1
|
Uncini A, Cavallaro T, Fabrizi GM, Manganelli F, Vallat JM. Conduction slowing, conduction block and temporal dispersion in demyelinating, dysmyelinating and axonal neuropathies: Electrophysiology meets pathology. J Peripher Nerv Syst 2024. [PMID: 38600691 DOI: 10.1111/jns.12625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/02/2024] [Accepted: 03/28/2024] [Indexed: 04/12/2024]
Abstract
Nerve conduction studies are usually the first diagnostic step in peripheral nerve disorders and their results are the basis for planning further investigations. However, there are some commonplaces in the interpretation of electrodiagnostic findings in peripheral neuropathies that, although useful in the everyday practice, may be misleading: (1) conduction block and abnormal temporal dispersion are distinctive features of acquired demyelinating disorders; (2) hereditary neuropathies are characterized by uniform slowing of conduction velocity; (3) axonal neuropathies are simply diagnosed by reduced amplitude of motor and sensory nerve action potentials with normal or slightly slow conduction velocity. In this review, we reappraise the occurrence of uniform and non-uniform conduction velocity slowing, conduction block and temporal dispersion in demyelinating, dysmyelinating and axonal neuropathies attempting, with a translational approach, a correlation between electrophysiological and pathological features as derived from sensory nerve biopsy in patients and animal models. Additionally, we provide some hints to navigate in this complex field.
Collapse
Affiliation(s)
- Antonino Uncini
- Department of Neurosciences, Imaging and Clinical Sciences, University "G. d'Annunzio", Chieti-Pescara, Italy
| | - Tiziana Cavallaro
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Gian Maria Fabrizi
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Fiore Manganelli
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Jean-Michel Vallat
- Department of Neurology, National Reference Center for "Rare Peripheral Neuropathies", CHU Dupuytren, Limoges, France
| |
Collapse
|
2
|
Li D, Yu H, Zhou M, Fan W, Guan Q, Li L. Case report: Chronic inflammatory demyelinating polyneuropathy superimposed on Charcot-Marie-tooth type 1A disease after SARS-CoV-2 vaccination and COVID-19 infection. Front Neurol 2024; 15:1358881. [PMID: 38651106 PMCID: PMC11033519 DOI: 10.3389/fneur.2024.1358881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/28/2024] [Indexed: 04/25/2024] Open
Abstract
Background There is growing evidence that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) or COVID-19 infection is associated with the development of immune mediated neuropathies like chronic inflammatory demyelinating polyneuropathy (CIDP), but the impact of SARS-CoV-2 vaccination and COVID-19 infection on genetic disorders such as Charcot-MarieTooth (CMT) remains unclear. Case presentation A 42-year-old male with occulted CMT neuropathy type lA (CMT1A) who developed limb numbness and weakness after the second SARS-CoV-2-vaccination was confirmed by identifying characteristic repeats in the p11.2 region of chromosome 17. Due to the progressive deterioration of muscle strength over 8 weeks, limb atrophy, moderately elevated protein counts in the cerebrospinal fluid, and significant improvement with intravenous human immunoglobulin, which were characteristic of acquired inflammatory neuropathies, he was eventually diagnosed with CIDP superimposed on CMT1A. However, after a three-month plateau, the patient contracted COVID-19, which led to repeated and worsening symptoms of limb weakness and atrophy, thus was diagnosed with a recurrence of CIDP and treated with Intravenous immunoglobulin and methylprednisolone 500 mg/d for 5 consecutive days, followed by oral prednisone and mycophenolate mofetil tablets. On 2 month follow-up, he exhibited remarkable clinical improvement and could walk independently with rocking gait. After 1 year of follow-up, the patient's condition was stable without further change. Conclusion Our case indicates that CMT1A can deteriorate after SARS-CoV-2 vaccination. Thus, SARS-CoV-2 vaccination should be considered a potential predisposing factor for CMT1A worsening. The possible superposition of CMTIA and CIDP in the context of SARS-CoV-2 infection or immunity suggests that any clinical exacerbation in patients with CMT1A should be carefully evaluated to rule out treatable superposition inflammation. In addition, electrophysiological and imaging examination of the proximal nerves, such as the axillary nerve, is helpful for the diagnosis of CIDP.
Collapse
Affiliation(s)
| | | | | | | | | | - Li Li
- Department of Neurology, Ningbo, Zhejiang, China
| |
Collapse
|
3
|
Gemignani F, Percesepe A, Gualandi F, Allegri I, Bellanova MF, Nuredini A, Saccani E, Ambrosini E, Barili V, Uliana V. Charcot-Marie-Tooth Disease with Myelin Protein Zero Mutation Presenting as Painful, Predominant Small-Fiber Neuropathy. Int J Mol Sci 2024; 25:1654. [PMID: 38338934 PMCID: PMC10855578 DOI: 10.3390/ijms25031654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 02/12/2024] Open
Abstract
Charcot-Marie-Tooth disease (CMT) rarely presents with painful symptoms, which mainly occur in association with myelin protein zero (MPZ) gene mutations. We aimed to further characterize the features of painful neuropathic phenotypes in MPZ-related CMT. We report on a 58-year-old woman with a longstanding history of intermittent migrant pain and dysesthesias. Examination showed minimal clinical signs of neuropathy along with mild changes upon electroneurographic examination, consistent with an intermediate pattern, and small-fiber loss upon skin biopsy. Genetic testing identified the heterozygous variant p.Trp101Ter in MPZ. We identified another 20 CMT patients in the literature who presented with neuropathic pain as a main feature in association with MPZ mutations, mostly in the extracellular MPZ domain; the majority of these patients showed late onset (14/20), with motor-nerve-conduction velocities predominantly in the intermediate range (12/20). It is hypothesized that some MPZ mutations could manifest with, or predispose to, neuropathic pain. However, the mechanisms linking MPZ mutations and pain-generating nerve changes are unclear, as are the possible role of modifier factors. This peculiar CMT presentation may be diagnostically misleading, as it is suggestive of an acquired pain syndrome rather than of an inherited neuropathy.
