NEMALINE MYOPATHY: WHAT IS THE RARE GENETIC DISORDER AFFECTING CHIEF JUSTICE DY CHANDRACHUD’S DAUGHTERS?

In a heartfelt and personal account, Chief Justice of India DY Chandrachud recently shed light on a rare genetic condition that deeply affects his own family — nemaline myopathy. Speaking at the 9th Annual National Stakeholders Consultation on “Protecting the Rights of Children Living with Disability and Intersectionality of Disabilities,” organized by the Supreme Court’s Juvenile Justice Committee, he shared the challenges his family has faced due to this condition, which affects his foster daughters.

His speech highlighted the lack of awareness, challenges in diagnosis, and the emotional toll on families caring for children with this condition.

What Is Nemaline Myopathy?

Nemaline myopathy is a hereditary condition, meaning it is passed down through families due to genetic mutations. The term “nemaline” comes from the Greek word “nema,” which means “thread-like.” This refers to the rod-like structures (nemaline bodies) that are found in the muscle cells of people affected by this condition. These structures are not present in healthy muscle tissue and are a hallmark of nemaline myopathy.

The condition is rare, occurring in approximately 1 in 50,000 live births worldwide. People with nemaline myopathy experience weakness in their skeletal muscles, which are the muscles responsible for voluntary movements like walking, swallowing, and breathing. However, the severity of the condition can vary significantly from person to person. Some individuals may have mild symptoms, while others may experience more severe impairments that affect their daily lives.

Symptoms of Nemaline Myopathy

The symptoms of nemaline myopathy can be diverse and affect different parts of the body. Some of the most common symptoms include:

1. Muscle Weakness: This is the primary symptom of nemaline myopathy. The weakness typically affects the muscles of the face, neck, and trunk, though it can also extend to the limbs.

2. Difficulty Swallowing and Feeding: Muscle weakness can interfere with a person’s ability to chew and swallow food, making feeding difficult. In severe cases, this can lead to malnutrition or require feeding through a tube.

3. Foot and Joint Deformities: Individuals with nemaline myopathy may develop foot deformities such as clubfoot. Joint deformities, including contractures (stiffness or tightening of the joints), can also occur due to prolonged muscle weakness.

4. Scoliosis: A curvature of the spine is common in individuals with muscle weakness and can further impact their mobility and posture.

5. Breathing Difficulties: The muscles that control breathing can be affected, leading to respiratory issues. This is a serious symptom as it can cause long-term complications, especially if not managed properly.

6. Decreased Muscle Tone: People with nemaline myopathy often have reduced muscle tone, making it harder for them to move efficiently and maintain their posture.

The symptoms of nemaline myopathy can range from mild to severe, and they may worsen over time. This progressive weakening of the muscles makes it difficult for individuals to respond to sudden or alarming situations, as their reflexes are often impaired. Early diagnosis and management are essential to slow the progression of symptoms and improve quality of life.

Diagnosis of Nemaline Myopathy

Diagnosing nemaline myopathy can be challenging, particularly in regions with limited medical resources. Families often face a lack of awareness about the condition, even among healthcare professionals. As highlighted in the personal account mentioned earlier, many doctors, caregivers, and even parents are unaware of the condition, leading to delays in diagnosis.

Typically, a doctor may begin the diagnostic process by observing the physical symptoms of muscle weakness. To confirm the diagnosis, further tests are required, including:

1. Genetic Testing: This can help identify mutations in the genes responsible for producing proteins that are critical for muscle function. Genetic mutations are the underlying cause of nemaline myopathy, and identifying them can confirm the diagnosis.

2. Muscle Biopsy: This is one of the most definitive tests for diagnosing nemaline myopathy. A small sample of muscle tissue is removed and examined under a microscope to look for the presence of nemaline bodies. However, as described in the personal account, this test can be invasive and painful, especially for young children. In some cases, muscle biopsies are done without anesthesia, which can cause significant distress and discomfort.

Due to the complexity and invasiveness of these tests, many families face emotional and physical challenges during the diagnostic process. In some parts of the world, testing facilities are not easily accessible, further complicating the situation for affected individuals.

Treatment and Management of Nemaline Myopathy

Unfortunately, there is currently no cure for nemaline myopathy. Since the condition is genetic, it cannot be prevented or reversed. However, various treatments are available to help manage the symptoms and improve the quality of life for individuals living with nemaline myopathy.

1. Respiratory Support: Breathing difficulties are common in individuals with nemaline myopathy. To manage these issues, non-invasive ventilation, such as BiPAP (bilevel positive airway pressure), may be used. In severe cases, a tracheostomy (a surgical opening in the neck to place a breathing tube) may be necessary.

2. Physical Therapy: Regular physical therapy can help maintain muscle strength and flexibility, slowing the progression of muscle weakness. Low-impact exercises are recommended to prevent further damage to already weakened muscles.

3. Occupational Therapy: This form of therapy helps individuals develop strategies to perform daily activities despite their physical limitations. Occupational therapists may recommend assistive devices like crutches, braces, or wheelchairs to enhance mobility.

4. Surgery: In cases where joint contractures or scoliosis become severe, surgery may be required to correct these deformities and improve function.

5. Feeding Support: For individuals with difficulty swallowing, enteral nutrition via tube feeding may be necessary to ensure they receive adequate nutrition.

6. Speech Therapy: Muscle weakness in the face and throat can affect speech, making it difficult for individuals to communicate. Speech therapy can help improve communication abilities.

7. Assistive Devices: Mobility aids such as wheelchairs, walkers, or braces can significantly improve the independence and quality of life for those with nemaline myopathy.

The Emotional and Social Impact on Families

Living with a rare condition like nemaline myopathy can be emotionally challenging for both the affected individuals and their families. Parents may experience feelings of denial, as mentioned in the speech, especially when faced with the lack of knowledge and resources. The absence of proper testing facilities and specialized schools adds to the difficulties families face.

Caring for a child with a chronic condition like nemaline myopathy requires a great deal of emotional, physical, and financial support. Families may struggle with the lack of adequate healthcare and education systems, particularly in regions where medical resources are limited. Additionally, the emotional burden of watching a loved one suffer through painful diagnostic tests or surgeries can take a toll on the mental health of both the patient and their family.

Despite these challenges, families often develop resilience and strength as they navigate the complexities of living with nemaline myopathy. Support groups and advocacy organizations play a crucial role in providing information, resources, and emotional support to affected families.

The Bottom Line

Nemaline myopathy is a rare genetic condition that profoundly affects the lives of those diagnosed with it and their families. The condition is marked by muscle weakness, difficulty swallowing, breathing problems, and other associated symptoms.

While there is no cure, early diagnosis and proper management can significantly improve the quality of life for individuals with nemaline myopathy. Families, caregivers, and healthcare professionals must work together to ensure that affected individuals receive the necessary treatments, therapies, and emotional support to live fulfilling lives despite the challenges they face.

Increased awareness, better diagnostic facilities, and more accessible treatment options can help reduce the emotional and physical burden on families caring for children with this condition.