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14-September-2008 12:50:26 - Marie-Tooth disease Charcot-Marie-Tooth disease Classification and external resources The foot of a person with Charcot-Marie-Tooth. The lack of muscle, a high arch, and hammer toes are signs of the genetic disease. ICD-10 G60.0 ICD-9 356.1 DiseasesDB 5815 2343 MedlinePlus 000727 eMedicine orthoped/43 pmr/29 MeSH D002607 Charcot-Marie-Tooth disease CMT, known also as Herary Motor and Sensory Neuropathy HMSN, Herary Sensorimotor Neuropathy HSMN, or Peroneal Muscular Atrophy, is a heterogeneous inherited disorder of nerves neuropathy that is characterized by loss of muscle tissue and touch sensation, predominantly in the feet and legs but also in the hands and arms in the advanced stages of disease. Presently incurable, this disease is one of the most common inherited neurological disorders, with 37 in 100,000 affected.1 Contents 1 Description 2 Symptoms 3 Diagnosis 4 Types of the disease 5 Genetic testing 6 Treatment 7 External links 8 References Description The disorder is caused by the absence of proteins that are essential for normal function of the nerves due to errors in the genes coding these molecules. The absence of these chemical substances gives rise to dysfunction either in the axon or the myelin sheath of the nerve cell. Most of the mutations identified result in disrupted myelin production, however a small proportion of mutations occur in gene MFN2, which doesn't seem to have anything to do with myelin. Instead MFN2 controls behaviour of mitochondria. Recent research showed that the mutated MFN2 causes mitochondria to form large clusters. In nerve cells these large clusters of mitochondria failed to travel down the axon towards the synapses. It is suggested these mitochondria clots make the synapses fail, resulting in CMT disease.2 The different classes of this disorder have been divided into the primary demyelinating neuropathies CMT1, CMT3, and CMT4 and the primary axonal neuropathies CMT2. Recent studies, however, show that the pathologies of these two classes are frequently intermingled, due to the dependence and close cellular interaction of Schwann cells and neurons. Schwann cells are responsible for myelin formation, enwrapping neural axons with their plasma membranes in a process called myelination.3 The molecular structure of the nerve depends upon the interactions between neurons, Schwann cells, and fibroblasts. Schwann cells and neurons, in particular, exchange signals that regulate survival and differentiation during development. These signals are important to CMT disease because a disturbed communication between Schwann cells and neurons, resulting from a genetic defect, is observed in this disorder.3 It is clear that interaction with demyelinating Schwann cells causes the expression of abnormal axonal structure and function, but we still do not know how these abnormalities result in CMT. One possibility is that the weakness and sensory loss experienced by patients with CMT is a result of axonal degradation. Another possibility is that axonal dysfunction occurs, not degeneration, and that this dysfunction is induced by demyelinating Schwann cells.1/ref Most patients experience demyelinating neuropathies, and this is characterized by a reduction in nerve conduction velocity NCV, due to a partial or complete loss of the myelin sheath. Axonopathies, on the other hand, are characterized by a reduced compound muscle action potential CMAP, while NCV is normal or only slightly reduced.3 The disease is named for those who classically described it: Jean-Martin Charcot 1825-1893 and his pupil Pierre Marie 1853-1940 Sur une forme particulière d'atrophie musculaire progressive, souvent familiale débutant par les pieds et les jambes et atteignant plus tard les mains, Revue médicale, Paris, 1886; 6: 97-138., and Howard Henry Tooth 1856-1925 The peroneal type of progressive muscular atrophy, dissertation, London, 1886. Symptoms Symptoms usually begin in late childhood or early adulthood. Usually, the initial symptom is foot drop early in the course of the disease. This can also cause hammer toe, where the toes are always curled. Wasting of muscle tissue of the lower parts of the legs may give rise to stork leg or