Clinical features of a patient with merosin-deficient congenital muscular dystrophy (MDC1A) with complete laminin α2 chain deficiency. (A) Facial weakness with an open mouth and reduced facial expression. Patient has developed bilateral elbow-flexion contractures, a fairly common sign in patients with MDC1A. (B) Bilateral knee-flexion contractures and lumbar hyperlordosis. (C) Truncal weakness and neck-flexion weakness (lack of head control) when the patient is pulled up from a lying position. Informed consent was obtained from the patient's parents for publication of the photographs.