; J. Neurol. Sci. 125: 158-167, 1994.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/7807161/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;7807161&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1016/0022-510x(94)90029-9&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="7807161">Partanen et al. (1994)</a> distinguished 6 types of distal myopathy: (1) Welander myopathy; (2) a late-onset autosomal dominant form with onset in the anterior compartment of the legs; (3) an early adult-onset recessive or sporadic form with onset in the anterior compartment of the legs with vacuolar myopathy on biopsy (<a href="#9" class="mim-tip-reference" title="Sunohara, N., Nonaka, I., Kamei, N., Satoyoshi, E. &lt;strong&gt;Distal myopathy with rimmed vacuole formation: a follow-up study.&lt;/strong&gt; Brain 112: 65-83, 1989.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/2645018/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;2645018&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1093/brain/112.1.65&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="2645018">Sunohara et al., 1989</a>); (4) an early adult-onset recessive distal myopathy of the posterior compartment of the legs (<a href="#6" class="mim-tip-reference" title="Miyoshi, K., Kawai, H., Isawa, M., Kusaka, K., Nishino, H. &lt;strong&gt;Autosomal recessive distal muscular dystrophy as a new type of progressive muscular dystrophy: seventeen cases in eight families including an autopsied case.&lt;/strong&gt; Brain 109: 31-54, 1986.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/3942856/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;3942856&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1093/brain/109.1.31&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="3942856">Miyoshi et al., 1986</a>; <a href="/entry/254130">254130</a>); (5) an autosomal recessive vacuolar myopathy sparing the quadriceps (<a href="#8" class="mim-tip-reference" title="Sadeh, M., Gadoth, N., Hadar, H., Ben-David, E. &lt;strong&gt;Vacuolar myopathy sparing the quadriceps.&lt;/strong&gt; Brain 116: 217-232, 1993.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/8453459/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;8453459&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1093/brain/116.1.217&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="8453459">Sadeh et al., 1993</a>; <a href="/entry/605820">605820</a>); and (6) a late-onset autosomal dominant tibial dystrophy as described by Udd et al. (<a href="#10" class="mim-tip-reference" title="Udd, B., Kaarianen, H., Somer, H. &lt;strong&gt;Muscular dystrophy with separate clinical phenotypes in a large family.&lt;/strong&gt; Muscle Nerve 14: 1050-1058, 1991.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/1745277/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;1745277&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1002/mus.880141103&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="1745277">1991</a>, <a href="#12" class="mim-tip-reference" title="Udd, B., Rapola, J., Nokelainen, P., Arikawa, E., Somer, H. &lt;strong&gt;Nonvacuolar myopathy in a large family with both late adult onset distal myopathy and severe proximal muscular dystrophy.&lt;/strong&gt; J. Neurol. Sci. 113: 214-221, 1992.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/1487757/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;1487757&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1016/0022-510x(92)90249-k&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="1487757">1992</a>) and <a href="#13" class="mim-tip-reference" title="Udd, B. &lt;strong&gt;Limb-girdle type muscular dystrophy in a large family with distal myopathy: homozygous manifestation of a dominant gene?&lt;/strong&gt; J. Med. Genet. 29: 383-389, 1992.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/1619633/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;1619633&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1136/jmg.29.6.383&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="1619633">Udd (1992)</a>. <a href="https://pubmed.ncbi.nlm.nih.gov/?term=1745277+1619633+8453459+3942856+7807161+1487757+2645018" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})"><span class="glyphicon glyphicon-plus-sign mim-tip-hint" title="Click this 'reference-plus' icon to see articles related to this paragraph in PubMed."></span></a></p><p><a href="#11" class="mim-tip-reference" title="Udd, B., Partanen, J., Halonen, P., Falck, B., Hakamies, L., Heikkila, H., Ingo, S., Kalimo, H., Kaariainen, H., Laulumaa, V., Paljarvi, L., Rapola, J., Reunanen, M., Sonninen, V., Somer, H. &lt;strong&gt;Tibial muscular dystrophy: late adult-onset distal myopathy in 66 Finnish patients.&lt;/strong&gt; Arch. Neurol. 50: 604-608, 1993.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/8503797/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;8503797&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1001/archneur.1993.00540060044015&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="8503797">Udd et al. (1993)</a> investigated 66 Finnish patients with late adult-onset tibial muscular dystrophy. Symptoms appeared after the age of 35 years with reduced ankle dorsiflexion, and progression was slow without marked disability. Facial muscles, upper extremities, and proximal muscles were usually spared. Pedigree data suggested autosomal dominant inheritance. The clinical studies suggested homogeneity in the various families affected with this rather frequent disorder in Finns. <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=8503797" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})"><span class="glyphicon glyphicon-plus-sign mim-tip-hint" title="Click this 'reference-plus' icon to see articles related to this paragraph in PubMed."></span></a></p><p><a href="#15" class="mim-tip-reference" title="Van den Bergh, P. Y. K., Bouquiaux, O., Verellen, C., Marchand, S., Richard, I., Hackman, P., Udd, B. &lt;strong&gt;Tibial muscular dystrophy in a Belgian family.&lt;/strong&gt; Ann. Neurol. 54: 248-251, 2003.