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Ferreira LA, Fitz FF, Gimenez MM, Matias MM, Bortolini MA, Castro RA. Management of Stress Urinary Incontinence With Pelvic Floor Muscle Training for a Woman With Charcot-Marie-Tooth Disease: A Case Report. J Chiropr Med 2022; 21:220-224. [PMID: 36118110 PMCID: PMC9479200 DOI: 10.1016/j.jcm.2022.02.015] [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: 09/16/2020] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 10/18/2022] Open
Abstract
Objective The purpose of this report is to describe the effects of pelvic floor muscle training (PFMT) in stress urinary incontinence (SUI) of a woman with Charcot-Marie-Tooth (CMT) disease. Clinical Features A 50-year-old female patient with a diagnosis of type II CMT disease was referred to treatment as a result of a complaint of urinary loss upon effort (ie, coughing and sneezing). She reported that the symptoms started about 36 months prior. The urodynamic study revealed SUI with a Valsalva leak point pressure of 84 cmH2O. Intervention and Outcome The treatment of SUI was carried out through a PFMT program for 12 weeks (with supervision) and exercises at home for another 12 weeks. A specialized physiotherapist measured symptoms and severity of SUI (3-day urinary diary, 1-hour pad test), pelvic floor muscle function (digital palpation, manometry and dynamometry), effect of the SUI on quality of life (Incontinence Quality of Life Questionnaire), and adherence to the outpatient sessions and to home exercise sets, which also were assessed (exercise diary). Conclusion In this patient with CMT disease, improvements in urinary symptoms and severity of SUI, pelvic floor muscle function, and effect of SUI on quality of life were noted after PFMT.
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Affiliation(s)
- Letícia A. Ferreira
- Corresponding author: Letícia A. Ferreira, PT, MSc. Rua Napoleão de Barros, 608 – Vila Clementino, CEP 04024-002, São Paulo, SP, Brazil
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Huang H, Zhang Y, Yang M, Lian B, Guo R, Cao L. Case Report: Early-Onset Charcot-Marie-Tooth 2N With Reversible White Matter Lesions Repeatedly Mimicked Stroke or Encephalitis. Front Pediatr 2022; 10:935721. [PMID: 35911843 PMCID: PMC9326065 DOI: 10.3389/fped.2022.935721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/14/2022] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Charcot-Marie-Tooth (CMT) disease is a rare group of peripheral neuropathies with high clinical and genetic heterogeneity. CMT type 2N (CMT 2N) is a rare subtype of CMT with few clinical reports. The clinical presentation mimics that of other diseases, frequently leading to misdiagnoses. We present a case of CMT 2N with reversible white matter lesions (WMLs), which repeatedly mimicked stroke or encephalitis. We include a literature review to the improve management of this disease. CASE DESCRIPTION An 8-year-old boy was admitted to the hospital with slurred speech and limb weakness that had persisted for 1 day. Physical examination revealed lethargy, dysarthria, and a positive bilateral Babinski sign. Cerebrospinal fluid (CSF) analysis showed no abnormalities. Brain magnetic resonance imaging (MRI) revealed symmetrical abnormal signal areas in the paraventricular white matter and corpus callosum. The patient was suspected of having viral encephalitis and recovered rapidly after treatment.He was hospitalized 3 years later for limb weakness, barylalia, and facial paralysis persisting for 1 day. MRI showed an abnormal signal in the bilateral corona radiata. He was suspected of having a stroke or encephalitis. He was completely recovered after treatment.After a second 3-year span, he was admitted for another stroke-like episode. Physical examination revealed facial-lingual hemiparesis, mild atrophy of the left thenar muscle, decreased muscle strength in the extremities, and disappearance of the tendon reflex. MRI revealed more pronounced abnormal signals in the bilateral centrum semiovale and corpus callosum. Antibodies against autoimmune encephalitis were negative. A nerve conduction velocity (NCV) study showed motor and sensory four-limb nerve demyelination with axonal damage, most notably at the distal end. His symptoms were resolved after active treatment. A follow-up MRI showed the complete disappearance of the abnormal white matter signal. Whole exon sequencing showed a heterozygous mutation [c.2093C > T(p.Ser698Phe)] in the alanyl-tRNA synthetase 1 gene (AARS1). His mutation, clinical features, and electrophysiological testing led to a diagnosis of CMT 2N. DISCUSSION Early-Onset CMT 2N with reversible WMLs can often mimic stroke or encephalopathy. Affected individuals may show an atypical posterior reversible encephalopathy syndrome (PRES) on MRI. Careful family history assessment, physical examination, nerve conduction studies, MRIs, and genetic testing are essential for early diagnosis. Further studies are required to confirm these findings.
