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Spiteri M, Mifsud M, Azzopardi T, Giele H. Population Study of Hand and Wrist Manifestations of Congenital Insensitivity to Pain. Hand (N Y) 2022; 17:155-161. [PMID: 32141314 PMCID: PMC8721796 DOI: 10.1177/1558944720906556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Congenital insensitivity to pain is a rare autosomal recessive condition characterized by insensitivity to painful stimuli due to absence of sensory and sympathetic post ganglionic neurons in the skin and skeletal system leading to lack of protective sensation and altered joint propioception. This study was performed to assess hand and wrist manifestations of patients with congenital insensitivity to pain in the Maltese Islands. Methods: Records of public and private hospitals were reviewed to identify patients suffering from this condition. A review of notes, patients, and imaging was performed. A Disabilities of the Arm, Shoulder, and Hand score was obtained to assess level of function. Results: Nine patients were identified. Mean age of diagnosis was 8.9 years. Interphalangeal joints were most commonly affected. Multiple spontaneous or posttraumatic fingertip ulceration occurred in 5 patients. Anhidrosis resulted in more protracted ulcers and infections, requiring amputation of distal and middle phalanges due to osteomyelitis. The wrist joint was less commonly involved and showed more complex joint involvement. Conclusion: The hand and wrist are involved in different ways, with fingertip ulceration leading to potential infection and osteomyelitis in the hand, whereas the wrist joint is involved in cases of increased axial loading and load transfer, such as following prolonged use of walking and mobility aids. The latter should be borne in mind during management of lower limb conditions. Hand care and hygiene is important in all patients, especially in cases of anhidrosis due to the increased rate of ulceration and osteomyelitis requiring surgical intervention. Despite the severity of the condition, patients report good overall function.
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Affiliation(s)
- Michelle Spiteri
- Nuffield Orthopaedic Centre, Oxford, UK,Michelle Spiteri, Hand Team, Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7LD, UK.
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2
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Negri S, Samuel TJ, Lee S. The Potential Role of Exercise Training and Mechanical Loading on Bone-Associated Skeletal Nerves. J Bone Metab 2021; 28:267-277. [PMID: 34905674 PMCID: PMC8671028 DOI: 10.11005/jbm.2021.28.4.267] [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: 10/20/2021] [Accepted: 11/07/2021] [Indexed: 11/11/2022] Open
Abstract
The spatial distribution, innervation, and functional role of the bone-associated skeletal nerves have been previously reported in detail. However, studies examining exercise-induced associations between skeletal nerves and bone metabolism are limited. This review introduces a potential relationship between exercise and the skeletal nerves and discusses how it can contribute to exercise-induced bone anabolism. First, the background and current understanding of nerve fiber types and their functions in the skeleton are provided. Next, the influence of exercise and mechanical loading on the skeletal nervous system is elaborated. Effective synthesis of recent studies could serve as an established baseline for the novel discovery of the effects of exercise on skeletal nerve density and bone anabolic activity in the future. Therefore, this review overviews the existing evidence for the neural control of bone metabolism and the potential positive effects of exercise on the peripheral skeletal nervous system. The influence of exercise training models on the relationships of sensory nerve signals with osteoblast-mediated bone formation and the increased bone volume provides the first insight on the potential importance of exercise training in stimulating positive adaptations in the skeletal nerve-bone interaction and its downstream effect on bone metabolism, thereby highlighting its therapeutic potential in a variety of clinical populations.
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Affiliation(s)
- Stefano Negri
- Department of Orthopedics and Trauma Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology of the University of Verona, Verona, Italy
| | - T Jake Samuel
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Seungyong Lee
- Department of Physiology, College of Graduate Studies, Midwestern University Arizona College of Osteopathic Medicine, Glendale, AZ, USA
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3
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Hanatleh OM, Kofahi NK, Aburahma SK, Bintareef EM, Al-Bashtawy M, Alkhawaldeh A, Ibnian AM. A 5-Year-Old Palestinian Bedouin Girl with Repeated Self-Induced Injuries to the Digits, a Diagnosis of Congenital Insensitivity to Pain, and Anhidrosis. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933486. [PMID: 34732685 PMCID: PMC8579061 DOI: 10.12659/ajcr.933486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Congenital insensitivity to pain with anhidrosis (CIPA), also referred to as hereditary sensory and autonomic neuropathy type IV, is a rare autosomal recessive disease caused by mutations in the NTRK1 gene. The inability to feel pain and temperature often leads to repeated severe and unintentional self-inflicted injuries; these can result in severe complications, as patients heal slowly from skin and bone injuries. This case report describes a 5-year-old Palestinian girl with self-inflicted injury to the digits, a dislocated distal inter-phalangeal joint of the left big toe, and a diagnosis of CIPA. CASE REPORT A 5-year-old girl, a daughter of related Palestinian Bedouin parents, presented with a chronic unhealed wound over the planter surface of the left foot. Painless repetitive minor traumata over the same area badly affected wound healing and this led to wound dehiscence and dislocation of the distal inter-phalangeal joint of the left big toe. Surgical fixation of the dislocated joint along with intravenous antibiotics and close follow-up resulted in eventual improvement and near complete wound healing despite the obviously slow healing process. The girl also displayed evidence of unintentional self-inflicted injury, which within the overall clinical context warranted a clinical suspicion of CIPA. This was confirmed by genetic testing for the presence of a homozygous frameshift mutation in the NTRK1 gene (c.1842_1843insT; p.Pro615Serfs*12). CONCLUSIONS This case report shows that a physician should have a low threshold of suspicion to investigate for CIPA when managing children with multiple unintentional self-inflicted injuries, anhidrosis, and pain insensitivity, mainly through genetic testing to detect mutations in the NTRK1 gene.
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Affiliation(s)
- Omar M Hanatleh
- Department of Orthopedics, Al-Safa Specialized Hospital, Jarash, Jordan
| | - Noran K Kofahi
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Samah K Aburahma
- Department of Pediatrics, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | | | | | - Ali M Ibnian
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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4
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Baghdadi S, Saberi S, Baghdadi T. Guided growth in the correction of knee deformity in patients with congenital insensitivity to pain. J Orthop Surg Res 2021; 16:184. [PMID: 33706758 PMCID: PMC7948364 DOI: 10.1186/s13018-021-02304-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/14/2021] [Indexed: 11/25/2022] Open
Abstract
Background Orthopedic manifestations of congenital insensitivity to pain (CIP) can be devastating if left untreated. Knee deformities are common in patients with CIP and might lead to joint destruction and loss of walking ability. The purpose of the present study was to report the results and complications of guided growth procedures around the knee in patients with CIP. Methods In a retrospective review, all patients with CIP who underwent guided growth procedures around the knee from 2009 to 2017 at a tertiary referral hospital were evaluated. Patients with secondary insensitivity to pain (e.g., syringomyelia), as well as patients with incomplete records, were excluded. Demographic data, clinical findings, correction rate, and complications were recorded. Results Ten knees in six patients fulfilled the inclusion criteria. The median age was 10 (range, 5–12), with a mean follow-up of 31 months (range, 16–56). Distal femoral tension-band hemiepiphysiodesis was the most common procedure, followed by proximal tibial hemiepiphysiodesis. The mean correction rate was 0.28°/month for femoral deformity. Staples were removed prematurely in one patient due to extrusion. No cases of infection or skin dehiscence were observed. None of the patients needed a reconstructive knee procedure during the study period. Conclusions The findings of this study suggest that guided growth procedures might have a role in the correction of knee deformities in patients with CIP. However, the correction rate is lower than that of typically developing children, patients should be closely followed to prevent complications, and stringent patient selection criteria should be followed to ensure success.
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Affiliation(s)
- Soroush Baghdadi
- Joint Reconstruction Research Center, Department of Orthopedics, Tehran University of Medical Sciences, Keshavarz Boulevard, Tehran, 1419733141, Iran
| | - Sadegh Saberi
- Joint Reconstruction Research Center, Department of Orthopedics, Tehran University of Medical Sciences, Keshavarz Boulevard, Tehran, 1419733141, Iran
| | - Taghi Baghdadi
- Joint Reconstruction Research Center, Department of Orthopedics, Tehran University of Medical Sciences, Keshavarz Boulevard, Tehran, 1419733141, Iran.
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5
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Alsaloum M, Higerd GP, Effraim PR, Waxman SG. Status of peripheral sodium channel blockers for non-addictive pain treatment. Nat Rev Neurol 2020; 16:689-705. [PMID: 33110213 DOI: 10.1038/s41582-020-00415-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 12/15/2022]
Abstract
The effective and safe treatment of pain is an unmet health-care need. Current medications used for pain management are often only partially effective, carry dose-limiting adverse effects and are potentially addictive, highlighting the need for improved therapeutic agents. Most common pain conditions originate in the periphery, where dorsal root ganglion and trigeminal ganglion neurons feed pain information into the CNS. Voltage-gated sodium (NaV) channels drive neuronal excitability and three subtypes - NaV1.7, NaV1.8 and NaV1.9 - are preferentially expressed in the peripheral nervous system, suggesting that their inhibition might treat pain while avoiding central and cardiac adverse effects. Genetic and functional studies of human pain disorders have identified NaV1.7, NaV1.8 and NaV1.9 as mediators of pain and validated them as targets for pain treatment. Consequently, multiple NaV1.7-specific and NaV1.8-specific blockers have undergone clinical trials, with others in preclinical development, and the targeting of NaV1.9, although hampered by technical constraints, might also be moving ahead. In this Review, we summarize the clinical and preclinical literature describing compounds that target peripheral NaV channels and discuss the challenges and future prospects for the field. Although the potential of peripheral NaV channel inhibition for the treatment of pain has yet to be realized, this remains a promising strategy to achieve non-addictive analgesia for multiple pain conditions.