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/12891679/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;12891679&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1002/ana.10647&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="12891679">Van den Bergh et al. (2003)</a> reported a Belgian family with tibial muscular dystrophy. The proband had onset of gait difficulties in his late 40s, and clinical examination showed steppage gait and weakness and atrophy of the anterior compartment muscles of the lower legs without proximal weakness or sensory loss. CT scan of the lower leg muscles showed marked atrophy and low density, suggestive of fatty degeneration. Family investigation revealed that the proband's father, a paternal uncle, and one of his daughters had mild tibialis anterior weakness and atrophy, although all were asymptomatic. In affected members of the family, <a href="#15" class="mim-tip-reference" title="Van den Bergh, P. Y. K., Bouquiaux, O., Verellen, C., Marchand, S., Richard, I., Hackman, P., Udd, B. &lt;strong&gt;Tibial muscular dystrophy in a Belgian family.&lt;/strong&gt; Ann. Neurol. 54: 248-251, 2003.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/12891679/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;12891679&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1002/ana.10647&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="12891679">Van den Bergh et al. (2003)</a> identified a heterozygous mutation in the Mex6 exon of the titin gene (<a href="/entry/188840#0006">188840.0006</a>). The authors noted that the family showed incomplete disease penetrance. <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=12891679" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})"><span class="glyphicon glyphicon-plus-sign mim-tip-hint" title="Click this 'reference-plus' icon to see articles related to this paragraph in PubMed."></span></a></p><p><strong><em>Pathologic Findings</em></strong></p><p>
In 12 affected members of a large Finnish pedigree with distal myopathy, <a href="#12" class="mim-tip-reference" title="Udd, B., Rapola, J., Nokelainen, P., Arikawa, E., Somer, H. &lt;strong&gt;Nonvacuolar myopathy in a large family with both late adult onset distal myopathy and severe proximal muscular dystrophy.&lt;/strong&gt; J. Neurol. Sci. 113: 214-221, 1992.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/1487757/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;1487757&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1016/0022-510x(92)90249-k&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="1487757">Udd et al. (1992)</a> found that muscle biopsy did not show vacuolar degeneration, which was in contrast to most adult-onset distal myopathies. Histopathologic changes correlating with the muscular dystrophy were extensive in tibial anterior muscles in patients with distal myopathy and in all muscles of those family members who had a severe limb-girdle muscular dystrophy phenotype. <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=1487757" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})"><span class="glyphicon glyphicon-plus-sign mim-tip-hint" title="Click this 'reference-plus' icon to see articles related to this paragraph in PubMed."></span></a></p><p>Among 66 Finnish patients with TMD, <a href="#11" class="mim-tip-reference" title="Udd, B., Partanen, J., Halonen, P., Falck, B., Hakamies, L., Heikkila, H., Ingo, S., Kalimo, H., Kaariainen, H., Laulumaa, V., Paljarvi, L., Rapola, J., Reunanen, M., Sonninen, V., Somer, H. &lt;strong&gt;Tibial muscular dystrophy: late adult-onset distal myopathy in 66 Finnish patients.&lt;/strong&gt; Arch. Neurol. 50: 604-608, 1993.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/8503797/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;8503797&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1001/archneur.1993.00540060044015&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="8503797">Udd et al. (1993)</a> found that muscle biopsies showed nonspecific dystrophic changes in clinically affected muscles and severe adipose replacement in the anterior tibial muscles. Asymptomatic muscles had mild myopathic changes only. Vacuolar degeneration was detected in a minority of patients. Electromyography showed profound myopathic changes in the anterior tibial muscle, but extensor brevis muscles were well preserved. Computed tomography or magnetic resonance imaging of muscles disclosed marked involvement of tibial extensor muscles and focal patches of fatty degeneration in various asymptomatic muscles. <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=8503797" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})"><span class="glyphicon glyphicon-plus-sign mim-tip-hint" title="Click this 'reference-plus' icon to see articles related to this paragraph in PubMed."></span></a></p><p>In tibial muscular dystrophy, some biopsies showed rimmed vacuoles and others did not. <a href="#14" class="mim-tip-reference" title="Udd, B. &lt;strong&gt;Personal Communication.&lt;/strong&gt; Vasa, Finland 10/31/1997."None>Udd (1997)</a> concluded that the presence or absence of rimmed vacuoles was not indicative of heterogeneity because there was intrafamilial variation and families with or without rimmed vacuoles were shown to be genealogically linked.</p>
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<p>In a Finnish tibial muscular dystrophy family with 11 affected individuals, Haravuori et al. (<a href="#5" class="mim-tip-reference" title="Haravuori, H., Makela-Bengs, P., Udd, B., Pulkkinen, L., Partanen, J., Somer, H., Peltonen, L. &lt;strong&gt;Assignment of the tibial muscular dystrophy (TMD) locus on chromosome 2q31. (Abstract)&lt;/strong&gt; Am. J. Hum. Genet. 61 (suppl.): A29 only, 1997."None>1997</a>, <a href="#4" class="mim-tip-reference" title="Haravuori, H., Makela-Bengs, P., Udd, B., Partanen, J., Pulkkinen, L., Somer, H., Peltonen, L. &lt;strong&gt;Assignment of the tibial muscular dystrophy locus to chromosome 2q31.&lt;/strong&gt; Am. J. Hum. Genet. 62: 620-626, 1998.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/9497249/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;9497249&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1086/301752&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="9497249">1998</a>) found a region of interest on 2q by a genomewide scan with microsatellite markers. Further analyses with additional family members and additional families, 1 of whom was the large Finnish family reported by <a href="#12" class="mim-tip-reference" title="Udd, B., Rapola, J., Nokelainen, P., Arikawa, E., Somer, H. &lt;strong&gt;Nonvacuolar myopathy in a large family with both late adult onset distal myopathy and severe proximal muscular dystrophy.