ABSTRACT
Background: Mutations of GDAP1 gene cause autosomal dominant and autosomal recessive Charcot-Marie-Tooth disease and more than 40 different mutations have been reported. The recessive Q163X mutation has been described in patients of Spanish ancestry, and a founder mutation in South American patients, originating in Spain has been demonstrated. Objective: We describe physical and histological features, and the molecular impact of mutation Q163X in a Colombian family. Methods: We report two female patients, daughters of consanguineous parents, with onset of symptoms within the first two years of life, developing severe functional impairment, without evidence of dysmorphic features, hoarseness or diaphragmatic paralysis. Electrophysiology tests showed a sensory and motor neuropathy with axonal pattern. Sequencing of GDAP1 gene was requested and the study identified a homozygous point mutation (c.487 C>T) in exon 4, resulting in a premature stop codon (p.Q163X). This result confirms the diagnosis of Charcot-Marie-Tooth disease, type 4A. Results: The patients were referred to Physical Medicine and Rehabilitation service, in order to be evaluated for ambulation assistance. They have been followed by Pulmonology service, for pulmonary function assessment and diaphragmatic paralysis evaluation. Genetic counseling was offered. The study of the genealogy of the patient, phenotypic features, and electrophysiological findings must be included as valuable tools in the clinical approach of the patient with Charcot-Marie-Tooth disease, in order to define a causative mutation. In patients of South American origin, the presence of GDAP1 gene mutations should be considered, especially the Q163X mutation, as the cause of CMT4A disease.
Antecedentes: Las mutaciones del gen GDAP1 son causantes de la enfermedad de Charcot Marie Tooth tanto autosómica dominante como recesiva, y se han reportado más de 40 mutaciones distintas. La mutación recesiva Q163X ha sido descrita en pacientes de ascendencia española y se ha demostrado una mutación fundadora originaria de España en pacientes de origen suramericano. Describimos las características físicas e histológicas y el impacto molecular de la mutación Q163X en una familia colombiana. Objetivo: Se describe el impacto de la mutación Q163X en las características físicas, histológicas y moleculares en una familia colombiana. Métodos: Se describe dos pacientes de sexo femenino, hijas de padres consanguíneos, quienes presentaron inicio de síntomas en los dos primeros años de vida, mostrando deterioro funcional severo, sin evidencia de dismorfía, disfonía o parálisis diafragmática. Los estudios de electrofisiología mostraron una neuropatía sensitiva y motora con patrón axonal. Se solicitó la secuenciación del gen GDAP1, y el estudio identificó una mutación homocigota puntual (c. 487 C>T) en el exón 4, causando un codón de parada prematuro (p. Q163X). Este resultado confirma el diagnóstico de Enfermedad de Charcot Marie Tooth, tipo 4A (recesiva, tipo axonal). Resultados: Las pacientes fueron remitidas al servicio de Fisiatría para evaluación de métodos de asistencia para deambulación. Ellas reciben seguimiento por el servicio de Neumología, quienes vigilan la función pulmonar y el desarrollo de parálisis diafragmática. Se brindó asesoramiento genético. La genealogía del paciente, las características fenotípicas y los hallazgos en los estudios electrofisiológicos son herramientas valiosas en el enfoque clínico del paciente con CMT, de forma que se pueda plantear una posible mutación causal. Se debe considerar la presencia de mutaciones en el gen GDAP1 en pacientes de origen suramericano, en especial la mutación Q163X, como causa de CMT4A.
Subject(s)
Adolescent , Child , Female , Humans , Charcot-Marie-Tooth Disease/genetics , Point Mutation , Colombia , Consanguinity , Charcot-Marie-Tooth Disease/pathology , Exons , Homozygote , Nerve Tissue Proteins , PedigreeABSTRACT
We reviewed dinical, histological and ultrastructural findings of 124 cases of sural nerve biopsy specimens to delineate the trends of peripheral nerve diseases in our institute. Eighty-one were men and 43 were women. We categorized them into five groups: specific diagnosis (66 cases, 53.2%), axonal degeneration type (47 cases, 37.9%), demyelinating type (4 cases, 3.2%), mixed axonal degeneration-demyelinating type (6 cases, 4.8%) and normal (1 case, 0.9%). Cases with specific diagnosis included 21 inflammatory demyelinating polyneuropathy (15 chronic inflammatory demyelinating polyradiculoneuropathy, 6 Guillain-Barre disease), 13 hereditary motor and sensory neuropathy (7 Charcot-Marie-Tooth type I, 6 Charcot-Marie-Tooth type II), 10 vasculitis, 6 toxic neuropathy, 4 leprosy, 3 diabetic neuropathy, 2 alcoholic neuropathy, 1 Fabry's disease and other specific diseases (5 cases). In our cases, the proportion of specific diagnoses was higher, while the proportion of demyelinating peripheral neuropathies and normal were lower than those of Western series. The results of this study indicate that 1) a dose clinicopathologic correlation is important to make a precise diagnosis of peripheral nerve biopsy, 2) Biopsy under strict indication may reduce unnecessary histologic examination, 3) There is no difference in disease pattern of peripheral neuropathy between Western people and Koreans.
