Exercise Study of Function and Pathology for Women With X-linked Adrenoleukodystrophy

Hugo W. Moser Research Institute at Kennedy Krieger, Inc.

Status

Completed

Conditions

X-linked Adrenoleukodystrophy

Treatments

Behavioral: exercise training

Study type

Interventional

Funder types

Other

Identifiers

NCT01594853

NA_00045673

Details and patient eligibility

About

The purpose is to see how X-linked adrenoleukodystrophy (X-ALD) is associated with strength and sensation using MRI, in women with X-ALD. The investigators will also see whether exercise can improve these symptoms for women with X-ALD.

Full description

X-linked adrenoleukodystrophy (X-ALD), a [sex-linked] progressive neurodegenerative disease, is caused by a defect in the ABCD1 gene. The disease is expressed in multiple ways, but the most common adult form is adrenomyeloneuropathy (AMN), which results in slowly progressive changes in muscle tone and weakness, sensory loss, and dysfunction of the autonomic nervous system. In a previous study the investigators linked abnormalities in the [brain/spinal cord] to lower extremity weakness in men with AMN; however, there have been no studies evaluating these relationships in women carriers (i.e., women with AMN). It is unknown, in women with AMN, how the pattern of damage in the brain and spinal cord relates to disability and if these patterns predict responsiveness to treatment. The investigators hypothesize that by using magnetization transfer (MT) and diffusion tensor imaging (DTI), two magnetic resonance imaging (MRI) modalities, to track particular changes in the brain and spinal cord will predict disability and additionally, who is likely to respond best to a training regimen. The investigators expect that these more advanced imaging techniques will be more sensitive and accurate quantitative measures of clinical motor function and women with greater loss in the spinal cord compared to the brain will benefit most from training to improve disability. To test this hypothesis, women with AMN will receive MRI scans at baseline and complete measures of global walking and lower extremity impairments of vibration sensation, spasticity, and strength at three time-points: baseline, 12 weeks, and 18 weeks after baseline. The group will participate in a resistive training program for 12 weeks. MRI data will be correlated to changes over time in measures of impairment to determine their relationships. The linking of this information will not only be important for better defining disability in women with AMN but it will also help to guide physicians and rehabilitation therapists in predicting who is likely to respond to rehabilitative interventions, as well as for optimizing the effects of future pharmacological interventions.

Enrollment

31 patients

Sex

Female

Ages

21 to 70 years old

Volunteers

Accepts Healthy Volunteers

Inclusion criteria

confirmed diagnosis, X-ALD heterozygote carrier
no medical contraindication to participating in a strength training program
able to follow complex directions as determined by a score of ≤1 on a subset of questions taken from the NIH Stroke scale (Brott et al. 1989)
hip flexion strength: 6.6-15.8kg
hip extension strength: up to 18.3 kg
normal passive range of motion at hips/knees/ankles
able to walk ≥50m

Exclusion criteria

Evidence of other neurological deficit that could interfere, such as previous stroke or muscle disease
congestive heart failure
cancer
orthopedic conditions
severe pain that precludes study participation
seizures
pregnancy
other medical condition that precludes participation in an exercise program, e.g., unstable angina, uncontrolled diabetes, uncontrolled hypertension

Healthy controls have the same age and exclusion criteria as women with AMN except that they will not be carriers for X-ALD. They must have normal neurological function.