&lt;/strong&gt; J. Neurol. Sci. 113: 214-221, 1992.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/1487757/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;1487757&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1016/0022-510x(92)90249-k&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="1487757">Udd et al. (1992)</a>, yielded a maximum 2-point lod score of 10.14 at theta = 0.05 with marker D2S364. Multipoint likelihood calculations assigned the TMD locus to the proximity of marker D2S324 with a maximum multipoint lod score of 12.4 at theta = 0.0. Haplotype analysis revealed the same core haplotype in all analyzed families, thus providing evidence for an ancestral mutation and further restricting the critical chromosomal region to about 1 cM. The location of the locus was determined to be 2q31 (<a href="#14" class="mim-tip-reference" title="Udd, B. &lt;strong&gt;Personal Communication.&lt;/strong&gt; Vasa, Finland 10/31/1997."None>Udd, 1997</a>; <a href="#4" class="mim-tip-reference" title="Haravuori, H., Makela-Bengs, P., Udd, B., Partanen, J., Pulkkinen, L., Somer, H., Peltonen, L. &lt;strong&gt;Assignment of the tibial muscular dystrophy locus to chromosome 2q31.&lt;/strong&gt; Am. J. Hum. Genet. 62: 620-626, 1998.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/9497249/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;9497249&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1086/301752&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="9497249">Haravuori et al., 1998</a>). <a href="https://pubmed.ncbi.nlm.nih.gov/?term=1487757+9497249" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})"><span class="glyphicon glyphicon-plus-sign mim-tip-hint" title="Click this 'reference-plus' icon to see articles related to this paragraph in PubMed."></span></a></p><p><a href="#1" class="mim-tip-reference" title="de Seze, J., Udd, B., Haravuori, H., Sablonniere, B., Maurage, C. A., Hurtevent, J. F., Boutry, N., Stojkovic, T., Schraen, S., Petit, H., Vermersch, P. &lt;strong&gt;The first European family with tibial muscular dystrophy outside the Finnish population.&lt;/strong&gt; Neurology 51: 1746-1748, 1998.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/9855539/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;9855539&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1212/wnl.51.6.1746&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="9855539">De Seze et al. (1998)</a> described a French family with TMD and confirmed the linkage to 2q31 with a different haplotype for linked markers. <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=9855539" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})"><span class="glyphicon glyphicon-plus-sign mim-tip-hint" title="Click this 'reference-plus' icon to see articles related to this paragraph in PubMed."></span></a></p>
</span>
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<div>
<a id="heterogeneity" class="mim-anchor"></a>
<h4 href="#mimHeterogeneityFold" id="mimHeterogeneityToggle" class="mimTriangleToggle" style="cursor: pointer;" data-toggle="collapse">
<span id="mimHeterogeneityToggleTriangle" class="small mimTextToggleTriangle">&#9660;</span>
<span class="mim-font">
<strong>Heterogeneity</strong>
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<div id="mimHeterogeneityFold" class="collapse in mimTextToggleFold">
<span class="mim-text-font">
<p><strong><em>Genetic Heterogeneity</em></strong></p><p>
<a href="#2" class="mim-tip-reference" title="Felice, K. J., Meredith, C., Binz, N., Butler, A., Jacob, R., Akkari, P., Hallmayer, J., Laing, N. &lt;strong&gt;Autosomal dominant distal myopathy not linked to the known distal myopathy loci.&lt;/strong&gt; Neuromusc. Disord. 9: 59-65, 1999.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/10220859/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;10220859&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1016/s0960-8966(98)00099-6&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="10220859">Felice et al. (1999)</a> reported a family with autosomal dominant distal myopathy spanning 4 generations in whom linkage to Nonaka distal myopathy (<a href="/entry/605820">605820</a>) on 9p, MPD1 (<a href="/entry/160500">160500</a>) on 14q, Miyoshi myopathy on 2p13, and TMD on 2q31 was excluded. Clinical features included onset in the second to third decade of foot drop, difficulty in stair climbing, and progressive leg weakness. Some had later involvement of proximal lower limb muscles and distal upper limb muscles. Laboratory studies showed increased serum creatine kinase and nonspecific myopathic changes without rimmed vacuoles. <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=10220859" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})"><span class="glyphicon glyphicon-plus-sign mim-tip-hint" title="Click this 'reference-plus' icon to see articles related to this paragraph in PubMed."></span></a></p>
</span>
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</div>
</div>
<div>
<a id="molecularGenetics" class="mim-anchor"></a>
<h4 href="#mimMolecularGeneticsFold" id="mimMolecularGeneticsToggle" class="mimTriangleToggle" style="cursor: pointer;" data-toggle="collapse">
<span id="mimMolecularGeneticsToggleTriangle" class="small mimTextToggleTriangle">&#9660;</span>
<span class="mim-font">
<strong>Molecular Genetics</strong>
</span>
</h4>
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<div id="mimMolecularGeneticsFold" class="collapse in mimTextToggleFold">
<span class="mim-text-font">
