Late-onset hereditary ataxia with global thermoanalgesia and absence of fungiform papillae on the tongue in a Japanese family

Neurolocalization of taste disorders

Neurolocalization of taste disorders requires a knowledge of the functional anatomy involved in mediating taste information from the peripheral mucosal surfaces through numerous peripheral cranial nerves to complex subcortical and cortical brain regions. Our understanding of this functional anatomy has advanced in recent years. Taste is an experience that is both innate and learned, and the "taste" experience involves the integration of information from other sensory modalities, such as olfaction and somatosensation. Normal taste perception is influenced by different neurophysiologic states, which involve endocrine function, emotions, and even attitudes and expectations toward eating. At its core, the normal effective ability to taste is a reflection of the proper function of many organ systems within the body and may be considered a marker for good health. Clinical taste disorders, on the other hand, involve the dysfunction of the normal neural taste pathways and/or aberrant influences on multisensory integration and cortical taste processing. The number of disease processes, which can adversely affect taste, are numerous and quite varied in their presentation. There may be contributory involvement of other organ systems within the body, and the appropriate management of taste disorders often requires a multidisciplinary approach to fully understand the disorder. Depending on the underlying cause, taste disorders can be effectively managed when identified. Treatments may include correcting underlying metabolic disturbances, eliminating infections, changing offending medications, replenishing nutritional deficiencies, operating on structural impairments, calming autoimmune processes, and even stabilizing electrochemical interactions.

Taste Exam: A Brief and Validated Test

The emerging importance of taste in medicine and biomedical research, and new knowledge about its genetic underpinnings, has motivated us to supplement classic taste-testing methods in two ways. First, we explain how to do a brief assessment of the mouth, including the tongue, to ensure that taste papillae are present and to note evidence of relevant disease. Second, we draw on genetics to validate taste test data by comparing reports of perceived bitterness intensity and inborn receptor genotypes. Discordance between objective measures of genotype and subjective reports of taste experience can identify data collection errors, distracted subjects or those who have not understood or followed instructions. Our expectation is that fast and valid taste tests may persuade researchers and clinicians to assess taste regularly, making taste testing as common as testing for hearing and vision. Finally, because many tissues of the body express taste receptors, taste responses may provide a proxy for tissue sensitivity elsewhere in the body and, thereby, serve as a rapid, point-of-care test to guide diagnosis and a research tool to evaluate taste receptor protein function.

Defects in tongue papillae and taste sensation indicate a problem with neurotrophic support in various neurological diseases

Neurotrophic support of developing neurons by neurotrophins is of critical importance in the development of fungiform papillae and taste buds. A number of neurological disorders show a decrease or increase in fungiform papillae or taste sensation. These can be grouped into disorders with reduced papillae (Machado-Joseph disease, Stüve-Wiedemann syndrome, familial dysautonomia, dystonia musculorum, and Behçet's disease) and those with taste defects only (Alzheimer's disease, Huntington's disease, hereditary sensory and autonomic neuropathy type IV, and diabetes mellitus). In addition, Parkinson's disease results in increased taste sensation. Here, we hypothesize that the main problem in these disorders is either not enough or too much neurotrophic support. Proneurotrophic drugs such as some antidepressants and aldose reductase inhibitors may prove useful in the treatment of these sensory and central nervous system disorders. Similarly, antineurotrophic drugs may also be useful in Parkinson's disease. Here we show that the protein involved in familial dysautonomia, IKAP, localizes to keratin filaments in HeLa cells, suggesting a role for the keratin cytoskeleton in neurotrophic support.

Adult-onset hereditary sensory and autonomic neuropathy accompanied by anosmia but without skin ulceration

We report a novel type of hereditary sensory and autonomic neuropathy (HSAN) with adult onset in a Japanese family. One male and 2 females of 6 siblings were affected. They developed anosmia initially at the ages of 20-50 years, followed by anhidrosis and sensory loss. Skin ulceration was absent. Both superficial and deep sensation were impaired in the most distal parts of all 4 limbs. Orthostatic hypotension was present in all patients. This is a unique subtype of HSAN distinct from the HSAN I-V described by Dyck.