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Affiliation(s)
- Huasheng Huang
- Department of Neurology, Liuzhou People’s Hospital, Liuzhou, China
| | - Yu Zhang
- Nursing Department, Zhejiang Hospital, Hangzhou, China
- Teaching Office, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Mingxiu Yang
- Department of Neurology, Liuzhou People’s Hospital, Liuzhou, China
| | - Baorong Lian
- Shantou University Medical College, Shantou University, Shantou, China
| | - Rui Guo
- Radiology Department, Liuzhou People’s Hospital, Liuzhou, China
| | - Liming Cao
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
- *Correspondence: Liming Cao,
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3
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Pridmore M, Castoro R, McCollum MS, Kang H, Li J, Dortch R. Length-dependent MRI of hereditary neuropathy with liability to pressure palsies. Ann Clin Transl Neurol 2020; 7:15-25. [PMID: 31872979 PMCID: PMC6952310 DOI: 10.1002/acn3.50953] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Hereditary neuropathy with liability to pressure palsies (HNPP) is caused by heterozygous deletion of the peripheral myelin protein 22 (PMP22) gene. Patients with HNPP present multifocal, reversible sensory/motor deficits due to increased susceptibility to mechanical pressure. Additionally, age-dependent axonal degeneration is reported. We hypothesize that length-dependent axonal loss can be revealed by MRI, irrespective of the multifocal phenotype in HNPP. METHODS Nerve and muscle MRI data were acquired in the proximal and distal leg of patients with HNPP (n = 10) and matched controls (n = 7). More specifically, nerve magnetization transfer ratios (MTR) were evaluated to assay proximal-to-distal gradients in nerve degeneration, while intramuscular fat percentages (Fper ) were evaluated to assay muscle fat replacement following denervation. Neurological disabilities were assessed via the Charcot-Marie-Tooth neuropathy score (CMTNS) for correlation with MRI. RESULTS Fper values were elevated in HNPP proximal muscle (9.8 ± 2.2%, P = 0.01) compared to controls (6.9 ± 1.0%). We observed this same elevation of HNPP distal muscles (10.5 ± 2.5%, P < 0.01) relative to controls (6.3 ± 1.1%). Additionally, the amplitude of the proximal-to-distal gradient in Fper was more significant in HNPP patients than controls (P < 0.01), suggesting length-dependent axonal loss. In contrast, nerve MTR values were similar between HNPP subjects (sciatic/tibial nerves = 39.4 ± 2.0/34.2 ± 2.5%) and controls (sciatic/tibial nerves = 37.6 ± 3.8/35.5 ± 1.2%). Proximal muscle Fper values were related to CMTNS (r = 0.69, P = 0.03), while distal muscle Fper and sciatic/tibial nerve MTR values were not related to disability. INTERPRETATION Despite the multifocal nature of the HNPP phenotype, muscle Fper measurements relate to disability and exhibit a proximal-to-distal gradient consistent with length-dependent axonal loss, suggesting that Fper may be a viable biomarker of disease progression in HNPP.