<p>Because of the map location of TMD on 2q31, the gene encoding the giant skeletal muscle protein titin (<a href="/entry/188840">188840</a>) was a strong positional as well as functional candidate for the site of causative mutations. <a href="#3" class="mim-tip-reference" title="Hackman, P., Vihola, A., Haravuori, H., Marchand, S., Sarparanta, J., de Seze, J., Labeit, S., Witt, C., Peltonen, L., Richard, I., Udd, B. &lt;strong&gt;Tibial muscular dystrophy is a titinopathy caused by mutations in TTN, the gene encoding the giant skeletal-muscle protein titin.&lt;/strong&gt; Am. J. Hum. Genet. 71: 492-500, 2002.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/12145747/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;12145747&lt;/a&gt;, &lt;a href=&quot;https://www.ncbi.nlm.nih.gov/pmc/?term=12145747[PMID]&amp;report=imagesdocsum&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed Image&#x27;, &#x27;domain&#x27;: &#x27;ncbi.nlm.nih.gov&#x27;})&quot;&gt;images&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1086/342380&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="12145747">Hackman et al. (2002)</a> demonstrated a heterozygous 11-bp deletion/insertion in the last exon (exon 363) of the TTN gene (<a href="/entry/188840#0004">188840.0004</a>) as the cause of TMD in 81 Finnish patients from 12 unrelated families. One of the families with the 11-bp deletion was the large Finnish family reported by <a href="#12" class="mim-tip-reference" title="Udd, B., Rapola, J., Nokelainen, P., Arikawa, E., Somer, H. &lt;strong&gt;Nonvacuolar myopathy in a large family with both late adult onset distal myopathy and severe proximal muscular dystrophy.&lt;/strong&gt; J. Neurol. Sci. 113: 214-221, 1992.[PubMed: &lt;a href=&quot;https://pubmed.ncbi.nlm.nih.gov/1487757/&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;name&#x27;: &#x27;PubMed&#x27;, &#x27;domain&#x27;: &#x27;pubmed.ncbi.nlm.nih.gov&#x27;})&quot;&gt;1487757&lt;/a&gt;] [&lt;a href=&quot;https://doi.org/10.1016/0022-510x(92)90249-k&quot; target=&quot;_blank&quot; onclick=&quot;gtag(&#x27;event&#x27;, &#x27;mim_outbound&#x27;, {&#x27;destination&#x27;: &#x27;Publisher&#x27;})&quot;&gt;Full Text&lt;/a&gt;]" pmid="1487757">Udd et al. (1992)</a>. A different mutation in the TTN gene, a missense mutation that was also located in the last exon (<a href="/entry/188840#0005">188840.0005</a>), was identified in an affected French family. <a href="https://pubmed.ncbi.nlm.nih.gov/?term=1487757+12145747" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})"><span class="glyphicon glyphicon-plus-sign mim-tip-hint" title="Click this 'reference-plus' icon to see articles related to this paragraph in PubMed."></span></a></p>
</span>
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</div>
<div>
<a id="references"class="mim-anchor"></a>
<h4 href="#mimReferencesFold" id="mimReferencesToggle" class="mimTriangleToggle" style="cursor: pointer;" data-toggle="collapse">
<span class="mim-font">
<span id="mimReferencesToggleTriangle" class="small mimTextToggleTriangle">&#9660;</span>
<strong>REFERENCES</strong>
</span>
</h4>
<div>
<p />
</div>
<div id="mimReferencesFold" class="collapse in mimTextToggleFold">
<ol>
<li>
<a id="1" class="mim-anchor"></a>
<a id="de Seze1998" class="mim-anchor"></a>
<div class="">
<p class="mim-text-font">
de Seze, J., Udd, B., Haravuori, H., Sablonniere, B., Maurage, C. A., Hurtevent, J. F., Boutry, N., Stojkovic, T., Schraen, S., Petit, H., Vermersch, P.
<strong>The first European family with tibial muscular dystrophy outside the Finnish population.</strong>
Neurology 51: 1746-1748, 1998.
[PubMed: <a href="https://pubmed.ncbi.nlm.nih.gov/9855539/" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">9855539</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=9855539" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">related citations</a>]
[<a href="https://doi.org/10.1212/wnl.51.6.1746" target="_blank">Full Text</a>]
</p>
</div>
</li>
<li>
<a id="2" class="mim-anchor"></a>
<a id="Felice1999" class="mim-anchor"></a>
<div class="">
<p class="mim-text-font">
Felice, K. J., Meredith, C., Binz, N., Butler, A., Jacob, R., Akkari, P., Hallmayer, J., Laing, N.
<strong>Autosomal dominant distal myopathy not linked to the known distal myopathy loci.</strong>
Neuromusc. Disord. 9: 59-65, 1999.
[PubMed: <a href="https://pubmed.ncbi.nlm.nih.gov/10220859/" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">10220859</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=10220859" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">related citations</a>]
[<a href="https://doi.org/10.1016/s0960-8966(98)00099-6" target="_blank">Full Text</a>]
</p>
</div>
</li>
<li>
<a id="3" class="mim-anchor"></a>
<a id="Hackman2002" class="mim-anchor"></a>
<div class="">
<p class="mim-text-font">
Hackman, P., Vihola, A., Haravuori, H., Marchand, S., Sarparanta, J., de Seze, J., Labeit, S., Witt, C., Peltonen, L., Richard, I., Udd, B.
<strong>Tibial muscular dystrophy is a titinopathy caused by mutations in TTN, the gene encoding the giant skeletal-muscle protein titin.</strong>
Am. J. Hum. Genet. 71: 492-500, 2002.
[PubMed: <a href="https://pubmed.ncbi.nlm.nih.gov/12145747/" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">12145747</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/?term=12145747[PMID]&report=imagesdocsum" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Image', 'domain': 'ncbi.nlm.nih.gov'})">images</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=12145747" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">related citations</a>]
[<a href="https://doi.org/10.1086/342380" target="_blank">Full Text</a>]
</p>
</div>
</li>
<li>
<a id="4" class="mim-anchor"></a>
<a id="Haravuori1998" class="mim-anchor"></a>
<div class="">
<p class="mim-text-font">
Haravuori, H., Makela-Bengs, P., Udd, B., Partanen, J., Pulkkinen, L., Somer, H., Peltonen, L.
<strong>Assignment of the tibial muscular dystrophy locus to chromosome 2q31.</strong>
Am. J. Hum. Genet. 62: 620-626, 1998.
[PubMed: <a href="https://pubmed.ncbi.nlm.nih.gov/9497249/" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">9497249</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=9497249" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">related citations</a>]
[<a href="https://doi.org/10.1086/301752" target="_blank">Full Text</a>]
</p>
</div>
</li>
<li>
<a id="5" class="mim-anchor"></a>
<a id="Haravuori1997" class="mim-anchor"></a>
<div class="">
<p class="mim-text-font">
Haravuori, H., Makela-Bengs, P., Udd, B., Pulkkinen, L., Partanen, J., Somer, H., Peltonen, L.
<strong>Assignment of the tibial muscular dystrophy (TMD) locus on chromosome 2q31. (Abstract)</strong>
Am. J. Hum. Genet. 61 (suppl.): A29 only, 1997.
</p>
</div>
</li>
<li>
<a id="6" class="mim-anchor"></a>
<a id="Miyoshi1986" class="mim-anchor"></a>
<div class="">
<p class="mim-text-font">
Miyoshi, K., Kawai, H., Isawa, M., Kusaka, K., Nishino, H.
