View source for Charcot-Marie-Tooth Syndrome

__NOTOC--
{{CMG}}
'''Quick Start:''' ''You don't need to be Editor-In-Chief to add or edit content. You can begin to add to or edit text on this wiki doc page by clicking on the edit button above and to the left on this same page. Type in the text you want to add. Once you are done, click the save changes button at the bottom.

'''Apply to be Editor-In-Chief for this topic:''' There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [mailto:charlesmichaelgibson@gmail.com] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.

== Overview ==

'''Charcot-Marie-Tooth disease''' ('''CMT'''), known also as '''Hereditary Motor and Sensory Neuropathy''' ('''HMSN''') or '''Peroneal Muscular Atrophy''', is a heterogeneous inherited disorder of [[nerve]]s ([[neuropathy]]) that is characterized by loss of muscle tissue and touch sensation, predominantly in the feet and legs but also in the hands and arms in the advanced stages of disease. Though presently incurable, this disease is one of the most common inherited neurological disorders, with 36 in 100,000 affected.<ref name="Krajewski">Krajewski, K.M., Lewis, R.A., Fuerst, D.R., Turansky, C., Hinderer, S.R., Gerbern, J., Kamholz, J. and M.E. Shy (2000) Brain 123:1516-1527 [http://brain.oxfordjournals.org/cgi/content/full/123/7/1516#SEC4, accessed 060220]</ref>

==Description==
The disorder is caused by the absence of molecules that are essential for normal function of the nerves due to errors in the genes coding these molecules. The absence of these chemical substances gives rise to dysfunction either in the [[axon]] or the [[myelin]] sheath of the nerve cell. Most of the mutations identified result in disrupted myelin production, however the most common mutations occur in gene MFN2, which doesn't seem to have anything to do with myelin. Instead MFN2 controls behaviour of mitochondria. Recent research showed that the mutated MFN2 causes mitochondria to form large clusters. In nerve cells these large clusters of mitochondria failed to travel down the axon towards the synapses. It is suggested these mitochondria clots make the synapses fail, resulting in CMT disease.<ref name="Baloh">Baloh, R., Schmidt, R., Pestronk, A. and Milbrandt, J. (2007) The Journal of Neuroscience 27(2):422-430, http://www.jneurosci.org/cgi/content/abstract/27/2/422 accessed 070122</ref>

The different classes of this disorder have been divided into the primary demyelinating neuropathies (CMT1, CMT3, and CMT4) and the primary axonal neuropathies (CMT2).  Recent studies, however, show that the pathologies of these two classes are frequently intermingled, due to the dependence and close cellular interaction of [[Schwann cell]]s and neurons.  Schwann cells are responsible for myelin formation, enwrapping neural axons with their plasma membranes in a process called “myelination”.<ref name="Berger">Berger, P., Young, P. and U. Suter (2002) Neurogenetics 4:1-15. http://www.springerlink.com/, accessed 060220</ref>

The molecular structure of the nerve depends upon the interactions between neurons, Schwann cells, and [[fibroblast]]s.  Schwann cells and neurons, in particular, exchange signals that regulate survival and differentiation during development.  These signals are important to CMT disease because a disturbed communication between Schwann cells and neurons, resulting from a genetic defect, is observed in this disorder.<ref name="Berger">Berger, P., Young, P. and U. Suter (2002) Neurogenetics 4:1-15. http://www.springerlink.com/, accessed 060220</ref>

It is clear that interaction with demyelinating Schwann cells causes the expression of abnormal axonal structure and function, but we still do not know how these abnormalities result in CMT.  One possibility is that the weakness and sensory loss experienced by patients with CMT is a result of axonal degradation.  Another possibility is that axonal dysfunction occurs, not degeneration, and that this dysfunction is induced by demyelinating Schwann cells.<ref name="Krajewski">Krajewski, K.M., Lewis, R.A., Fuerst, D.R., Turansky, C., Hinderer, S.R., Gerbern, J., Kamholz, J. and M.E. Shy (2000) Brain 123:1516-1527 [http://brain.oxfordjournals.org/cgi/content/full/123/7/1516#SEC4, accessed 060220]</ref>   

Most patients experience demyelinating neuropathies, and this is characterized by a reduction in nerve conduction velocity (NCV), due to a partial or complete loss of the myelin sheath.  Axonopathies, on the other hand, are characterized by a reduced compound muscle action potential (CMAP), while NCV is normal or only slightly reduced.<ref name="Berger">Berger, P., Young, P. and U. Suter (2002) Neurogenetics 4:1-15. http://www.springerlink.com/, accessed 060220</ref>

The disease is named for those who classically described it: [[Jean-Martin Charcot]] (1825-1893) and his pupil [[Pierre Marie]] (1853-1940)  (''"Sur une forme particulière d'atrophie musculaire progressive, souvent familiale débutant par les pieds et les jambes et atteignant plus tard les mains"'', Revue médicale, Paris, 1886; 6: 97-138.), and [[Howard Henry Tooth]] (1856-1925) ("The peroneal type of progressive muscular atrophy", dissertation, London, 1886.)