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Affiliation(s)
- Michael Pridmore
- Vanderbilt University Institute of Imaging ScienceVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Ryan Castoro
- Department of NeurologyDivision of Neuromuscular MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | | | - Hakmook Kang
- Department of BiostatisticsVanderbilt UniversityNashvilleTennesseeUSA
| | - Jun Li
- Department of NeurologyWayne State University School of MedicineDetroitMichiganUSA
| | - Richard Dortch
- Vanderbilt University Institute of Imaging ScienceVanderbilt University Medical CenterNashvilleTennesseeUSA
- Department of Biomedical EngineeringVanderbilt UniversityNashvilleTennesseeUSA
- Department of Radiology and Radiological SciencesVanderbilt University Medical CenterNashvilleTennesseeUSA
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4
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Pazzaglia C, Padua L, Pareyson D, Schenone A, Aiello A, Fabrizi GM, Cavallaro T, Santoro L, Manganelli F, Coraci D, Gemignani F, Vitetta F, Quattrone A, Mazzeo A, Russo M, Vita G. Are novel outcome measures for Charcot–Marie–Tooth disease sensitive to change? The 6-minute walk test and StepWatch™ Activity Monitor in a 12-month longitudinal study. Neuromuscul Disord 2019; 29:310-316. [DOI: 10.1016/j.nmd.2019.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 12/13/2018] [Accepted: 01/29/2019] [Indexed: 11/25/2022]
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5
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Johnson NE, Heatwole C, Creigh P, McDermott MP, Dilek N, Hung M, Bounsanga J, Tang W, Shy ME, Herrmann DN. The Charcot-Marie-Tooth Health Index: Evaluation of a Patient-Reported Outcome. Ann Neurol 2018; 84:225-233. [PMID: 30014533 DOI: 10.1002/ana.25282] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/29/2018] [Accepted: 06/23/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The development of a disease-specific patient-reported outcome for Charcot-Marie-Tooth disease is an important step in the preparation for therapeutic trials. This study describes the development of the Charcot-Marie-Tooth Health Index (CMTHI). METHODS Inherited Neuropathy Consortium Contact Registry participants were queried on the symptoms that most impacted their lives. The CMTHI was developed based on these responses. Factor analysis, assessment of test-retest reliability, known group validity, and patient interviews were utilized to refine the instrument. RESULTS The final CMTHI contains 18 themes that capture Charcot-Marie-Tooth disease (CMT) burden. The CMTHI has a high internal consistency and test-retest reliability. The CMTHI was able to discriminate between patient groups expected to have different disease burden. The CMTHI was able to discriminate levels of disability as measured by the CMT examination score and the mobility-Disability Severity Index. INTERPRETATION The CMTHI represents a valid and reliable outcome to assess patient-reported disease burden in CMT. Ann Neurol 2018;84:225-233.
