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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: 69] [Impact Index Per Article: 7.7] [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.
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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
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102
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Fridman V, Bundy B, Reilly MM, Pareyson D, Bacon C, Burns J, Day J, Feely S, Finkel RS, Grider T, Kirk CA, Herrmann DN, Laurá M, Li J, Lloyd T, Sumner CJ, Muntoni F, Piscosquito G, Ramchandren S, Shy R, Siskind CE, Yum SW, Moroni I, Pagliano E, Zuchner S, Scherer SS, Shy ME. CMT subtypes and disease burden in patients enrolled in the Inherited Neuropathies Consortium natural history study: a cross-sectional analysis. J Neurol Neurosurg Psychiatry 2015; 86:873-8. [PMID: 25430934 PMCID: PMC4516002 DOI: 10.1136/jnnp-2014-308826] [Citation(s) in RCA: 232] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 10/06/2014] [Accepted: 10/24/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND The international Inherited Neuropathy Consortium (INC) was created with the goal of obtaining much needed natural history data for patients with Charcot-Marie-Tooth (CMT) disease. We analysed clinical and genetic data from patients in the INC to determine the distribution of CMT subtypes and the clinical impairment associated with them. METHODS We analysed data from 1652 patients evaluated at 13 INC centres. The distribution of CMT subtypes and pathogenic genetic mutations were determined. The disease burden of all the mutations was assessed by the CMT Neuropathy Score (CMTNS) and CMT Examination Score (CMTES). RESULTS 997 of the 1652 patients (60.4%) received a genetic diagnosis. The most common CMT subtypes were CMT1A/PMP22 duplication, CMT1X/GJB1 mutation, CMT2A/MFN2 mutation, CMT1B/MPZ mutation, and hereditary neuropathy with liability to pressure palsy/PMP22 deletion. These five subtypes of CMT accounted for 89.2% of all genetically confirmed mutations. Mean CMTNS for some but not all subtypes were similar to those previously reported. CONCLUSIONS Our findings confirm that large numbers of patients with a representative variety of CMT subtypes have been enrolled and that the frequency of achieving a molecular diagnosis and distribution of the CMT subtypes reflects those previously reported. Measures of severity are similar, though not identical, to results from smaller series. This study confirms that it is possible to assess patients in a uniform way between international centres, which is critical for the planned natural history study and future clinical trials. These data will provide a representative baseline for longitudinal studies of CMT. CLINICAL TRIAL REGISTRATION ID number NCT01193075.
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Affiliation(s)
- V Fridman
- Departments of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - B Bundy
- University of South Florida Epidemiology Center, Tampa, Florida, USA
| | - M M Reilly
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, UK
| | - D Pareyson
- Departments of Neurology, IRCCS Foundation, Carlo Besta Neurological Institute, Milan, Italy
| | - C Bacon
- Departments of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - J Burns
- Departments of Neurology, University of Sydney & Children's Hospital, Sydney, Australia
| | - J Day
- Departments of Neurology, Stanford University, Stanford, California, USA
| | - S Feely
- Departments of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA Departments of Neurology, Wayne State University, Detroit, Michigan, USA
| | - R S Finkel
- Departments of Neurology, Nemours Children's Hospital, Orlando, Florida, USA
| | - T Grider
- Departments of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - C A Kirk
- University of South Florida Epidemiology Center, Tampa, Florida, USA
| | - D N Herrmann
- Departments of Neurology, University of Rochester, Rochester, New York, USA
| | - M Laurá
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, UK
| | - J Li
- Departments of Neurology, Vanderbilt University, Nashville, Tennessee, USA
| | - T Lloyd
- Departments of Neurology, John Hopkins University, Baltimore, Maryland, USA
| | - C J Sumner
- Departments of Neurology, John Hopkins University, Baltimore, Maryland, USA
| | - F Muntoni
- Departments of Neurology, UCL Institute of Child Health & Great Ormond Street Hospital, London, UK
| | - G Piscosquito
- Departments of Neurology, IRCCS Foundation, Carlo Besta Neurological Institute, Milan, Italy
| | - S Ramchandren
- Departments of Neurology, Wayne State University, Detroit, Michigan, USA Departments of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - R Shy
- Departments of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA Departments of Neurology, Wayne State University, Detroit, Michigan, USA
| | - C E Siskind
- Departments of Neurology, Stanford University, Stanford, California, USA
| | - S W Yum
- Departments of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA Departments of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - I Moroni
- Departments of Neurology, IRCCS Foundation, Carlo Besta Neurological Institute, Milan, Italy
| | - E Pagliano
- Departments of Neurology, IRCCS Foundation, Carlo Besta Neurological Institute, Milan, Italy
| | - S Zuchner
- Departments of Neurology, Center for Human Molecular Genomics, University of Miami, Miami, Florida, USA
| | - S S Scherer
- Departments of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - M E Shy
- Departments of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA Departments of Neurology, Wayne State University, Detroit, Michigan, USA
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103
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Piscosquito G, Reilly MM, Schenone A, Fabrizi GM, Cavallaro T, Santoro L, Manganelli F, Vita G, Quattrone A, Padua L, Gemignani F, Visioli F, Laurà M, Calabrese D, Hughes RAC, Radice D, Solari A, Pareyson D. Responsiveness of clinical outcome measures in Charcot−Marie−Tooth disease. Eur J Neurol 2015; 22:1556-63. [DOI: 10.1111/ene.12783] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 06/05/2015] [Indexed: 11/29/2022]
