Further Outpatient Care

See the list below:

Rehabilitation management coordinates the administration of appropriate therapeutic modalities.
- The physiatrist initiates and coordinates diagnostic studies, because muscular dystrophy may not have been diagnosed in these patients prior to the initial visit.
- Routine health care issues include the recommendation of yearly influenza vaccinations, as well as the administration of pneumococcal vaccine.
- Given the progressive nature of the BMD, anticipatory guidance is ongoing. The physiatrist provides recommendations for classroom accommodations and activity during a patient's school years. Work-related concerns during the patient's adult years of employment are primary issues, with work modification scenarios and the use of assistive devices being prominent concerns.
Cardiopulmonary evaluations include pulmonary function and electrocardiographic testing.
- Pulmonary evaluations are important in tracking the progression of muscular weakness affecting ventilation.
- A simple clinical test with a spirometer may be employed to measure maximal expiratory volume during routine clinic visits.
- A pattern of falling maximal expiratory volumes over time may indicates the need for formal pulmonary function to determine the need for ventilatory support.
- Nighttime ventilatory support with a mask or nasal bilevel positive airway pressure is commonly used if a rising pCO₂ is noted. The results from sleep studies also may suggest progressive difficulty in nighttime ventilation.
- Cardiovascular health supervision guidelines are available^[15]

Deterrence

See the list below:

Prenatal diagnosis is available for a woman with an at-risk pregnancy who has been identified as having a family history of muscular dystrophy. Identification of dystrophin gene exon deletions in a male fetus points to the risk of a child with muscular dystrophy. Couples may elect to terminate the pregnancy if the fetus is affected.
Carrier status may be determined in the mother and siblings of a proband.

Complications

See the list below:

Progressive disability
Dilated cardiomyopathy
Respiratory symptoms, with a potential need for ventilatory support
Joint contractures
Scoliosis
Dysphagia
Functional constipation

Prognosis

See the list below:

See Mortality/Morbidity.

Patient Education

See the list below:

Well in advance of the projected necessity, discuss the decision, with the occurrence of pulmonary failure, to place a tracheostomy tube for positive-pressure ventilation, as well as for airway and secretion management. Inform the patient, family members, and/or caregivers of the implications of placing the patient on a ventilator. Early education can help the patient and his/her family to determine advanced directives.