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Affiliation(s)
| | - Chad Heatwole
- Department of Neurology, University of Rochester, Rochester, NY
| | - Peter Creigh
- Department of Neurology, University of Rochester, Rochester, NY
| | - Michael P McDermott
- Department of Neurology, University of Rochester, Rochester, NY.,Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY
| | - Nuran Dilek
- Department of Neurology, University of Rochester, Rochester, NY
| | - Man Hung
- Department of Orthopedics, University of Utah, Salt Lake City, UT
| | - Jerry Bounsanga
- Department of Orthopedics, University of Utah, Salt Lake City, UT
| | - Wan Tang
- Department of Global Biostatistics and Data Science, Tulane University, New Orleans, LA
| | - Michael E Shy
- Department of Neurology, University of Iowa, Iowa City, IA
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6
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Sabblah TT, Nandini S, Ledray AP, Pasos J, Calderon JLC, Love R, King LE, King SJ. A novel mouse model carrying a human cytoplasmic dynein mutation shows motor behavior deficits consistent with Charcot-Marie-Tooth type 2O disease. Sci Rep 2018; 8:1739. [PMID: 29379136 PMCID: PMC5789002 DOI: 10.1038/s41598-018-20081-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/11/2018] [Indexed: 11/09/2022] Open
Abstract
Charcot-Marie-Tooth disease (CMT) is a peripheral neuromuscular disorder in which axonal degeneration causes progressive loss of motor and sensory nerve function. The loss of motor nerve function leads to distal muscle weakness and atrophy, resulting in gait problems and difficulties with walking, running, and balance. A mutation in the cytoplasmic dynein heavy chain (DHC) gene was discovered to cause an autosomal dominant form of the disease designated Charcot-Marie-Tooth type 2 O disease (CMT2O) in 2011. The mutation is a single amino acid change of histidine into arginine at amino acid 306 (H306R) in DHC. In order to understand the onset and progression of CMT2, we generated a knock-in mouse carrying the corresponding CMT2O mutation (H304R/+). We examined H304R/+ mouse cohorts in a 12-month longitudinal study of grip strength, tail suspension, and rotarod assays. H304R/+ mice displayed distal muscle weakness and loss of motor coordination phenotypes consistent with those of individuals with CMT2. Analysis of the gastrocnemius of H304R/+ male mice showed prominent defects in neuromuscular junction (NMJ) morphology including reduced size, branching, and complexity. Based on these results, the H304R/+ mouse will be an important model for uncovering functions of dynein in complex organisms, especially related to CMT onset and progression.
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Affiliation(s)
- Thywill T Sabblah
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL, 32827, USA
| | - Swaran Nandini
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL, 32827, USA
| | - Aaron P Ledray
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL, 32827, USA
| | - Julio Pasos
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL, 32827, USA
| | - Jami L Conley Calderon
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL, 32827, USA
| | - Rachal Love
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL, 32827, USA
| | - Linda E King
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL, 32827, USA
| | - Stephen J King
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL, 32827, USA.
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7
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Roberts-Clarke D, Fornusek C, Saigal N, Halaki M, Burns J, Nicholson G, Fiatarone Singh M, Hackett D. Relationship between physical performance and quality of life in Charcot-Marie-Tooth disease: a pilot study. J Peripher Nerv Syst 2016; 21:357-364. [DOI: 10.1111/jns.12191] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 12/24/2022]
Affiliation(s)
- Daniel Roberts-Clarke
- Exercise, Health and Performance Faculty Research Group; Faculty of Health Sciences, The University of Sydney; Lidcombe Australia
| | - Che Fornusek
- Exercise, Health and Performance Faculty Research Group; Faculty of Health Sciences, The University of Sydney; Lidcombe Australia
| | - Nidhi Saigal
- Exercise, Health and Performance Faculty Research Group; Faculty of Health Sciences, The University of Sydney; Lidcombe Australia
| | - Mark Halaki
- Exercise, Health and Performance Faculty Research Group; Faculty of Health Sciences, The University of Sydney; Lidcombe Australia
| | - Joshua Burns
- Arthritis and Musculoskeletal Research Group; Faculty of Health Sciences, The University of Sydney; Lidcombe Australia
- Paediatric Gait Analysis Service of New South Wales; Sydney Children's Hospitals Network (Randwick and Westmead); Sydney Australia
| | - Garth Nicholson
- Concord Clinical School; ANZAC Institute, Concord Repatriation Hospital; Concord Australia
| | - Maria Fiatarone Singh
- Exercise, Health and Performance Faculty Research Group; Faculty of Health Sciences, The University of Sydney; Lidcombe Australia
| | - Daniel Hackett