Affiliation(s)
- G. Piscosquito
- C. Besta Neurological Institute; IRCCS Foundation; Milan Italy
| | - M. M. Reilly
- MRC Centre for Neuromuscular Diseases; Institute of Neurology; University College London; London UK
| | - A. Schenone
- Department of Neurology, Ophthalmology and Genetics; University of Genoa; Genoa Italy
| | - G. M. Fabrizi
- Department of Neurological, Neuropsychological, Morphological and Motor Sciences; University of Verona; Verona Italy
| | - T. Cavallaro
- Department of Neurological, Neuropsychological, Morphological and Motor Sciences; University of Verona; Verona Italy
| | - L. Santoro
- Department of Neurosciences, Reproductive and Odontostomatological Sciences; University Federico II of Naples; Naples Italy
| | - F. Manganelli
- Department of Neurosciences, Reproductive and Odontostomatological Sciences; University Federico II of Naples; Naples Italy
| | - G. Vita
- Department of Neurosciences; University of Messina; Messina Italy
- Clinical Centre NEMO SUD; Fondazione Aurora Onlus; Messina Italy
| | - A. Quattrone
- Neurology Clinic; Neuroimaging Research Unit; National Research Council; Magna Graecia University; Catanzaro Italy
| | - L. Padua
- Department of Geriatrics; Neurosciences and Orthopaedics - Università Cattolica del Sacro Cuore; Rome; Don Carlo Gnocchi Foundation Milan Italy
| | - F. Gemignani
- Department of Neurosciences; University of Parma; Parma Italy
| | - F. Visioli
- Department of Pharmacological Sciences; University School of Pharmacy; Milan Italy
- Department of Molecular Medicine; University of Padua; Padua Italy
| | - M. Laurà
- MRC Centre for Neuromuscular Diseases; Institute of Neurology; University College London; London UK
| | - D. Calabrese
- C. Besta Neurological Institute; IRCCS Foundation; Milan Italy
| | - R. A. C. Hughes
- MRC Centre for Neuromuscular Diseases; Institute of Neurology; University College London; London UK
| | - D. Radice
- Department of Epidemiology and Biostatistics; European Institute of Oncology; Milan Italy
| | - A. Solari
- C. Besta Neurological Institute; IRCCS Foundation; Milan Italy
| | - D. Pareyson
- C. Besta Neurological Institute; IRCCS Foundation; Milan Italy
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104
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Ramchandren S, Shy M, Feldman E, Carlos R, Siskind C. Defining disability: development and validation of a mobility-Disability Severity Index (mDSI) in Charcot-Marie-tooth disease. J Neurol Neurosurg Psychiatry 2015; 86:635-9. [PMID: 25157034 PMCID: PMC4920058 DOI: 10.1136/jnnp-2013-307390] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 08/06/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To develop and validate a reliable patient-reported scale that grades the severity of disability in Charcot-Marie-tooth disease (CMT), from an in-depth analysis of patient and healthcare provider perspectives on what mobility changes constitutes mild, moderate and severe disability. DESIGN In this prospective, cross-sectional study, a 19-item Disability Questionnaire was developed following literature and expert review. Between 2011 and 2012, the Disability Questionnaire was provided to healthcare providers experienced in CMT attending national scientific meetings, and to patients self-registered with the Inherited Neuropathy Consortium--Rare Diseases Clinical Research Consortium on-line contact registry. Provider and patient responses were compared utilising a two-sided unpaired t test with Bonferroni correction. The questionnaire was then assessed for validity, reliability and unidimensionality. RESULTS We analysed 259 Disability Questionnaires (167 patients, 92 providers); these showed perfect agreement between patient and provider responses on qualitative descriptions of disability, but significant differences in quantitative responses on items corresponding to minimal or severe disability (p<0.001). Validity and test-retest reliability of the questionnaire was excellent (Cronbach's α=0.96; intraclass correlation coefficients (ICC)=0.977 (0.951 to 0.993). Exploratory factor analysis and the Mokken Scaling Procedure supported the unidimensionality of the mobility-Disability Severity Index. CONCLUSIONS The mobility-Disability Severity Index is a unique instrument, categorising disability from the patient's perspective, and will undergo further cross-validation studies in CMT.
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Affiliation(s)
- Sindhu Ramchandren
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Shy
- Department of Neurology, University of Iowa, Iowa City, Iowa, USA
| | - Eva Feldman
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ruth Carlos
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Carly Siskind
- Department of Neurology, Stanford Hospital and Clinics, Stanford, California, USA
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105
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Abstract
Heritable diseases of the peripheral nerves (Charcot-Marie-Tooth disease [CMT]) affect the motor units and sensory nerves, and they are among the most prevalent genetic conditions in the pediatric patient population. The typical clinical presentation includes distal muscle weakness and atrophy, but the severity and progression are largely variable. Improvements in supportive treatment have led to better preservation of patients' motor functions. More than 80 genes have been associated with CMT. These genetic discoveries, along with the developments of cellular and transgenic disease models, have allowed clinicians to better understand the disease mechanisms, which should lead to more specific treatments.
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Affiliation(s)
- Agnes Jani-Acsadi
- Department of Neurology, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Sylvia Ounpuu
- Department of Orthopedic Surgery, Connecticut Children's Medical Center, Farmington, CT, USA
| | - Kristan Pierz
- Department of Orthopedic Surgery, Center of Motion Analysis, Connecticut Children's Medical Center, Farmington, CT, USA
| | - Gyula Acsadi
- Division of Neurology, Department of Neurology, Connecticut Children's Medical Center, University of Connecticut School of Medicine, 505 Farmington Avenue, Farmington, CT 06032, USA.