Collapse
Affiliation(s)
- Franco Gemignani
- European Diagnostic Center, Polyclinic Dalla Rosa Prati, 43126 Parma, Italy
| | - Antonio Percesepe
- Medical Genetics Unit, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Medical Genetics Unit, University Hospital of Parma, 43126 Parma, Italy
| | - Francesca Gualandi
- Medical Genetics Unit, Department of Mother and Child, Sant’Anna University Hospital of Ferrara, 44121 Ferrara, Italy
| | - Isabella Allegri
- Neurology Unit, Department of Specialized Medicine, University Hospital of Parma, 43126 Parma, Italy
| | - Maria Federica Bellanova
- Laboratory of Neuromuscular Histopathology, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Andi Nuredini
- Neurology Unit, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Elena Saccani
- Neurology Unit, Department of Specialized Medicine, University Hospital of Parma, 43126 Parma, Italy
| | - Enrico Ambrosini
- Medical Genetics Unit, University Hospital of Parma, 43126 Parma, Italy
| | - Valeria Barili
- Medical Genetics Unit, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Vera Uliana
- Medical Genetics Unit, University Hospital of Parma, 43126 Parma, Italy
| |
Collapse
|
4
|
Pinto J, Santos M, Matos D, Ferreira A, Santos AF. Clinical Worsening of Charcot-Marie-Tooth Disease Due to Overlapping Acute Inflammatory Polyneuropathy. Cureus 2023; 15:e47750. [PMID: 38021856 PMCID: PMC10676282 DOI: 10.7759/cureus.47750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
We report a case of a six-year-old male with Charcot-Marie-Tooth disease (CMT) type 1B due to MPZ gene mutation who experienced an acute worsening of his symptoms a few years after the diagnosis. He was not able to walk without assistance and had transitory paresthesia in his hands, 10 days after suffering from an upper respiratory and diarrheal illness. The investigation revealed elevated cerebrospinal fluid (CSF) protein levels with no pleocytosis, and sensory and motor chronic demyelinating neuropathy without active denervation findings on electrophysiological studies. The patient completely recovered following treatment with intravenous immunoglobulin. We describe the patient's history and engage in a review of the literature to find similar clinical cases. It has been proposed that MPZ gene mutations can change the myelin structure and result in abnormal exposure of the nervous cell components to immune cells. Hence, patients with this type of CMT would be predisposed to concurrent inflammatory forms of neuropathy.
Collapse
Affiliation(s)
| | | | - Diana Matos
- Neurology, Alto Minho Local Health Unit, Hospital de Santa Luzia, Viana do Castelo, PRT
| | | | | |
Collapse
|
5
|
Remyelination in PNS and CNS: current and upcoming cellular and molecular strategies to treat disabling neuropathies. Mol Biol Rep 2021; 48:8097-8110. [PMID: 34731366 DOI: 10.1007/s11033-021-06755-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 09/15/2021] [Indexed: 10/19/2022]
Abstract
Myelin is a lipid-rich nerve cover that consists of glial cell's plasmalemma layers and accelerates signal conduction. Axon-myelin contact is a source for many developmental and regenerative signals of myelination. Intra- or extracellular factors including both enhancers and inhibitors are other factors affecting the myelination process. Myelin damages are observed in several congenital and hereditary diseases, physicochemical conditions, infections, or traumatic insults, and remyelination is known as an intrinsic response to injuries. Here we discuss some molecular events and conditions involved in de- and remyelination and compare the phenomena of remyelination in CNS and PNS. We have explained applying some of these molecular events in myelin restoration. Finally, the current and upcoming treatment strategies for myelin restoration are explained in three groups of immunotherapy, endogenous regeneration enhancement, and cell therapy to give a better insight for finding the more effective rehabilitation strategies considering the underlying molecular events of a lesion formation and its current condition.
Collapse
|
6
|
Fernandez-Garcia MA, Stettner GM, Kinali M, Clarke A, Fallon P, Knirsch U, Wraige E, Jungbluth H. Genetic neuropathies presenting with CIDP-like features in childhood. Neuromuscul Disord 2021; 31:113-122. [PMID: 33386210 DOI: 10.1016/j.nmd.2020.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 12/15/2022]
Abstract
Inherited neuropathies are amongst the most common neuromuscular disorders. The distinction from chronic inflammatory demyelinating polyneuropathy (CIDP) may be challenging, considering its rarity in childhood, that genetic neuropathies may show secondary inflammatory features, and that subacute CIDP presentations may closely mimic the disease course of inherited disorders. The overlap between genetic neuropathies and CIDP is increasingly recognized in adults but rarely reported in children. Here we report 4 children with a neuropathy of subacute onset, initially considered consistent with an immune-mediated neuropathy based on suggestive clinical, laboratory and neurophysiological features. None showed convincing response to intravenous immunoglobulin therapy, leading to re-evaluation and confirmation of a genetic neuropathy in each case (including PMP22, MPZ and SH3TC2 genes). A review of the few Paediatric cases reported in the literature showed similar delays in diagnosis and no significant changes to immunomodulatory treatment. Our findings emphasize the importance of considering an inherited neuropathy in children with a CIDP-like presentation. In addition to an inconclusive response to treatment, subtle details of the family and developmental history may indicate a genetic rather than an acquired background. Correct diagnostic confirmation of a genetic neuropathy in a child is crucial for appropriate management, prognostication and genetic counselling.
Collapse
Affiliation(s)
- Miguel A Fernandez-Garcia
- Department of Paediatric Neurology, Neuromuscular Service, Evelina Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, F02 - Becket House, Lambeth Palace Road, London SE1 7EU, United Kingdom
| | - Georg M Stettner
- Division of Paediatric Neurology, University Children´s Hospital Zurich, Zurich, Switzerland
| | - Maria Kinali
- Department of Paediatric Neurology, The Portland Hospital, HCA Healthcare, United Kingdom; Imperial College, London, United Kingdom
| | - Antonia Clarke
- Department of Paediatric Neurosciences, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Penny Fallon
- Department of Paediatric Neurosciences, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Ursula Knirsch
- Division of Paediatric Neurology, University Children´s Hospital Zurich, Zurich, Switzerland
| | - Elizabeth Wraige
- Department of Paediatric Neurology, Neuromuscular Service, Evelina Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, F02 - Becket House, Lambeth Palace Road, London SE1 7EU, United Kingdom
| | - Heinz Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, F02 - Becket House, Lambeth Palace Road, London SE1 7EU, United Kingdom; Muscle Signalling Section, Randall Division for Cell and Molecular Biophysics, King's College, London, United Kingdom; Department of Basic and Clinical Neuroscience, King's College, IoPPN, London, United Kingdom.