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Affiliation(s)
- Matthew Alsaloum
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.,Center for Neuroscience & Regeneration Research, Yale University, West Haven, CT, USA.,Center for Rehabilitation Research, VA Connecticut Healthcare System, West Haven, CT, USA.,Yale Medical Scientist Training Program, Yale School of Medicine, New Haven, CT, USA.,Interdepartmental Neuroscience Program, Yale School of Medicine, New Haven, CT, USA
| | - Grant P Higerd
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.,Center for Neuroscience & Regeneration Research, Yale University, West Haven, CT, USA.,Center for Rehabilitation Research, VA Connecticut Healthcare System, West Haven, CT, USA.,Yale Medical Scientist Training Program, Yale School of Medicine, New Haven, CT, USA
| | - Philip R Effraim
- Center for Neuroscience & Regeneration Research, Yale University, West Haven, CT, USA.,Center for Rehabilitation Research, VA Connecticut Healthcare System, West Haven, CT, USA.,Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
| | - Stephen G Waxman
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA. .,Center for Neuroscience & Regeneration Research, Yale University, West Haven, CT, USA. .,Center for Rehabilitation Research, VA Connecticut Healthcare System, West Haven, CT, USA.
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Santoya-Montes Y, Gutiérrez-Ruiz K, Zequeira Cotes R, Puentes Rozo P. Two Case Reports of Neuropsychological Functioning in Congenital Insensitivity to Pain with Anhidrosis (CIPA). Dev Neuropsychol 2020; 45:414-430. [PMID: 32985248 DOI: 10.1080/87565641.2020.1825719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Individuals with congenital insensitivity to pain with anhidrosis (CIPA) are reported to have intellectual disability but to our knowledge, no detailed study about neuropsychological functioning of this condition has ever been published. The present study assessed neuropsychological outcomes of two children with CIPA using standardized neuropsychological tests. The neuropsychological assessment revealed difficulties in a wide range of cognitive, executive, and integrative functions, such as a behavioral and adaptive level. Both children with CIPA functioned in the intellectual disability range with symptoms related to an executive dysfunction and negative-oriented personal emotional processing, and limitations in academic and self-care skills.
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Affiliation(s)
- Yanin Santoya-Montes
- Department of Psychology, Tecnológica de Bolívar University , Cartagena, Colombia
| | - Karol Gutiérrez-Ruiz
- Department of Psychology, Tecnológica de Bolívar University , Cartagena, Colombia
| | | | - Pedro Puentes Rozo
- Caribbean Neurosciences Research Group, Cognitive Neurosciences Unit, Simón Bolívar University , Barranquilla, Colombia
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7
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Delniotis I, Leidinger B. A 10-year follow-up of asymptomatic Charcot hip joints caused by CIPA syndrome (congenital insensitivity to pain with anhidrosis) with failure of any surgical reconstructive treatment. J Surg Case Rep 2019; 2019:rjz154. [PMID: 31186831 PMCID: PMC6537910 DOI: 10.1093/jscr/rjz154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/27/2019] [Indexed: 11/13/2022] Open
Abstract
Congenital insensitivity to pain with anhidrosis (CIPA) is a rare genetic disorder. Patients with CIPA lack among other things the protective sensation of pain. Orthopaedic manifestations are fractures, infections and hip joint dislocation. We report a 10-year follow-up of late developing hip dysplasia with CIPA and the result of several reconstructive surgical procedures. The final outcome was asymptomatic Charcot hip joints with superior migration and dislocation of both hips without pain. In conformance with the literature standard operative techniques in these rare cases usually seem to fail. A multidisciplinary conservative approach with close observation and activity modification is the proposed treatment of choice.
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Affiliation(s)
- Ioannis Delniotis
- Orthopaedic Hospital Volmarstein, Department of Paediatric Orthopaedics, Neuro-Orthopaedics, Foot & Ankle Surgery, Germany
| | - Benedikt Leidinger
- Orthopaedic Hospital Volmarstein, Department of Paediatric Orthopaedics, Neuro-Orthopaedics, Foot & Ankle Surgery, Germany
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8
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Chen H, Hu B, Lv X, Zhu S, Zhen G, Wan M, Jain A, Gao B, Chai Y, Yang M, Wang X, Deng R, Wang L, Cao Y, Ni S, Liu S, Yuan W, Chen H, Dong X, Guan Y, Yang H, Cao X. Prostaglandin E2 mediates sensory nerve regulation of bone homeostasis. Nat Commun 2019; 10:181. [PMID: 30643142 PMCID: PMC6331599 DOI: 10.1038/s41467-018-08097-7] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 12/14/2018] [Indexed: 12/15/2022] Open
Abstract
Whether sensory nerve can sense bone density or metabolic activity to control bone homeostasis is unknown. Here we found prostaglandin E2 (PGE2) secreted by osteoblastic cells activates PGE2 receptor 4 (EP4) in sensory nerves to regulate bone formation by inhibiting sympathetic activity through the central nervous system. PGE2 secreted by osteoblasts increases when bone density decreases as demonstrated in osteoporotic animal models. Ablation of sensory nerves erodes the skeletal integrity. Specifically, knockout of the EP4 gene in the sensory nerves or cyclooxygenase-2 (COX2) in the osteoblastic cells significantly reduces bone volume in adult mice. Sympathetic tone is increased in sensory denervation models, and propranolol, a β2-adrenergic antagonist, rescues bone loss. Furthermore, injection of SW033291, a small molecule to increase PGE2 level locally, significantly boostes bone formation, whereas the effect is obstructed in EP4 knockout mice. Thus, we show that PGE2 mediates sensory nerve to control bone homeostasis and promote regeneration.
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Affiliation(s)
- Hao Chen
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, 21205, USA
- Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215000, P. R. China
| | - Bo Hu
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, 21205, USA
- Section of Spine Surgery, Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, 200433, P. R. China
| | - Xiao Lv
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Shouan Zhu
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Gehua Zhen
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Mei Wan
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Amit Jain
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Bo Gao
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Yu Chai
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Mi Yang
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Xiao Wang
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Ruoxian Deng
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Lei Wang
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Yong Cao
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Shuangfei Ni
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Shen Liu
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Wen Yuan
- Section of Spine Surgery, Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, 200433, P. R. China
| | - Huajiang Chen
- Section of Spine Surgery, Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, 200433, P. R. China
| | - Xinzhong Dong
- Howard Hughes Medical Institute and The Solomon H. Snyder Department of Neuroscience, Center for Sensory Biology, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Yun Guan
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| | - Huilin Yang
- Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215000, P. R. China.
| | - Xu Cao
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, 21205, USA.
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9
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Mifsud M, Spiteri M, Camilleri K, Bonello M, Azzopardi T, Abela M. The Orthopedic Manifestations of Congenital Insensitivity to Pain: A Population-based Study. Indian J Orthop 2019; 53:665-673. [PMID: 31488938 PMCID: PMC6699213 DOI: 10.4103/ortho.ijortho_378_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Congenital insensitivity to pain (CIP) is an extremely rare condition in which there is a failure of the development of the afferent sensory nerves in the dorsal root ganglia resulting in indifference to painful stimuli. The associated orthopedic manifestations are various and often present a diagnostic quandary for the treating surgeon. PURPOSE This population study provides insight into the orthopedic manifestations and functional scores in patients with CIP, to guide prognosis and management. PATIENTS AND METHODS We retrospectively review and describe the orthopedic manifestations of all cases of CIP in Malta. All patients were then scored for upper and lower limb function using the abridged version of the Disability of Arm, Shoulder, and Hand score (QuickDASH) and the Lower Extremity Functional Score (LEFS). RESULTS Nine patients were recruited in total. Mean age at the time of recruitment into this study was of 33.7 years (range 15-58). All patients were Caucasian of Maltese heritage. None had consanguineous parents. All patients had been diagnosed with the condition in childhood (mean age 8.9 years). In total, these patients had 6 long bone fractures, 1 vertebral fracture, 39 upper limb surgical procedures, 88 lower limb surgical procedures, and 7 major lower limb amputations. These are discussed in detail. The main QuickDASH score was 23.97. The main LEFS was 42.22. CONCLUSIONS This paper is the first population-based study of this condition and one of the largest series with functional scores. A multidisciplinary approach is essential in managing these patients. The surgical treatment of these conditions is often difficult and protracted, and judicious and careful consideration to both the bony and soft tissues aspects of the management need to be taken into account, with functional limb amputation not necessarily being considered as a last resort.