<strong>Autosomal recessive distal muscular dystrophy as a new type of progressive muscular dystrophy: seventeen cases in eight families including an autopsied case.</strong>
Brain 109: 31-54, 1986.
[PubMed: <a href="https://pubmed.ncbi.nlm.nih.gov/3942856/" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">3942856</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=3942856" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">related citations</a>]
[<a href="https://doi.org/10.1093/brain/109.1.31" target="_blank">Full Text</a>]
</p>
</div>
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<a id="7" class="mim-anchor"></a>
<a id="Partanen1994" class="mim-anchor"></a>
<div class="">
<p class="mim-text-font">
Partanen, J., Laulumaa, V., Paljarvi, L., Partanen, K., Naukkarinen, A.
<strong>Late onset foot-drop muscular dystrophy with rimmed vacuoles.</strong>
J. Neurol. Sci. 125: 158-167, 1994.
[PubMed: <a href="https://pubmed.ncbi.nlm.nih.gov/7807161/" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">7807161</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=7807161" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">related citations</a>]
[<a href="https://doi.org/10.1016/0022-510x(94)90029-9" target="_blank">Full Text</a>]
</p>
</div>
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<a id="8" class="mim-anchor"></a>
<a id="Sadeh1993" class="mim-anchor"></a>
<div class="">
<p class="mim-text-font">
Sadeh, M., Gadoth, N., Hadar, H., Ben-David, E.
<strong>Vacuolar myopathy sparing the quadriceps.</strong>
Brain 116: 217-232, 1993.
[PubMed: <a href="https://pubmed.ncbi.nlm.nih.gov/8453459/" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">8453459</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=8453459" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">related citations</a>]
[<a href="https://doi.org/10.1093/brain/116.1.217" target="_blank">Full Text</a>]
</p>
</div>
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<li>
<a id="9" class="mim-anchor"></a>
<a id="Sunohara1989" class="mim-anchor"></a>
<div class="">
<p class="mim-text-font">
Sunohara, N., Nonaka, I., Kamei, N., Satoyoshi, E.
<strong>Distal myopathy with rimmed vacuole formation: a follow-up study.</strong>
Brain 112: 65-83, 1989.
[PubMed: <a href="https://pubmed.ncbi.nlm.nih.gov/2645018/" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">2645018</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=2645018" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">related citations</a>]
[<a href="https://doi.org/10.1093/brain/112.1.65" target="_blank">Full Text</a>]
</p>
</div>
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<li>
<a id="10" class="mim-anchor"></a>
<a id="Udd1991" class="mim-anchor"></a>
<div class="">
<p class="mim-text-font">
Udd, B., Kaarianen, H., Somer, H.
<strong>Muscular dystrophy with separate clinical phenotypes in a large family.</strong>
Muscle Nerve 14: 1050-1058, 1991.
[PubMed: <a href="https://pubmed.ncbi.nlm.nih.gov/1745277/" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">1745277</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=1745277" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">related citations</a>]
[<a href="https://doi.org/10.1002/mus.880141103" target="_blank">Full Text</a>]
</p>
</div>
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<li>
<a id="11" class="mim-anchor"></a>
<a id="Udd1993" class="mim-anchor"></a>
<div class="">
<p class="mim-text-font">
Udd, B., Partanen, J., Halonen, P., Falck, B., Hakamies, L., Heikkila, H., Ingo, S., Kalimo, H., Kaariainen, H., Laulumaa, V., Paljarvi, L., Rapola, J., Reunanen, M., Sonninen, V., Somer, H.
<strong>Tibial muscular dystrophy: late adult-onset distal myopathy in 66 Finnish patients.</strong>
Arch. Neurol. 50: 604-608, 1993.
[PubMed: <a href="https://pubmed.ncbi.nlm.nih.gov/8503797/" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">8503797</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=8503797" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">related citations</a>]
[<a href="https://doi.org/10.1001/archneur.1993.00540060044015" target="_blank">Full Text</a>]
</p>
</div>
</li>
<li>
<a id="12" class="mim-anchor"></a>
<a id="Udd1992" class="mim-anchor"></a>
<div class="">
<p class="mim-text-font">
Udd, B., Rapola, J., Nokelainen, P., Arikawa, E., Somer, H.
<strong>Nonvacuolar myopathy in a large family with both late adult onset distal myopathy and severe proximal muscular dystrophy.</strong>
J. Neurol. Sci. 113: 214-221, 1992.
[PubMed: <a href="https://pubmed.ncbi.nlm.nih.gov/1487757/" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">1487757</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=1487757" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">related citations</a>]
[<a href="https://doi.org/10.1016/0022-510x(92)90249-k" target="_blank">Full Text</a>]
</p>
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<li>
<a id="13" class="mim-anchor"></a>
<a id="Udd1992" class="mim-anchor"></a>
<div class="">
<p class="mim-text-font">
Udd, B.
<strong>Limb-girdle type muscular dystrophy in a large family with distal myopathy: homozygous manifestation of a dominant gene?</strong>
J. Med. Genet. 29: 383-389, 1992.
[PubMed: <a href="https://pubmed.ncbi.nlm.nih.gov/1619633/" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">1619633</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=1619633" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">related citations</a>]
[<a href="https://doi.org/10.1136/jmg.29.6.383" target="_blank">Full Text</a>]
</p>
</div>
</li>
<li>
<a id="14" class="mim-anchor"></a>
<a id="Udd1997" class="mim-anchor"></a>
<div class="">
<p class="mim-text-font">
Udd, B.
<strong>Personal Communication.</strong>
Vasa, Finland 10/31/1997.
</p>
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<a id="15" class="mim-anchor"></a>
<a id="Van den Bergh2003" class="mim-anchor"></a>
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Van den Bergh, P. Y. K., Bouquiaux, O., Verellen, C., Marchand, S., Richard, I., Hackman, P., Udd, B.