- Exercise, Health and Performance Faculty Research Group; Faculty of Health Sciences, The University of Sydney; Lidcombe Australia
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8
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Padua L, Pazzaglia C, Pareyson D, Schenone A, Aiello A, Fabrizi GM, Cavallaro T, Santoro L, Manganelli F, Gemignani F, Vitetta F, Quattrone A, Mazzeo A, Russo M, Vita G. Novel outcome measures for Charcot-Marie-Tooth disease: validation and reliability of the 6-min walk test and StepWatch(™) Activity Monitor and identification of the walking features related to higher quality of life. Eur J Neurol 2016; 23:1343-50. [PMID: 27160471 DOI: 10.1111/ene.13033] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/22/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Charcot-Marie-Tooth (CMT) disease is the most common inherited neuropathy, but therapeutic options have been limited to symptom management. Past pharmacological trials have failed, possibly due to insensitive outcome measures (OMs). The aim of the current study was to evaluate the validity and reliability of the 6-min walk test (6MWT) and StepWatch(™) Activity Monitoring (SAM) with other previously validated OMs in CMT disease. METHODS A prospective multicenter study was performed, consecutively enrolling 168 CMT patients (104 with CMT1A, 27 with CMT1B, 37 with X-linked CMT) from Italian centers specializing in CMT care. RESULTS Statistical analysis showed that the 6MWT was highly related with all previously used OMs. Some, but not all, SAM parameters were related to commonly used OMs but may provide more information about quality of life. CONCLUSIONS The current study demonstrated the validity and reliability of the 6MWT and SAM as OMs for CMT. Moreover, SAM provides data that correlate better with quality of life measures, making it useful in future rehabilitation trials.
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Affiliation(s)
- L Padua
- Department of Neuroscience, Don Carlo Gnocchi Onlus Foundation, Milan, Italy.,Department of Geriatrics, Neuroscience and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - C Pazzaglia
- Department of Neuroscience, Don Carlo Gnocchi Onlus Foundation, Milan, Italy
| | - D Pareyson
- Department of Clinical Neurosciences, IRCCS Foundation, 'C. Besta' Neurological Institute, Milan, Italy
| | - A Schenone
- Department of Neuroscience, Ospedale San Martino Genova, Genoa, Italy
| | - A Aiello
- Department of Neuroscience, Ospedale San Martino Genova, Genoa, Italy
| | - G M Fabrizi
- Department of Neurological, Biomedical and Motor Sciences, University of Verona, Verona, Italy
| | - T Cavallaro
- UOC Neurologia B, AOUI Verona, Verona, Italy
| | - L Santoro
- Department of Neurological Sciences, Reproductive Sciences and Odontostomatological, 'Federico II' University, Naples, Italy
| | - F Manganelli
- Department of Neurological Sciences, Reproductive Sciences and Odontostomatological, 'Federico II' University, Naples, Italy
| | - F Gemignani
- Department of Neurosciences, University of Parma, Parma, Italy
| | - F Vitetta
- Department of Neurosciences, University of Parma, Parma, Italy
| | - A Quattrone
- Department of Medical Sciences, 'Magna Graecia' University, Catanzaro, Italy
| | - A Mazzeo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - M Russo
- Nemo Sud Clinical Center for Neuromuscular Diseases, Messina, Italy
| | - G Vita
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.,Nemo Sud Clinical Center for Neuromuscular Diseases, Messina, Italy
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9
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McCorquodale D, Pucillo EM, Johnson NE. Management of Charcot-Marie-Tooth disease: improving long-term care with a multidisciplinary approach. J Multidiscip Healthc 2016; 9:7-19. [PMID: 26855581 PMCID: PMC4725690 DOI: 10.2147/jmdh.s69979] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Charcot–Marie–Tooth (CMT) disease is the most common inherited neuropathy and one of the most common inherited diseases in humans. The diagnosis of CMT is traditionally made by the neurologic specialist, yet the optimal management of CMT patients includes genetic counselors, physical and occupational therapists, physiatrists, orthotists, mental health providers, and community resources. Rapidly developing genetic discoveries and novel gene discovery techniques continue to add a growing number of genetic subtypes of CMT. The first large clinical natural history and therapeutic trials have added to our knowledge of each CMT subtype and revealed how CMT impacts patient quality of life. In this review, we discuss several important trends in CMT research factors that will require a collaborative multidisciplinary approach. These include the development of large multicenter patient registries, standardized clinical instruments to assess disease progression and disability, and increasing recognition and use of patient-reported outcome measures. These developments will continue to guide strategies in long-term multidisciplinary efforts to maintain quality of life and preserve functionality in CMT patients.