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Affiliation(s)
- Maximillian Mifsud
- Department of Trauma and Orthopaedics, Nuffield Orthopaedic Centre, Oxford, UK,Address for correspondence: Dr. Maximillian Mifsud, Department of Trauma and Orthopaedics, Nuffield Orthopaedic Centre, Oxford, UK. E-mail:
| | - Michelle Spiteri
- Department of Trauma and Orthopaedics, Nuffield Orthopaedic Centre, Oxford, UK
| | - Karl Camilleri
- Department of Trauma and Orthopaedics, Mater Dei Hospital, Msida, Malta
| | - Matthew Bonello
- Department of Trauma and Orthopaedics, Mater Dei Hospital, Msida, Malta
| | - Thomas Azzopardi
- Department of Trauma and Orthopaedics, Mater Dei Hospital, Msida, Malta
| | - Massimo Abela
- Department of Trauma and Orthopaedics, Mater Dei Hospital, Msida, Malta
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10
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Wang R, Liu Y, Zhou YY, Wang JY, Xu ZJ, Chen SY, Wang QQ, Yuan P. Postoperative redislocation of the hip in a patient with congenital insensitivity to pain with anhidrosis: A case report and review of literature. World J Clin Cases 2018; 6:836-841. [PMID: 30510952 PMCID: PMC6264989 DOI: 10.12998/wjcc.v6.i14.836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/16/2018] [Accepted: 10/22/2018] [Indexed: 02/05/2023] Open
Abstract
Pelvic osteotomy is commonly used to adjust acetabula dysplasia for congenital dislocation of the hip, whereas congenital insensitivity to pain with anhidrosis (CIPA) is a rare hereditary disease that often has the characteristics of joint development deformity and easy fracture. This article reports the case involving a CIPA patient who was surgically treated by Chiari pelvic osteotomy and proximal femoral rotation osteotomy for congenital dislocation of the left hip joint and was provided long-term follow-up for redislocation and bilateral femoral head absorption.
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Affiliation(s)
- Rui Wang
- The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
| | - Yi Liu
- The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
| | - Yi-Yi Zhou
- The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
| | - Jia-Ying Wang
- The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
| | - Zhu-Jie Xu
- The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
| | - Sha-Yang Chen
- The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
| | - Qi-Qi Wang
- The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
| | - Peng Yuan
- The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
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11
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Liu Z, Liu J, Liu G, Cao W, Liu S, Chen Y, Zuo Y, Chen W, Chen J, Zhang Y, Huang S, Qiu G, Giampietro PF, Zhang F, Wu Z, Wu N. Phenotypic heterogeneity of intellectual disability in patients with congenital insensitivity to pain with anhidrosis: A case report and literature review. J Int Med Res 2018; 46:2445-2457. [PMID: 29619836 PMCID: PMC6023048 DOI: 10.1177/0300060517747164] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Congenital insensitivity to pain with anhidrosis (CIPA) is a rare autosomal recessive heterogeneous disorder mainly caused by mutations in the neurotrophic tyrosine receptor kinase 1 gene (NTRK1) and characterized by insensitivity to noxious stimuli, anhidrosis, and intellectual disability. We herein report the first north Han Chinese patient with CIPA who exhibited classic phenotypic features and severe intellectual disability caused by a homozygous c.851-33T>A mutation of NTRK1, resulting in aberrant splicing and an open reading frame shift. We reviewed the literature and performed in silico analysis to determine the association between mutations and intellectual disability in patients with CIPA. We found that intellectual disability was correlated with the specific Ntrk1 protein domain that a mutation jeopardized. Mutations located peripheral to the Ntrk1 protein do not influence important functional domains and tend to cause milder symptoms without intellectual disability. Mutations that involve critical amino acids in the protein are prone to cause severe symptoms, including intellectual disability.
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Affiliation(s)
- Zhenlei Liu
- 1 Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, PR China.,2 Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, PR China.,*These authors contributed equally to this work
| | - Jiaqi Liu
- 1 Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, PR China.,3 Breast Surgical Oncology, Cancer Hospital of Chinese Academy of Medical Sciences, Beijing, PR China.,*These authors contributed equally to this work
| | - Gang Liu
- 1 Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, PR China.,4 Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, PR China.,*These authors contributed equally to this work
| | - Wenjian Cao
- 5 State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, PR China
| | - Sen Liu
- 1 Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, PR China.,4 Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, PR China
| | - Yixin Chen
- 1 Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, PR China
| | - Yuzhi Zuo
- 1 Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, PR China.,4 Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, PR China
| | - Weisheng Chen
- 1 Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, PR China
| | - Jun Chen
- 1 Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, PR China
| | - Yu Zhang
- 6 Berry Genomics Co., Ltd., Beijing, PR China
| | - Shishu Huang
- 7 Department of Orthopaedic Surgery, Peking Union Medical College Hospital, West China Hospital, Sichuan University, Chengdu, PR China
| | - Guixing Qiu
- 1 Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, PR China.,4 Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, PR China
| | - Philip F Giampietro
- 8 Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Feng Zhang
- 4 Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, PR China.,5 State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, PR China
| | - Zhihong Wu
- 4 Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, PR China.,9 Department of Central Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, PR China
| | - Nan Wu
- 1 Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, PR China.,4 Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, PR China
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12
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Mostafa MI, Abouzaid MR, Thomas MM, El-Kamah GY. Could Congenital Insensitivity to Pain with Anhidrosis Be Misdiagnosed as Papillon-Lefèvre Syndrome? J Pediatr Genet 2017; 6:238-240. [PMID: 29142767 DOI: 10.1055/s-0037-1602801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
Abstract
Papillon-Lefèvre syndrome (PLS) is a rare autosomal recessive disorder characterized by early loss of teeth with hyperkeratosis of the palms and soles. Congenital insensitivity to pain with anhidrosis (CIPA) is a disorder of decreased pain sensation, decreased sweating, recurrent infections, and fever. Here, we report a 5-year-old girl born to consanguineous parents with a family history of a similarly affected sibling. The girl presented with early loss of teeth and palmoplantar hyperkeratosis, hence, provisionally diagnosed as PLS. Further clinical examination and detailed history taking shifted the diagnosis to CIPA. CIPA could be misdiagnosed as PLS. Congenital insensitivity to pain with anhidrosis, although rare, should be considered in the differential diagnosis of PLS.
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Affiliation(s)
- Mostafa Ibrahim Mostafa
- Division of Human Genetics and Genome Research, Department of Oro-Dental Genetics, National Research Centre, Cairo, Egypt
| | - Maha Rashed Abouzaid
- Division of Human Genetics and Genome Research, Department of Oro-Dental Genetics, National Research Centre, Cairo, Egypt
| | - Manal Micheal Thomas
- Division of Human Genetics and Genome Research, Department of Clinical Genetics, National Research Centre, Cairo, Egypt
| | - Ghada Yousef El-Kamah
- Division of Human Genetics and Genome Research, Department of Clinical Genetics, National Research Centre, Cairo, Egypt
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13
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Dagnino A, Ursino N, Ripamonti CAM, Fiorentini CE, Scelsi M, D'Ambrosi R, Portinaro NM. Total Hip Arthroplasty in an Inveterate Femoral Neck Fracture in a Patient with Congenital Insensitivity to Pain with Anhidrosis. JOINTS 2017; 5:249-252. [PMID: 29270564 PMCID: PMC5738471 DOI: 10.1055/s-0037-1606619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Congenital insensitivity to pain with anhidrosis (CIPA) is an extremely rare disorder characterized by autonomic and sensory nerves malfunction with insensitivity to both deep and superficial painful stimuli, inability to sweat and produce tears, and mild to moderate mental retardation with self-mutilating behavior. Related consequences of inveterate musculoskeletal injuries represent a major issue for these patients, since pain cannot act as a protection mechanism. For the same reason, the patients are at risk during postoperative rehabilitation, which should be taken into account when selecting an orthopaedic implant. To our knowledge, only one case of total hip arthroplasty has been reported in the literature to date. A 21-year-old Caucasian male patient affected with CIPA arrived at our attention complaining about a functional limitation of the left hip. No history of trauma was reported. The X-rays showed an inveterate femoral neck fracture with a severe necrosis and resorption of the femoral head. We decided to perform a total hip arthroplasty with a cemented stem and a cemented dual mobility cup. The postoperative course and rehabilitation were satisfactory, with excellent clinical results, measured with the Harris Hip Score at 1 year.
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Affiliation(s)
| | - Nicola Ursino
- I.R.C.C.S. Istituto Ortopedico Galeazzi, U.O. CASCO, Milan, Italy
| | | | | | - Michele Scelsi
- I.R.C.C.S. Istituto Ortopedico Galeazzi, U.O. CASCO, Milan, Italy
| | - Riccardo D'Ambrosi
- I.R.C.C.S. Istituto Ortopedico Galeazzi, U.O. CASCO, Milan, Italy.,Università degli Studi di Milano, Milan, Italy
| | - Nicola M Portinaro
- Università degli Studi di Milano, Milan, Italy.,Istituto Clinico Humanitas, U.O. Ortopedia Pediatrica, Milan, Italy
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14
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15
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Charcot spinal arthropathy in patients with congenital insensitivity to pain: a report of two cases and review of the literature. Neurosurg Rev 2017; 41:899-908. [PMID: 28124176 DOI: 10.1007/s10143-017-0814-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/08/2017] [Accepted: 01/12/2017] [Indexed: 12/29/2022]
Abstract
Charcot spine, or neuropathic spinal arthropathy, involves the progressive destruction of the spinal joint due to the lack of normal protective sensations and proprioception. A rare cause of Charcot spine is congenital insensitivity to pain, which is an absent or abnormal response to painful stimuli. There are few case reports describing this condition, and long-term follow-up data are limited. The presentation and treatment of two patients with Charcot spine secondary to congenital insensitivity to pain are described. Both cases were characterized by lumbar involvement and were treated with circumferential decompression and an extended lumbo-pelvic fusion construct. The cases described here demonstrate stable neurological status at 1.5 and 5 years follow-up. Patient characteristics, pre- and post-operative imaging, operative approach, and outcomes are described. The literature regarding this rare condition is also reviewed, with an emphasis on operative management and outcomes. Surgical management is traditionally complicated by a high rate of hardware failure and adjacent segment degeneration. The current review highlights the importance of prompt and aggressive management following diagnosis of Charcot spine, as well as extended follow-up.