inverted bottle appearance. Weakness in the hands and forearms occurs in many people later in life as the disease progresses. Symptoms and progression of the disease can vary. Breathing can be affected in some; so can hearing, vision, and the neck and shoulder muscles. Scoliosis is common. Hip sockets can be malformed. Gastrointestinal problems can be part of CMT, as can chewing, swallowing, and speaking as vocal cords atrophy. A tremor can develop as muscles waste. Pregnancy has been known to exacerbate CMT, as well as extreme emotional stress. Diagnosis A definitive diagnosis for a specific type of CMT is established via genetic testing for most types. However, some genetic markers have not yet been identified, and a diagnosis can also be established via an electromyography examination which shows that the velocity of nerve impulse conduction is decreased and the time required to charge the nerve is increased and nerve biopsy. Types of the disease CMT Type 1 CMT1: Type 1 affects approximately 80% of CMT patients and is the most common type of CMT. The subtypes share clinical symptoms. Autosomal dominant. Causes demyelination, which can be detected by measuring nerve conduction velocities. CMT Type 2 CMT2: Type 2 affects approximately 20-40% of CMT patients. Type 2 CMT is Autosomal dominant neuropathy with its main effect on the axon. The average nerve conduction velocity is slightly below normal, but generally above 38m/s CMT Type 3 CMT3: Type 3 affects very few CMT patients. CMT Type 4 CMT4: Type 4 affects very few CMT patients. CMT X-Linked CMTX: CMTX affects approximately 10-20% of CMT patients and is X-linked dominant. Approx 10% of X-linked CMT patients have some other form than CMTX. However a study published in 1997 indicates that a connexin 32 gene mutation is associated with this form which may be more common than previously thought.4 More details on the types are provided in the table below: Type OMIM Gene Locus Description CMT1A 118220 PMP22 17p11.2 The most common form of the disease, 70-80% of Type 1 patients. Average NCV: 20-25m/s when associated with essential tremor and ataxia, called Roussy-Levy Syndrome 180800 CMT1B 118200 MPZ 1q22 Caused by mutations in the gene producing protein zero P0. 5-10% of Type 1 patients. Average NCV: 15m/s CMT1C LITAF 16p13.1-p12.3 Causes severe demyelination, which can be detected by measuring nerve conduction velocities. Autosomal dominant. Usually shows up in infancy. Average NCV: 26-42m/s. Identical symptoms to CMT-1A. CMT1D EGR2 10q21.1-q22.1 Average NCV: 15-20m/s CMT2A 118210 MFN2 or KIF1B 1p36 The cause is likely located on chromosome 1 for the mitofusion 2 protein. Some research has also linked this form of CMT to the protein kinesin 1B. Does not show up on nerve conduction velocity tests, because it is caused by axonopathy. CMT2B 600882 RAB7 RAB7A, RAB7B 3q21. CMT2B1 LMNA 1q22 Autosomal recessive axonal CMT, laminopathy CMT2C 606071 12q23-q24 May cause vocal cord, diaphragm, and distal weaknesses. CMT2D 601472 GARS 7p15 Patients with mutations in the GARS gene tend to have more severe symptoms in the upper extremities hands, which is atypical for CMT in general. CMT2E NEFL 8p21 CMT2F 606595 HSPB1 7q11-q21 CMT2G 608591 12q12-13 CMT2H 607731 GDAP1 8q13-q21.1 CMT2J 607736 1q22 CMT2K 607831 8q13-q21.1 CMT2L 608673 12q24 CMT3 145900 varies varies Sometimes called Dejerine-Sottas disease. Rarely found. Autosomal recessive. Average NCV: Normal 50-60m/s CMT4A 214400 GDAP1 8q13-q21.1 Autosomal recessive. CMT4B1 601382 MTMR2 11q22 Autosomal recessive. CMT4B2 CMT4B2 SBF2 11p15 May be called SBF2/MTMR13. Autosomal recessive. CMT4C KIAA1985 SH3TC2 5q32 May lead to respiratory compromise. CMT4D 601455 NDRG1 8q24.3 Autosomal recessive, demyelinating, deafness CMT1E 118300 PMP22 17p11.2 Autosomal dominant, demyelinating, deafness CMT4E EGR2 10q21.1-10q22.1 CMT4E is a tentative name CMT4F PRX 19q13.1-19q13.2 CMT4F is a tentative name CMT4H FGD4 12p11.21 Autosomal recessive CMT4J 611228 KIAA0274 FIG4 6q21 Autosomal recessive CMTX1 302800 GJB1 Xq13.1 Average NCV: 25-40m/s CMTX2 302801 Xq22.2 CMTX3 302802 Xq26 CMT 118301 with Ptosis and Parkinsonism CMT 302803 type 1 aplasia cutis congenita Genetic testing Genetic testing is available for many of the different types