Options for Treatment Intervention

Depending on the form of Muscular Dystrophy that exists, there are some medications and surgical therapies used to appease the disease or its effects. For Duchenne’s and Becker’s, and most forms, medications offer little help in the decline of muscle deterioration or improvement in muscle function. In Myotonic MD however, because it involves an inability for the muscle membrane to relax, some medications like phenytoin, procainamide, gabapentin and others may help with the symptom of myotonia. These agents are anti-seizure and anti-arrhythmia drugs, and because they share properties of cell membrane stabilization, they also seem to help with muscle membrane stability and myotonia. Likewise, these medications and others like quinine can reduce muscle cramps and spasms if present.

Particularly in children, the need for surgical assistance may be needed. When muscle weakness of the spine develops and results in spinal deformities, surgery to correct this can improve respiratory function greatly and prolong longevity. Because our breathing depends significantly on a normal anatomy of our chest and spine, these deformities can be eventually life-threatening. Other surgeries may relieve joint and tendon contractures that have developed from lack of muscle function, and can allow greater mobility and function in turn. Other less common operations can address eyelid drop, or ptosis, in Oculopharyngeal MD, or the development of obstructive sleep apnea syndromes where muscle weakness results in narrowing of the airways during sleep. All of these surgeries are always very individualized as the benefits and risks of the operations vary greatly in patients with Muscular Dystrophy.

A mainstay in the treatment of all forms of Muscular Dystrophy is physical therapy and occupational therapy. Physical therapy focuses on muscle strengthening, ability to walk, posture, muscle and tendon mobility, musculoskeletal pain, and activities of daily living that involve major muscle groups. Because muscles shrink in MD, and are not being used as fully, tendons can shorten and the related joints do not get the routine full range of motion. This can be significantly prevented through aggressive stretching exercises, often performed manually by the therapist. This then prolongs functional abilities of these joints and muscles and reduces potential pain. Occupational therapy is crucial to maintain dexterity tasks, daily living abilities, and levels of independence. As children affected with MD grow older and larger, this can have a significant impact on the caregivers involved. Special tools and utensils assist abilities when weakness makes it difficult to use normal devices. Likewise, different techniques can be taught to circumvent problematic areas of function. Both of these therapies may also be supplemented by massage which further decreases pain, reduces contractures, and promotes mobility and function.