| |
Collapse
|
7
|
Immune-mediated inflammatory polyneuropathy overlapping Charcot-Marie-Tooth 1B. J Clin Neurosci 2020; 75:228-231. [DOI: 10.1016/j.jocn.2020.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 03/09/2020] [Indexed: 11/23/2022]
|
8
|
Sedghi M, Moslemi AR, Cabrera-Serrano M, Ansari B, Ghasemi M, Baktashian M, Fattahpour A, Tajsharghi H. Recessive Charcot-Marie-Tooth and multiple sclerosis associated with a variant in MCM3AP. Brain Commun 2019; 1:fcz011. [PMID: 32954258 PMCID: PMC7425404 DOI: 10.1093/braincomms/fcz011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 01/09/2023] Open
Abstract
Variants in MCM3AP, encoding the germinal-centre associated nuclear protein, have been associated with progressive polyneuropathy with or without intellectual disability and ptosis in some cases, and with a complex phenotype with immunodeficiency, skin changes and myelodysplasia. MCM3AP encoded protein functions as an acetyltransferase that acetylates the replication protein, MCM3, and plays a key role in the regulation of DNA replication. In this study, we report a novel variant in MCM3AP (p.Ile954Thr), in a family including three affected individuals with characteristic features of Charcot-Marie-Tooth neuropathy and multiple sclerosis, an inflammatory condition of the central nervous system without known genetic cause. The affected individuals were homozygous for a missense MCM3AP variant, located at the Sac3 domain, which was predicted to affect conserved amino acid likely important for the function of the germinal-centre associated nuclear protein. Our data support further expansion of the clinical spectrum linked to MCM3AP variant and highlight that MCM3AP should be considered in patients with accompaniment of recessive motor axonal Charcot-Marie-Tooth neuropathy and multiple sclerosis.
Collapse
Affiliation(s)
- Maryam Sedghi
- Medical Genetics Laboratory, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali-Reza Moslemi
- Department of Pathology, Sahlgrenska University Hospital, Gothenburg University, Gothenburg, Sweden
| | - Macarena Cabrera-Serrano
- Department of Neurology, Hospital Universitario Virgen del Rocio, Sevilla, Spain.,Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Sevilla, Spain
| | - Behnaz Ansari
- Department of neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Ghasemi
- Department of neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojtaba Baktashian
- Medical Genetics Laboratory, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Fattahpour
- Radiology Resident, Department of Radiology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Homa Tajsharghi
- Division of Biomedicine, School of Health Science, University of Skovde, SE-541 28 Skovde, Sweden
| |
Collapse
|
9
|
Yiu EM, Wanigasinghe J, Mackay MT, Gonzales M, Nicholson GA, Ryan MM. Infantile-Onset Myelin Protein Zero-Related Demyelinating Neuropathy Presenting as an Upper Extremity Monoplegia. Semin Pediatr Neurol 2018; 26:52-55. [PMID: 29961519 DOI: 10.1016/j.spen.2017.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We describe an infant with an early-onset demyelinating neuropathy who presented with an upper extremity monoplegia and progressive asymmetric weakness. Neurophysiologic testing revealed a generalized severe neuropathy with marked slowing of nerve conduction. The disproportionate severity and asymmetry of upper extremity involvement at presentation was atypical of inherited neuropathies, and an initial diagnosis of chronic inflammatory demyelinating polyneuropathy was considered. Nerve biopsy showed severe depletion of large myelinated fibers without inflammatory cells, and focally folded myelin sheaths were seen on electron microscopy. Genetic testing revealed a de novo heterozygous mutation in the myelin protein zero gene.
Collapse
Affiliation(s)
- Eppie M Yiu
- Department of Neurology, Royal Children׳s Hospital, Melbourne, Parkville, Victoria, Australia; Neurosciences Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.
| | | | - Mark T Mackay
- Department of Neurology, Royal Children׳s Hospital, Melbourne, Parkville, Victoria, Australia; Neurosciences Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Michael Gonzales
- Department of Anatomical Pathology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Garth A Nicholson
- Northcott Neuroscience Laboratory, ANZAC Research Institute, University of Sydney, Concord, New South Wales, Australia; Molecular Medicine Laboratory, Concord Hospital, Concord, New South Wales, Australia
| | - Monique M Ryan
- Neurosciences Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.
| |
Collapse
|
10
|
Fabrizi GM, Tamburin S, Cavallaro T, Cabrini I, Ferrarini M, Taioli F, Magrinelli F, Zanette G. The spectrum of Charcot-Marie-Tooth disease due to myelin protein zero: An electrodiagnostic, nerve ultrasound and histological study. Clin Neurophysiol 2017; 129:21-32. [PMID: 29136549 DOI: 10.1016/j.clinph.2017.09.117] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/13/2017] [Accepted: 09/29/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Nerve ultrasound (US) data on myelin protein zero (MPZ)-related Charcot-Marie-Tooth disease (CMT) are lacking. To offer a comprehensive perspective on MPZ-related CMTs, we combined nerve US with clinics, electrodiagnosis and histopathology. METHODS We recruited 36 patients (12 MPZ mutations), and correlated nerve US to clinical, electrodiagnostic measures, and sural nerve biopsy. RESULTS According to motor nerve conduction velocity (MNCV) criteria, nine patients were categorized as "demyelinating" CMT1B, 17 as "axonal" CMT2I/J, and 10 as dominant "intermediate" CMTDID. Sural nerve biopsy showed hypertrophic de-remyelinating neuropathy with numerous complex onion bulbs in one patient, de-remyelinating neuropathy with scanty/absent onion bulbs in three, axonal neuropathy in two, mixed demyelinating-axonal neuropathy in five. Electrodiagnosis significantly differed in CMT1B vs. CMT2I/J and CMTDID subgroups. CMT1B had slightly enlarged nerve cross sectional area (CSA) especially at proximal upper-limb (UL) sites. CSA was negatively correlated to UL MNCV and not increased at entrapment sites. Major sural nerve pathological patterns were uncorrelated to UL nerve US and MNCV. CONCLUSIONS Sural nerve biopsy confirmed the wide pathological spectrum of MPZ-CMT. UL nerve US identified two major patterns corresponding to the CMT1B and CMT2I/J-CMTDID subgroups. SIGNIFICANCE Nerve US phenotype of MPZ-CMT diverged from those in other demyelinating peripheral neuropathies and may have diagnostic value.
