BECKER DIAGNOSIS

Having an accurate, timely diagnosis is a critical aspect of care. A combination of tests and evaluations may be used to help confirm a diagnosis of Becker muscular dystrophy. The following tests are typically used to confirm a preliminary diagnosis.

CREATINE KINASE (CK) BLOOD TEST

If your family doctor suspects that you or your child has a medical problem in the muscles, it is likely that your doctor will order a CK (creatine kinase, sometimes referred to as a CPK or creatine phosphokinase) blood test as a first step in the diagnostic process.

CK is an enzyme that normally lives inside muscles. In healthy muscle, the membrane surrounding the muscle is intact, keeping the CK inside. In Becker, the lack of functional dystrophin keeps the muscle from tolerating the constant muscle movement of everyday activities, giving rise to tiny tears in the damaged muscle membrane. When this happens, CK leaks out of the muscle and into the blood.

The CK level of a person who does not have dystrophinopathy (Duchenne/Becker) is usually less than 200 units/liter. Elevated CK levels show that someone has damage to their muscles, rather than a health concern that can show similar symptoms such as a difference in their nerves. However, CK testing is not a diagnostic test and cannot confirm if Becker is the cause of the muscle damage.  Unlike Duchenne muscular dystrophy, where CK levels are expected to be extremely elevated at diagnosis, individuals with Becker muscular dystrophy sometimes have only mild CK elevations.

If you/your child have an elevated CK test, your doctor should offer testing that can give a diagnosis. The two types of tests that are used to make a diagnosis are genetic testing and muscle biopsy. Learn about CK testing here.

GENETIC TESTING

Genetic testing can give helpful information to confirm a diagnosis of dystrophinopathy and may show changes in the gene that are more typical of Becker muscular dystrophy. To diagnose Becker, DNA-based genetic testing is used to find variants (changes) in the DMD gene, which is the gene that provides the information for the body to make the dystrophin protein. 

There are different genetic testing methods that find different types of variants, and some people may need more than one test to confirm their diagnosis. If a person with Becker has a complete set of genetic tests, it is very likely that the lab will find a variant. If the lab finds a variant, most individuals will not need to have a muscle biopsy. Learn more about genetic testing and PPMD’s free genetic testing program, Decode Duchenne.

MUSCLE BIOPSY

If genetic testing is not able to accurately provide a diagnosis, a muscle biopsy may be performed. A muscle biopsy is a surgical procedure that involves taking a small sample of muscle for analysis to look for changes in the amount and appearance of dystrophin protein. This is usually done by immunohistochemistry of slides of the muscle (putting a stain on the muscle, then looking at the muscle cells under a microscope for evidence of dystrophin) or by a Western blot test of the muscle protein (a chemical process that tests for the chemical presence of dystrophin). This type of testing can usually tell whether a person has Duchenne or Becker muscular dystrophy based on how much dystrophin protein is seen, however it is not always conclusive. Because this is a surgical procedure, it is more invasive than a blood test.

MAKING INFORMED CHOICES

Every primary care provider has a different amount of experience with Becker and with genetic testing. Some will know how to help you make informed choices about the pros and cons of muscle biopsy and genetic testing, and others may not. Many primary care providers will refer you to a neuromuscular or genetics specialist for diagnosis and testing and for long term management. If you have any concerns after meeting with the specialist, a second opinion may be useful. Informing yourself is always a good way to help promote good healthcare for your family.

If you are unsure of where to find a specialist, you can see a list of PPMD’s Certified Duchenne Care Centers or email careteam@parentprojectmd.org and we are happy to assist with finding a provider close to you.