Zusammenfassung
Myopathien können durch eine Vielzahl von Medikamenten und Toxinen hervorgerufen werden. Ihre Inzidenz ist nicht bekannt, aufgrund häufiger subklinischer Verläufe ist jedoch von einer hohen Dunkelziffer auszugehen. Das frühe Erkennen dieser Myopathien ist für den Krankheitsverlauf entscheidend, da sie nach Absetzen des auslösenden Agens meist reversibel sind. Die Symptomatik reicht von leichten Muskelschmerzen bis hin zu schweren Paresen und Plegien. Als potenziell tödliche Komplikation kann sich eine Rhabdomyolyse mit einem akuten Nierenversagen entwickeln. Die zugrunde liegenden Pathomechanismen sind bisher nur unvollständig geklärt. Der Schwerpunkt des vorliegenden Artikels liegt auf der Beschreibung der häufigsten medikamenten- und toxininduzierten Myopathien und ihrer bisher beschriebenen pathophysiologischen Hintergründe.
Abstract
Multiple drugs and toxins can cause myopathy. The exact incidence is unknown. Due to various subclinical forms one has to consider a high number of undetected cases. Early diagnosis is important, because these myopathies are potentially reversible on removal of the offending substance. Symptoms vary from mild muscle pain to severe muscle weakness. Rhabdomyolysis and renal failure are potentially lethal complications. The underlying mechanisms are not completely understood. This article focusses on the definition of the most common drug- and toxin-induced myopathies and gives an overview of their possible pathophysiology.
Literatur
-
1
Fernandez-Sola J, Cusso R, Picado C. et al .
Patients with chronic glucocorticoid treatment develop changes in muscle glykogen metabolism.
J Neurol Sci.
1993;
117
103-106
-
2
Tran M, Elias A N.
Severe myopathy and psychosis in a patient with Cushing's disease macroadenoma.
Clin Neurol Neurosurg.
2003;
106
1-4
-
3
Blanco C, Marazuela M, Flores J, Alvarez J.
Severe respiratory failure secondary to Cushing's myopathy.
J Endocrinol Invest.
2001;
24
618-621
-
4
Batchelor T T, Taylor L P, Thaler H AT. et al .
Steroid myopathy in cancer patients.
Neurology.
1997;
48
1234-1238
-
5
Amaya-Villar R, Garnacho-Montero J, Garcia-Garmendia J L. et al .
Steroid-induced myopathy in patients intubated due to exacerbation of chronic obstructive pulmonary disease.
Intensive Care Med.
2005;
31
157-161
-
6
Hirano M, Ott B R, Raps E C. et al .
Acute quadriplegic myopathy: a complication of treatment with steroids, nondepolarizing blocking agents, or both.
Neurology.
1999;
42
2082-2087
-
7
Sitwell L D, Weinshenker B G, Monpetit V, Reid D.
Complete ophthalmoplegia as a complication of acute corticosteroid- and pancuronium associated myopathy.
Neurology.
1991;
41
921-922
-
8
Kanda F, Okuda S, Matsushita T. et al .
Steroid myopathy: pathogenesis and effects of growth hormone and insulin-like growth factor-I administration.
Horm Res.
2001;
56
24-28
-
9
Gayan-Ramirez G, Vanderhoydonc F, Verhoeven G, Decramer M.
Acute treatment with corticosteroids decreases IGF-1 and IGF-2 expression in the rat diaphragm and gastrocnemius.
Am J Respir Crit Care Med.
1999;
159
283-289
-
10
Singleton J R, Baker B L, Thorburn A.
Dexamethasone inhibits insulin-like growth factor signaling and potentiates myoblast apoptosis.
Endocrinology.
2000;
141
2945-2950
-
11
Hickson R C, Czerwinski S M, Wegrzyn L E.
Glutamine prevents downregulation of myosin heavy chain synthesis and muscle atrophy from glucocorticoids.
Am J Physiol.
1995;
268
E730-734
-
12
Hodel C.
Myopathy and rhabdomyolysis with lipid-lowering drugs.
Toxicol Lett.
2002;
128
159-168
-
13
Phillips P S, Haas R H, Bannykh S. et al .
Statin-associated myopathy with normal creatine kinase levels.
Ann Intern Med.
2002;
137
581-585
-
14
Vasconcelos O M, Campbell W W.
Dermatomyositis-like syndrome and HMG-CoA reductase inhibitor (statin) intake.