Subject(s)
Adult , Female , Humans , Male , Biopsy , Charcot-Marie-Tooth Disease/pathology , Demyelinating Diseases/pathology , Fabry Disease/pathology , Hereditary Sensory and Motor Neuropathy/pathology , Korea , Leprosy/pathology , Microscopy, Electron , Nerve Fibers, Myelinated/pathology , Peripheral Nerves/ultrastructure , Peripheral Nerves/pathology , Peripheral Nervous System Diseases/pathology , Peripheral Nervous System Diseases/microbiology , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/pathology , Sural Nerve/ultrastructure , Sural Nerve/pathologyABSTRACT
We report three siblings of a family with hereditary motor and sensory plyneuropathy (HMSN) and buphthalmos. Eletrophysiological studies showed a demyelinating neuropathy and pathological findings showed severe loss of myelinated fibers (MF), thin myelin sheaths and myelin infoldings in a few remaining MF. The presumed mode of inheritance is autosomal recesive. This family probably represents an unique form of CMT4 that may be related to one of the congenital glaucoma genic locus, particularly GLC3A and GLC3B, described in Turkish families.
Subject(s)
Adult , Humans , Female , Charcot-Marie-Tooth Disease/diagnosis , Charcot-Marie-Tooth Disease/genetics , Glaucoma/congenital , Charcot-Marie-Tooth Disease/pathology , Glaucoma/diagnosis , Hereditary Sensory and Motor Neuropathy/genetics , PedigreeABSTRACT
En este trabajo se hace una descripción didáctica de un grupo de neuropatías englobadas en el término de neuropatías sensitivas motoras hereditarias. Después de dar datos para el diagnóstico de los 7 tipos presentes se analiza la enfermedad de Charcot Marie Tooth como la más frecuente, desde el punto de vista diagnóstico, patogénico y de tratamiento
Subject(s)
Humans , Male , Female , Charcot-Marie-Tooth Disease/diagnosis , Charcot-Marie-Tooth Disease/pathology , Charcot-Marie-Tooth Disease/therapy , Education/methods , Hereditary Sensory and Motor Neuropathy/classification , Hereditary Sensory and Motor Neuropathy/diagnosis , Hereditary Sensory and Motor Neuropathy/geneticsABSTRACT
Presentamos una paciente de sexo femenino de 42 años afectada de enfermedad de Charcot-Marie-Tooth. Hace dos años a nuestra paciente se le añade un cuadro de esclerodermia sistémica con insuficiencia pulmonar severa y síntomas típicamente dermatológicos. Los anticuerpos anti Scl 70 y anticentrómero fueron positivos. La anatomía patológica mostró además miositis y las características típicas de la esclerodermia. El tratamiento con corticoides, lidocaína y vasodilatadores periféricos no fue efectivo y nuestra paciente falleció
Subject(s)
Humans , Female , Adult , Charcot-Marie-Tooth Disease/complications , Scleroderma, Systemic/complications , Polymyositis/complications , Charcot-Marie-Tooth Disease/immunology , Charcot-Marie-Tooth Disease/pathology , Scleroderma, Systemic/pathology , Scleroderma, Systemic/drug therapy , Polymyositis/pathologyABSTRACT
Säo apresentados os resultados da biópsia do nervo sural à microscopia óptica e eletrônica (ME) em 41 pacientes com doença de Charcot-Marie-Tooth (CMT). Por estudos de neuroconduçäo prévios nove eram do tipo I e 32 do tipo II. No tipo I, todos tinham grande diminuiçäo do número de fibras, sendo os histogramas do tipo unimodal. Encontramos imagens de desmielinizaçäo, remielinizaçäo, formaçäo de bulbos de cebola e de regeneraçäo. Um paciente apresentava espessamento da bainha de mielina (atrofia axonal). No tipo II, sete pacientes näo apresentavam anomalia à microscopia, com histograma normal. Nos restantes havia discreta a intensa perda de fibras mielínicas principalmente as de grande calibre. Em cinco enfermos havia aumento do número de fibras devido a grande regeneraçäo. Alguns pacientes do tipo II apresentavam à ME imagens de pequenos bulbos de cebola e em um havia também atrofia axonal. Comparando com os dados clínicos e de neurconduçäo motora, no tipo I näo encontramos relaçäo entre a intensidade do quadro clínico e da perda de fibras mielínicas porém houve paralelismo da queda da neuroconduçäo motora e a diminuiçäo do número de fibras. No tipo II näo houve relaçäo entre o quadro clínico, a neuroconduçäo e os achados da biópsia nervosa
Subject(s)
Humans , Female , Adult , Charcot-Marie-Tooth Disease/pathology , Sural Nerve/pathology , Axons/pathology , Axons/ultrastructure , Biopsy , Microscopy, Electron , Nerve Fibers, Myelinated/pathology , Nerve Fibers, Myelinated/ultrastructure , Sural Nerve/ultrastructureABSTRACT
As doenças degenerativas, como a demência senil, as enfermedades de Alzheimer, Pick e Creutzfeldt-Jakob, dentre outras, despertam interesse crescente entre os clínicos, sendo porém necessária uma visäo realista das mesmas, o que só é possível à luz da patologia