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106
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Roth LA, Marra JD, LaMarca NH, Sproule DM. Measuring disease progression in giant axonal neuropathy: implications for clinical trial design. J Child Neurol 2015; 30:741-8. [PMID: 25186661 DOI: 10.1177/0883073814542946] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Accepted: 06/01/2014] [Indexed: 11/16/2022]
Abstract
As part of a natural history study of giant axonal neuropathy, we hypothesized that the Friedreich Ataxia Rating Scale and the Gross Motor Function Measure would show a significant change over 6 months, reflecting subjects' decline in motor function. The Friedreich Ataxia Rating Scale was performed on 11 subjects and the Gross Motor Function Measure was performed on 10 subjects twice with a six-month interval. A paired two-tailed t-test was used to assess the difference in each subject's score. Significant changes were found over six months of 11.7 ± 11.0 (P = 0.006) for the Friedreich Ataxia Rating Scale and -10.0 ± 13.5 (P = 0.043) for the Gross Motor Function Measure, reflecting subjects' decline in motor function on examination and by report. These standardized assessments of clinical function are the first to be validated in giant axonal neuropathy and will be used in an upcoming gene therapy clinical trial.
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Affiliation(s)
- Lisa A Roth
- Division of Pediatric Neurology, Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Jonathan D Marra
- Division of Pediatric Neurology, Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Nicole H LaMarca
- Division of Pediatric Neurology, Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Douglas M Sproule
- Division of Pediatric Neurology, Department of Neurology, Columbia University Medical Center, New York, NY, USA
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Hashizume A, Katsuno M, Suzuki K, Banno H, Suga N, Mano T, Araki A, Hijikata Y, Grunseich C, Kokkinis A, Hirakawa A, Watanabe H, Yamamoto M, Fischbeck KH, Sobue G. A functional scale for spinal and bulbar muscular atrophy: Cross-sectional and longitudinal study. Neuromuscul Disord 2015; 25:554-62. [PMID: 25913211 DOI: 10.1016/j.nmd.2015.03.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 03/03/2015] [Accepted: 03/15/2015] [Indexed: 01/09/2023]
Abstract
We aimed to develop, validate, and evaluate a disease-specific outcome measure for SBMA: the Spinal and Bulbar Muscular Atrophy Functional Rating Scale (SBMAFRS). We examined the Japanese version (SBMAFRS-J) in 80 Japanese SBMA subjects to evaluate its validity and reliability. We then assessed this scale longitudinally in 41 additional SBMA subjects. The English version (SBMAFRS-E) was also tested in 15 US subjects. The total score of the SBMAFRS-J was distributed normally without an extreme ceiling or floor effect. For SBMAFRS-J, the high intra- and inter-rater agreement was confirmed (intra-class correlation coefficients [ICCs] 0.910 and 0.797, respectively), and internal consistency was satisfactory (Cronbach's alpha 0.700-0.822). In addition, SBMAFRS-J demonstrated concurrent, convergent, and discriminant validity, except for the respiratory subscale. The inter-rater reliability and internal consistency of SBMAFRS-E were also satisfactory. Longitudinally, SBMAFRS-J showed a higher sensitivity to disease progression than the existing clinical measures. In conclusion, we developed and validated a disease-specific functional rating scale for SBMA in both Japanese and English versions, although it needs to be re-assessed in interventional studies with a larger sample size including English speaking subjects.
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Affiliation(s)
- Atsushi Hashizume
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Keisuke Suzuki
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Haruhiko Banno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan; Institute for Advanced Research, Nagoya University, Nagoya 464-8601, Japan
| | - Noriaki Suga
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Tomoo Mano
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Amane Araki
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Yasuhiro Hijikata
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Christopher Grunseich
- Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Angela Kokkinis
- Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Akihiro Hirakawa
- Biostatistics Section, Center for Advanced Medicine and Clinical Research, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hirohisa Watanabe
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Masahiko Yamamoto
- Department of Speech Pathology and Audiology, Aichi-Gakuin University School of Health Science, 12 Araike, Iwasaki-cho, Nisshin 470-0195, Japan
| | - Kenneth H Fischbeck
- Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Gen Sobue
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan.
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108
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Mathis S, Magy L, Vallat JM. Therapeutic options in Charcot–Marie–Tooth diseases. Expert Rev Neurother 2015; 15:355-66. [DOI: 10.1586/14737175.2015.1017471] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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109
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Brennan KM, Shy ME. New and emerging treatments of Charcot–Marie–Tooth disease. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1009037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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110
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The motor function measure to study limitation of activity in children and adults with Charcot-Marie-Tooth disease. Ann Phys Rehabil Med 2014; 57:587-99. [DOI: 10.1016/j.rehab.2014.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 09/08/2014] [Accepted: 09/08/2014] [Indexed: 11/23/2022]
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111
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Patel RM, Nagamani SCS, Cuthbertson D, Campeau PM, Krischer JP, Shapiro JR, Steiner RD, Smith PA, Bober MB, Byers PH, Pepin M, Durigova M, Glorieux FH, Rauch F, Lee BH, Hart T, Sutton VR. A cross-sectional multicenter study of osteogenesis imperfecta in North America - results from the linked clinical research centers. Clin Genet 2014; 87:133-40. [PMID: 24754836 DOI: 10.1111/cge.12409] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 04/08/2014] [Accepted: 04/19/2014] [Indexed: 02/06/2023]
Abstract
Osteogenesis imperfecta (OI) is the most common skeletal dysplasia that predisposes to recurrent fractures and bone deformities. In spite of significant advances in understanding the genetic basis of OI, there have been no large-scale natural history studies. To better understand the natural history and improve the care of patients, a network of Linked Clinical Research Centers (LCRC) was established. Subjects with OI were enrolled in a longitudinal study, and in this report, we present cross-sectional data on the largest cohort of OI subjects (n = 544). OI type III subjects had higher prevalence of dentinogenesis imperfecta, severe scoliosis, and long bone deformities as compared to those with OI types I and IV. Whereas the mean lumbar spine area bone mineral density (LS aBMD) was low across all OI subtypes, those with more severe forms had lower bone mass. Molecular testing may help predict the subtype in type I collagen-related OI. Analysis of such well-collected and unbiased data in OI can not only help answering questions that are relevant to patient care but also foster hypothesis-driven research, especially in the context of 'phenotypic expansion' driven by next-generation sequencing.