Muscle Nerve.
2004;
30
803-807
-
15
Baker S K, Tarnopolsky M A.
Statin myopathies: pathophysiologic and clinical perspectives.
Clin Invest Med.
2001;
24
258-272
-
16
Kagan T, Davis C, Lin L, Zakeri Z.
Coenzyme Q 10 can in some circumstances block apoptosis, and this effect is mediated through mitochondria.
Ann N Y Acad Sci.
1999;
887
31-47
-
17
Flint O P, Masters B A, Gregg R E, Durham S K.
Inhibition of cholesterol synthesis by squalene synthesis inhibitors does not induce myotoxicity in vitro.
Toxicol Appl Pharmacol.
1997;
145
91-98
-
18
Pinieux G De, Chariot P, Ammi-Said M. et al .
Lipid-lowering drugs and mitochondrial function: effects of HMG-CoA reductase inhibitors on serum ubiquinone and blood lactate/pyruvate ratio.
Br J Clin Pharmacol.
1996;
42
333-337
-
19
Owczarek J, Jasinska M, Orszulak-Michalak D.
Drug-induced myopathies. An overview of the possible mechanisms.
Pharmacol Reports.
2005;
57
23-34
-
20
Guis S, Mattei J P, Liote F.
Drug-induced and toxic myopathies.
Best Pract Res Clin Rheumatol.
2003;
17
877-907
-
21
Thompson P D, Clarkson P, Karas R H.
Statin-associated myopathy.
JAMA.
2003;
289
1681-1690
-
22
Arnaudo E, Dalakas M, Shanske S. et al .
Depletion of muscle mitochondrial DNA in AIDS patients with zidovudine-induced myopathy.
Lancet.
1991;
337
508-510
-
23
Dalakas M C, Illa I, Pezeshkpour G H. et al .
Mitochondrial myopathy caused by long-term zidovudine therapy.
N Engl J Med.
1990;
322
1098-1105
-
24
Urbano-Marquez A, Fernandez-Sola J.
Effects of alcohol on skeletal and cardiac muscle.
Muscle Nerve.
2004;
30
689-707
-
25
Lindner A, Zierz S.
Rhabdomyolyse und Myoglobinurie.
Nervenarzt.
2003;
74
505-515
-
26
Haller R G, Carter N W, Ferguson E, Knochel J P.
Serum and muscle potassium in experimental alcoholic myopathy.
Neurology.
1984;
34
529-532
-
27
Finsterer J, Hess B, Jarius C. et al .
Malnutrition-induced hypokalemic myopathy in chronic alcoholism.
J Toxicol Clin Toxicol.
1998;
36
369-373
-
28
Fernandez-Sola J, Nicolas J M, Sacanella E. et al .
Low-dose ethanol consumption allows strength recovery in chronic alcoholic myopathy.
QJ Med.
2000;
93
35-40
-
29
Slavin G, Martin F, Ward P. et al .
Chronic alcohol excess is associated with selective but reversible injury to 2B muscle fibers.
J Clin Pathol.
1983;
36
722-777
-
30
Sieb J, Gillessen T.
Iatrogenic and toxic myopathies.
Muscle Nerve.
2003;
27
142-156
-
31
Niemela O, Parkilla S, Worral S. et al .
Generation of aldehyde-derived protein modifications in ethanol-exposed heart.
Alcohol Clin Exp Res.
2003;
27
1987-1991
-
32
Walsh R J, Amato A A.
Toxic myopahies.
Neurol Clin.
2005;
23
397-428
-
33
Authier F J, Cherin P, Creange A. et al .
Central nervous system disease in patients with macrophagic myofasciitis.
Brain.
2001;
124
974-983
-
34
Fischer D, Reimann J, Schröder R.
Makrophagische Myofasciitis. Eine Impfungs-assoziierte entzündliche Muskelerkrankung.
Dtsch med Wochenschr.
2003;
128
2305-2308
-
35
Guis S, Pellissier J F, Nicoli F. et al .
HLA-DRB1*01 and macrophagic myofasciitis.
Arthritis Rheum.
2002;
46
2535-2537
Dr. med. V. Fürer
Klinik und Poliklinik für Neurologie · Universitätsklinikum Carl Gustav Carus · Technische Universität Dresden
Schubertstraße 62
01307 Dresden
Email: Verena.Fuerer@neuro.med.tu-dresden.de