Questions

Becker PE, Kiener F. [A new x-chromosomal muscular dystrophy.]. Arch Psychiatr Nervenkr Z Gesamte Neurol Psychiatr. 1955. 193(4):427-48. [QxMD MEDLINE Link].
Becker PE. Two families of benign sex-linked recessive muscular dystrophy. Rev Can Biol. 1962 Sep-Dec. 21:551-66. [QxMD MEDLINE Link].
Andrews JG, Wahl RA. Duchenne and Becker muscular dystrophy in adolescents: current perspectives. Adolesc Health Med Ther. 2018. 9:53-63. [QxMD MEDLINE Link]. [Full Text].
Thada PK, Bhandari J, Umapathi KK. Becker Muscular Dystrophy. StatPearls. 2023 Jul 19. [QxMD MEDLINE Link]. [Full Text].
Straub V, Guglieri M. An update on Becker muscular dystrophy. Curr Opin Neurol. 2023 Oct 1. 36 (5):450-4. [QxMD MEDLINE Link]. [Full Text].
Angelini C, Fanin M, Pegoraro E, et al. Clinical-molecular correlation in 104 mild X-linked muscular dystrophy patients: characterization of sub-clinical phenotypes. Neuromuscul Disord. 1994 Jul. 4(4):349-58. [QxMD MEDLINE Link].
Gurvich OL, Tuohy TM, Howard MT, et al. DMD pseudoexon mutations: splicing efficiency, phenotype, and potential therapy. Ann Neurol. 2008 Jan. 63(1):81-9. [QxMD MEDLINE Link].
Ashton EJ, Yau SC, Deans ZC, et al. Simultaneous mutation scanning for gross deletions, duplications and point mutations in the DMD gene. Eur J Hum Genet. 2008 Jan. 16(1):53-61. [QxMD MEDLINE Link].
Arahata K, Beggs AH, Honda H, et al. Preservation of the C-terminus of dystrophin molecule in the skeletal muscle from Becker muscular dystrophy. J Neurol Sci. 1991 Feb. 101(2):148-56. [QxMD MEDLINE Link].
Koenig M, Beggs AH, Moyer M, et al. The molecular basis for Duchenne versus Becker muscular dystrophy: correlation of severity with type of deletion. Am J Hum Genet. 1989 Oct. 45(4):498-506. [QxMD MEDLINE Link]. [Full Text].
Schwartz M, Hertz JM, Sveen ML, et al. LGMD2I presenting with a characteristic Duchenne or Becker muscular dystrophy phenotype. Neurology. 2005 May 10. 64(9):1635-7. [QxMD MEDLINE Link].
Cirak S, Feng L, Anthony K, Arechavala-Gomeza V, Torelli S, Sewry C, et al. Restoration of the Dystrophin-associated Glycoprotein Complex After Exon Skipping Therapy in Duchenne Muscular Dystrophy. Mol Ther. 2011 Nov 15. [QxMD MEDLINE Link].
Mavrogeni S, Markousis-Mavrogenis G, Papavasiliou A, Kolovou G. Cardiac involvement in Duchenne and Becker muscular dystrophy. World J Cardiol. 2015 Jul 26. 7 (7):410-4. [QxMD MEDLINE Link].
Nicolas A, Raguenes-Nicol C, Ben Yaou R, et al. Becker muscular dystrophy severity is linked to the structure of dystrophin. Hum Mol Genet. 2015 Mar 1. 24 (5):1267-79. [QxMD MEDLINE Link].
Cardiovascular health supervision for individuals affected by Duchenne or Becker muscular dystrophy. Pediatrics. 2005 Dec. 116(6):1569-73. [QxMD MEDLINE Link]. [Full Text].
Emery AE, Skinner R. Clinical studies in benign (Becker type) X-linked muscular dystrophy. Clin Genet. 1976 Oct. 10(4):189-201. [QxMD MEDLINE Link].
Holloway SM, Wilcox DE, Wilcox A, et al. Life expectancy and death from cardiomyopathy amongst carriers of Duchenne and Becker muscular dystrophy in Scotland. Heart. 2007 Oct 11. [QxMD MEDLINE Link].
Young HK, Barton BA, Waisbren S, et al. Cognitive and Psychological Profile of Males With Becker Muscular Dystrophy. J Child Neurol. 2007 Dec 3. [QxMD MEDLINE Link].
De Wel B, Willaert S, Nadaj-Pakleza A, et al. Respiratory decline in adult patients with Becker muscular dystrophy: a longitudinal study. Neuromuscul Disord. 2020 Dec 26. [QxMD MEDLINE Link].
Zhang H, Zhu Y, Sun Y, et al. Serum creatinine level: a supplemental index to distinguish Duchenne muscular dystrophy from Becker muscular dystrophy. Dis Markers. 2015. 2015:141856. [QxMD MEDLINE Link].
Menezes MP, North KN. Inherited neuromuscular disorders: Pathway to diagnosis. J Paediatr Child Health. 2011 Nov 3. [QxMD MEDLINE Link].
Lim BC, Lee S, Shin JY, Kim JI, Hwang H, Kim KJ, et al. Genetic diagnosis of Duchenne and Becker muscular dystrophy using next-generation sequencing technology: comprehensive mutational search in a single platform. J Med Genet. 2011 Nov. 48(11):731-6. [QxMD MEDLINE Link].
Marty B, Gilles R, Toussaint M, et al. Comprehensive evaluation of structural and functional myocardial impairments in Becker muscular dystrophy using quantitative cardiac magnetic resonance imaging. Eur Heart J Cardiovasc Imaging. 2018 Dec 24. [QxMD MEDLINE Link].
Rutkove SB, Darras BT. Electrical impedance myography for the assessment of children with muscular dystrophy: a preliminary study. J Phys Conf Ser. 2013. 434(1):[QxMD MEDLINE Link]. [Full Text].
Magot A, Wahbi K, Leturcq F, et al. Diagnosis and management of Becker muscular dystrophy: the French guidelines. J Neurol. 2023 Oct. 270 (10):4763-81. [QxMD MEDLINE Link]. [Full Text].
Grootenhuis MA, de Boone J, van der Kooi AJ. Living with muscular dystrophy: health related quality of life consequences for children and adults. Health Qual Life Outcomes. 2007. 5:31. [QxMD MEDLINE Link]. [Full Text].
Yamada Y, Kawakami M, Wada A, Otsuka T, Muraoka K, Liu M. A comparison of swallowing dysfunction in Becker muscular dystrophy and Duchenne muscular dystrophy. Disabil Rehabil. 2017 Mar 13. 1-5. [QxMD MEDLINE Link].
Hayes J, Veyckemans F, Bissonnette B. Duchenne muscular dystrophy: an old anesthesia problem revisited. Paediatr Anaesth. 2008 Feb. 18(2):100-6. [QxMD MEDLINE Link].
Segura LG, Lorenz JD, Weingarten TN, Scavonetto F, Bojanic K, Selcen D, et al. Anesthesia and Duchenne or Becker muscular dystrophy: review of 117 anesthetic exposures. Paediatr Anaesth. 2013 Sep. 23(9):855-64. [QxMD MEDLINE Link].
Jenkins HM, Stocki A, Kriellaars D, Pasterkamp H. Breath stacking in children with neuromuscular disorders. Pediatr Pulmonol. 2013 Aug 16. [QxMD MEDLINE Link].
Pouwels S, de Boer A, Leufkens HG, Weber WE, Cooper C, van Onzenoort HA, et al. Risk of fracture in patients with muscular dystrophies. Osteoporos Int. 2013 Aug 15. [QxMD MEDLINE Link].
Duan D. Myodys, a full-length dystrophin plasmid vector for Duchenne and Becker muscular dystrophy gene therapy. Curr Opin Mol Ther. 2008 Feb. 10(1):86-94. [QxMD MEDLINE Link].
Bowles DE, McPhee SW, Li C, Gray SJ, Samulski JJ, Camp AS, et al. Phase 1 Gene Therapy for Duchenne Muscular Dystrophy Using a Translational Optimized AAV Vector. Mol Ther. 2011 Nov 8. [QxMD MEDLINE Link].