==Symptoms==
Symptoms usually begin in late childhood or early adulthood. Usually, the initial symptom is [[foot drop]] due to involvement of the [[peroneal nerve]], which is responsible for raising the feet, early in the course of the disease. This can also cause [[hammer toe]], where the toes are always curled. Wasting of muscle tissue of the lower parts of the legs may give rise to "stork leg" or "inverted bottle" appearance. Weakness in the hands and forearms occurs in many people later in life as the disease progresses. 

Symptoms and progression of the disease can vary. Breathing can be affected in some; so can hearing, vision, and the neck and shoulder muscles. [[Scoliosis]] is common. [[Hip sockets]] can be malformed. Gastrointestinal problems can be part of CMT, as can chewing, swallowing, and speaking (as [[vocal cords]] atrophy). A [[tremor]] can develop as muscles waste. [[Pregnancy]] has been known to exacerbate CMT, as well as extreme emotional stress. About the [[chemotherapy]] drug [[vincristine]], the Charcot-Marie-Tooth Association classifies the drug as a '''Definite High Risk''' and states that ''vincristine has been proven hazardous and should be avoided by all CMT patients, including those with no symptoms.''<ref>[http://www.charcot-marie-tooth.org/med_alert.php CMT Association: Medical Alert]</ref>

==Diagnosis==
The diagnosis is established by [[electromyography]] examination (which shows that the velocity of nerve impulse conduction is decreased and the time required to charge the nerve is increased) and nerve [[biopsy]].  [[Genetic marker]]s have been identified for some, but not all forms of the disease.

==Types of the disease==
* CMT Type 1 (CMT1): Type 1 affects approximately 80% of CMT patients and is the most common type of CMT.  The subtypes share clinical symptoms.  [[Autosomal dominant]].  Causes demyelination, which can be detected by measuring nerve conduction velocities.

* CMT Type 2 (CMT2): Type 2 affects approximately 20-40% of CMT patients.  Type 2 CMT is [[Autosomal dominant]] neuropathy  with its main effect on the axon.  The average [[nerve conduction velocity]] is slightly below normal, but generally above 38[[Metre per second|m/s]]

* CMT Type 3 (CMT3): Type 3 affects a very few CMT patients.

* CMT Type 4 (CMT4): Type 4 affects a very few CMT patients.

* CMT X-Linked (CMTX): CMTX affects approximately 10-20% of CMT patients and is [[Dominant gene|X-linked dominant]]. Approx 10% of X-linked CMT patients have some other form than CMTX.

More details on the types are provided in the table below:

