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Laudanski K, Elmadhoun O, Mathew A, Kahn-Pascual Y, Kerfeld MJ, Chen J, Sisniega DC, Gomez F. Anesthetic Considerations for Patients with Hereditary Neuropathy with Liability to Pressure Palsies: A Narrative Review. Healthcare (Basel) 2024; 12:858. [PMID: 38667620 PMCID: PMC11050561 DOI: 10.3390/healthcare12080858] [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: 02/11/2024] [Revised: 03/28/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
Hereditary neuropathy with liability to pressure palsies (HNPP) is an autosomal dominant demyelinating neuropathy characterized by an increased susceptibility to peripheral nerve injury from trauma, compression, or shear forces. Patients with this condition are unique, necessitating distinct considerations for anesthesia and surgical teams. This review describes the etiology, prevalence, clinical presentation, and management of HNPP and presents contemporary evidence and recommendations for optimal care for HNPP patients in the perioperative period. While the incidence of HNPP is reported at 7-16:100,000, this figure may be an underestimation due to underdiagnosis, further complicating medicolegal issues. With the subtle nature of symptoms associated with HNPP, patients with this condition may remain unrecognized during the perioperative period, posing significant risks. Several aspects of caring for this population, including anesthetic choices, intraoperative positioning, and monitoring strategy, may deviate from standard practices. As such, a tailored approach to caring for this unique population, coupled with meticulous preoperative planning, is crucial and requires a multidisciplinary approach.
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Affiliation(s)
- Krzysztof Laudanski
- Department of Anesthesiology and Perioperative Care, Mayo Clinic, Rochester, MN 55902, USA; (K.L.); (O.E.); (M.J.K.); (J.C.)
| | - Omar Elmadhoun
- Department of Anesthesiology and Perioperative Care, Mayo Clinic, Rochester, MN 55902, USA; (K.L.); (O.E.); (M.J.K.); (J.C.)
| | - Amal Mathew
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA 19104, USA;
| | - Yul Kahn-Pascual
- St George’s University Hospitals NHS Foundation Trust, London SW17 0QT, UK;
| | - Mitchell J. Kerfeld
- Department of Anesthesiology and Perioperative Care, Mayo Clinic, Rochester, MN 55902, USA; (K.L.); (O.E.); (M.J.K.); (J.C.)
| | - James Chen
- Department of Anesthesiology and Perioperative Care, Mayo Clinic, Rochester, MN 55902, USA; (K.L.); (O.E.); (M.J.K.); (J.C.)
| | - Daniella C. Sisniega
- Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Francisco Gomez
- Department of Neurology, University of Missouri, Columbia, MO 65211, USA
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Krauter D, Stausberg D, Hartmann TJ, Volkmann S, Kungl T, Rasche DA, Saher G, Fledrich R, Stassart RM, Nave KA, Goebbels S, Ewers D, Sereda MW. Targeting PI3K/Akt/mTOR signaling in rodent models of PMP22 gene-dosage diseases. EMBO Mol Med 2024; 16:616-640. [PMID: 38383802 PMCID: PMC10940316 DOI: 10.1038/s44321-023-00019-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 12/15/2023] [Accepted: 12/15/2023] [Indexed: 02/23/2024] Open
Abstract
Haplo-insufficiency of the gene encoding the myelin protein PMP22 leads to focal myelin overgrowth in the peripheral nervous system and hereditary neuropathy with liability to pressure palsies (HNPP). Conversely, duplication of PMP22 causes Charcot-Marie-Tooth disease type 1A (CMT1A), characterized by hypomyelination of medium to large caliber axons. The molecular mechanisms of abnormal myelin growth regulation by PMP22 have remained obscure. Here, we show in rodent models of HNPP and CMT1A that the PI3K/Akt/mTOR-pathway inhibiting phosphatase PTEN is correlated in abundance with PMP22 in peripheral nerves, without evidence for direct protein interactions. Indeed, treating DRG neuron/Schwann cell co-cultures from HNPP mice with PI3K/Akt/mTOR pathway inhibitors reduced focal hypermyelination. When we treated HNPP mice in vivo with the mTOR inhibitor Rapamycin, motor functions were improved, compound muscle amplitudes were increased and pathological tomacula in sciatic nerves were reduced. In contrast, we found Schwann cell dedifferentiation in CMT1A uncoupled from PI3K/Akt/mTOR, leaving partial PTEN ablation insufficient for disease amelioration. For HNPP, the development of PI3K/Akt/mTOR pathway inhibitors may be considered as the first treatment option for pressure palsies.
