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  In this Article
 »  Abstract
 »  Introduction
 »  Material and methods
 »  Result
 »  Discussion
 »  References

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Year : 2000  |  Volume : 48  |  Issue : 2  |  Page : 187-8

Studies on skeletal muscle biopsies in endemic skeletal fluorosis.


Division of Pathology, National Institute of Nutrition, Hyderabad, 500007, India.

Correspondence Address:
Division of Pathology, National Institute of Nutrition, Hyderabad, 500007, India.

  »  Abstract

Neurological manifestations of skeletal fluorosis have been attributed to compressive radiculomyelopathy. Experimental fluorosis has shown evidence of myopathic changes. Data on human muscle pathology is very scanty. This study included 22 patients with established osteofluorosis. 16 of them showed only EMG changes of neurogenic muscle disease. Histochemistry and histopathology of muscle biopsies showed features of muscle atrophy, evidenced by 'type I' atrophy and 'type I' grouping. No myopathic changes were observed. It may be concluded that the primary changes are related to the nerve, with muscle being affected secondarily. There was no evidence of any primary muscle pathology due to fluorosis.

How to cite this article:
Sesikeran B, Krishnamurthy D, Harinarayana Rao S, Ramachandran E P, Raja Reddy D. Studies on skeletal muscle biopsies in endemic skeletal fluorosis. Neurol India 2000;48:187


How to cite this URL:
Sesikeran B, Krishnamurthy D, Harinarayana Rao S, Ramachandran E P, Raja Reddy D. Studies on skeletal muscle biopsies in endemic skeletal fluorosis. Neurol India [serial online] 2000 [cited 2020 Dec 6];48:187. Available from: https://www.neurologyindia.com/text.asp?2000/48/2/187/1545




   »   Introduction Top

Neurological manifestations associated with skeletal fluorosis have been attributed to compressive radioculomyelopathy.[1] Reports suggesting a direct anterior horn cell involvement have also been published.[2],[3] Experimental fluorosis has demonstrated non-skeletal toxic effects in the skeletal muscle and spinal cord.[4] One electrophysiological study confirmed that the myopathy was secondary to nerve compression.[5] Since several regions of Andhra Pradesh in south India have the problem of fluorosis, our study were planned to examine histopathologically, the various changes in the skeletal muscle.


   »   Material and methods Top

A total of 22 patients with radiologically confirmed skeletal fluorosis (19 males and 3 females) in the age range of 27 to 65 years formed part of this investigation. These patients had their origin from the fluorosis affected districts of Nalgonda, Mahaboobnagar, Warangal and Ranga Reddy in Andhra Pradesh. Sixteen of them did not have any neurological deficit. While four showed quadriparesis of upper motor neurone type, the remaining exhibited paraparesis. Electrophysiological studies were conducted according to the methods described earlier.[2] A skeletal muscle biopsy was performed under local anaesthesia after obtaining an informed consent. The muscles biopsied were vastus (16) gastrocnemius (4) and deltoid (2). Biopsy samples were snap frozen and 10 µ m serial cross sections of the muscle were made on a cryostat. These sections were stained by enzyme histochemical methods for oxidative enzyme NADH-TR, conventional ATPase at pH 9.4 and reversal ATPase at pH 4.6 and 4.3. Muscle fibre typing was done on serial photomicrographs as Type-1, 2A, 2B and 2C. Sections were also studied with conventional histological stains i.e. haematoxylin-eosin, Modified Gomori's trichrome, Masson's, PAS and phospho-tungstic acid haematoxylin. Muscle fibre diameter was measured by the principle of lesser diameter on these photomicrographs.[6],[7]


   »   Result Top

Fibre type predominance (>55%) involving 'type I' fibres was seen in 9 of these biopsies [Figure. 1]. Type II fibres were not predominant in any biopsy. Muscle fibre atrophy was seen in 20 cases, of which 6 biopsies had Type I atrophy and the remaining 14 showed Type II atrophy. Fibre grouping was observed in 8 biopsies. Hypertrophy was seen in type I fibres in 5 biopsies. Qualitative changes included small angular fibres in 9, pyknotic nuclear clumps in 14 and moth eaten fibres in 10 biopsy samples.


   »   Discussion Top

Based on the above observations, it was found that almost all the features are characteristic of denervating muscle changes. 14 out of these 22 patients showed neurogenic secondary muscle changes. A single case had features of myopathy. The remaining biopsies were essentially equivocal. Skeletal muscle changes confirmed that compression associated neurogenic atrophy of muscle exists in humans with skeletal fluorosis. Our earlier studies on small nerve biopsies had demonstrated a direct toxic effect on the sensory neurons as well.
These two studies, though done in tandem, indicate that in patients with skeletal fluorosis, neuromuscular changes could be of two types: (a) a compression radiculopathy associated neurogenic muscle changes and (b) myelinated fibre degeneration, possibly due to a direct toxic effect on the neurons. Myopathic changes of the type which have been observed in experimental fluorosis[4] were not seen in humans.

 

  »   References Top

1.Singh A, Jolly SS: Endemic fluorosis with particular reference to fluorotic radiculo-myelopathy. QJM 1961; 30: 357-372.   Back to cited text no. 1    
2.Murthy JMK, Anandavalli TE, Reddy DR: Late response in skeletal fluorosis. Fluoride 1986; 19: 181-183.   Back to cited text no. 2    
3.Reddy DR: Skeletal fluorosis. In: Vinken PJ, Bruyn GW (eds). Handbook of Clinical Neurology. 1979; Vol. 36, North Holland Publishing. Amsterdam. pp. 465-504.   Back to cited text no. 3    
4.Kaul RD, Susheela AK: Symposium on the non-skeletal phase of chronic fluorosis. The muscle. Fluoride 1976; 9: 9  Back to cited text no. 4    
5.18.   Back to cited text no. 5    
6.Veeraraghava Reddy M, Raja Reddy D, Ramulu SB et al: Electromyographic studies in endemic skeletal fluorosis. Fluoride 1978; 11: 33-36.   Back to cited text no. 6    
7.Dubowitz V: Muscle biopsy. A practical approach. 2nd edition. London, Philadelphia. Toronto. Bailliere, Tindall. 1985.   Back to cited text no. 7    
8.Dubowitz V, Brooke MH: Muscle Biopsy. A modern. approach. Saunders, London. 1973.   Back to cited text no. 8    
9.Sesikeran B, Harinarayana Rao S, Krishnamurthy D et al: Studies on sural nerve biopsies in endemic skeletal fluorosis. Fluoride 1994; 27: 189-193.   Back to cited text no. 9    

 

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