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Affiliation(s)
- Donald McCorquodale
- Department of Neurology, Eccles Institute of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | - Evan M Pucillo
- Department of Neurology, Eccles Institute of Human Genetics, University of Utah, Salt Lake City, UT, USA
| | - Nicholas E Johnson
- Department of Neurology, Eccles Institute of Human Genetics, University of Utah, Salt Lake City, UT, USA
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10
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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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11
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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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12
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Johnson NE, Heatwole CR, Dilek N, Sowden J, Kirk CA, Shereff D, Shy ME, Herrmann DN. Quality-of-life in Charcot-Marie-Tooth disease: the patient's perspective. Neuromuscul Disord 2014; 24:1018-23. [PMID: 25092060 PMCID: PMC4253871 DOI: 10.1016/j.nmd.2014.06.433] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 06/11/2014] [Accepted: 06/17/2014] [Indexed: 11/26/2022]
Abstract
This study determines the impact of symptoms associated with Charcot-Marie-Tooth disease on quality-of-life. Charcot-Marie-Tooth patients in the Inherited Neuropathies Consortium Rare Diseases Clinical Research Network Contact Registry were surveyed. The survey inquired about 214 symptoms and 20 themes previously identified as important to Charcot-Marie-Tooth patients through patient interviews. Symptom population impact was calculated as the prevalence multiplied by the relative importance of each symptom identified. Prevalence and symptom impact were analyzed by age, symptom duration, gender, Charcot-Marie-Tooth type, and employment status. 407 participants returned the survey, identifying foot and ankle weakness (99.7%) and impaired balance (98.6%) as the most prevalent themes. Foot and ankle weakness and limitations with mobility were the themes with the highest impact. Both symptom prevalence and impact gradually increased with age and symptom duration. Several themes were more prevalent in women with Charcot-Marie-Tooth, including activity limitations, pain, fatigue, hip-thigh weakness, and gastrointestinal issues. All of the themes, except emotional or body image issues, were more prevalent among unemployed individuals. There were minimal differences in symptom prevalence between Charcot-Marie-Tooth types. There are multiple symptoms that impact Charcot-Marie-Tooth quality-of-life in adults. These symptoms have different levels of importance, are readily recognized by patients, and represent critical areas of Charcot-Marie-Tooth health.
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Affiliation(s)
- Nicholas E Johnson
- The University of Utah, The Department of Neurology, Department of Pediatrics, and Department of Pathology, United States.