Collapse
Affiliation(s)
- Gian Maria Fabrizi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Neurology Division, Department of Neuroscience, AOUI Verona, Verona, Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Neurology Division, Department of Neuroscience, AOUI Verona, Verona, Italy.
| | - Tiziana Cavallaro
- Neurology Division, Department of Neuroscience, AOUI Verona, Verona, Italy
| | - Ilaria Cabrini
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Neurology Division, Department of Neuroscience, AOUI Verona, Verona, Italy
| | - Moreno Ferrarini
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Neurology Division, Department of Neuroscience, AOUI Verona, Verona, Italy
| | - Federica Taioli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Neurology Division, Department of Neuroscience, AOUI Verona, Verona, Italy
| | - Francesca Magrinelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; Neurology Division, Department of Neuroscience, AOUI Verona, Verona, Italy
| | - Giampietro Zanette
- Neurology Division, Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| |
Collapse
|
11
|
Fujisawa M, Sano Y, Omoto M, Ogasawara JI, Koga M, Takashima H, Kanda T. Charcot-Marie-Tooth disease type 2 caused by homozygous MME gene mutation superimposed by chronic inflammatory demyelinating polyneuropathy. Rinsho Shinkeigaku 2017; 57:515-520. [PMID: 28855494 DOI: 10.5692/clinicalneurol.cn-001036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report a 59-year-old Japanese male who developed gradually worsening weakness and numbness of distal four extremities since age 50. His parents were first cousins, and blood and cerebral spinal examinations were unremarkable. Homozygous mutation of MME gene was detected and thus he was diagnosed as autosomal-recessive Charcot-Marie-Tooth disease 2T (AR-CMT2T); however, electrophysiological examinations revealed scattered demyelinative changes including elongated terminal latency in several peripheral nerve trunks. Sural nerve biopsy showed endoneurial edema and a lot of thinly myelinated nerve fibers with uneven distribution of remnant myelinated fibers within and between fascicles. Immunoglobulin treatment was initiated considering the possibility of superimposed inflammation and demyelination, and immediate clinical as well as electrophysiological improvements were noted. Our findings indicate that AR-CMT2T caused by MME mutation predisposes to a superimposed inflammatory demyelinating neuropathy. This is the first report which documented the co-existence of CMT2 and chronic inflammatory demyelinating polyneuropathy (CIDP); however, in the peripheral nervous system, neprilysin, a product of MME gene, is more abundant in myelin sheath than in axonal component. The fragility of myelin sheath due to mutated neprilysin may trigger the detrimental immune response against peripheral myelin in this patient.
Collapse
Affiliation(s)
- Miwako Fujisawa
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medical Science.,Department of Neurology, Yamaguchi Prefectural Grand Medical Center
| | - Yasuteru Sano
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medical Science
| | - Masatoshi Omoto
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medical Science
| | - Jyun-Ichi Ogasawara
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medical Science
| | - Michiaki Koga
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medical Science
| | - Hiroshi Takashima
- Department of Neurology and Geriatrics Kagoshima University Graduate School of Medical and Dental Sciences
| | - Takashi Kanda
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medical Science
| |
Collapse
|
12
|
Weis J, Claeys KG, Roos A, Azzedine H, Katona I, Schröder JM, Senderek J. Towards a functional pathology of hereditary neuropathies. Acta Neuropathol 2017; 133:493-515. [PMID: 27896434 DOI: 10.1007/s00401-016-1645-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 11/10/2016] [Accepted: 11/13/2016] [Indexed: 12/11/2022]
Abstract
A growing number of hereditary neuropathies have been assigned to causative gene defects in recent years. The study of human nerve biopsy samples has contributed substantially to the discovery of many of these neuropathy genes. Genotype-phenotype correlations based on peripheral nerve pathology have provided a comprehensive picture of the consequences of these mutations. Intriguingly, several gene defects lead to distinguishable lesion patterns that can be studied in nerve biopsies. These characteristic features include the loss of certain nerve fiber populations and a large spectrum of distinct structural changes of axons, Schwann cells and other components of peripheral nerves. In several instances the lesion patterns are directly or indirectly linked to the known functions of the mutated gene. The present review is designed to provide an overview on these characteristic patterns. It also considers other aspects important for the manifestation and pathology of hereditary neuropathies including the role of inflammation, effects of chemotherapeutic agents and alterations detectable in skin biopsies.
Collapse
Affiliation(s)
- Joachim Weis
- Institute of Neuropathology, RWTH Aachen University Medical School, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Kristl G Claeys
- Institute of Neuropathology, RWTH Aachen University Medical School, Pauwelsstr. 30, 52074, Aachen, Germany
- Department of Neurology, RWTH Aachen University Medical School, Pauwelsstr. 30, 52074, Aachen, Germany
- Department of Neurology, University Hospitals Leuven and University of Leuven (KU Leuven), Leuven, Belgium
| | - Andreas Roos
- Institute of Neuropathology, RWTH Aachen University Medical School, Pauwelsstr. 30, 52074, Aachen, Germany
- Leibniz-Institut für Analytische Wissenschaften-ISAS-e.V., Otto-Hahn-Str. 6b, 44227, Dortmund, Germany
| | - Hamid Azzedine
- Institute of Neuropathology, RWTH Aachen University Medical School, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Istvan Katona
- Institute of Neuropathology, RWTH Aachen University Medical School, Pauwelsstr. 30, 52074, Aachen, Germany
| | - J Michael Schröder
- Institute of Neuropathology, RWTH Aachen University Medical School, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Jan Senderek
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-University, Ziemssenstr. 1a, 80336, Munich, Germany.
| |
Collapse
|
13
|
Rajabally YA, Adams D, Latour P, Attarian S. Hereditary and inflammatory neuropathies: a review of reported associations, mimics and misdiagnoses. J Neurol Neurosurg Psychiatry 2016; 87:1051-60. [PMID: 27010614 DOI: 10.1136/jnnp-2015-310835] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 02/28/2016] [Indexed: 02/03/2023]
Abstract
Distinguishing between hereditary and inflammatory neuropathy is usually straightforward on clinical grounds with the help of a family history. There are nevertheless cases where the distinction is less clear. The advent of molecular genetics has in the past several years aided confirmatory diagnosis for an increasing proportion of patients with genetic neuropathy. Various reports have described associations of Charcot-Marie-Tooth disease with a suspected or confirmed inflammatory neuropathy occasionally responding to immunotherapy. Possible predisposition to an inflammatory component was suggested in a subset of patients. Such reports have, however, been relatively few in number, suggesting the rarity of such associations and of such a predisposition if it exists. There have been a number of publications detailing clinical presentations suggestive of inflammatory neuropathy in patients with a known or later proven genetic aetiology, and subsequently felt to be part of the phenotype rather than representing an association. A number of genetically mediated multisystemic diseases with neuropathy have otherwise been reported as mimicking chronic inflammatory demyelinating polyneuropathy (CIDP). The most common example is that of familial amyloid polyneuropathy, of particular concern for the clinician when misdiagnosed as CIDP, in view of the therapeutic implications. We review the literature on reported associations, mimics and misdiagnoses of hereditary and inflammatory neuropathy and attempt to determine a practical approach to the problem in clinical practice using clinical features, electrophysiology, histopathology and targeted early genetic testing. The issue of attempting immunomodulatory therapy is discussed in view of the published literature.