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Affiliation(s)
- Doris Krauter
- Research Group "Translational Neurogenetics", Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
- Department of Neurogenetics, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
- Division of Molecular Neurobiology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm, Sweden
| | - Daniela Stausberg
- Research Group "Translational Neurogenetics", Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
- Department of Neurogenetics, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
| | - Timon J Hartmann
- Research Group "Translational Neurogenetics", Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
- Department of Neurogenetics, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
| | - Stefan Volkmann
- Department of Neurogenetics, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
| | - Theresa Kungl
- Institute of Anatomy, University of Leipzig, Leipzig, Germany
| | - David A Rasche
- Research Group "Translational Neurogenetics", Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
- Department of Neurogenetics, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Gesine Saher
- Department of Neurogenetics, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
| | - Robert Fledrich
- Institute of Anatomy, University of Leipzig, Leipzig, Germany
| | - Ruth M Stassart
- Institute of Neuropathology, University of Leipzig, Leipzig, Germany
| | - Klaus-Armin Nave
- Department of Neurogenetics, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
| | - Sandra Goebbels
- Department of Neurogenetics, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany.
| | - David Ewers
- Research Group "Translational Neurogenetics", Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany.
- Department of Neurogenetics, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany.
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany.
| | - Michael W Sereda
- Research Group "Translational Neurogenetics", Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany.
- Department of Neurogenetics, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany.
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany.
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Tanei T, Nishimura Y, Nagashima Y, Ishii M, Nishii T, Fukaya N, Abe T, Kato H, Maesawa S, Saito R. Efficacy of Spinal Cord Stimulation Using Differential Target Multiplexed Stimulation for Intractable Pain of Hereditary Neuropathy with Liability to Pressure Palsies: A Case Report. NMC Case Rep J 2023; 10:203-208. [PMID: 37539362 PMCID: PMC10396390 DOI: 10.2176/jns-nmc.2023-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/17/2023] [Indexed: 08/05/2023] Open
Abstract
Hereditary neuropathy with liability to pressure palsies is an extremely rare genetic disorder; it is an autosomal dominant disorder with a high incidence of neuropathic and/or musculoskeletal pain. A case of achieving pain relief by spinal cord stimulation using differential target multiplexed stimulation for a 44-year-old female patient with hereditary neuropathy with liability to pressure palsies who was experiencing severe pain in her back, face, and all four limbs is presented. In her early teens, the initial symptoms were numbness and weakness of a limb after movement, which improved spontaneously. Transient pain in her back followed by systemic and persistent muscle weakness and pain developed. Deletion of the gene for peripheral myelin protein 22 was detected by peripheral nerve biopsy. The diagnosis of hereditary neuropathy with liability to pressure palsies was made in her early thirties. A spinal cord stimulation trial was performed because her severe pain continued despite administering many medications. Therefore, two spinal cord stimulation systems were implanted at the C3-5 and Th8-9 levels by two procedures. Pain in her back, arms, and legs decreased from 8 to 1, 5 to 1, and 6 to 2 on the numerical rating scale, respectively. Furthermore, opioid usage was tapered. The pain of hereditary neuropathy with liability to pressure palsies has a complicated pathogenesis and is resistant to pharmacological treatment. Spinal cord stimulation using differential target multiplexed stimulation may be a viable treatment option.