of Charcot-Marie-Tooth. For a listing of test availabilities, see GeneTests.org Treatment Although there is no current standard treatment, the use of ascorbic acid has been proposed, and has shown some benefit in animal models.5 There is currently a clinical trial to determine the effectiveness of high doses of ascorbic acid vitamin C in treating humans with CMT type 1A.6 Not all types of CMT are expected to respond to this treatment. The Charcot-Marie-Tooth Association classifies the chemotherapy drug vincristine as a definite high risk and states that vincristine has been proven hazardous and should be avoided by all CMT patients, including those with no symptoms.7 There are also several corrective surgical procedures that can be done to improve physical condition. External links Charcot Marie Tooth Association Charcot Marie Tooth North American Database - patients with CMT who do not live in North America are also encouraged to join Muscular Dystrophy Association - Although CMT is not a form of Muscular Dystrophy, it is one of several non-muscular dystrophy diseases for which the MDA offers support Muscular Dystrophy Canada Herary Neuropathy Foundation CMT International Charcot-Marie-Tooth disease at the Open Directory Project References ^ a b Krajewski KM, Lewis RA, Fuerst DR, et al 2000. Neurological dysfunction and axonal degeneration in Charcot-Marie-Tooth disease type 1A. Brain 123 Pt 7: 1516-27. PMID 10869062. ^ Baloh RH, Schmidt RE, Pestronk A, Milbrandt J 2007. Altered axonal mitochondrial transport in the pathogenesis of Charcot-Marie-Tooth disease from mitofusin 2 mutations. J. Neurosci. 27 2: 422-30. doi:10.1523/JNEUROSCI.4798-06.2007. PMID 17215403. ^ a b c Berger P, Young P, Suter U 2002. Molecular cell biology of Charcot-Marie-Tooth disease. Neurogenetics 4 1: 1-15. PMID 12030326. ^ Latour P, Fabreguette A, Ressot C, et al 1997. New mutations in the X-linked form of Charcot-Marie-Tooth disease. Eur. Neurol. 37 1: 38-42. PMID 9018031. ^ Passage E, Norreel JC, Noack-Fraissignes P, et al 2004. Ascorbic acid treatment corrects the phenotype of a mouse model of Charcot-Marie-Tooth disease. Nat. Med. 10 4: 396-401. doi:10.1038/nm1023. PMID 15034573. ^ Clinical Trials - Neuromuscular Trial/Study 2007-07-18. Retrieved on 2008-05-28. ^ CMT Association: Medical Alert v d e Nervous system pathology, primarily PNS G50-G99, 350-359 Nerve, nerve root and plexus disorders Cranial nerve disease V Trigeminal neuralgia - VII Facial nerve paralysis, Bell's palsy, Melkersson-Rosenthal syndrome, Central seven - XI Accessory nerve disorder Radiculopathy, plexopathy Brachial plexus lesion - Thoracic outlet syndrome - Phantom limb Mono- neuropathy upper limb Carpal tunnel syndrome, Ulnar nerve entrapment, Radial neuropathy lower limb Meralgia paraesthetica, Tarsal tunnel syndrome, Morton's neuroma Causalgia - Mononeuritis multiplex Polyneuropathies HMSN Charcot-Marie-Tooth disease - Dejerine Sottas syndrome - Refsum's disease Polyradiculoneuropathy autoimmune Guillain-Barré syndrome, Chronic inflammatory demyelinating polyneuropathy - Alcoholic polyneuropathy Diseases of muscle myopathy/ neuromuscular disease Neuromuscular junction disease autoimmune Myasthenia gravis, Lambert-Eaton myasthenic syndrome Muscular dystrophy Congenital - dystrophin Becker's, Duchenne - Distal - Emery-Dreifuss - Facioscapulohumeral - Limb-girdle muscular dystrophy - Myotonic - Oculopharyngeal Myotonia Myotonic dystrophy - Myotonia congenita - Thomsen disease - Neuromyotonia - Paramyotonia congenita Congenital myopathy Bethlem myopathy - Central core disease - Centronuclear myopathy - Nemaline myopathy - Zaspopathy Mitochondrial myopathy MELAS - MERRF - KSS - PEO Periodic paralysis Hypokalemic - Hyperkalemic Dysautonomia/ Autonomic neuropathy HSAN Familial dysautonomia - Horner's syndrome - Multiple system atrophy Shy-Drager syndrome, Olivopontocerebellar atrophy Retrieved from http://en..org/wiki/Charcot-Marie-Tooth_disease Categories: Neurological disorders | Genetic disorders Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Català Deutsch Español Français Italiano Nederlands 日本語 Norsk bokmål Polski Português Svenska This page was last modified on 3 September 2008, at 01:10
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