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16
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Shaikh SS, Chen YC, Halsall SA, Nahorski MS, Omoto K, Young GT, Phelan A, Woods CG. A Comprehensive Functional Analysis of NTRK1 Missense Mutations Causing Hereditary Sensory and Autonomic Neuropathy Type IV (HSAN IV). Hum Mutat 2016; 38:55-63. [PMID: 27676246 PMCID: PMC5299464 DOI: 10.1002/humu.23123] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/19/2016] [Accepted: 09/07/2016] [Indexed: 11/07/2022]
Abstract
Hereditary sensory and autonomic neuropathy type IV (HSAN IV) is an autosomal recessive disorder characterized by a complete lack of pain perception and anhidrosis. Here, we studied a cohort of seven patients with HSAN IV and describe a comprehensive functional analysis of seven novel NTRK1 missense mutations, c.1550G >A, c.1565G >A, c.1970T >C, c.2096T >C, c.2254T >A, c.2288G >C, and c.2311C >T, corresponding to p.G517E, p.G522E, p.L657P, p.I699T, p.C752S, p.C763S, and p.R771C, all of which were predicted pathogenic by in silico analysis. The results allowed us to assess the pathogenicity of each mutation and to gain novel insights into tropomyosin receptor kinase A (TRKA) downstream signaling. Each mutation was systematically analyzed for TRKA glycosylation states, intracellular and cell membrane expression patterns, nerve growth factor stimulated TRKA autophosphorylation, TRKA-Y496 phosphorylation, PLCγ activity, and neurite outgrowth. We showed a diverse range of functional effects: one mutation appeared fully functional, another had partial activity in all assays, one mutation affected only the PLCγ pathway and four mutations were proved null in all assays. Thus, we conclude that complete abolition of TRKA kinase activity is not the only pathogenic mechanism underlying HSAN IV. By corollary, the assessment of the clinical pathogenicity of HSAN IV mutations is more complex than initially predicted and requires a multifaceted approach.
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Affiliation(s)
- Samiha S Shaikh
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, CB2 0XY, UK
| | - Ya-Chun Chen
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, CB2 0XY, UK
| | | | - Michael S Nahorski
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, CB2 0XY, UK
| | - Kiyoyuki Omoto
- Neuroscience and Pain Research Unit, Pfizer Ltd, Great Abington, UK
| | - Gareth T Young
- Neuroscience and Pain Research Unit, Pfizer Ltd, Great Abington, UK
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17
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Bakri FG, Wahbeh A, Abu Sneina A, Al Khader A, Obeidat F, AlAwwa I, Buni M, Ki CS, Masri A. Congenital insensitivity to pain and anhydrosis due to a rare mutation and that is complicated by inflammatory bowel disease and amyloidosis: a case report. Clin Case Rep 2016; 4:997-1000. [PMID: 27761255 PMCID: PMC5054479 DOI: 10.1002/ccr3.689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/12/2016] [Accepted: 08/18/2016] [Indexed: 12/19/2022] Open
Abstract
Patients with congenital insensitivity to pain and anhydrosis syndrome are at risk for renal amyloidosis and inflammatory bowel disease. Physicians caring for such patients should be aware of these complications.
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Affiliation(s)
- Faris G Bakri
- Department of Medicine School of Medicine The University of Jordan Amman Jordan
| | - Ayman Wahbeh
- Department of Medicine School of Medicine The University of Jordan Amman Jordan
| | - Awni Abu Sneina
- Department of Medicine School of Medicine The University of Jordan Amman Jordan
| | - Ali Al Khader
- Department of Laboratory Medicine Division of Pathology Jordan University Hospital The University of Jordan Amman Jordan
| | - Fatima Obeidat
- Department of Laboratory Medicine Division of Pathology Jordan University Hospital The University of Jordan Amman Jordan
| | - Izzat AlAwwa
- Department of Medicine School of Medicine The University of Jordan Amman Jordan
| | - Maryam Buni
- Internal Medicine Residency Training Program Department of Internal Medicine University of Texas Medical School at Houston Houston Texas USA
| | - Chang-Seok Ki
- Department of Laboratory Medicine & Genetics Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Amira Masri
- Department of Pediatrics Division of Child Neurology Jordan University Hospital The University of Jordan Amman Jordan
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18
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Willock J, Habiballah L, Long D, Palmer K, Anthony D. A comparison of the performance of the Braden Q and the Glamorgan paediatric pressure ulcer risk assessment scales in general and intensive care paediatric and neonatal units. J Tissue Viability 2016; 25:119-26. [DOI: 10.1016/j.jtv.2016.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 02/28/2016] [Accepted: 03/03/2016] [Indexed: 02/06/2023]
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19
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Phatarakijnirund V, Mumm S, McAlister WH, Novack DV, Wenkert D, Clements KL, Whyte MP. Congenital insensitivity to pain: Fracturing without apparent skeletal pathobiology caused by an autosomal dominant, second mutation in SCN11A encoding voltage-gated sodium channel 1.9. Bone 2016; 84:289-298. [PMID: 26746779 PMCID: PMC4755825 DOI: 10.1016/j.bone.2015.11.022] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/19/2015] [Accepted: 11/22/2015] [Indexed: 11/30/2022]
Abstract
Congenital insensitivity to pain (CIP) comprises the rare heritable disorders without peripheral neuropathy that feature inability to feel pain. Fracturing and joint destruction are common complications, but lack detailed studies of mineral and skeletal homeostasis and bone histology. In 2013, discovery of a heterozygous gain-of-function mutation in SCN11A encoding voltage-gated sodium channel 1.9 (Nav1.9) established a distinctive CIP in three unrelated patients who suffered multiple painless fractures, self-inflicted mutilation, chronic diarrhea, and hyperhidrosis. Here, we studied a mother and two children with CIP by physical examination, biochemical testing, radiological imaging including DXA, iliac crest histology, and mutation analysis. She suffered fractures primarily of her lower extremities beginning at age two years, and had Charcot deformity of both ankles and joint hypermobility. Nerve conduction velocity together with electromyography were normal. Her children had recurrent major fractures beginning in early childhood, joint hypermobility, and chronic diarrhea. She had an excoriated external nare, and both children had hypertrophic scars from scratching. Skin collagen studies were normal. Radiographs revealed fractures and deformities. However, lumbar spine and total hip BMD Z-scores, biochemical parameters of mineral and skeletal homeostasis, and iliac crest histology of the mother (after in vivo tetracycline labeling) were normal. Genomic DNA from the children revealed a unique heterozygous missense mutation in exon 23 (c.3904C>T, p.Leu1302Phe) of SCN11A that is absent in SNP databases and alters an evolutionarily conserved amino acid. This autosomal dominant CIP reflects the second gain-of-function mutation of SCN11A. Perhaps joint hypermobility is an unreported feature. How mutation of Nav1.9 causes fracturing remains unexplained. Lack of injury awareness is typically offered as the reason, and was supported by our unremarkable biochemical, radiological, and histological findings indicating no skeletal pathobiology. However, low-trauma fracturing in these patients suggests an uncharacterized defect in bone quality.
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Affiliation(s)
- Voraluck Phatarakijnirund
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, MO 63110, USA; Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
| | - Steven Mumm
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, MO 63110, USA; Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
| | - William H McAlister
- Department of Pediatric Radiology, Mallinckrodt Institute of Radiology at St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA.
| | - Deborah V Novack
- Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
| | - Deborah Wenkert
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, MO 63110, USA.
| | - Karen L Clements
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, MO 63110, USA.
| | - Michael P Whyte
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, MO 63110, USA; Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
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20
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Yozu A, Haga N, Funato T, Owaki D, Chiba R, Ota J. Hereditary sensory and autonomic neuropathy types 4 and 5: Review and proposal of a new rehabilitation method. Neurosci Res 2015; 104:105-11. [PMID: 26562335 DOI: 10.1016/j.neures.2015.10.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 10/13/2015] [Accepted: 10/20/2015] [Indexed: 01/21/2023]
Abstract
Although pain is unpleasant, it should serve as a reminder for individuals to avoid similar damaging incidents in the future. Hereditary sensory and autonomic neuropathy (HSAN) includes genetic disorders involving various sensory and autonomic dysfunctions. They are classified by the mode of inheritance, clinical features, and related genes. HSAN type 4 (HSAN-4) and type 5 (HSAN-5) are characterized by insensitivity to pain and thermal sensation. Further, HSAN-4 is accompanied by decreased sweating and intellectual disabilities. These characteristics of HSAN-4 and -5 result in many clinical features, such as pediatric, psychiatric, orthopedic, oral, dermatological, and ophthalmological problems. Orthopedic problems include destructive injuries such as multiple fractures and joint dislocation. Studies on gait have shown greater speed and higher heel contact angular velocity in HSAN-4 and -5 patients compared with controls. Studies on grasp-lift-holding tasks have shown higher grasp force and fluctuations in acceleration of the object. We believe that these findings represent outcomes of deficient motor learning. We propose a new rehabilitation method for patients with HSAN-4 and -5, with the aim of decreasing their destructive injuries.