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Affiliation(s)
- R M Patel
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
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113
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Gray K, Burns J, Little D, Bellemore M, Gibbons P. Is tibialis anterior tendon transfer effective for recurrent clubfoot? Clin Orthop Relat Res 2014; 472:750-8. [PMID: 24061847 PMCID: PMC3890208 DOI: 10.1007/s11999-013-3287-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 09/05/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tibialis anterior tendon transfer surgery forms a part of Ponseti management for children with congenital talipes equinovarus who, after initial correction, present with residual dynamic supination. Although retrospective studies support good outcomes, prospective longitudinal studies in this population are lacking. QUESTIONS/PURPOSES We assessed strength, plantar loading, ROM, foot alignment, function, satisfaction, and quality of life in patients with clubfoot that recurred after Ponseti casting who met indications for tibialis anterior tendon transfer surgery, and compared them with a group of patients with clubfoot treated with casting but whose deformity did not recur (therefore who were not indicated for tibialis anterior tendon transfer surgery). METHODS Twenty children with idiopathic congenital talipes equinovarus indicated for tibialis anterior tendon transfer surgery were recruited. Assessment at baseline (before surgery), and 3, 6, and 12 months (after surgery) included strength (hand-held dynamometry), plantar loading (capacitance transducer matrix platform), ROM (Dimeglio scale), foot alignment (Foot Posture Index(©)), function and satisfaction (disease-specific instrument for clubfoot), and quality of life (Infant Toddler Quality of Life Questionnaire™). Outcomes were compared with those of 12 age-matched children with congenital talipes equinovarus not indicated for tibialis anterior tendon transfer surgery. Followup was 100% in the control group and 95% (19 of 20) in the tibialis anterior transfer group. RESULTS At baseline, the tibialis anterior tendon transfer group had a significantly worse eversion-to-inversion strength ratio, plantar loading, ROM, foot alignment, and function and satisfaction. At 3 months after surgery, eversion-to-inversion strength, plantar loading, and function and satisfaction were no longer different between groups. Improvements were maintained at 12 months after surgery (eversion-to-inversion strength mean difference, 8% body weight; 95% CI, -26% to 11%; p = 0.412; plantar loading, p > 0.251; function and satisfaction, p = 0.076). ROM remained less and foot alignment more supinated in the tibialis anterior tendon transfer group between baseline and followup (p < 0.001, p < 0.001). CONCLUSIONS Tibialis anterior tendon transfer surgery was an effective procedure, which at 12-month followup restored the balance of eversion-to-inversion strength and resulted in plantar loading and function and satisfaction outcomes similar to those of age-matched children with congenital talipes equinovarus who after Ponseti casting were not indicated for tibialis anterior tendon transfer.
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Affiliation(s)
- Kelly Gray
- Department of Orthopaedic Surgery, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia,
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Burns J, Menezes M, Finkel RS, Estilow T, Moroni I, Pagliano E, Laurá M, Muntoni F, Herrmann DN, Eichinger K, Shy R, Pareyson D, Reilly MM, Shy ME. Transitioning outcome measures: relationship between the CMTPedS and CMTNSv2 in children, adolescents, and young adults with Charcot-Marie-Tooth disease. J Peripher Nerv Syst 2014; 18:177-80. [PMID: 23781965 DOI: 10.1111/jns5.12024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Long-term studies of Charcot-Marie-Tooth (CMT) disease across the entire lifespan require stable endpoints that measure the same underlying construct (e.g., disability). The aim of this study was to assess the relationship between the CMT Pediatric Scale (CMTPedS) and the adult CMT Neuropathy Score (CMTNSv2) in 203 children, adolescents, and young adults with CMT. There was a moderate curvilinear correlation between the CMTPedS and the CMTNSv2 (Spearman's rho ρ = 0.716, p < 0.0001), although there appears to be a floor effect of the CMTNSv2 in patients with a milder CMT phenotype. Univariate analyses indicate that the relationship between the CMTPedS and CMTNSv2 scores improves with worsening disease severity and advancing age. Although one universal scale throughout life would be ideal, our data supports the transition from the CMTPedS in childhood to the CMTNSv2 in adulthood as a continuum of measuring lifelong disability in patients with CMT.
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Affiliation(s)
- Joshua Burns
- The University of Sydney & Institute for Neuroscience and Muscle Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.
