ATROPHY (KENNEDY’S DISEASE) WITH LONG- TERM ELECTROPHYSIOLOGICAL EVALUATION

ABSTRACT- X-linked spinal and bulbar muscular atrophy or Kennedy’s disease is an adult-onset motor neu-ronopathy caused by a CAG repeat expansion within the first exon of an androgen receptor gene. We report the case of a 66-year-old man, previously diagnosed with motor neuron disease (MND), who presented acute and reversible left vocal fold (dysphonia) and pharyngeal paresis, followed by a slowly progressive weakness and also bouts of weakness, wasting and fasciculation on tongue, masseter, face, pharyngeal, and some proximal more than distal upper limb muscles, associated to bilateral hand tremor and mild gyneco-mastia. There were 5 electroneuromyography exams between 1989 and 2003 that revealed chronic reinner-vation, some fasciculations (less than clinically observed) and rare fibrillation potentials, and slowly progres-sive sensory nerve action potentials (SNAP) abnormality, leading to absent/low amplitude potentials. PCR techniques of DNA analysis showed an abnormal number of CAG repeats, found to be 44 (normal 11-34). Our case revealed an acute and asymmetric clinical presentation related to bulbar motoneurons; low am-plitude/absent SNAP with mild asymmetry; a sub-clinical or subtle involvement of proximal/distal muscles of both upper and lower limbs; and a probable evolution with bouts of acute dennervation, followed by an efficient reinnervation. KEY WORDS: X-linked spinal and bulbar muscular atrophy, Kennedy’s disease, bulbospinal neuronopathy