Collapse
Affiliation(s)
- Yusuf A Rajabally
- School of Life and Health Sciences, Aston Brain Centre, Aston University, Birmingham, UK Regional Neuromuscular Clinic, Queen Elizabeth Hospital, University Hospitals of Birmingham, Birmingham, UK
| | - David Adams
- Department of Neurology, National Reference Centre for FAP and other rare peripheral neuropathies (NNERf) APHP, CHU Bicêtre, HUPS, INSERM U1195, Université Paris Sud, Le Kremlin-Bicêtre, France FILNEMUS, Filière nationale des Maladies neuromusculaires, Marseille, France
| | - Philippe Latour
- Laboratoire de Neurogénétique Moléculaire, Groupe Hospitalier Est, Hospices Civils de Lyon, Lyon, France
| | - Shahram Attarian
- FILNEMUS, Filière nationale des Maladies neuromusculaires, Marseille, France Reference Centre for Neuromuscular Diseases and ALS, Centre Hospitalier Universitaire La Timone, Marseille, France Inserm UMR_S 910 Medical Genetics and Functional Genomics, Aix-Marseille University, Marseille, France
| |
Collapse
|
14
|
Werheid F, Azzedine H, Zwerenz E, Bozkurt A, Moeller MJ, Lin L, Mull M, Häusler M, Schulz JB, Weis J, Claeys KG. Underestimated associated features in CMT neuropathies: clinical indicators for the causative gene? Brain Behav 2016; 6:e00451. [PMID: 27088055 PMCID: PMC4782242 DOI: 10.1002/brb3.451] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 01/25/2016] [Accepted: 02/02/2016] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Charcot-Marie-Tooth neuropathy (CMT) is a genetically heterogeneous group of peripheral neuropathies. In addition to the classical clinical phenotype, additional features can occur. METHODS We studied a wide range of additional features in a cohort of 49 genetically confirmed CMT patients and performed a systematic literature revision. RESULTS Patients harbored a PMP22 gene alteration (n = 28) or a mutation in MPZ (n = 11), GJB1 (n = 4), LITAF (n = 2), MFN2 (n = 2), INF2 (n = 1), NEFL (n = 1). We identified four novel mutations (3 MPZ, 1 GJB1). A total of 88% presented at least one additional feature. In MPZ patients, we detected hypertrophic nerve roots in 3/4 cases that underwent spinal MRI, and pupillary abnormalities in 27%. In our cohort, restless legs syndrome (RLS) was present in 18%. We describe for the first time RLS associated with LITAF or MFN2 and predominant upper limb involvement with LITAF. Cold-induced hand cramps occurred in 10% (PMP22,MPZ,MFN2), and autonomous nervous system involvement in 18% (PMP22,MPZ, LITAF,MFN2). RLS and respiratory insufficiency were mostly associated with severe neuropathy, and pupillary abnormalities with mild to moderate neuropathy. CONCLUSIONS In CMT patients, additional features occur frequently. Some of them might be helpful in orienting genetic diagnosis. Our data broaden the clinical spectrum and genotype-phenotype associations with CMT.
Collapse
Affiliation(s)
- Friederike Werheid
- Department of Neurology University Hospital RWTH Aachen Aachen Germany; Institute of Neuropathology University Hospital RWTH Aachen Aachen Germany
| | - Hamid Azzedine
- Institute of Neuropathology University Hospital RWTH Aachen Aachen Germany
| | - Eva Zwerenz
- Department of Neurology University Hospital RWTH Aachen Aachen Germany; Institute of Neuropathology University Hospital RWTH Aachen Aachen Germany
| | - Ahmet Bozkurt
- Department of Plastic and Reconstructive Surgery Hand Surgery-Burn Center University Hospital RWTH Aachen Aachen Germany; Department of Plastic & Aesthetic, Reconstructive & Hand Surgery Center for Reconstructive Microsurgery and Peripheral Nerve Surgery (ZEMPEN) Agaplesion Markus Hospital Frankfurt am Main Germany
| | - Marcus J Moeller
- Section Immunology and Nephrology Department of Internal Medicine University Hospital RWTH Aachen Aachen Germany
| | - Lilian Lin
- Department of Neurology University Hospital RWTH Aachen Aachen Germany; Institute of Neuropathology University Hospital RWTH Aachen Aachen Germany
| | - Michael Mull
- Department of Neuroradiology University Hospital RWTH Aachen Aachen Germany
| | - Martin Häusler
- Division of Neuropediatrics and Social Pediatrics Department of Pediatrics University Hospital RWTH Aachen Aachen Germany
| | - Jörg B Schulz
- Department of Neurology University Hospital RWTH Aachen Aachen Germany; JARA - Translational Brain Medicine Aachen Germany
| | - Joachim Weis
- Institute of Neuropathology University Hospital RWTH Aachen Aachen Germany
| | - Kristl G Claeys
- Department of Neurology University Hospital RWTH Aachen Aachen Germany; Institute of Neuropathology University Hospital RWTH Aachen Aachen Germany; Department of Neurology University Hospitals Leuven and University of Leuven (KU Leuven) Leuven Belgium
| |
Collapse
|
15
|
Sanmaneechai O, Feely S, Scherer SS, Herrmann DN, Burns J, Muntoni F, Li J, Siskind CE, Day JW, Laura M, Sumner CJ, Lloyd TE, Ramchandren S, Shy RR, Grider T, Bacon C, Finkel RS, Yum SW, Moroni I, Piscosquito G, Pareyson D, Reilly MM, Shy ME. Genotype-phenotype characteristics and baseline natural history of heritable neuropathies caused by mutations in the MPZ gene. Brain 2015; 138:3180-92. [PMID: 26310628 DOI: 10.1093/brain/awv241] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 06/30/2015] [Indexed: 11/14/2022] Open
Abstract
We aimed to characterize genotype-phenotype correlations and establish baseline clinical data for peripheral neuropathies caused by mutations in the myelin protein zero (MPZ) gene. MPZ mutations are the second leading cause of Charcot-Marie-Tooth disease type 1. Recent research makes clinical trials for patients with MPZ mutations a realistic possibility. However, the clinical severity varies with different mutations and natural history data on progression is sparse. We present cross-sectional data to begin to define the phenotypic spectrum and clinical baseline of patients with these mutations. A cohort of patients with MPZ gene mutations was identified in 13 centres of the Inherited Neuropathies Consortium - Rare Disease Clinical Research Consortium (INC-RDCRC) between 2009 and 2012 and at Wayne State University between 1996 and 2009. Patient phenotypes were quantified by the Charcot-Marie-Tooth disease neuropathy score version 1 or 2 and the Charcot-Marie-Tooth disease paediatric scale outcome instruments. Genetic testing was performed in all patients and/or in first- or second-degree relatives to document mutation in MPZ gene indicating diagnosis of Charcot-Marie-Tooth disease type 1B. There were 103 patients from 71 families with 47 different MPZ mutations with a mean age of 40 years (range 3-84 years). Patients and mutations were separated into infantile, childhood and adult-onset groups. The infantile onset group had higher Charcot-Marie-Tooth disease neuropathy score version 1 or 2 and slower nerve conductions than the other groups, and severity increased with age. Twenty-three patients had no family history of Charcot-Marie-Tooth disease. Sixty-one patients wore foot/ankle orthoses, 19 required walking assistance or support, and 10 required wheelchairs. There was hearing loss in 21 and scoliosis in 17. Forty-two patients did not begin walking until after 15 months of age. Half of the infantile onset patients then required ambulation aids or wheelchairs for ambulation. Our results demonstrate that virtually all MPZ mutations are associated with specific phenotypes. Early onset (infantile and childhood) phenotypes likely represent developmentally impaired myelination, whereas the adult-onset phenotype reflects axonal degeneration without antecedent demyelination. Data from this cohort of patients will provide the baseline data necessary for clinical trials of patients with Charcot-Marie-Tooth disease caused by MPZ gene mutations.