<strong>Tibial muscular dystrophy in a Belgian family.</strong>
Ann. Neurol. 54: 248-251, 2003.
[PubMed: <a href="https://pubmed.ncbi.nlm.nih.gov/12891679/" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">12891679</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/?cmd=link&linkname=pubmed_pubmed&from_uid=12891679" target="_blank" onclick="gtag('event', 'mim_outbound', {'name': 'PubMed Related', 'domain': 'pubmed.ncbi.nlm.nih.gov'})">related citations</a>]
[<a href="https://doi.org/10.1002/ana.10647" target="_blank">Full Text</a>]
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Victor A. McKusick - updated : 9/17/2002
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Victor A. McKusick - updated : 6/3/1999<br>Victor A. McKusick - updated : 5/7/1998<br>Victor A. McKusick - updated : 11/13/1997<br>Victor A. McKusick - updated : 10/22/1997
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alopez : 11/09/2023
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<h3>
<span class="mim-font">
<strong>#</strong> 600334
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<span class="mim-font">
TIBIAL MUSCULAR DYSTROPHY, TARDIVE; TMD
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<span class="mim-font">
<em>Alternative titles; symbols</em>
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<span class="mim-font">
TARDIVE TIBIAL MUSCULAR DYSTROPHY<br />
UDD MYOPATHY
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<span class="mim-text-font">
<strong>SNOMEDCT:</strong> 698846009; &nbsp;
<strong>ORPHA:</strong> 609; &nbsp;
<strong>DO:</strong> 0111078; &nbsp;
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<h4>
<span class="mim-font">
<strong>Phenotype-Gene Relationships</strong>
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Location
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Phenotype
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Phenotype <br /> MIM number
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Inheritance
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Phenotype <br /> mapping key
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Gene/Locus
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Gene/Locus <br /> MIM number
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<span class="mim-font">
2q31.2
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Tibial muscular dystrophy, tardive
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600334
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Autosomal dominant
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3
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TTN
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188840
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<span class="mim-font">
<strong>TEXT</strong>
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<p>A number sign (#) is used with this entry because of evidence that tibial muscular dystrophy (TMD) is caused by heterozygous mutation in the gene encoding the giant skeletal muscle protein titin (TTN; 188840) on chromosome 2q31.</p><p>Homozygous mutation in the titin gene causes the more severe limb-girdle muscular dystrophy type 2J (LGMD2J; 608807).</p>
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<strong>Description</strong>
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<p>Tardive tibial muscular dystrophy (TMD) is an autosomal dominant late-onset myopathy in which weakness and atrophy are usually confined to the anterior compartment of the lower leg, in particular, the tibialis anterior muscle. Onset usually occurs at ages 35 to 45 years, but can be later (summary by Hackman et al., 2002). </p>
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<strong>Clinical Features</strong>
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<p>Udd (1992) reported a large consanguineous Finnish pedigree with 2 separate muscle disease phenotypes: mild late-onset distal myopathy inherited in an autosomal dominant pattern and severe limb-girdle muscular dystrophy (see LGMD2J) inherited in an autosomal recessive pattern. Segregation analysis showed that the corrected proportion of affected persons with the severe proximal type was 0.246 and the proportion of affected persons with the distal myopathy was 0.58. The findings were compatible with the hypothesis that the severe LGMD phenotype was the homozygous manifestation of a dominant gene that in the heterozygous state caused the milder distal myopathy. Udd et al. (1992), who referred to the distal myopathy as 'tibial muscular dystrophy,' reported follow-up on the large affected Finnish pedigree. </p><p>Partanen et al. (1994) studied a family with very late-onset (fifth or sixth decade) or asymptomatic hereditary myopathy of the anterior tibial muscle. The muscles of the upper extremity were spared. The anterior tibial muscles had a characteristic myopathic alteration with rimmed vacuoles. Twelve persons, both male and female, were affected, and male-to-male transmission was demonstrated. </p><p>Partanen et al. (1994) distinguished 6 types of distal myopathy: (1) Welander myopathy; (2) a late-onset autosomal dominant form with onset in the anterior compartment of the legs; (3) an early adult-onset recessive or sporadic form with onset in the anterior compartment of the legs with vacuolar myopathy on biopsy (Sunohara et al., 1989); (4) an early adult-onset recessive distal myopathy of the posterior compartment of the legs (Miyoshi et al., 1986; 254130); (5) an autosomal recessive vacuolar myopathy sparing the quadriceps (Sadeh et al., 1993; 605820); and (6) a late-onset autosomal dominant tibial dystrophy as described by Udd et al. (1991, 1992) and Udd (1992). </p><p>Udd et al. (1993) investigated 66 Finnish patients with late adult-onset tibial muscular dystrophy. Symptoms appeared after the age of 35 years with reduced ankle dorsiflexion, and progression was slow without marked disability. Facial muscles, upper extremities, and proximal muscles were usually spared. Pedigree data suggested autosomal dominant inheritance. The clinical studies suggested homogeneity in the various families affected with this rather frequent disorder in Finns. </p><p>Van den Bergh et al. (2003) reported a Belgian family with tibial muscular dystrophy. The proband had onset of gait difficulties in his late 40s, and clinical examination showed steppage gait and weakness and atrophy of the anterior compartment muscles of the lower legs without proximal weakness or sensory loss. CT scan of the lower leg muscles showed marked atrophy and low density, suggestive of fatty degeneration. Family investigation revealed that the proband's father, a paternal uncle, and one of his daughters had mild tibialis anterior weakness and atrophy, although all were asymptomatic. In affected members of the family, Van den Bergh et al. (2003) identified a heterozygous mutation in the Mex6 exon of the titin gene (188840.0006). The authors noted that the family showed incomplete disease penetrance. </p><p><strong><em>Pathologic Findings</em></strong></p><p>