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Affiliation(s)
- Arito Yozu
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Nobuhiko Haga
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Tetsuro Funato
- Graduate School of Informatics and Engineering, The University of Electro-Communications, 1-5-1 Chofugaoka, Chofu, Tokyo 182-8585, Japan
| | - Dai Owaki
- Research Institute of Electrical Communication, Tohoku University, 2-1-1 Katahira, Aoba-ku, Sendai 980-8577, Japan
| | - Ryosuke Chiba
- Research Center for Brain Function and Medical Engineering, Asahikawa Medical University, 1-1-1 Midorigaoka-higashi-nijyou, Asahikawa, Hokkaido 078-8510, Japan
| | - Jun Ota
- Research into Artifacts, Center for Engineering, The University of Tokyo, 5-1-5, Kashiwanoha, Kashiwa, Chiba 277-8568, Japan
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21
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Liu S, Wu N, Liu J, Ming X, Chen J, Pavelec D, Su X, Qiu G, Tian Y, Giampietro P, Wu Z. Novel NTRK1 Frameshift Mutation in Congenital Insensitivity to Pain With Anhidrosis. J Child Neurol 2015; 30:1357-61. [PMID: 25316729 DOI: 10.1177/0883073814552438] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 08/11/2014] [Indexed: 11/17/2022]
Abstract
Congenital insensitivity to pain with anhidrosis is a rare autosomal recessive disorder. It has been reported that the defect in the NTRK1 gene encoding tropomyosin-related kinase A (TrkA) can cause congenital insensitivity to pain with anhidrosis. Nerve growth factor (NGF), the product of NGFB, mediates biological effects by binding to and activating tropomyosin-related kinase A. In addition, necdin (encoded by NDN) is also essential in nerve growth factor-tropomyosin-related kinase A pathway. We performed mutation analysis in NTRK1, NGFB, and NDN genes in a Chinese Han 17-year-old female patient with congenital insensitivity to pain with anhidrosis and her healthy family members. As a result, the patient was found to have a novel insertion in exon 7 (c.727insT) of NTRK1, which causes premature termination, and a single nucleotide polymorphism (rs2192206 G>A) in NDN. Our findings imply that the genetic variations of the nerve growth factor-tropomyosin-related kinase A pathway play an important role in congenital insensitivity to pain with anhidrosis.
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Affiliation(s)
- Sen Liu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Nan Wu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Jiaqi Liu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Xuan Ming
- National Institute of Biological Sciences, Beijing, China
| | - Jun Chen
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Derek Pavelec
- Bioinformatics Resource Center, Biotechnology Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Xinlin Su
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Guixing Qiu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Ye Tian
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Philip Giampietro
- Department of Pediatrics, Division of Genetics and Metabolism, University of Wisconsin-Madison, Madison, WI, USA
| | - Zhihong Wu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P. R. China
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22
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Ravichandra KS, Kandregula CR, Koya S, Lakhotia D. Congenital Insensitivity to Pain and Anhydrosis: Diagnostic and Therapeutic Dilemmas revisited. Int J Clin Pediatr Dent 2015; 8:75-81. [PMID: 26124587 PMCID: PMC4472877 DOI: 10.5005/jp-journals-10005-1288] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 09/02/2014] [Indexed: 11/23/2022] Open
Abstract
First described in 1932 by Dearborn as 'congenital pure analgesia', congenital insensitivity to pain and anhydrosis (CIPA) or hereditary sensory and autonomic neuropathy (HSAN) type IV is an extremely rare autosomal recessive disorder. A 7-year-old female child who is an established case of congenital insensitivity to pain and anhydrosis visited the department of pediatric medicine with osteoarthritic neuropathy. A multidisciplinary team approach was utilized to treat the child under general anesthesia. This article also discusses the diagnostic and therapeutic dilemmas involved in treating this type of children. How to cite this article: Ravichandra KS, Kandregula CR, Koya S, Lakhotia D. Congenital Insensitivity to Pain and Anhydrosis: Diagnostic and Therapeutic Dilemmas revisited. Int J Clin Pediatr Dent 2015;8(1):75-81.
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Affiliation(s)
- K S Ravichandra
- Professor and Head, Department of Pedodontics and Preventive Dentistry, Drs Sudha and Nageswara Rao Siddhartha Institute of Health Sciences, Chinnoutpalli, Andhra Pradesh, India
| | - Chaitanya Ram Kandregula
- Senior Lecturer, Department of Pedodontics, Drs Sudha and Nageswara Rao Siddhartha Institute of Dental Sciences, Chinnoutpalli Andhra Pradesh, India
| | - Srikanth Koya
- Senior Lecturer, Department of Pedodontics, Drs Sudha and Nageswara Rao Siddhartha Institute of Dental Sciences, Chinnoutpalli Andhra Pradesh, India
| | - Disha Lakhotia
- Senior Lecturer, Department of Pedodontics, Drs Sudha and Nageswara Rao Siddhartha Institute of Dental Sciences, Chinnoutpalli Andhra Pradesh, India
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23
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Rice bodies within the neuropathic hip in a child with congenital insensitivity to pain. Pediatr Radiol 2015; 45:782-3. [PMID: 25344822 DOI: 10.1007/s00247-014-3203-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/12/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
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24
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Hereditary sensory and autosomal peripheral neuropathy-type IV: case series and review of literature. Oral Maxillofac Surg 2015; 19:117-23. [PMID: 25744033 DOI: 10.1007/s10006-015-0486-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 02/15/2015] [Indexed: 10/23/2022]
Abstract
Hereditary sensory and autonomic neuropathy (HSAN) IV is a rare autosomal recessive disorder which is characterized by a decrease in the number of myelinated and non-myelinated nerve fibers of peripheral nerves which causes diminished or absent pain sensation leading to increase in self-mutilative habits. A retrospective study of eight cases ranging from age group of 4 to 17 years for oral and digital signs and symptoms is presented. All the patients showed congenital insensitivity to pain and anhidrosis. Oral self-mutilations, such as autoextraction of teeth and severe bite injuries (with resultant scarring) of the finger tips and oral soft tissues (tongue, lip, and buccal mucosa) were found in most patients. Our study suggests that early diagnosis and specific treatment plan are important for prevention of characteristic of the oral as well as digital trauma associated with this disorder.
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25
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Syringomyelia with Chiari I malformation presenting as hip charcot arthropathy: a case report and literature review. Case Rep Neurol Med 2015; 2015:487931. [PMID: 25692057 PMCID: PMC4322850 DOI: 10.1155/2015/487931] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 01/07/2015] [Indexed: 01/29/2023] Open
Abstract
Neuroarthropathy (neuropathic osteoarthropathy), also known as Charcot joint, is a condition characterized by a progressive articular surface destruction in the setting of impaired nociceptive and proprioceptive innervation of the involved joint. It is seen most commonly in the foot and ankle secondary to peripheral neuropathy associated with diabetes mellitus. Cases of hip (Charcot) neuroarthropathy are rare and almost exclusively reported in patients with neurosyphilis (tabes dorsalis). We report a case of a 36-year-old man who presented to the emergency department complaining of right hip pain. On physical examination, pain and thermal sensory deficits were noted in the upper torso with a cape-like distribution, as well as signs of an upper motor neuron lesion in the left upper and lower extremities. A magnetic resonance imaging study (MRI) of the right hip showed evidence of early articular surface destruction and periarticular edema consistent with hip Charcot arthropathy. An MRI of the spine revealed an Arnold-Chiari type I malformation with extensive syringohydromyelia of the cervical and thoracic spine.
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26
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Haga N, Kubota M, Miwa Z. Hereditary sensory and autonomic neuropathy types IV and V in Japan. Pediatr Int 2015; 57:30-6. [PMID: 25422087 DOI: 10.1111/ped.12538] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 10/26/2014] [Accepted: 10/29/2014] [Indexed: 11/30/2022]
Abstract
Hereditary sensory and autonomic neuropathy (HSAN) is a group of genetic disorders involving varying sensory and autonomic dysfunction. HSAN types IV and V are characterized by congenital generalized loss of pain and thermal sensation. HSAN type IV is additionally accompanied by decreased sweating and intellectual disability. From 2010 to 2013, we (members of the Japanese Research Group on Congenital Insensitivity to Pain) carried out research on HSAN types IV and V. Research by this group included epidemiological data, examination of clinical findings, solutions of disease etiology, investigation of complications and development of their management. Complications were categorized into musculoskeletal complications, oral/dental complications, dermal complications, ocular complications, complications resulting from impaired thermal control, anesthetic considerations, other complications possibly related to autonomic dysfunction, and abnormal mental development and behavior. Treatment and care for patients with HSAN types IV and V require a wide range of knowledge and experience, and a multidisciplinary team approach. Therefore, we produced the "Guideline of Total Management and Care for Congenital Insensitivity to Pain (Ver.1)" in 2012, to provide information for medical specialists based on our knowledge and experience. This guideline includes medical issues, as well as descriptions of social participation and welfare. This review outlines the situation of HSAN types IV and V in Japan, and the recommendations of treatment and care for patients, mostly based on research conducted by the Japanese Research Group.