Collapse
Affiliation(s)
- Oranee Sanmaneechai
- 1 Department of Neurology, University of Iowa Hospitals and Clinics, Iowa, IA, USA 2 Division of Neurology, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Shawna Feely
- 1 Department of Neurology, University of Iowa Hospitals and Clinics, Iowa, IA, USA
| | - Steven S Scherer
- 3 The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - David N Herrmann
- 4 Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Joshua Burns
- 5 Arthritis and Musculoskeletal Research Group, University of Sydney / Paediatric Gait Analysis Service of NSW, Children's Hospital at Westmead, Sydney / Neuromuscular Research Group, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Francesco Muntoni
- 6 University College London Institute of Child Health and Great Ormond Street Hospital, London, UK
| | - Jun Li
- 7 Department of Neurology, Vanderbilt University, Nashville, TN, USA
| | - Carly E Siskind
- 8 Department of Neurology, Stanford University, Stanford, CA, USA
| | - John W Day
- 8 Department of Neurology, Stanford University, Stanford, CA, USA
| | - Matilde Laura
- 9 MRC Centre for Neuromuscular Diseases, University College London Institute of Neurology, London, UK
| | - Charlotte J Sumner
- 10 Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas E Lloyd
- 10 Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Rosemary R Shy
- 1 Department of Neurology, University of Iowa Hospitals and Clinics, Iowa, IA, USA
| | - Tiffany Grider
- 1 Department of Neurology, University of Iowa Hospitals and Clinics, Iowa, IA, USA
| | - Chelsea Bacon
- 1 Department of Neurology, University of Iowa Hospitals and Clinics, Iowa, IA, USA
| | | | - Sabrina W Yum
- 3 The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA 13 Neuromuscular Program, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Isabella Moroni
- 14 Departments of Child Neurology, IRCCS Foundation, Carlo Besta Neurological Institute, Milan, Italy
| | - Giuseppe Piscosquito
- 15 Departments of Clinical Neurosciences, IRCCS Foundation, Carlo Besta Neurological Institute, Milan, Italy
| | - Davide Pareyson
- 15 Departments of Clinical Neurosciences, IRCCS Foundation, Carlo Besta Neurological Institute, Milan, Italy
| | - Mary M Reilly
- 9 MRC Centre for Neuromuscular Diseases, University College London Institute of Neurology, London, UK
| | - Michael E Shy
- 1 Department of Neurology, University of Iowa Hospitals and Clinics, Iowa, IA, USA
| | | |
Collapse
|
16
|
Pareyson D, Marchesi C, Salsano E. Dominant Charcot-Marie-Tooth syndrome and cognate disorders. HANDBOOK OF CLINICAL NEUROLOGY 2013; 115:817-845. [PMID: 23931817 DOI: 10.1016/b978-0-444-52902-2.00047-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Charcot-Marie-Tooth neuropathy (CMT) is a group of genetically heterogeneous disorders sharing a similar phenotype, characterized by wasting and weakness mainly involving the distal muscles of lower and upper limbs, variably associated with distal sensory loss and skeletal deformities. This chapter deals with dominantly transmitted CMT and related disorders, namely hereditary neuropathy with liability to pressure palsies (HNPP) and hereditary neuralgic amyotrophy (HNA). During the last 20 years, several genes have been uncovered associated with CMT and our understanding of the underlying molecular mechanisms has greatly improved. Consequently, a precise genetic diagnosis is now possible in the majority of cases, thus allowing proper genetic counseling. Although, unfortunately, treatment is still unavailable for all types of CMT, several cellular and animal models have been developed and some compounds have proved effective in these models. The first trials with ascorbic acid in CMT type 1A have been completed and, although negative, are providing relevant information on disease course and on how to prepare for future trials.
Collapse
Affiliation(s)
- Davide Pareyson
- Clinics of Central and Peripheral Degenerative Neuropathies Unit, Department of Clinical Neurosciences, IRCCS Foundation, C. Besta Neurological Institute, Milan, Italy.
| | | | | |
Collapse
|
17
|
Heng HS, Tang SS, Goyal S, Wraige EA, Lim MJ. Beneficial use of steroids in hereditary neuropathy with liability to pressure palsy. Dev Med Child Neurol 2012; 54:183-6. [PMID: 22098098 DOI: 10.1111/j.1469-8749.2011.04131.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Management of hereditary neuropathy with liability to pressure palsy (HNPP) is primarily conservative, aimed at preventing nerve injury by avoiding trauma or other potential aggravating factors. No pharmacological treatment is known to be beneficial. We describe two adolescents, one with HNPP (male; aged 15y) and another with a clinical picture suggestive of HNPP (genetically unconfirmed; female; aged 14y), who showed considerable improvement of their symptoms after receiving corticosteroid therapy. Both individuals were symptomatic for at least 5 months before the treatment. Following corticosteroids, both individuals demonstrated rapid improvement leading to near-complete recovery of muscle power. Clinical improvement after corticosteroid therapy has been reported in some individuals with other hereditary neuropathies. Our cases demonstrate that corticosteroid therapy may also be beneficial in individuals with HNPP who have a protracted or incomplete course of recovery.
