Nakagawa Masanori
Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine.
Rinsho Shinkeigaku. 2009 Nov;49(11):950-2. doi: 10.5692/clinicalneurol.49.950.
Hereditary neuropathies are classified into HMSN/Charcot-Marie-Tooth disease (CMT), familial amyloid polyneuropathy (FAP), hereditary motor neuropathies (HMN) and hereditary sensory (and autonomic) neuropathies (HSAN). The clinical features of HMSN are generally characterized as distal dominant motor and sensory involvements. However, we have reported a novel HMSN with proximal dominancy (HMSN-P) originated in Okinawa and Shiga prefectures, Japan. The gene locus is located in the centromere region of chromosome 3. In 2008, a new family with the HMSN-P was reported from Brazilians of Japanese ancestry. This Brazilian family was initially diagnosed as having "a familial ALS". The HMSN-P linked to ch.3 is not limited in Japan, but may be present in the worldwide. The overseas scientific research for the elucidation of the mechanism of HMSN-P supported by JSPS KAKENHI (21406026) is planning. Recently several other types of HMSN-P have been reported; HMSN-P with urinary disturbance and paroxysmal dry cough, a patient with both CMT 1A and mild spinal muscular atrophy and CMT1A with severe paresis of the proximal lower limb muscles. Therefore the clinical concept of HMSN is not limited as the disease with distal dominant motor sensory involvement. HMSN has the wider spectrum from distal to proximal and motor/sensory to autonomic neuropathies.
遗传性神经病分为遗传性运动感觉神经病/夏科-马里-图斯病(CMT)、家族性淀粉样多神经病(FAP)、遗传性运动神经病(HMN)和遗传性感觉(及自主神经)神经病(HSAN)。遗传性运动感觉神经病的临床特征通常表现为以远端为主的运动和感觉受累。然而,我们报道了一种起源于日本冲绳县和滋贺县的具有近端优势的新型遗传性运动感觉神经病(HMSN-P)。该基因位点位于3号染色体的着丝粒区域。2008年,一个有日本血统的巴西家庭报道了患有HMSN-P的新病例。这个巴西家庭最初被诊断为患有“家族性肌萎缩侧索硬化症”。与3号染色体相关的HMSN-P并不局限于日本,可能在全球范围内都存在。由日本学术振兴会科研资助金(21406026)支持的关于阐明HMSN-P发病机制的海外科研正在筹备中。最近又报道了其他几种类型的HMSN-P;伴有排尿障碍和阵发性干咳的HMSN-P、一名同时患有CMT 1A和轻度脊髓性肌萎缩症的患者以及伴有近端下肢肌肉严重麻痹的CMT1A。因此,遗传性运动感觉神经病的临床概念并不局限于以远端为主的运动感觉受累疾病。遗传性运动感觉神经病具有从远端到近端、从运动/感觉神经病到自主神经病的更广泛谱系。