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Affiliation(s)
- Takafumi Tanei
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yusuke Nishimura
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yoshitaka Nagashima
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Motonori Ishii
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Tomoya Nishii
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Nobuhisa Fukaya
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takashi Abe
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hiroyuki Kato
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Satoshi Maesawa
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Karklinsky S, Kugler S, Bar-Yosef O, Nissenkorn A, Grossman-Jonish A, Tirosh I, Vivante A, Pode-Shakked B. Hereditary neuropathy with liability to pressure palsies (HNPP): Intrafamilial phenotypic variability and early childhood refusal to walk as the presenting symptom. Ital J Pediatr 2022; 48:84. [PMID: 35658923 PMCID: PMC9164845 DOI: 10.1186/s13052-022-01280-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 05/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Limping and/or refusal to walk is a common complaint in the setting of the pediatric department, with a widely diverse differential diagnosis. An unusual etiology, is that of a hereditary neuropathy. Hereditary neuropathy with liability to pressure palsies (HNPP) is a recurrent, episodic demyelinating neuropathy, most commonly caused by a 17p11.2 chromosomal deletion encompassing the PMP22 gene. METHODS We pursued chromosomal microarray analysis (CMA) in multiple affected individuals of a single extended family, manifesting a range of phenotypic features consistent with HNPP. RESULTS A 4.5 years-old boy presented for in-patient evaluation due to refusal to walk. Initial investigations including spine MRI and bone scan failed to yield a conclusive diagnosis. Following family history, which implied an autosomal dominant mode of inheritance, CMA was pursued and confirmed a 17p11.2 deletion in the proband consistent with HNPP. Importantly, following this diagnosis, four additional affected family members were demonstrated to harbor the deletion. Their variable phenotypic features, ranging from a prenatal diagnosis of a 6 months-old sibling, to recurrent paresthesias manifesting in the fourth decade of life, are discussed. CONCLUSIONS Our experience with the family reported herein demonstrates how a thorough anamnesis can lead to a rare genetic etiology with a favorable prognosis and prevent unnecessary investigations, and underscores HNPP as an uncommon diagnostic possibility in the limping child.
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Affiliation(s)
- Shani Karklinsky
- Department of Pediatrics B, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 52621, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shir Kugler
- Department of Pediatrics B, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 52621, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Omer Bar-Yosef
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Pediatric Neurology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
- Talpiot Medical Leadership Program, Sheba Medical Center, Tel-Hashomer, Israel
| | - Andreea Nissenkorn
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Pediatric Neurology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
- Center for Rare Disorders-Magen, Wolfson Medical Center, Holon, Israel
| | - Anat Grossman-Jonish
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- The Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel-Hashomer, Israel
| | - Irit Tirosh
- Department of Pediatrics B, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 52621, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Pediatric Rheumatology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Asaf Vivante
- Department of Pediatrics B, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 52621, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Talpiot Medical Leadership Program, Sheba Medical Center, Tel-Hashomer, Israel
- Pediatric Nephrology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Ben Pode-Shakked
- Department of Pediatrics B, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 52621, Tel-Hashomer, Israel.
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
- Talpiot Medical Leadership Program, Sheba Medical Center, Tel-Hashomer, Israel.
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Neuropatie ereditarie da ipersensibilità alla pressione (neuropatia tomaculare o allantoidea). Neurologia 2018. [DOI: 10.1016/s1634-7072(18)41292-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Khadilkar SV, Yadav RS, Patel BA. Hereditary Liability to Pressure Palsies. Neuromuscul Disord 2018. [DOI: 10.1007/978-981-10-5361-0_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Choi K, Ahn SH, Baek SH, Kim JS, Choi SJ, Shin JY, Kim SM, Hong YH, Sung JJ. Spinobulbar muscular atrophy combined with atypical hereditary neuropathy with liability to pressure palsy. J Clin Neurosci 2017; 48:90-92. [PMID: 29137918 DOI: 10.1016/j.jocn.2017.10.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 10/10/2017] [Indexed: 11/17/2022]
Abstract
Spinobulbar muscular atrophy (SBMA) is an X-linked recessive disease, presenting motor weakness and wasting of facial, bulbar and limb muscles. Hereditary neuropathy with liability to pressure palsy (HNPP) is autosomal dominant disorder characterized by recurrent neuropathies at common entrapment sites. We report a case of co-existence of SBMA and atypical HNPP with genetic confirmation of CAG expansion in the androgen receptor (AR) gene and deletion of the peripheral myelin protein 22 (PMP22) gene. A 62-year-old man presented with progressive muscle weakness, fasciculations in upper and lower limbs and dysesthesia predominantly in the distal regions. No family members, including his children, experienced similar symptoms. The electrodiagnostic examination was compatible with demyelinating sensorimotor polyneuropathy. Simultaneous hereditary polyneuropathy and motor neuron disease were suspected and relevant genetic testing was confirmed HNPP and SBMA. This case presented with 2 rare genetic neuromuscular disorders and the atypical HNPP phenotype. This case highlight the importance of detailed patient histories, as well as neurological and electrophysiological examinations for diagnosis of atypical and combination of rare genetic disorders.
