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A case of Becker muscular dystrophy with schizophrenic symptoms

A case of Becker muscular dystrophy with schizophrenic symptoms

No to Shinkei 42(11): 1061-1066

A 23-year-old male patient with Becker muscular dystrophy (BMD) who showed schizophrenic symptoms was reported. He tumbled easily and was poor at running since age at 8 years. He had difficulty in climbing stairs and was idle all day long since age at 21 years. Although his premorbid personality was not schizoid, he showed auditory hallucinations and delusions without any psychogenetic moment at the age of 23. At first, he seemed to be schizophrenic, but after the treatment with antipsychotics, he always had an insight into his disease and exhibited natural emotional communication. He showed no autism and character changes. According to the Wechsler Adult Intelligence Scale (WAIS), intellectual impairment was notified (total IQ58). Neurological examinations revealed weakness and atrophy of muscles in the proximal part of his lower extremities, and pseudohypertrophy of calves. In the serum enzyme, serum creatine kinase (CK) level was elevated (700 U/L). Abnormal Q waves appeared in the leads, II, III, aVF, V5, V6 on the electrocardiogram (ECG), and the finding of the echocardiography suggested dilated cardiomyopathy. The electroencephalogram (EEG) revealed the basic rhythm of 9-10 Hz with .theta. activities of 6-7 Hz which were predominant in frontparietal and central leads. The electromyogram (EMG) revealed a myopathic pattern with low voltage and short duration. A muscle biopsy from right biceps brachii disclosed the abnormal immunofluorescent staining pattern of dystrophin which is consistent with BMD patient, i.e., "patchy", discontinuous and faint immunoreaction at surface membrane of the fiber. Both molecular weight (380 kd:n = 400) and amount (30%; n = 100) of dystrophin were reduced. In brain magnetic resonance imaging (MRI), the 3rd ventricle was dilated and diffuse mild atrophy was detected in the cerebral cortex. In ascertainment of families, no evidence of muscular weakness and abnormal CK level were found in his mother who was considered as carrier of the BMD gene. Although the relationship between BMD, schizophrenic symptoms and intellectual impairment remains to be dissolved, we infer that our patient could be classified as an organic psychosis.

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Accession: 006932083

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PMID: 2076351

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