{| class="wikitable"
| '''Type''' || '''[[OMIM]]''' || '''Gene ''' || '''[[Locus (genetics)|Locus]]'''  || '''Description'''
 |- 
 |  CMT1A  || {{OMIM2|118220}}   || {{Gene|PMP22}}  || 17p11.2  ||  The most common form of the disease, 70-80% of Type 1 patients.  Average [[Nerve conduction velocity|NCV]]: 15-20[[Metre per second|m/s]]  when associated with essential tremor and ataxia, called [http://www.ncbi.nlm.nih.gov/entrez/dispomim.cgi?id=180800 Roussy-Levy Syndrome]
 |- 
 |  CMT1B || {{OMIM2|118200}}   || {{Gene|MPZ}}  || 1q22  ||  Caused by mutations in the gene producing [[protein zero]] (P0). 5-10% of Type 1 patients. Average [[Nerve conduction velocity|NCV]]: <20[[Metre per second|m/s]]
 |- 
 |  CMT1C  ||   || {{Gene|LITAF}}  || 16p13.1-p12.3  ||  Causes severe [[myelin|demyelination]], which can be detected by measuring nerve conduction velocities.  [[Autosomal dominant]].  Usually shows up in infancy.    Average [[Nerve conduction velocity|NCV]]: 26-42[[Metre per second|m/s]].  Identical symptoms to CMT-1A.
 |- 
 |  CMD1D  ||   || {{Gene|EGR2}}  || 10q21.1-q22.1  ||  Average [[NCV]]: 15-20[[m/s]]
 |- 
 |  CMT2A || {{OMIM2|118210}}   || {{Gene|MFN2}} or {{Gene|KIF1B}}  || 1p36  ||  The cause is likely located on chromosome 1 for the mitofusion 2 protein.   Some research has also linked this form of CMT to the protein kinesin 1B.. Does not show up on nerve condution velocity tests, because it is caused by [[axonopathy]].
 |- 
 |  CMT2B || {{OMIM2|600882}}   || RAB7 ({{Gene|RAB7A}}, {{Gene|RAB7B}})  || 3q21.  || 
 |- 
 |  CMT2B1 ||   || {{Gene|LMNA}}  ||  1q22 || Autosomal recessive axonal CMT, ([[Laminopathies|laminopathy]])
 |- 
 |  CMT2C  || {{OMIM2|606071}}  ||   || 12q23-q24  ||  May cause vocal cord, diaphragm, and distal weaknesses.
 |- 
 |  CMT2D || {{OMIM2|601472}}   || {{Gene|GARS}}  || 7p15  || Patients with mutations in the GARS gene tend to have more severe symptoms in the upper extremities (hands), which is atypical for CMT in general.
 |- 
 |  CMT2E  ||   || {{Gene|NEFL}}  || 8p21  || 
 |- 
 |  CMT2F || {{OMIM2|606595}}   || {{Gene|HSPB1}}  || 7q11-q21  || 
 |- 
 |  CMT2G  || {{OMIM2|608591}}  ||   || 12q12-13  || 
 |- 
 |  CMT2H || {{OMIM2|607731}}   || {{Gene|GDAP1}}  ||  8q13-q21.1 || 
 |- 
 |  CMT2J || {{OMIM2|607736}}   ||   || 1q22  || 
 |- 
 |  CMT2K || {{OMIM2|607831}}   ||   || 8q13-q21.1  || 
 |- 
 |  CMT2L || {{OMIM2|608673}}   ||   || 12q24  || 
 |- 
 |  CMT3  || {{OMIM2|145900}}  ||  varies || varies  ||  Sometimes called [[Dejerine-Sottas disease]].  Rarely found. [[Autosomal recessive]]. Average [[Nerve conduction velocity|NCV]]: Normal (50-60m/s)
 |- 
 |  CMT4A || {{OMIM2|214400}}   || {{Gene|GDAP1}}  || 8q13-q21.1  ||  [[Autosomal recessive]].
 |- 
 |  CMT4B1 || {{OMIM2|601382}}   || {{Gene|MTMR2}}  || 11q22  ||  [[Autosomal recessive]].
 |- 
 |  CMT4B2  ||   ||  CMT4B2 ({{Gene|SBF2}}) || 11p15  || May be called "SBF2/MTMR13".  [[Autosomal recessive]].
 |- 
 |  CMT4C  ||   ||  KIAA1985 ({{Gene|SH3TC2}}) || 5q32  ||  May lead to respiratory compromise.
 |- 
 |  CMT4D  || {{OMIM2|601455}} ||  {{Gene|NDRG1}}  || 8q24.3  || [[Autosomal recessive]], [[demyelinating]], [[deafness]] 
 |- 
 |  CMT1E  || {{OMIM2|118300}}   || {{Gene|PMP22}}  || 17p11.2  || [[Autosomal dominant]], [[demyelinating]], [[deafness]]
 |- 
 |  CMT4E  ||   ||  {{Gene|EGR2}}   || 10q21.1-10q22.1  ||  "CMT4E" is a tentative name
 |- 
 |  CMT4F  ||   ||  {{Gene|PRX}}   || 19q13.1-19q13.2  ||  "CMT4F" is a tentative name
 |-
 |  CMT4J  || {{OMIM2|611228}}  || KIAA0274 ({{Gene|FIG4}}) || 6q21  ||  Autosomal recessive
 |- 
 |  CMTX1  || {{OMIM2|302800}}   || {{Gene|GJB1}}  || Xq13.1  ||  Average [[Nerve conduction velocity|NCV]]: 25-40[[Metre per second|m/s]]
 |- 
 |  CMTX2  || {{OMIM2|302801}}   ||  || Xq22.2  ||  
 |- 
 |  CMTX3  || {{OMIM2|302802}}   ||  || Xq26  || 
 |- 
 |   CMT   || {{OMIM2|118301}}   ||  || || with Ptosis and Parkinsonism 
 |- 
 |   CMT   || {{OMIM2|302803}}   ||  || || type 1 aplasia cutis congenita

|}

==Genetic testing==
Genetic testing is available for many of the different types of Charcot-Marie-Tooth.  For a listing of test availabilities, see [http://www.genetests.org GeneTests.org]

==External links==
* {{DMOZ|Health/Conditions_and_Diseases/Neurological_Disorders/Peripheral_Nervous_System/Charcot-Marie-Tooth_Disease/}}

==Sources==
www.wikipedia.org

==References==
<div class="references-small">
{{reflist|2}}
</div>

[[Category:Neurological Disease]]
[[Category:Genetic Disease]]

== Acknowledgements ==
The content on this page was first contributed by: C. Michael Gibson, M.S., M.D.

List of contributors:

== Suggested Reading and Key General References ==

== Suggested Links and Web Resources ==

== For Patients ==

 

[[ca:Malaltia de Charcot-Marie-Tooth]]
[[de:Morbus Charcot-Marie-Tooth]]
[[fr:Maladie de Charcot-Marie-Tooth]]
[[it:Malattia di Charcot-Marie-Tooth]]
[[nl:Hereditaire Motorische en Sensorische Neuropathieën]]
[[ja:シャルコー・マリー・トゥース病]]
[[no:Charcot-Marie-Tooths sykdom]]
[[pl:Choroba Charcota, Mariego i Tootha]]
[[pt:Doença de Charcot-Marie-Tooth]]
[[sv:Charcot-Marie-Tooths sjukdom]]
{{WikiDoc Help Menu}}