In 12 affected members of a large Finnish pedigree with distal myopathy, Udd et al. (1992) found that muscle biopsy did not show vacuolar degeneration, which was in contrast to most adult-onset distal myopathies. Histopathologic changes correlating with the muscular dystrophy were extensive in tibial anterior muscles in patients with distal myopathy and in all muscles of those family members who had a severe limb-girdle muscular dystrophy phenotype. </p><p>Among 66 Finnish patients with TMD, Udd et al. (1993) found that muscle biopsies showed nonspecific dystrophic changes in clinically affected muscles and severe adipose replacement in the anterior tibial muscles. Asymptomatic muscles had mild myopathic changes only. Vacuolar degeneration was detected in a minority of patients. Electromyography showed profound myopathic changes in the anterior tibial muscle, but extensor brevis muscles were well preserved. Computed tomography or magnetic resonance imaging of muscles disclosed marked involvement of tibial extensor muscles and focal patches of fatty degeneration in various asymptomatic muscles. </p><p>In tibial muscular dystrophy, some biopsies showed rimmed vacuoles and others did not. Udd (1997) concluded that the presence or absence of rimmed vacuoles was not indicative of heterogeneity because there was intrafamilial variation and families with or without rimmed vacuoles were shown to be genealogically linked.</p>
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<span class="mim-font">
<strong>Mapping</strong>
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<span class="mim-text-font">
<p>In a Finnish tibial muscular dystrophy family with 11 affected individuals, Haravuori et al. (1997, 1998) found a region of interest on 2q by a genomewide scan with microsatellite markers. Further analyses with additional family members and additional families, 1 of whom was the large Finnish family reported by Udd et al. (1992), yielded a maximum 2-point lod score of 10.14 at theta = 0.05 with marker D2S364. Multipoint likelihood calculations assigned the TMD locus to the proximity of marker D2S324 with a maximum multipoint lod score of 12.4 at theta = 0.0. Haplotype analysis revealed the same core haplotype in all analyzed families, thus providing evidence for an ancestral mutation and further restricting the critical chromosomal region to about 1 cM. The location of the locus was determined to be 2q31 (Udd, 1997; Haravuori et al., 1998). </p><p>De Seze et al. (1998) described a French family with TMD and confirmed the linkage to 2q31 with a different haplotype for linked markers. </p>
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<span class="mim-font">
<strong>Heterogeneity</strong>
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<span class="mim-text-font">
<p><strong><em>Genetic Heterogeneity</em></strong></p><p>
Felice et al. (1999) reported a family with autosomal dominant distal myopathy spanning 4 generations in whom linkage to Nonaka distal myopathy (605820) on 9p, MPD1 (160500) on 14q, Miyoshi myopathy on 2p13, and TMD on 2q31 was excluded. Clinical features included onset in the second to third decade of foot drop, difficulty in stair climbing, and progressive leg weakness. Some had later involvement of proximal lower limb muscles and distal upper limb muscles. Laboratory studies showed increased serum creatine kinase and nonspecific myopathic changes without rimmed vacuoles. </p>
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<h4>
<span class="mim-font">
<strong>Molecular Genetics</strong>
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<p>Because of the map location of TMD on 2q31, the gene encoding the giant skeletal muscle protein titin (188840) was a strong positional as well as functional candidate for the site of causative mutations. Hackman et al. (2002) demonstrated a heterozygous 11-bp deletion/insertion in the last exon (exon 363) of the TTN gene (188840.0004) as the cause of TMD in 81 Finnish patients from 12 unrelated families. One of the families with the 11-bp deletion was the large Finnish family reported by Udd et al. (1992). A different mutation in the TTN gene, a missense mutation that was also located in the last exon (188840.0005), was identified in an affected French family. </p>
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<h4>
<span class="mim-font">
<strong>REFERENCES</strong>
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</h4>
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<p />
</div>
<div>
<ol>
<li>
<p class="mim-text-font">
de Seze, J., Udd, B., Haravuori, H., Sablonniere, B., Maurage, C. A., Hurtevent, J. F., Boutry, N., Stojkovic, T., Schraen, S., Petit, H., Vermersch, P.
<strong>The first European family with tibial muscular dystrophy outside the Finnish population.</strong>
Neurology 51: 1746-1748, 1998.
[PubMed: 9855539]
[Full Text: https://doi.org/10.1212/wnl.51.6.1746]
</p>
</li>
<li>
<p class="mim-text-font">
Felice, K. J., Meredith, C., Binz, N., Butler, A., Jacob, R., Akkari, P., Hallmayer, J., Laing, N.
<strong>Autosomal dominant distal myopathy not linked to the known distal myopathy loci.</strong>
Neuromusc. Disord. 9: 59-65, 1999.
[PubMed: 10220859]
[Full Text: https://doi.org/10.1016/s0960-8966(98)00099-6]
</p>
</li>
<li>
<p class="mim-text-font">
Hackman, P., Vihola, A., Haravuori, H., Marchand, S., Sarparanta, J., de Seze, J., Labeit, S., Witt, C., Peltonen, L., Richard, I., Udd, B.
<strong>Tibial muscular dystrophy is a titinopathy caused by mutations in TTN, the gene encoding the giant skeletal-muscle protein titin.</strong>
Am. J. Hum. Genet. 71: 492-500, 2002.
[PubMed: 12145747]
[Full Text: https://doi.org/10.1086/342380]
</p>
</li>
<li>
<p class="mim-text-font">
Haravuori, H., Makela-Bengs, P., Udd, B., Partanen, J., Pulkkinen, L., Somer, H., Peltonen, L.
<strong>Assignment of the tibial muscular dystrophy locus to chromosome 2q31.</strong>
Am. J. Hum. Genet. 62: 620-626, 1998.
[PubMed: 9497249]
[Full Text: https://doi.org/10.1086/301752]
</p>
</li>
<li>
<p class="mim-text-font">
Haravuori, H., Makela-Bengs, P., Udd, B., Pulkkinen, L., Partanen, J., Somer, H., Peltonen, L.