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El-Abassi R, England JD, Carter GT. Charcot-Marie-Tooth disease: an overview of genotypes, phenotypes, and clinical management strategies. PM R 2014; 6:342-55. [PMID: 24434692 DOI: 10.1016/j.pmrj.2013.08.611] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 08/10/2013] [Accepted: 08/31/2013] [Indexed: 11/30/2022]
Abstract
Charcot-Marie-Tooth (CMT) disease, which encompasses several hereditary motor and sensory neuropathies, is one of the most common neuromuscular disorders. Our understanding of the molecular genotypes of CMT and the resultant clinical and electrophysiological phenotypes has increased greatly in the past decade. Characterized by electrodiagnostic studies into demyelinating (type 1) and axonal (type 2) forms, subsequent genetic testing often provides an exact diagnosis of a specific subtype of CMT. These advancements have made diagnostic paradigms fairly straightforward. Still, the nature and extent of neuromuscular disability is often complex in persons with CMT, and no curative treatments are yet available. Genotypically homologous animal models of CMT have improved exploration of disease-modifying treatments, of which molecular genetic manipulation and stem cell therapies appear to be the most promising. Research is also needed to develop better rehabilitative strategies that may limit disease burden and improve physical performance and psychosocial integration. Clinical management should be multidisciplinary, including neurologists, physiatrists, neurogeneticists, neuromuscular nurse practitioners, and orthopedists, along with physical and occupational therapists, speech-language pathologists, orthotists, vocational counselors, social workers, and other rehabilitation clinicians. Goals should include maximizing functional independence and quality of life while minimizing disability and secondary morbidity.
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Affiliation(s)
- Rima El-Abassi
- Department of Neurology at the Louisiana State University School of Medicine, New Orleans, LA(∗)
| | - John D England
- Department of Neurology at the Louisiana State University School of Medicine, New Orleans, LA(†)
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Caetano JS, Costa C, Baets J, Zimon Phd M, Venâncio Phd M, Saraiva Phd J, Negrão L, Fineza I. Autosomal recessive axonal neuropathy with neuromyotonia: a rare entity. Pediatr Neurol 2014; 50:104-7. [PMID: 24131582 DOI: 10.1016/j.pediatrneurol.2013.08.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Revised: 08/02/2013] [Accepted: 08/25/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Autosomal recessive axonal neuropathy with neuromyotonia is a recently described entity associated to the HINT1 gene, encoding histidine triad nucleotide-binding protein 1. PATIENT The authors report a Portuguese 16-year-old girl of Roma ethnicity, descendant of consanguineous parents, with progressive distal muscular atrophy and weakness, beginning at age 6. After several years of extensive investigation with inconclusive results, clinical myotonia was identified. Electrophysiologic studies revealed neuromyotonia associated with a severe chronic predominantly motor axonal neuropathy and homozygous mutation (c.334 C > A, p.H112 N) in HINT1 was detected. CONCLUSION This report emphasizes the late onset of clinical myotonia essential to the diagnosis.
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Affiliation(s)
- Joana Serra Caetano
- Unidade de Neuropediatria, Centro de Desenvolvimento da Criança Luis Borges, Hospital Pediátrico de Coimbra, Centro Hospitalar Universitário de Coimbra, Portugal.
| | - Carmen Costa
- Neurogenetics Group, VIB-Department of Molecular Genetics, University of Antwerp, Antwerpen, Belgium
| | - Jonathan Baets
- Neurogenetics Group, VIB-Department of Molecular Genetics, University of Antwerp, Antwerpen, Belgium; Laboratory of Neurogenetics, Institute Born-Bunge, University of Antwerp, Antwerpen, Belgium; Department of Neurology, Antwerp University Hospital, Antwerpen, Belgium
| | - Madgalena Zimon Phd
- Laboratory of Neurogenetics, Institute Born-Bunge, University of Antwerp, Antwerpen, Belgium; Molecular Neurogenomics Group, VIB Department of Molecular Genetics, University of Antwerp, Antwerpen, Belgium
| | - Margarida Venâncio Phd
- Serviço de Genética Médica, Hospital Pediátrico de Coimbra, Centro HospitalarUniversitário de Coimbra, Portugal; Faculdade de Medicina, Universidade de Coimbra, Portugal
| | - Jorge Saraiva Phd
- Serviço de Genética Médica, Hospital Pediátrico de Coimbra, Centro HospitalarUniversitário de Coimbra, Portugal; Faculdade de Medicina, Universidade de Coimbra, Portugal
| | - Luís Negrão
- Consulta de Doenças Neuromusculares, Hospitais da Universidade de Coimbra, Centro Hospitalar Universitário de Coimbra, Portugal
| | - Isabel Fineza
- Unidade de Neuropediatria, Centro de Desenvolvimento da Criança Luis Borges, Hospital Pediátrico de Coimbra, Centro Hospitalar Universitário de Coimbra, Portugal
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Lewis RA, McDermott MP, Herrmann DN, Hoke A, Clawson LL, Siskind C, Feely SME, Miller LJ, Barohn RJ, Smith P, Luebbe E, Wu X, Shy ME. High-dosage ascorbic acid treatment in Charcot-Marie-Tooth disease type 1A: results of a randomized, double-masked, controlled trial. JAMA Neurol 2013; 70:981-7. [PMID: 23797954 DOI: 10.1001/jamaneurol.2013.3178] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE No current medications improve neuropathy in subjects with Charcot-Marie-Tooth disease type 1A (CMT1A). Ascorbic acid (AA) treatment improved the neuropathy of a transgenic mouse model of CMT1A and is a potential therapy. A lower dosage (1.5 g/d) did not cause improvement in humans. It is unknown whether a higher dosage would prove more effective. OBJECTIVE To determine whether 4-g/d AA improves the neuropathy of subjects with CMT1A. DESIGN A futility design to determine