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Affiliation(s)
- Kyomin Choi
- Department of Neurology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - So Hyun Ahn
- Department of Neurology, Seoul National University Hospital, Republic of Korea
| | - Seol-Hee Baek
- Department of Neurology, Korea University Anam Hospital, Republic of Korea
| | - Jun-Soon Kim
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Seok-Jin Choi
- Department of Neurology, Seoul National University Hospital, Republic of Korea
| | - Je-Young Shin
- Department of Neurology, Seoul National University Hospital, Republic of Korea
| | - Sung-Min Kim
- Department of Neurology, Seoul National University Hospital, Republic of Korea
| | - Yoon-Ho Hong
- Department of Neurology, Seoul Metropolitan Government Boramae Medical Center, Republic of Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Republic of Korea.
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8
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Choi YH, Dunn B. Low back pain with radicular symptoms as a presentation of hereditary neuropathy with liability to pressure palsies: the diagnostic challenge of an atypical presentation. Muscle Nerve 2016; 53:655-6. [PMID: 26773980 DOI: 10.1002/mus.25040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 01/04/2016] [Accepted: 01/07/2016] [Indexed: 01/17/2023]
Affiliation(s)
- Yoonhee H Choi
- Department of Physical Medicine and Rehabilitation, State University of New York, Upstate Medical University, Syracuse, New York
| | - Bernadette Dunn
- Department of Physical Medicine and Rehabilitation, State University of New York, Upstate Medical University, Syracuse, New York
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Chrestian N, McMillan H, Poulin C, Campbell C, Vajsar J. Hereditary neuropathy with liability to pressure palsies in childhood: Case series and literature update. Neuromuscul Disord 2015; 25:693-8. [PMID: 26189194 DOI: 10.1016/j.nmd.2015.06.463] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 06/08/2015] [Accepted: 06/26/2015] [Indexed: 11/25/2022]
Abstract
Hereditary Neuropathy with Liability to Pressure Palsy (HNPP) is a rare condition in childhood with a diverse range of clinical presentations. We analyzed the clinical presentation and electrophysiological data of 12 children with a confirmed PMP22 gene deletion and reviewed the published reports of HNPP in children and compared our data with the reports from the literature review. Peroneal palsy was the most common presentation (42%) followed by brachial plexus palsy in 25% of our cases. Nerve conduction studies were always suggestive of the diagnosis demonstrating 3 major patterns: multifocal demyelination at the area of entrapment, generalized sensory-motor polyneuropathy and a combination of the two first patterns in a vast majority (60%). Surprisingly, there was bilateral or unilateral electrophysiological entrapment of the median nerve at the carpal tunnel in all our patients. The clinical presentation of HNPP in childhood is heterogeneous and electrophysiological findings are helpful in establishing the diagnosis. Any unexplained mononeuropathy or multifocal neuropathy should lead to PMP22 gene testing to look for the deletion. Early diagnosis is important in order to facilitate appropriate genetic counseling and also for the appropriate care for these patients.
