Maximum bite force in patients with spinal muscular atrophy during the first year of nusinersen therapy – A pilot study

Teresa Kruse 1,2, Raoul Heller 2,3, Brunhilde Wirth 2,3,4, Julia Glöggler 5, Claudia D. Wurster 6, Albert C. Ludolph 6, Bert Braumann 1,2

1 Poliklinik für Kieferorthopädie, Universität zu Köln, Medizinische Fakultät und Universitätsklinikum Köln, Deutschland; 2 Zentrum für Seltene Erkrankungen, Universität zu Köln, Medizinische Fakultät und Universitätsklinikum Köln, Deutschland; 3 Institut für Humangenetik, Universität zu Köln, Medizinische Fakultät und Universitätsklinikum Köln, Deutschland; 4 Zentrum für Molekulare Genetik, Universität zu Köln, Medizinische Fakultät und Universitätsklinikum Köln, Deutschland; 5 Klinik für Kieferorthopädie und Orthodontie, Universitätsklinikum Ulm, Deutschland; 6 Klinik für Neurologie, Universitätsklinikum Ulm, Deutschland

Objectives. Spinal muscular atrophy is a monogenic disease characterized by progressive spinal and bulbar muscle weakness and atrophy. It is caused by the degeneration of alpha-motoneurons. The recent approval of the antisense oligonucleotide nusinersen highlights the need for reliable clinical tools to evaluate motor function in patients with neuromuscular disorders. Measurement of the bulbar neuromuscular function (e.g., bite force) could be an extension to existing motor scales, sensitive to more nuanced changes, especially in symptomatic patients with severely reduced functional abilities. 

Materials and methods. Maximum bite force measurement was used to quantify changes of the masticatory function in adult monozygotic female twins with SMA type II. Using piezoelectric transducers, 550 observations were recorded for each patient during the first year of nusinersen therapy. 

Results. During the application of four loading doses of nusinersen, bite force levels steadily increased and reached a statistically significantly higher level compared to the initial state in both patients. Subsequent maintenance doses coincided with smaller or no statistically significant changes in maximum bite force. 

Conclusions. This pilot study indicates that the measurement of maximum bite force may be a useful tool to detect changes of the bulbar function in SMA patients. As such, it may supplement existing scales to identify treatment-related changes in motor function.

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