whether AA was unable to reduce worsening on the CMT Neuropathy Score (CMTNS) by at least 50% over a 2-year period relative to a natural history control group. SETTING Three referral centers with peripheral nerve clinics (Wayne State University, Johns Hopkins University, and University of Rochester). PARTICIPANTS One hundred seventy-four subjects with CMT1A were assessed for eligibility; 48 did not meet eligibility criteria and 16 declined to participate. The remaining 110 subjects, aged 13 to 70 years, were randomly assigned in a double-masked fashion with 4:1 allocation to oral AA (87 subjects) or matching placebo (23 subjects). Sixty-nine subjects from the treatment group and 16 from the placebo group completed the study. Two subjects from the treatment group and 1 from the placebo group withdrew because of adverse effects. INTERVENTIONS Oral AA (4 g/d) or matching placebo. MAIN OUTCOMES AND MEASURES Change from baseline to year 2 in the CMTNS, a validated composite impairment score for CMT. RESULTS The mean 2-year change in the CMTNS was -0.21 for the AA group and -0.92 for the placebo group, both better than natural history (+1.33). This was well below 50% reduction of CMTNS worsening from natural history, so futility could not be declared (P > .99). CONCLUSIONS AND RELEVANCE Both treated patients and those receiving placebo performed better than natural history. It seems unlikely that our results support undertaking a larger trial of 4-g/d AA treatment in subjects with CMT1A. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00484510.
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Affiliation(s)
- Richard A Lewis
- Department of Neurology, Wayne State University, Detroit, Michigan, USA
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118
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Afferent control of walking: are there distinct deficits associated to loss of fibres of different diameter? Clin Neurophysiol 2013; 125:327-35. [PMID: 23948160 DOI: 10.1016/j.clinph.2013.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 07/10/2013] [Accepted: 07/22/2013] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To compare the gait pattern in patients affected by different types of neuropathy. METHODS We recruited healthy subjects (HS, n=38), patients with Charcot-Marie-Tooth disease type 1A (CMT1A) (n=10) and patients with diabetic neuropathy (DNP) (n=12). Neuropathy impairment score and neuropathy score were assessed. Body sway during quiet stance, and spatio-temporal gait parameters were recorded. RESULTS Most patients had reduced or absent tendon-tap reflexes. Strength of foot dorsiflexor muscles (p<0.05) and conduction velocity (CV) of leg nerves (p<0.0001) were more impaired in CMT1A than DNP, whereas joint-position sense was more affected (p<0.05) in DNP. Body sway while standing was larger in DNP compared to CMT1A and HS (p<0.01 and p<0.0001 respectively). During gait, the distribution of foot sole contact pressure was abnormal in CMT1A (p<0.05) but not in DNP. Velocity and step length were decreased, and foot yaw angle at foot flat increased, in DNP with respect to CMT1A and HS (both variables, p<0.001). Gait velocity and step length were decreased (p<0.005) also in CMT1A, but to a smaller extent than in DNP, so that the difference between patient groups was significant (p<0.0005). Duration of the double support was protracted in DNP compared to CMT1A and HS (p<0.0005). For DNP only, velocity of gait and duration of single support were correlated (p<0.05) both to sway path and lower limb muscle strength. CONCLUSIONS Changes in both body sway and stance phase of gait were larger in DNP than CMT1A, indicating more impaired static and dynamic control of balance when neuropathy affects the small in addition to the large afferent fibres. Diminished somatosensory input from the smaller fibres rather than muscle weakness or foot deformity plays a critical role in the modulation of the support phase of gait. SIGNIFICANCE The analysis of balance and gait in patients with neuropathy can offer a tool for understanding the nature and functional impact of the neuropathy and should be included in their functional evaluation.
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Roth LA, Johnson-Kerner BL, Marra JD, LaMarca NH, Sproule DM. The absence of curly hair is associated with a milder phenotype in Giant Axonal Neuropathy. Neuromuscul Disord 2013; 24:48-55. [PMID: 23890932 DOI: 10.1016/j.nmd.2013.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 05/29/2013] [Accepted: 06/11/2013] [Indexed: 01/23/2023]
Abstract
Giant Axonal Neuropathy is a pediatric neurodegenerative disorder caused by autosomal recessive mutations in the GAN gene on chromosome 16q24.1. Mutations in the GAN gene lead to functional impairment of the cytoskeletal protein gigaxonin and a generalized disorder of intermediate filaments, including neurofilaments in axons. Tightly curled hair is a common but not universal feature of Giant Axonal Neuropathy. The pathogenesis of curly hair is unknown, although disruption of keratin architecture is thought to play a role. As part of a broader natural history study of Giant Axonal Neuropathy, we found that the absence of curly hair is correlated with superior motor function (p=0.013) when controlling for age, as measured by the Gross Motor Function Measure. Theoretically, higher levels of functional gigaxonin protein or compensatory mechanisms could produce fewer abnormalities of neurofilaments and keratin, accounting for this phenotype. We suggest that straight-haired patients with Giant Axonal Neuropathy are potentially underdiagnosed due to their divergence from the classic phenotype of the disease. Due to their non-specific features of an axonal neuropathy, these patients may be misdiagnosed with Charcot-Marie-Tooth Disease type 2. Genetic testing for Giant Axonal Neuropathy should be considered in relevant cases of Charcot-Marie-Tooth Disease type 2.
