Which feature may be present in the presymptomatic stage of Duchenne muscular dystrophy?

• A. Possible delayed motor milestones
• B. Advanced hypertonia
• C. Immediate wheelchair dependency
• D. Severe respiratory failure

Answer: (A)

In Duchenne muscular dystrophy, the presymptomatic stage means before clear muscle weakness is seen. The earliest subtle clue can be a mild delay in achieving motor milestones, such as walking or running milestones, due to underlying early muscle involvement even before noticeable weakness appears. Advanced hypertonia isn’t typical this early—the usual pattern in DMD starts with reduced muscle tone (hypotonia) and progressive proximal weakness, not increased tone. Wheelchair dependency and severe respiratory failure are hallmark features of later disease stages when weakness has progressed significantly. So, a possible delay in motor milestones best fits what may appear pre-symptomatically.