Collapse
Affiliation(s)
- Hock S Heng
- Department of Paediatric Neurology, Evelina Children's Hospital, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | | | | | | | | |
Collapse
|
18
|
|
19
|
Marques W, Funayama CAR, Secchin JB, Lourenço CM, Gouvêa SP, Marques VD, Bastos PG, Barreira AA. Coexistence of two chronic neuropathies in a young child: Charcot-marie-tooth disease type 1A and chronic inflammatory demyelinating polyneuropathy. Muscle Nerve 2010; 42:598-600. [DOI: 10.1002/mus.21753] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
20
|
Souayah N, Tick Chong PS. Asymmetric phenotype associated with rare myelin protein zero mutation. J Clin Neuromuscul Dis 2010; 11:110-113. [PMID: 20215982 DOI: 10.1097/cnd.0b013e3181c5058a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Myelin protein zero (MPZ) mutations cause demyelinating neuropathies that range from severe neonatal to milder adult forms. We report a 36-year-old man who developed weakness of his left little finger adduction 3 years earlier. The weakness progressed to his other limbs. Examination revealed mildly high-arched feet with asymmetric weakness of ulnar-innervated muscles (left > right) and asymmetric weakness of peroneal-innervated muscles (right > left). Motor nerve conduction velocities ranged from 18.4 to 24.4 m/s in the upper extremities and from 14.8 to 22.7 in the lower extremities. Left median partial motor conduction block was noted at the forearm segment. Genetic testing demonstrated MPZ mutation with ARG98HIS amino acid change. The patient's father is a 68-year-old man who was asymptomatic and who was noticed to have high-arched feet and asymmetric leg muscle atrophy and weakness (right > left). The patient's 2-year-old son is "clumsy" with history of neonatal laryngomalacia. He has flat feet, areflexia, and difficulty standing on individual right versus left leg. The patient's paternal grandfather had high-arched feet and hearing loss. We conclude that ARG98HIS MPZ mutation may cause hereditary and relatively mild and asymmetric demyelinating sensorimotor polyneuropathy.
Collapse
Affiliation(s)
- Nizar Souayah
- Department of Neurology and Neurosciences, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA.
| | | |
Collapse
|
21
|
Abstract
The complement (C) system plays a central role in innate immunity and bridges innate and adaptive immune responses. A fine balance of C activation and regulation mediates the elimination of invading pathogens and the protection of the host from excessive C deposition on healthy tissues. If this delicate balance is disrupted, the C system may cause injury and contribute to the pathogenesis of various diseases, including neurodegenerative disorders and neuropathies. Here we review evidence indicating that C factors and regulators are locally synthesized in the nervous system and we discuss the evidence supporting the protective or detrimental role of C activation in health, injury, and disease of the nerve.
Collapse
Affiliation(s)
- V Ramaglia
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | |
Collapse
|
22
|
Bissay V, Flamez A, Schmedding E, Ebinger G. Fatigue as the presenting symptom of chronic inflammatory demyelinating polyneuropathy. Muscle Nerve 2008; 38:1653-7. [DOI: 10.1002/mus.21158] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
23
|
Ramaglia V, Daha M, Baas F. The complement system in the peripheral nerve: Friend or foe? Mol Immunol 2008; 45:3865-77. [DOI: 10.1016/j.molimm.2008.06.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Revised: 06/09/2008] [Accepted: 06/13/2008] [Indexed: 12/21/2022]
|
24
|
Li J, Bai Y, Ianakova E, Grandis M, Uchwat F, Trostinskaia A, Krajewski KM, Garbern J, Kupsky WJ, Shy ME. Major myelin protein gene (P0) mutation causes a novel form of axonal degeneration. J Comp Neurol 2007; 498:252-65. [PMID: 16856127 DOI: 10.1002/cne.21051] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Mutations in the major peripheral nervous system (PNS) myelin protein, myelin protein zero (MPZ), cause Charcot-Marie-Tooth Disease type 1B (CMT1B), typically thought of as a demyelinating peripheral neuropathy. Certain MPZ mutations, however, cause adult onset neuropathy with minimal demyelination but pronounced axonal degeneration. Mechanism(s) for this phenotype are unknown. We performed an autopsy of a 73-year-old woman with a late-onset neuropathy caused by an H10P MPZ mutation whose nerve conduction studies suggested severe axonal loss but no demyelination. The autopsy demonstrated axonal loss and reorganization of the molecular architecture of the axolemma. Segmental demyelination was negligible. In addition, we identified focal nerve enlargements containing MPZ and ubiquitin either in the inner myelin intralaminar and/or periaxonal space that separates axons from myelinating Schwann cells. Taken together, these data confirmed that a mutation in MPZ can cause axonal neuropathy, in the absence of segmental demyelination, thus uncoupling the two pathological processes. More important, it also provided potential molecular mechanisms as to how the axonal degeneration occurred: either by disruption of glial-axon interaction by protein aggregates or by alterations in the molecular architecture of internodes and paranodes. This report represents the first study in which the molecular basis of axonal degeneration in the late-onset CMT1B has been explored in human tissue.
Collapse
Affiliation(s)
- Jun Li
- Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan 48201, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Triggs WJ, Brown RH, Menkes DL. Case records of the Massachusetts General Hospital. Case 18-2006. A 57-year-old woman with numbness and weakness of the feet and legs. N Engl J Med 2006; 354:2584-92. [PMID: 16775239 DOI: 10.1056/nejmcpc069009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- William J Triggs
- Department of Neurology, McKnight Brain Institute, University of Florida, and the University of Florida College of Medicine, Gainesville, USA
| | | | | |
Collapse
|
26
|
Burns TM, Phillips LH, Dimberg EL, Vaught BK, Klein CJ. Novel myelin protein zero mutation (Arg36Trp) in a patient with acute onset painful neuropathy. Neuromuscul Disord 2006; 16:308-10. [PMID: 16616847 DOI: 10.1016/j.nmd.2006.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2005] [Revised: 02/07/2006] [Accepted: 02/17/2006] [Indexed: 11/19/2022]
Abstract
We present a patient with acute onset painful polyneuropathy found to have a novel MPZ mutation (Arg36Trp). The Arg36Trp mutation described in this report occurs at a putative adhesion interface. An alternative explanation for his polyneuropathy was not found and his mother was identified to have polyneuropathy and carry the same mutation. Two hundred normal controls were without this base alteration. The temporal profile of the index case may provide further indirect evidence suggesting an immune mechanism contributing to the pathogenesis of some cases of MPZ mutations. We predict that other rapid symptom onset polyneuropathies will be found to have direct genetic susceptibility.