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Affiliation(s)
- Lisa A Roth
- College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, United States.
| | - Bethany L Johnson-Kerner
- College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, United States
| | - Jonathan D Marra
- Division of Pediatric Neurology, Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Nicole H LaMarca
- Division of Pediatric Neurology, Department of Neurology, Columbia University Medical Center, New York, NY, United States
| | - Douglas M Sproule
- Division of Pediatric Neurology, Department of Neurology, Columbia University Medical Center, New York, NY, United States
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120
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Ferrarin M, Lencioni T, Rabuffetti M, Moroni I, Pagliano E, Pareyson D. Changes of gait pattern in children with Charcot-Marie-Tooth disease type 1A: a 18 months follow-up study. J Neuroeng Rehabil 2013; 10:65. [PMID: 23819439 PMCID: PMC3707823 DOI: 10.1186/1743-0003-10-65] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 06/14/2013] [Indexed: 11/11/2022] Open
Abstract
Background In a previous study we identified 3 different gait patterns in a group of children with CMT1A disease: Normal-like (NL), Foot-drop (FD), Foot-drop and Push-off Deficit (FD&POD). Goal of the present study was to perform a follow-up evaluation of the same group of patients to analyze possible changes of gait features in relation to disease progression or specific therapy. Methods Nineteen children with CMT1A were evaluated clinically (CMT-Examination Score and Overall Neuropathy Limitation Scale) and through gait analysis 18.2±1.5 months after a baseline evaluation. Meanwhile, 3 of them had foot surgery. Results Fifteen out of the 16 non-operated patients significantly changed at least one of the two parameters associated to primary signs (FD and/or POD). Eleven participants worsened at least one parameter and 9 improved one parameter. CMTES significantly worsened for the group of non-operated patients. However, there was no change in CMTES score in 4 patients and in ONLS score in 11. At subgroup level, participants originally belonging to NL group showed a trend towards a foot-drop deficit (−15%, ns); FD and FD&POD subgroups did not change their primary signs, although significant changes were identified individually. All 3 patients operated have improved push-off and proximal joint patterns during walking. Clinical scores did not change within any sub-group. Conclusions Subtle changes occurring in 1.5 year in gait features of CMT1A children can be instrumentally identified. Such changes show a large inter-subject variability, with some patients even improving their walking pattern. There is anecdotal evidence that foot surgery may improve the push-off phase of gait.
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Affiliation(s)
- Maurizio Ferrarin
- Biomedical Technology Department, Don Carlo Gnocchi Foundation Onlus IRCCS, Milan, Italy.
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121
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Visioli F, Reilly M, Solari A, Pareyson D. Authors’ response to Rahman and Fontes. PHARMANUTRITION 2013. [DOI: 10.1016/j.phanu.2013.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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122
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Kennerson ML, Yiu EM, Chuang DT, Kidambi A, Tso SC, Ly C, Chaudhry R, Drew AP, Rance G, Delatycki MB, Züchner S, Ryan MM, Nicholson GA. A new locus for X-linked dominant Charcot-Marie-Tooth disease (CMTX6) is caused by mutations in the pyruvate dehydrogenase kinase isoenzyme 3 (PDK3) gene. Hum Mol Genet 2013; 22:1404-16. [PMID: 23297365 PMCID: PMC3596851 DOI: 10.1093/hmg/dds557] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 12/16/2012] [Accepted: 12/27/2012] [Indexed: 01/30/2023] Open
Abstract
Hereditary motor and sensory disorders of the peripheral nerve form one of the most common groups of human genetic diseases collectively called Charcot-Marie-Tooth (CMT) neuropathy. Using linkage analysis in a three generation kindred, we have mapped a new locus for X-linked dominant CMT to chromosome Xp22.11. A microsatellite scan of the X chromosome established significant linkage to several markers including DXS993 (Zmax = 3.16; θ = 0.05). Extended haplotype analysis refined the linkage region to a 1.43-Mb interval flanked by markers DXS7110 and DXS8027. Whole exome sequencing identified a missense mutation c.G473A (p.R158H) in the pyruvate dehydrogenase kinase isoenzyme 3 (PDK3) gene. The change localized within the 1.43-Mb linkage interval, segregated with the affected phenotype and was excluded in ethnically matched control chromosomes. PDK3 is one of the four isoenzymes regulating the pyruvate dehydrogenase complex (PDC), by reversible phosphorylation, and is a nuclear-coded protein located in the mitochondrial matrix. PDC catalyzes the oxidative decarboxylation of pyruvate to acetyl CoA and is a key enzyme linking glycolysis to the energy-producing Krebs cycle and lipogenic pathways. We found that the R158H mutation confers enzyme hyperactivity and binds with stronger affinity than the wild-type to the inner-lipoyl (L2) domain of the E2p chain of PDC. Our findings suggest a reduced pyruvate flux due to R158H mutant PDK3-mediated hyper-phosphorylation of the PDC as the underlying pathogenic cause of peripheral neuropathy. The results highlight an important causative link between peripheral nerve degeneration and an essential bioenergetic or biosynthetic pathway required for the maintenance of peripheral nerves.
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Affiliation(s)
- Marina L Kennerson
- Northcott Neuroscience Laboratory, ANZAC Research Institute, Concord, NSW, Australia.