<strong>Assignment of the tibial muscular dystrophy (TMD) locus on chromosome 2q31. (Abstract)</strong>
Am. J. Hum. Genet. 61 (suppl.): A29 only, 1997.
</p>
</li>
<li>
<p class="mim-text-font">
Miyoshi, K., Kawai, H., Isawa, M., Kusaka, K., Nishino, H.
<strong>Autosomal recessive distal muscular dystrophy as a new type of progressive muscular dystrophy: seventeen cases in eight families including an autopsied case.</strong>
Brain 109: 31-54, 1986.
[PubMed: 3942856]
[Full Text: https://doi.org/10.1093/brain/109.1.31]
</p>
</li>
<li>
<p class="mim-text-font">
Partanen, J., Laulumaa, V., Paljarvi, L., Partanen, K., Naukkarinen, A.
<strong>Late onset foot-drop muscular dystrophy with rimmed vacuoles.</strong>
J. Neurol. Sci. 125: 158-167, 1994.
[PubMed: 7807161]
[Full Text: https://doi.org/10.1016/0022-510x(94)90029-9]
</p>
</li>
<li>
<p class="mim-text-font">
Sadeh, M., Gadoth, N., Hadar, H., Ben-David, E.
<strong>Vacuolar myopathy sparing the quadriceps.</strong>
Brain 116: 217-232, 1993.
[PubMed: 8453459]
[Full Text: https://doi.org/10.1093/brain/116.1.217]
</p>
</li>
<li>
<p class="mim-text-font">
Sunohara, N., Nonaka, I., Kamei, N., Satoyoshi, E.
<strong>Distal myopathy with rimmed vacuole formation: a follow-up study.</strong>
Brain 112: 65-83, 1989.
[PubMed: 2645018]
[Full Text: https://doi.org/10.1093/brain/112.1.65]
</p>
</li>
<li>
<p class="mim-text-font">
Udd, B., Kaarianen, H., Somer, H.
<strong>Muscular dystrophy with separate clinical phenotypes in a large family.</strong>
Muscle Nerve 14: 1050-1058, 1991.
[PubMed: 1745277]
[Full Text: https://doi.org/10.1002/mus.880141103]
</p>
</li>
<li>
<p class="mim-text-font">
Udd, B., Partanen, J., Halonen, P., Falck, B., Hakamies, L., Heikkila, H., Ingo, S., Kalimo, H., Kaariainen, H., Laulumaa, V., Paljarvi, L., Rapola, J., Reunanen, M., Sonninen, V., Somer, H.
<strong>Tibial muscular dystrophy: late adult-onset distal myopathy in 66 Finnish patients.</strong>
Arch. Neurol. 50: 604-608, 1993.
[PubMed: 8503797]
[Full Text: https://doi.org/10.1001/archneur.1993.00540060044015]
</p>
</li>
<li>
<p class="mim-text-font">
Udd, B., Rapola, J., Nokelainen, P., Arikawa, E., Somer, H.
<strong>Nonvacuolar myopathy in a large family with both late adult onset distal myopathy and severe proximal muscular dystrophy.</strong>
J. Neurol. Sci. 113: 214-221, 1992.
[PubMed: 1487757]
[Full Text: https://doi.org/10.1016/0022-510x(92)90249-k]
</p>
</li>
<li>
<p class="mim-text-font">
Udd, B.
<strong>Limb-girdle type muscular dystrophy in a large family with distal myopathy: homozygous manifestation of a dominant gene?</strong>
J. Med. Genet. 29: 383-389, 1992.
[PubMed: 1619633]
[Full Text: https://doi.org/10.1136/jmg.29.6.383]
</p>
</li>
<li>
<p class="mim-text-font">
Udd, B.
<strong>Personal Communication.</strong>
Vasa, Finland 10/31/1997.
</p>
</li>
<li>
<p class="mim-text-font">
Van den Bergh, P. Y. K., Bouquiaux, O., Verellen, C., Marchand, S., Richard, I., Hackman, P., Udd, B.
<strong>Tibial muscular dystrophy in a Belgian family.</strong>
Ann. Neurol. 54: 248-251, 2003.
[PubMed: 12891679]
[Full Text: https://doi.org/10.1002/ana.10647]
</p>
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Victor A. McKusick - updated : 9/17/2002<br>Victor A. McKusick - updated : 6/3/1999<br>Victor A. McKusick - updated : 5/7/1998<br>Victor A. McKusick - updated : 11/13/1997<br>Victor A. McKusick - updated : 10/22/1997
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Victor A. McKusick : 1/23/1995
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alopez : 11/09/2023<br>carol : 03/23/2023<br>ckniffin : 03/22/2023<br>carol : 03/21/2023<br>ckniffin : 03/20/2023<br>carol : 06/21/2016<br>carol : 6/20/2016<br>carol : 7/28/2004<br>ckniffin : 7/20/2004<br>carol : 12/29/2003<br>ckniffin : 12/24/2003<br>alopez : 9/18/2002<br>carol : 9/17/2002<br>mgross : 4/5/2001<br>mgross : 1/24/2000<br>kayiaros : 7/13/1999<br>carol : 6/15/1999<br>jlewis : 6/15/1999<br>jlewis : 6/14/1999<br>terry : 6/3/1999<br>terry : 8/5/1998<br>terry : 8/5/1998<br>terry : 5/7/1998<br>jenny : 11/18/1997<br>terry : 11/13/1997<br>terry : 10/28/1997<br>jenny : 10/28/1997<br>jenny : 10/28/1997<br>jenny : 10/27/1997<br>terry : 10/22/1997<br>mimadm : 9/23/1995<br>carol : 1/31/1995<br>carol : 1/27/1995<br>carol : 1/24/1995<br>carol : 1/23/1995
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