Clinical practice guidelines for the diagnosis and management of Charcot-Marie-Tooth disease

INTRODUCTION

Charcot-Marie-Tooth (CMT) disease is classified considering the neurophysiological and histological findings, the inheritance pattern and the underlying genetic defect. In recent years, with the advent of next generation sequencing, genetic complexity has increased exponentially, expanding the knowledge about disease pathways, and having an impact in clinical management. The aim of this guide is to offer recommendations for the diagnosis, prognosis, monitoring and treatment of this disease in Spain.

MATERIAL AND METHODS

This consensus guideline has been developed by a multidisciplinary panel encompassing a broad group of professionals including neurologists, neuropediatricians, geneticists, rehabilitators, and orthopaedic surgeons.

RECOMMENDATIONS

The diagnosis is based in the clinical characterization, usually presenting with a common phenotype. It should be followed by an appropriate neurophysiological study that allows for a correct classification, specific recommendations are established for the parameters that should be included. Genetic diagnosis must be approached in sequentially, once the PMP22 duplication has been ruled out if appropriate, a next generation sequencing should be considered taking into account the limitations of the available techniques. To date, there is no pharmacological treatment that modifies the course of the disease, but symptomatic management is important, as are the rehabilitation and orthopaedic considerations. The latter should be initiated early to identify and improve the patient's functional impairments, including individualised exercise guidelines, orthotic adaptation, and assessment of conservative surgeries such as tendon transpositions. The follow-up of patients with CMT is exclusively clinical, ancillary testing are not necessary in routine clinical practice.

[Practical usefulness of genogram in the handicapped patient care]

OBJECTIVE

To know the practical use of genogram in the handicapped patient care, describing their characteristics and those of their families and to obtain the prevalence of bad care immobilized patients belonging to the health centre.

DESIGN

Descriptive observational.

SETTING

Urban health centre.

PARTICIPANTS

People of both sexes registered at the health centre, immobilized in their houses, with a disability score of three or more in the physical disability scale of the Red Cross.

MEASUREMENTS AND RESULTS

The most important features of our immobilized people, obtained from the genogram, are: women (63.5%), with mean age of 78.8 +/- 13.2 years old (CI, 76.5-81.17), with disability score of 3 (46.8%), immersed in a nuclear family (34.9%), in phase VI of dissolution of the vital cycle (45.2%), with very closed relations (45.2%), with arthrosis (23.8%) as the most frequent immobilized cause, and with one unique home career only (72%). The prevalence of bad care immobilized patients was 25.4%.

CONCLUSIONS

The genogram is an excellent tool for describing immobilized people and their family nucleus, allowing the definition of an immobilized profile. If the patient is bad cared, he will need an special consideration. The immobilized score and the family relations ship may complicate their care, conditioning a worse prognosis. We wish to emphasize the importance of carrying out the genogram in the initial moment of the immobilization, because it establishes a dialogue route between the families and the sanitary professionals to improve the attention of these patients.