Collapse
Affiliation(s)
- Ted M Burns
- Department of Neurology, University of Virginia, Hospital Drive, McKim Hall, P.O. Box 800394, Charlottesville, VA 22908, USA.
| | | | | | | | | |
Collapse
|
27
|
Antoine JC. [Biochemical features of chronic inflammatory demyelinating polyradiculoneuropathy]. Rev Neurol (Paris) 2006; 162:533-8. [PMID: 16585917 DOI: 10.1016/s0035-3787(06)75047-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although there are no specific biological markers of chronic inflammatory demyelinating polyneuropathies (CIDP), biological investigations have played an important role in determining the limits of the concept of CIDP. This is best exemplified by the individualisation of demyelinating neuropathies associated with IgM monoclonal proteins reacting with glycolipids. The signification of CIDP associated with diabetes mellitus, monoclonal IgG or IgA, or mutations of myelin proteins has recently been discussed as they may have implications in our understanding of the pathophysiology of CIDP and raise the question of knowing whether they confer to CIDP a particular clinical presentation or evolution.
Collapse
Affiliation(s)
- J-C Antoine
- Service de Neurologie, CHU de Saint-Etienne, Hôpital Bellevue, Saint-Etienne Cedex 02.
| |
Collapse
|
28
|
Carvalho AAS, Vital A, Ferrer X, Latour P, Lagueny A, Brechenmacher C, Vital C. Charcot-Marie-Tooth disease type 1A: clinicopathological correlations in 24 patients. J Peripher Nerv Syst 2005; 10:85-92. [PMID: 15703022 DOI: 10.1111/j.1085-9489.2005.10112.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We examined nerve biopsies from 24 patients with Charcot-Marie-Tooth disease type 1A (CMT1A) and proven 17p11.2-12 duplication. There were seven males and 17 females with a mean age of 27.85 +/- 18.95 years at the time of nerve biopsy. A family history consistent with dominant inheritance was present in 17 patients. Clinical features were classical in 16 patients and were atypical in the other eight: one had calf hypertrophy; two had Roussy-Levy syndrome; one had had a subacute inflammatory demyelinating polyneuropathy 11 years earlier and presented a relapse on the form of a chronic inflammatory demyelinating polyneuropathy; one had carpal tunnel syndrome; one had a recent painful neuropathy in both legs; and two had chronic inflammatory demyelinating polyneuropathy. Onion bulb formations (OMFs) were present in every case and most of them were characteristic, whereas burnt-out or cluster-associated OMFs were less common. Depletion of myelinated fibers was severe in 20 cases (169-2927/mm2) and varied from 5187 to 3725/mm2 in three children (4-9 years old). In addition, features of macrophage-associated demyelination were observed in the last four atypical cases. Known for more than 20 years, inflammatory demyelination superimposed in the course of CMT1A has been reported in a few cases in the past few years, mainly concerning asymptomatic or atypical patients. Such an association deserves to be better known because corticotherapy improves weakness in most of these patients.
Collapse
Affiliation(s)
- Alzira A S Carvalho
- Neuropathology Department, Victor Segalen University, Pessac, Bordeaux, France
| | | | | | | | | | | | | |
Collapse
|
29
|
Fleury M, Anheim M, Tranchant C, Warter JM. Aggravation aiguë régressive d’une maladie de Charcot-Marie-Tooth de type 1B : la Protéine P0 peut-elle agir comme un auto-antigène ? Rev Neurol (Paris) 2004; 160:839-42. [PMID: 15454874 DOI: 10.1016/s0035-3787(04)71042-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The natural history of Charcot-Marie-Tooth neuropathy is marked by accentuated motor and sensitive deficits suggestive of acute polyradiculoneuritis or, more generally, chronic inflammatory demyelinizing polyneuropathy. OBSERVATION A 41-year-old woman, with Charcot-Marie-Tooth (CMT) 1B neuropathy associated with a P0 gene mutation, developed several episodes of ataxia which resolved after intravenous administration of IgG or corticosteroids. CONCLUSION The sudden increase of a motor or sensitive deficit in this patient with CMT type I led to two hypotheses: chance association between an inherited and an inflammatory neuropathy, or a dysimmune inflammatory reaction, the mutated protein acting like an autoantigen. These two hypotheses are discussed.
Collapse
Affiliation(s)
- M Fleury
- Département de Neurologie, Hôpitaux Universitaires, Strasbourg
| | | | | | | |
Collapse
|
30
|
Martini R, Toyka KV. Immune-mediated components of hereditary demyelinating neuropathies: lessons from animal models and patients. Lancet Neurol 2004; 3:457-65. [PMID: 15261606 DOI: 10.1016/s1474-4422(04)00822-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Most demyelinating forms of Charcot-Marie-Tooth type 1 (CMT1) neuropathy are slowly progressive and do not respond to anti-inflammatory treatment. In nerve biopsy samples, overt lymphocytic infiltration is absent, but pathological features typical of macrophage-related demyelination have been reported. In mouse models of CMT1, demyelination was substantially reduced when the mutants were backcrossed into an immunodeficient genetic background. A few individual patients with CMT1 respond to anti-inflammatory treatment; however, unlike most patients with CMT1, these patients show accelerated worsening of symptoms, inflammatory infiltrates in nerve biopsies, and clinical features resembling chronic inflammatory demyelinating polyneuropathy as well as CMT1. We conclude that in patients with typical CMT1 and in animal models, a cryptic and mild inflammatory process not responsive to standard anti-inflammatory treatment fosters genetically mediated demyelination.
Collapse
Affiliation(s)
- Rudolf Martini
- Department of Neurology, University of Wuerzburg, Germany.
| | | |
Collapse
|
31
|
Rocha CT, Escolar DM. Update on diagnosis and treatment of hereditary and acquired polyneuropathies in childhood. SUPPLEMENTS TO CLINICAL NEUROPHYSIOLOGY 2004; 57:255-71. [PMID: 16106624 DOI: 10.1016/s1567-424x(09)70362-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Carolina Tesi Rocha
- Department of Neurology, Research Center for Genetic Medicine, MDA Clinic, Children's National Medical Center, George Washington University, Washington, DC 20010, USA
| | | |
Collapse
|
32
|
|