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Affiliation(s)
- Nobuhiko Haga
- Department of Rehabilitation Medicine, University of Tokyo, Tokyo, Japan
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Congenital Insensitivity to Pain without Anhidrosis: Orodental Problems and Management. Case Rep Dent 2015; 2015:179892. [PMID: 26457210 PMCID: PMC4592712 DOI: 10.1155/2015/179892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 09/09/2015] [Indexed: 11/18/2022] Open
Abstract
This paper reports the case of a 4-year-old male patient who was brought by parents requesting for replacement of multiple missing anterior teeth. The patient suffered from congenital insensitivity to pain without anhidrosis and presented with full blown sequelae of the condition in the form of oral self-mutilation leading to loss of teeth, tongue tip amputation, finger tips destruction, and lower limb wound infections. Dental and orthopaedic treatment consists of local management of oral wound and prevention from further oral and finger injuries that takes the form of dental splints and finger sleeve splints, constant feet coverage with shoes, and behavioural medical therapy. The age of the patient and parents’ education present challenges in managing this condition to avoid morbidity and premature mortality.
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Zhang Y, Haga N. Skeletal complications in congenital insensitivity to pain with anhidrosis: a case series of 14 patients and review of articles published in Japanese. J Orthop Sci 2014; 19:827-31. [PMID: 24953503 DOI: 10.1007/s00776-014-0595-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 05/01/2014] [Indexed: 02/09/2023]
Abstract
BACKGROUND Congenital insensitivity to pain with anhidrosis (CIPA) is a rare disorder with various skeletal complications; thus, a compilation of data on affected patients could provide a valuable resource for the management of this disease. The aim of this study was to ascertain and report the frequency, location, age of onset, cause, and management of skeletal complications in Japanese patients with CIPA. METHODS The medical records of 14 CIPA patients in our institute and information on 77 patients reported in Japanese articles were analyzed. Data regarding skeletal-system complications, including location, symptom, major cause and management of fractures, joint dislocations, infections, and Charcot joints, were extracted. RESULTS Fractures occurred in 59/91 patients (65%), 91% of them in the lower limbs. Joint dislocations occurred in 27/91 patients (30%), 91% of them in the hip joint. Bone and joint infections occurred in 22 patients (24%) and Charcot joints in 26 patients (29%); 62% of infections and 87% of Charcot joints developed in the lower limbs. Most fractures occurred from 1 to 7 years of age; there was no apparent relationship between age and other complications. The major known causes of bone disorders were minor trauma such as short falls; however, most were of unknown cause. Conservative therapy was used more frequently than surgery to manage fractures, dislocations, and Charcot joints. CONCLUSIONS These data show that most CIPA patients have skeletal complications, most of which occur in the lower limbs. Fractures are frequent between 1 and 7 years of age, whereas other bone disorders have no apparent age relationship. The major known causes of bone disorders were minor trauma such as short falls. Conservative therapy was more frequently used to manage fractures, dislocations, and Charcot joints.
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Affiliation(s)
- Yasu Zhang
- Department of Rehabilitation Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Willock J. Interrater reliability of the Glamorgan scale: overt and covert data. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2013. [PMID: 24225511 DOI: 10.12968/bjon.2013.22.sup15.s4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
UNLABELLED The Glamorgan Paediatric Pressure Ulcer Risk Assessment Scale (Glamorgan scale) had been developed using statistical analysis of patient data. The aim of this study was to assess the reliability of the Glamorgan scale using overt and covert methods. METHOD For the overt data collection, randomly selected trained nursing staff were invited to participate. Twenty-seven trained nursing staff assessed 27 children and young people within 10 minutes of an assessment by the researcher. For the covert part of the data collection the researcher and the paediatric tissue viability (TV) link nurse risk assessed inpatients on wards and units where the overt data collection had taken place, their findings were compared with the last recorded assessment by the clinical nurses. RESULTS In the overt data collection 24 out of 27 nurses agreed with the researcher (88.9% agreement, kappa 0.867). In the covert data collection, 41 out of 55 risk assessments had been completed. Of the 41 completed assessments 34 agreed with the researcher and tissue viability link nurse (82.9% agreement, kappa 0.763). CONCLUSION The level of agreement was good for overt and covert interrater reliability data.
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Affiliation(s)
- Jane Willock
- Senior Lecturer at the University of South Wales, Pontypridd, and Clinical Nurse Specialist in Childrens Rheumatology at the Childrens Hospital for Wales, Cardiff
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Willock J. Interrater reliability of the Glamorgan scale: overt and covert data. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2013; 22:S4-S9. [PMID: 24225511 DOI: 10.12968/bjon.2013.22.sup20.s4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
UNLABELLED The Glamorgan Paediatric Pressure Ulcer Risk Assessment Scale (Glamorgan scale) had been developed using statistical analysis of patient data. The aim of this study was to assess the reliability of the Glamorgan scale using overt and covert methods. METHOD For the overt data collection, randomly selected trained nursing staff were invited to participate. Twenty-seven trained nursing staff assessed 27 children and young people within 10 minutes of an assessment by the researcher. For the covert part of the data collection the researcher and the paediatric tissue viability (TV) link nurse risk assessed inpatients on wards and units where the overt data collection had taken place, their findings were compared with the last recorded assessment by the clinical nurses. RESULTS In the overt data collection 24 out of 27 nurses agreed with the researcher (88.9% agreement, kappa 0.867). In the covert data collection, 41 out of 55 risk assessments had been completed. Of the 41 completed assessments 34 agreed with the researcher and tissue viability link nurse (82.9% agreement, kappa 0.763). CONCLUSION The level of agreement was good for overt and covert interrater reliability data.
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Affiliation(s)
- Jane Willock
- Senior Lecturer at the University of South Wales, Pontypridd, and Clinical Nurse Specialist in Childrens Rheumatology at the Childrens Hospital for Wales, Cardiff
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31
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Kim W, Guinot A, Marleix S, Chapuis M, Fraisse B, Violas P. Hereditary sensory and autonomic neuropathy type IV and orthopaedic complications. Orthop Traumatol Surg Res 2013; 99:881-5. [PMID: 24070693 DOI: 10.1016/j.otsr.2013.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 04/25/2013] [Accepted: 05/15/2013] [Indexed: 02/02/2023]
Abstract
Hereditary sensory and autonomic neuropathy type IV (HSAN-IV) is a very rare autosomal recessive disorder characterized by recurrent episodes of unexplained fever, extensive anhidrosis, total insensitivity to pain, hypotonia, and mental retardation. The most frequent complications of this disease are corneal scarring, multiple fractures, joint deformities, osteomyelitis, and disabling self-mutilations. We reported the case of a 12-year-old boy. The goal was to discuss our decision-making and compare this case with cases described in the literature.
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Affiliation(s)
- W Kim
- Service de Chirurgie Pédiatrique, Hôpital Sud, boulevard de Bulgarie, 35200 Rennes, France
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Zhang Y, Ogata N, Yozu A, Haga N. Two-dimensional video gait analyses in patients with congenital insensitivity to pain. Dev Neurorehabil 2013; 16:266-70. [PMID: 23477459 DOI: 10.3109/17518423.2012.760117] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To clarify the features of gait in patients with congenital insensitivity to pain (CIP) by analyzing the video-recorded gait. METHODS Eleven patients with the diagnosis of hereditary sensory and autonomic neuropathy (HSAN) type 4 or 5 and 15 healthy participants were enrolled in this study. Gait was analyzed using two-dimensional (2D) digital video and video analysis software. Walking speed, cadence, step length, stance phase duration, and heel contact to foot flat period were compared between patients and healthy participants. RESULTS The results showed that walking speed and heel contact angular velocity were significantly higher (p < 0.05), and step length was significantly longer (p < 0.05) in CIP patients, especially in the younger age group. CONCLUSION Young patients with CIP walked faster, with a longer step length and higher heel contact angular velocity than young control participants. These results may explain the frequency of lower extremity injuries in CIP patients.