| | - Chad R Heatwole
- The University of Rochester, Department of Neurology, United States
| | - Nuran Dilek
- The University of Rochester, Department of Neurology, United States
| | - Janet Sowden
- The University of Rochester, Department of Neurology, United States
| | - Callyn A Kirk
- The University of South Florida, Pediatrics Epidemiology Center, United States
| | - Denise Shereff
- The University of South Florida, School of Information, United States
| | - Michael E Shy
- The University of Iowa, Department of Neurology, United States
| | - David N Herrmann
- The University of Rochester, Department of Neurology, United States
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Dortch RD, Dethrage LM, Gore JC, Smith SA, Li J. Proximal nerve magnetization transfer MRI relates to disability in Charcot-Marie-Tooth diseases. Neurology 2014; 83:1545-53. [PMID: 25253751 DOI: 10.1212/wnl.0000000000000919] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The objectives of this study were (1) to develop a novel magnetization transfer ratio (MTR) MRI assay of the proximal sciatic nerve (SN), which is inaccessible via current tools for assessing peripheral nerves, and (2) to evaluate the resulting MTR values as a potential biomarker of myelin content changes in patients with Charcot-Marie-Tooth (CMT) diseases. METHODS MTR was measured in the SN of patients with CMT type 1A (CMT1A, n = 10), CMT type 2A (CMT2A, n = 3), hereditary neuropathy with liability to pressure palsies (n = 3), and healthy controls (n = 21). Additional patients without a genetically confirmed subtype (n = 4), but whose family histories and electrophysiologic tests were consistent with CMT, were also included. The relationship between MTR and clinical neuropathy scores was assessed, and the interscan and inter-rater reliability of MTR was estimated. RESULTS Mean volumetric MTR values were significantly decreased in the SN of patients with CMT1A (33.8 ± 3.3 percent units) and CMT2A (31.5 ± 1.9 percent units) relative to controls (37.2 ± 2.3 percent units). A significant relationship between MTR and disability scores was also detected (p = 0.01 for genetically confirmed patients only, p = 0.04 for all patients). From interscan and inter-rater reliability analyses, proximal nerve MTR values were repeatable at the slicewise and mean volumetric levels. CONCLUSIONS MTR measurements may be a viable biomarker of proximal nerve pathology in patients with CMT.
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Affiliation(s)
- Richard D Dortch
- From the Department of Radiology and Radiological Sciences (R.D.D., J.C.G., S.A.S.), Vanderbilt University Institute of Imaging Science (R.D.D., L.M.D., J.C.G., S.A.S.), and the Departments of Biomedical Engineering (R.D.D., J.C.G., S.A.S.), Physics and Astronomy (J.C.G., S.A.S.), Molecular Physiology and Biophysics (J.C.G.), and Neurology (J.L.), Vanderbilt University, Nashville, TN.
| | - Lindsey M Dethrage
- From the Department of Radiology and Radiological Sciences (R.D.D., J.C.G., S.A.S.), Vanderbilt University Institute of Imaging Science (R.D.D., L.M.D., J.C.G., S.A.S.), and the Departments of Biomedical Engineering (R.D.D., J.C.G., S.A.S.), Physics and Astronomy (J.C.G., S.A.S.), Molecular Physiology and Biophysics (J.C.G.), and Neurology (J.L.), Vanderbilt University, Nashville, TN
| | - John C Gore
- From the Department of Radiology and Radiological Sciences (R.D.D., J.C.G., S.A.S.), Vanderbilt University Institute of Imaging Science (R.D.D., L.M.D., J.C.G., S.A.S.), and the Departments of Biomedical Engineering (R.D.D., J.C.G., S.A.S.), Physics and Astronomy (J.C.G., S.A.S.), Molecular Physiology and Biophysics (J.C.G.), and Neurology (J.L.), Vanderbilt University, Nashville, TN
| | - Seth A Smith
- From the Department of Radiology and Radiological Sciences (R.D.D., J.C.G., S.A.S.), Vanderbilt University Institute of Imaging Science (R.D.D., L.M.D., J.C.G., S.A.S.), and the Departments of Biomedical Engineering (R.D.D., J.C.G., S.A.S.), Physics and Astronomy (J.C.G., S.A.S.), Molecular Physiology and Biophysics (J.C.G.), and Neurology (J.L.), Vanderbilt University, Nashville, TN
| | - Jun Li
- From the Department of Radiology and Radiological Sciences (R.D.D., J.C.G., S.A.S.), Vanderbilt University Institute of Imaging Science (R.D.D., L.M.D., J.C.G., S.A.S.), and the Departments of Biomedical Engineering (R.D.D., J.C.G., S.A.S.), Physics and Astronomy (J.C.G., S.A.S.), Molecular Physiology and Biophysics (J.C.G.), and Neurology (J.L.), Vanderbilt University, Nashville, TN
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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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