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Crone C, Krarup C. Neurophysiological approach to disorders of peripheral nerve. HANDBOOK OF CLINICAL NEUROLOGY 2013; 115:81-114. [PMID: 23931776 DOI: 10.1016/b978-0-444-52902-2.00006-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Disorders of the peripheral nerve system (PNS) are heterogeneous and may involve motor fibers, sensory fibers, small myelinated and unmyelinated fibers and autonomic nerve fibers, with variable anatomical distribution (single nerves, several different nerves, symmetrical affection of all nerves, plexus, or root lesions). Furthermore pathological processes may result in either demyelination, axonal degeneration or both. In order to reach an exact diagnosis of any neuropathy electrophysiological studies are crucial to obtain information about these variables. Conventional electrophysiological methods including nerve conduction studies and electromyography used in the study of patients suspected of having a neuropathy and the significance of the findings are discussed in detail and more novel and experimental methods are mentioned. Diagnostic considerations are based on a flow chart classifying neuropathies into eight categories based on mode of onset, distribution, and electrophysiological findings, and the electrophysiological characteristics in each type of neuropathy are discussed.
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Affiliation(s)
- Clarissa Crone
- Department of Clinical Neurophysiology, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
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Rance G, Ryan M, Carew P, Corben L, Yiu E, Tan J, Delatycki M. Binaural speech processing in individuals with auditory neuropathy. Neuroscience 2012; 226:227-35. [DOI: 10.1016/j.neuroscience.2012.08.054] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 08/20/2012] [Accepted: 08/26/2012] [Indexed: 10/27/2022]
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Estilow T, Kozin SH, Glanzman AM, Burns J, Finkel RS. Flexor digitorum superficialis opposition tendon transfer improves hand function in children with Charcot-Marie-Tooth disease: case series. Neuromuscul Disord 2012; 22:1090-5. [PMID: 22944171 DOI: 10.1016/j.nmd.2012.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 07/11/2012] [Accepted: 07/23/2012] [Indexed: 12/18/2022]
Abstract
Charcot-Marie-Tooth disease limits hand function. Tendon transfer has not been reported in pediatric CMT. We report two severely affected children following long finger flexor digitorum superficialis opposition tendon transfer. Improvement was noted in palmar abduction, (30°/40°), opposition, (thumb to all digits), and acquisition of pincer, palmar, and lateral pinch with measureable force (1 lb). Dexterity testing improved on the 9 Hole Peg Test (1.03 s/77 s, 22 s) and Functional Dexterity Test (13 s/33 s, 88 s). Functional improvements were observed in self feeding, clothing management, and play. These cases support flexor digitorum superficialis opposition tendon transfer surgery to improve hand function in children with CMT.
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Affiliation(s)
- T Estilow
- The Children's Hospital of Philadelphia Philadelphia, PA 19104, USA.
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Burns J, Ouvrier R, Estilow T, Shy R, Laurá M, Eichinger K, Muntoni F, Reilly MM, Pareyson D, Acsadi G, Shy ME, Finkel RS. Symmetry of foot alignment and ankle flexibility in paediatric Charcot-Marie-Tooth disease. Clin Biomech (Bristol, Avon) 2012; 27:744-7. [PMID: 22424781 PMCID: PMC3389135 DOI: 10.1016/j.clinbiomech.2012.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 02/13/2012] [Accepted: 02/16/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Charcot-Marie-Tooth disease is the most common inherited nerve disorder and typically presents with pes cavus foot deformity and ankle equinus during childhood. Level in the variation of symmetry of musculoskeletal lower limb involvement across the clinical population is unknown, despite early reports describing gross asymmetry. METHODS We measured foot alignment and ankle flexibility of the left and right limbs using accurate and reliable standardised paediatric outcome measures in 172 patients aged 3-20 years with a variety of disease subtypes recruited from the United States, United Kingdom, Italy and Australia. FINDINGS While a large range of differences existed between left and right feet for a small proportion of children, there was no overall significant difference between limbs. INTERPRETATION There are two important implications of these findings. Children with Charcot-Marie-Tooth disease generally exhibit symmetrical foot alignment and ankle flexibility between limbs. As such, analysing one limb only for biomechanical-related research is appropriate and satisfies the independence requirements for statistical analysis. However, because there are large differences between feet for a small proportion of children, an individualised limb-focused approach to clinical care is required.
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Affiliation(s)
- Joshua Burns
- The Children's Hospital at Westmead & The University of Sydney, Australia
| | - Robert Ouvrier
- The Children's Hospital at Westmead & The University of Sydney, Australia
| | - Tim Estilow
- Neuromuscular Program, The Children's Hospital of Philadelphia, PA, USA
| | - Rosemary Shy
- Department of Pediatrics, The Children's Hospital of Michigan, Detroit, MI, USA
| | - Matilde Laurá
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, Queen Square, London, UK
| | | | - Francesco Muntoni
- UCL Institute of Child Health & Great Ormond Street Hospital, London, UK
| | - Mary M. Reilly
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, Queen Square, London, UK
| | - Davide Pareyson
- IRCCS Foundation, Carlo Besta Neurological Institute, Milan, Italy
| | - Gyula Acsadi
- Neurology Division, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Michael E. Shy
- School of Medicine, Wayne State University, Detroit, MI & Dept of Neurology, University of Iowa, Iowa City IA, USA
| | - Richard S. Finkel
- Neuromuscular Program, The Children's Hospital of Philadelphia, PA, USA,Depts. of Neurology and Pediatrics, University of Pennsylvania School of Medicine, PA, USA
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