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Affiliation(s)
- Yasu Zhang
- Department of Rehabilitation Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Gao L, Guo H, Ye N, Bai Y, Liu X, Yu P, Xue Y, Ma S, Wei K, Jin Y, Wen L, Xuan K. Oral and craniofacial manifestations and two novel missense mutations of the NTRK1 gene identified in the patient with congenital insensitivity to pain with anhidrosis. PLoS One 2013; 8:e66863. [PMID: 23799134 PMCID: PMC3682965 DOI: 10.1371/journal.pone.0066863] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 05/10/2013] [Indexed: 01/25/2023] Open
Abstract
Congenital insensitivity to pain with anhidrosis (CIPA) is a rare inherited disorder of the peripheral nervous system resulting from mutations in neurotrophic tyrosine kinase receptor 1 gene (NTRK1), which encodes the high-affinity nerve growth factor receptor TRKA. Here, we investigated the oral and craniofacial manifestations of a Chinese patient affected by autosomal-recessive CIPA and identified compound heterozygosity in the NTRK1 gene. The affected boy has multisystemic disorder with lack of reaction to pain stimuli accompanied by self-mutilation behavior, the inability to sweat leading to defective thermoregulation, and mental retardation. Oral and craniofacial manifestations included a large number of missing teeth, nasal malformation, submucous cleft palate, severe soft tissue injuries, dental caries and malocclusion. Histopathological evaluation of the skin sample revealed severe peripheral nerve fiber loss as well as mild loss and absent innervation of sweat glands. Ultrastructural and morphometric studies of a shed tooth revealed dental abnormalities, including hypomineralization, dentin hypoplasia, cementogenesis defects and a dysplastic periodontal ligament. Genetic analysis revealed a compound heterozygosity- c.1561T>C and c.2057G>A in the NTRK1 gene. This report extends the spectrum of NTRK1 mutations observed in patients diagnosed with CIPA and provides additional insight for clinical and molecular diagnosis.
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Affiliation(s)
- Li Gao
- Department of Pediatric Dentistry, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi Province, People's Republic of China
| | - Hao Guo
- Department of Pediatric Dentistry, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi Province, People's Republic of China
| | - Nan Ye
- Department of Dentistry, Hospital of PLA 309, Beijing, People's Republic of China
| | - Yudi Bai
- Department of Pediatric Dentistry, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi Province, People's Republic of China
| | - Xin Liu
- Department of Orthodontics, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi Province, People's Republic of China
| | - Ping Yu
- Institute of Genomic Medicine, Wenzhou Medical College, Wenzhou, Zhejiang Province, People's Republic of China
| | - Yang Xue
- Department of Oral Biology, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi Province, People's Republic of China
| | - Shufang Ma
- Department of Pediatric Dentistry, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi Province, People's Republic of China
| | - Kewen Wei
- Department of Endodontics, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi Province, People's Republic of China
| | - Yan Jin
- Department of Oral Histology and Pathology, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi Province, People's Republic of China
- * E-mail: (YJ); (LYW); (KX)
| | - Lingying Wen
- Department of Pediatric Dentistry, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi Province, People's Republic of China
- * E-mail: (YJ); (LYW); (KX)
| | - Kun Xuan
- Department of Pediatric Dentistry, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi Province, People's Republic of China
- * E-mail: (YJ); (LYW); (KX)
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Karthikeyan M, Sreenivas T, Menon J, Patro DK. Congenital insensitivity to pain and anhydrosis: a report of two cases. J Orthop Surg (Hong Kong) 2013; 21:125-8. [PMID: 23630006 DOI: 10.1177/230949901302100132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report on 2 patients with congenital insensitivity to pain and anhydrosis. The first one was a 7-month-old boy who presented with non-traumatic, haematogenous septic dislocation of the right elbow with physeal separation of the distal humerus. The second one was a 3-year-old girl suspected to have Job syndrome with an altered immunological profile.
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ANTUNES-FERREIRA NATHALIE, MATOS VÍTORM, SANTOS ANALUÍSA. Leprosy in individuals unearthed near the Ermida de Santo André and Leprosarium of Beja, Portugal. ANTHROPOL SCI 2013. [DOI: 10.1537/ase.130702] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- NATHALIE ANTUNES-FERREIRA
- Instituto Superior de Ciências da Saúde Egas Moniz, Caparica
- Research Centre for Anthropology and Health (CIAS), University of Coimbra, Coimbra
| | - VÍTOR M.J. MATOS
- Research Centre for Anthropology and Health (CIAS), University of Coimbra, Coimbra
| | - ANA LUÍSA SANTOS
- Research Centre for Anthropology and Health (CIAS), University of Coimbra, Coimbra
- Department of Life Sciences, University of Coimbra, Coimbra
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Udayashankar C, Oudeacoumar P, Nath AK. Congenital insensitivity to pain and anhidrosis: a case report from South India. Indian J Dermatol 2012; 57:503. [PMID: 23248377 PMCID: PMC3519266 DOI: 10.4103/0019-5154.103080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Congenital insensitivity to pain with anhidrosis, also known as hereditary sensory and autonomic neuropathy type IV, is an autosomal recessive disorder characterized by the congenital lack of pain sensation, inability to sweat, episodes of recurrent hyperpyrexia, mental retardation, and self-mutilating behavior. It is an extremely rare disorder with only a handful of reports from India. A five- year- old boy, born to second-degree consanguineous parents after uneventful antenatal period, presented to us with history of recurrent unexplained fever, recurrent ulcers in the lower limbs, insensitivity to painful stimuli (like injections, vaccination) and self-mutilating behavior from early childhood. Cutaneous examination showed multiple ulcers, loss of teeth, loss of tip of the tongue (due to biting), scarring of finger tips, xerosis and lichenification. Sensory examination showed complete loss of pain and temperature sensations, but fine touch and vibration were preserved. Deep tendon reflexes were normal. Evaluation for Hansen's disease was non-contributory. An intradermal injection of histamine did not show any flare response. Based on clinical as well as compatible histological features a diagnosis of congenital insensitivity to pain with anhidrosis was made. The ulcers were treated with appropriate antibiotics and daily dressings. The parents were counseled about appropriate care of the child.
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Affiliation(s)
- Carounanidy Udayashankar
- Department of Dermatology, Indira Gandhi Medical College and Research Institute, Puducherry, India
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Erdil M, Bilsel K, Imren Y, Ceylan HH, Tuncay I. Total hip arthroplasty in a patient with congenital insensitivity to pain: a case report. J Med Case Rep 2012; 6:190. [PMID: 22776296 PMCID: PMC3419663 DOI: 10.1186/1752-1947-6-190] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 07/09/2012] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Congenital insensitivity to pain, a rare neurological entity, is characterized by varying degrees of sensory loss and autonomic dysfunction. Orthopedic manifestations of congenital insensitivity to pain include delayed diagnosis of fractures, nonunions, malunions, Charcot arthropathy, acro-osteolysis, avascular necrosis, osteomyelitis, heterotopic ossification and joint dislocations. We here report the case of a patient with congenital insensitivity to pain who had multiple lower extremity fractures at varying intervals, the most recent being a femoral neck fracture managed by total hip replacement. To the best of our knowledge, this is the first report of cementless hip arthroplasty in such a patient. CASE PRESENTATION A 37-year-old Caucasian woman was admitted to our hospital complaining of painless swellings in her lower limb and limping. She had been diagnosed with multiple lower extremity fractures at different times. On physical examination, we found multiple perioral mucosal ulcers, shortening of her nails and acro-osteolysis, a prematurely aged facial appearance, undersized skeletal structure, Charcot arthropathy of her right ankle, anosmia, insensitivity to temperature differences and evidence of mild intellectual disability. A right subtrochanteric femur fracture was treated with an intramedullary nail. Eighteen months later, she presented with similar symptoms and we diagnosed a right femoral neck fracture. We removed the nail and performed cementless total right hip arthroplasty. CONCLUSIONS Congenital insensitivity to pain is a rare condition that is associated with severe orthopedic problems. This case report, which will be of particular interest to orthopedic surgeons, presents several difficulties in the management of patients with congenital insensitivity to pain and notes the importance of close follow-up and early recognition of complications. Cementless total hip arthroplasty may be a good therapeutic option for femoral neck fracture in these patients.
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Affiliation(s)
- Mehmet Erdil
- Orthopedics and Traumatology Department, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.
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Abstract
Congenital insensitivity to pain and anhidrosis (CIPA) is a rare reported entity characterised by disturbance in the pain and temperature perception due to involvement of the autonomic and sensory nervous system. It is an autosomal recessive trait with several defects of the gene NTRK1 coding for the neurotrophic tyrosine kinase - a nerve growth factor receptor on chromosome 1q21-q22. Traumatic fractures are common and, because of lack of pain, may go unrecognised for prolonged periods, resulting in nonunion or pseudoarthrosis. A Charcot joint may be the end result. Treatment complications are very common in these patients and range from infection to wound breakdown to failure of fixation. We report here a rare case of CIPA in a 9-year-old girl and her younger male sibling with generalised absence of pain, anhidrosis and its orthopaedic implications.
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Affiliation(s)
- Ashok H Sasnur
- Department of Orthopaedics, Al Ameen Medical College and Hospital, Athani Road, Bijapur, Karnataka, India
| | - Prakash A Sasnur
- Department of Orthopaedics, Al Ameen Medical College and Hospital, Athani Road, Bijapur, Karnataka, India,Address for correspondence: Dr. Prakash A Sasnur, Department of Orthopaedics, Al Ameen Medical College Hospital, Athani Road, Bijapur - 586 108, Karnataka, India. E-mail:
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Abstract
Charcot neuroarthropathy is a common cause of morbidity in persons with diabetes mellitus and sensory neuropathy. Although Charcot neuroarthropathy is rare, it likely will become more prevalent in conjunction with increased incidence of diabetes mellitus. Prevention of disease progression remains the mainstay of treatment, with surgical intervention usually reserved for refractory cases. Late deformities are often complicated by chronic ulceration, infection, and osteomyelitis. The clinical presentation is best summarized with the Eichenholtz classification, and progression often follows a predictable pattern. Although Charcot neuroarthropathy is a clinical diagnosis, recent advances in diagnostic imaging have eased the clinical challenge of deciphering infection from Charcot changes. Advances in surgical treatment have demonstrated new options for limb salvage. Pharmacologic therapies directed toward decreasing bone resorption have also shown promise for treatment, but clinical application remains theoretical.