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Affiliation(s)
- Nicolas Chrestian
- The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
| | - Hugh McMillan
- Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, Ontario K1H 8L1, Canada
| | - Chantal Poulin
- The Montreal Children's Hospital, McGill University, 1001 Boulevard Décarie, Montreal, Quebec H4A 3J1, Canada
| | - Craig Campbell
- Children's Health Research Institute Western University, 800 Commissioners Road East, London, Ontario N6C 2V5, Canada
| | - Jiri Vajsar
- The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
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Yilmaz U, Bird TT, Carter GT, Wang LH, Weiss MD. Pain in hereditary neuropathy with liability to pressure palsy: An association with fibromyalgia syndrome? Muscle Nerve 2015; 51:385-90. [DOI: 10.1002/mus.24331] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2014] [Indexed: 12/16/2022]
Affiliation(s)
- Ugur Yilmaz
- Department of Neurology; University of Washington Medical Center; Box 356115, 1959 NE Pacific Street Seattle Washington 98195 USA
| | - Thomas T. Bird
- Department of Neurology; University of Washington Medical Center; Box 356115, 1959 NE Pacific Street Seattle Washington 98195 USA
| | - Gregory T. Carter
- MEDEX Division; University of Washington School of Medicine; Seattle Washington USA
| | - Leo H. Wang
- Department of Neurology; University of Washington Medical Center; Box 356115, 1959 NE Pacific Street Seattle Washington 98195 USA
| | - Michael D. Weiss
- Department of Neurology; University of Washington Medical Center; Box 356115, 1959 NE Pacific Street Seattle Washington 98195 USA
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Bulusu S, McMillan HJ. A Report of Hereditary Neuropathy with Liability to Pressure Palsy (HNPP) Presenting with Brachial Plexopathy: The Value of Complete Electrodiagnostic Testing. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/1086508x.2011.11079818] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Srinivas Bulusu
- Division of Neurology, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Hugh J. McMillan
- Division of Neurology, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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12
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Fledrich R, Stassart RM, Sereda MW. Murine therapeutic models for Charcot-Marie-Tooth (CMT) disease. Br Med Bull 2012; 102:89-113. [PMID: 22551516 DOI: 10.1093/bmb/lds010] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION OR BACKGROUND Charcot-Marie-Tooth (CMT) disease represents a broad group of inherited motor and sensory neuropathies which can originate from various genetic aberrations, e.g. mutations, deletions and duplications. SOURCES OF DATA We performed a literature review on murine animal models of CMT disease with regard to experimental therapeutic approaches. Hereby, we focussed on the demyelinating subforms of CMT (CMT1). PubMed items were CMT, animal model, demyelination and therapy. AREAS OF AGREEMENT Patients affected by CMT suffer from slowly progressive, distally pronounced muscle atrophy caused by an axonal loss. The disease severity is highly variable and impairments may result in wheelchair boundness. No therapy is available yet. AREAS OF CONTROVERSY Numerous rodent models for the various CMT subtypes are available today. The selection of the correct animal model for the specific CMT subtype provides an important prerequisite for the successful translation of experimental findings in patients. GROWING POINTS Despite more than 20 years of remarkable progress in CMT research, the disease is still left untreatable. There is a growing number of experimental therapeutic strategies that may be translated into future clinical trials in patients with CMT. AREAS TIMELY FOR DEVELOPING RESEARCH The slow disease progression and insensitive outcome measures hamper clinical therapy trials in CMT. Biomarkers may provide powerful tools to monitor therapeutic efficacy. Recently, we have shown that transcriptional profiling can be utilized to assess and predict the disease severity in a transgenic rat model and in affected humans.
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Affiliation(s)
- Robert Fledrich
- Research Group 'Molecular and Translational Neurology', Department of Neurogenetics, Max-Planck-Institute of Experimental Medicine, Göttingen, Germany
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13
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Conceição I, Nzwalo H, de Carvalho M. Coexistence of transthyretin familial amyloid polyneuropathy and hereditary neuropathy with liability to pressure palsy. Clin Neurol Neurosurg 2012; 114:1355-7. [PMID: 22520972 DOI: 10.1016/j.clineuro.2012.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 03/08/2012] [Accepted: 03/15/2012] [Indexed: 11/18/2022]
Affiliation(s)
- Isabel Conceição
- Department of Neurosciences, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Portugal.
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Wijayasiri L, Batas D, Quiney N. Hereditary neuropathy with liability to pressure palsies and anaesthesia: peri-operative nerve injury. Anaesthesia 2006; 61:1004-6. [PMID: 16978318 DOI: 10.1111/j.1365-2044.2006.04786.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 43-year-old female with carcinoma of the left breast underwent wide local excision of the tumour and sentinel lymph node biopsy under general anaesthesia. Three lymph nodes were removed uneventfully during the operation. Postoperatively, the patient complained of weakness and decreased sensation of her left arm. A diagnosis of peri-operative neuropraxia was made. This resolved completely over the following 4 weeks. Genetic testing confirmed a diagnosis of hereditary neuropathy with liability to pressure palsies.
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Affiliation(s)
- L Wijayasiri
- Department of Anaesthetics, Royal Surrey County Hospital, Guildford, UK.
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