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Suriu C, Khayat M, Weiler M, Kfir N, Cohen C, Zinger A, Aslanidis C, Schmitz G, Falik-Zaccai TC. Skoura - a genetic island for congenital insensitivity to pain and anhidrosis among Moroccan Jews, as determined by a novel mutation in the NTRK1 gene. Clin Genet 2009; 75:230-6. [PMID: 19250380 DOI: 10.1111/j.1399-0004.2008.01143.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Congenital insensitivity to pain with anhidrosis (CIPA) or hereditary sensory and autonomic neuropathy type IV is a rare, autosomal recessive neurologic disorder, characterized by absence of reaction to painful stimuli, mental retardation, self- mutilating behavior, anhidrosis, and recurrent episodes of hyperthermia. Mutations in the neurotrophic tyrosine kinase receptor 1, a receptor phosphorylated by nerve growth factor, have been documented in diverse ethnic groups. We identified the same novel nonsense mutation in two unrelated families of Moroccan Jewish descent, each with two affected siblings. This possible founder mutation may trace to the rural Jewish village in southern Morocco from where both these families originated. Genetic screening for the causative mutation among 300 unrelated Moroccan Jews did not reveal carriers for the causative mutation, thus excluding high risk for CIPA in this ethnic subpopulation.
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Affiliation(s)
- C Suriu
- Institute of Human Genetics, Western Galilee Hospital-Nahariya, Israel
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Expanded HSAN4 phenotype associated with two novel mutations in NTRK1. Neuromuscul Disord 2008; 18:681-4. [PMID: 18657423 DOI: 10.1016/j.nmd.2008.06.370] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 06/10/2008] [Accepted: 06/19/2008] [Indexed: 11/23/2022]
Abstract
Hereditary sensory and autonomic neuropathy type IV (HSAN4) is a severe autosomal recessive disorder characterized by childhood onset of sensory and autonomic dysfunction leading to hyperthermia, recurrent infections and physical impairment due to complications of osteoarthritis. Cognitive impairment and aggressive behaviour is common. HSAN4 is caused by mutations in the NTRK1 gene coding for the tyrosine kinase receptor A. We present detailed description of a rare, mild HSAN4 phenotype associated with two novel NTRK1 mutations. This Swedish patient presents with an adult onset of painful Charcot arthropathy, prolonged wound healing, discrete polyneuropathy, hypohidrosis without further autonomic dysfunction and no cognitive affection.
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Shalimar A, Sharaf I, Farah Wahida I, Ruszymah BH. Congenital insensitivity to pain with anhydrosis in a Malaysian family: a genetic analysis. J Orthop Surg (Hong Kong) 2007; 15:357-60. [PMID: 18162686 DOI: 10.1177/230949900701500323] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A Malaysian family with congenital insensitivity to pain with anhydrosis was diagnosed based on clinical symptoms of chronic ulcers, joint deformities, malunited fractures, anhydrosis, and learning disabilities. We detected a compound heterozygous mutation in exon 16: V709L from the mother and G718S from the father. Two novel mutations were identified: at amino acid 709, a change of G to C at nucleotide 2209 (approximately 2209G to C) causing a valine to leucine substitution (V709L), and at amino acid 718, a change of G to A at nucleotide 2236 (approximately 2236G to A) causing a glycine to serine substitution (G718S). Polymorphisms identified were at nucleotides approximately 2113G to C and approximately 2176T to C.
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Affiliation(s)
- A Shalimar
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
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Zimmermann A, Law C, Blount J, Gilbert S. Neuropathic arthropathy of the elbow in a paediatric patient with myelomeningocele. Dev Neurorehabil 2007; 10:261-4. [PMID: 17564866 DOI: 10.1080/17518420701403593] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION This case report describes perhaps the youngest case of neuropathic arthropathy (NA) in an upper extremity documented in a patient with myelomeningocele. METHODS Case report. RESULTS This case report describes presenting symptoms, results of radiologic work-up, treatment approach and functional outcome thus far. Included is a clinical picture of the patient as well as a radiograph of the affected elbow. DISCUSSION NA, also known as Charcot joint, is a rare occurrence in the upper extremity. NA is well documented in the literature; however, the majority of reports are of adults with affected lower extremities. This report describes the very rare occurrence of upper extremity involvement of a 5 year old child with myleomeningocele. As the literature does not guide treatment for this age of patient, this study reports the treatment plan and the child's outcome thus far. Due to the rarity of this situation, future research will be quite difficult. Reports of cases such as this including treatment and outcome will be helpful to guide clinical decision-making for future cases.
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Affiliation(s)
- Amy Zimmermann
- Physical Medicine and Rehabilitation, Resident Physician, Hoover, USA.
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Emad Y, El Yasaki A, Ragab Y, Khalifa M, Moawayh O, Salama M. Arthritis in a child secondary to congenital insensitivity to pain and self-aggression. Why and when pain is good? Clin Rheumatol 2006; 26:1164-6. [PMID: 16770519 DOI: 10.1007/s10067-006-0290-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2006] [Revised: 03/12/2006] [Accepted: 03/13/2006] [Indexed: 11/30/2022]
Abstract
A 9 year-old female child presented with recurrent arthritis of ankles, left knee and unequal leg length. Clinical examination revealed mild valgus deformity in her left knee with grade 2 effusion, arthritis of both ankles and deformity in her left wrist. Examination of the affected joints showed no evidence of tenderness upon active or passive movements and the patient did not show any limping upon gait analysis. Past history of the patient revealed evidence of previous dislocation of her left hip and previous fibular fracture. Revision of her previous x-rays showed left hip dislocation, fracture left fibula and fracture of right metatarsal bone after repetitive trauma which pass unnoticed. Recent x-ray of her left knee showed osteochondral injury. Laboratory investigations were done to rule out common causes of childhood arthritis and revealed: ESR 12 1st hours, CRP negative, negative rheumatoid factor, and negative ANA. Neurological evaluation of the patient documented congenital insensitivity to pain and EMG studies confirmed evidence of sensory neuropathy. Traumatic arthritis resulting from congenital insensitivity to pain with self-aggression is rarely encountered in children but should be considered in the differential diagnosis specially if radiological features point to repetitive trauma with attempts of healing.
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Affiliation(s)
- Y Emad
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
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Minde J, Svensson O, Holmberg M, Solders G, Toolanen G. Orthopedic aspects of familial insensitivity to pain due to a novel nerve growth factor beta mutation. Acta Orthop 2006; 77:198-202. [PMID: 16752279 DOI: 10.1080/17453670610045911] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Congenital insensitivity to pain is a rare hereditary sensory neuropathy. PATIENTS We present 6 patients from a family with a mutation in the nerve growth factor beta gene (NGFB). RESULTS 3 patients were homozygous with a mutilating arthropathy starting early in life, and 3 patients were presumably heterozygous with a milder course starting in adulthood. All patients had normal mental abilities. In addition to absence of deep pain, the patients had impaired temperature sensation, but no autonomic deficiency. Sural nerve biopsies showed a moderate loss of A-delta fibres and a severe reduction in C fibers. Clinically, the disorder most often affected the lower extremities, with an insidious progressive joint swelling or a painless fracture, but the spine could also be involved with gross and unstable spondylolisthesis. Fracture healing was uneventful, but the arthropathy was progressive, eventually resulting in gross deformity and instability. When treating patients with congenital disorders such as this one, it is important to consider the slowly progressive nature of the disorder, and the orthopedic operations should therefore be planned from a long-term standpoint. Arthrodesis, limb lengthening and spinal decompression or fusion are the only elective procedures that seem reasonable. Fitting of orthosis for joint protection is also demanding. To delay the development of neuropathic arthropathy, patient education is essential but difficult in the very young. INTERPRETATION The different expression between homo- and heterozygous subjects and the central role of nerve growth factor make this disease an interesting model system for studies of disease mechanisms and the molecular background to pain.
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Affiliation(s)
- Jan Minde
- Department of Orthopedics, Gällivare Hospital, Gällivare,
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Shea KG, Showalter L. Ilizarov method of repair of achilles tendon rupture in a patient with congenital insensitivity to pain. A case report. J Bone Joint Surg Am 2003; 85:1816-8. [PMID: 12954845 DOI: 10.2106/00004623-200309000-00026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Kevin G Shea
- St. Luke's Children's Hospital and Intermountain Orthopaedics, Boise, Idaho, USA.
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Escard E, Barret L. Sévices à des enfants ou insensibilité congénitale à la douleur? Paediatr Child Health 2003; 8:151-4. [DOI: 10.1093/pch/8.3.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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