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中间型遗传性运动感觉神经病:电生理学再评估和系统综述。

Intermediate Charcot-Marie-Tooth disease: an electrophysiological reappraisal and systematic review.

机构信息

Service of Neurology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Universidad de Cantabria (UC), and Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Santander, Spain.

Professor Emeritus, Department of Medicine and Psychiatry, "Edificio Escuela Universitaria de Enfermería (cuarta planta)", Avda. de Valdecilla s/n, University of Cantabria, 39008, Santander, Spain.

出版信息

J Neurol. 2017 Aug;264(8):1655-1677. doi: 10.1007/s00415-017-8474-3. Epub 2017 Mar 31.

Abstract

Charcot-Marie-Tooth disease (CMT) is the most frequent form of inherited neuropathy with great variety of phenotypes, inheritance patterns, and causative genes. According to median motor nerve conduction velocity (MNCV), CMT is divided into demyelinating (CMT1) with MNCV below 38 m/s, axonal (CMT2) with MNCV above 38 m/s, and intermediate CMT with MNCV between 25 and 45 m/s. In each category, transmission may be autosomal dominant, autosomal recessive, or X-linked. The nosology of intermediate CMT is controversial because of concerns about electrophysiological delimitation. A systematic computer-based literature search was conducted on PubMed, using the following MeSH: (1) intermediate Charcot-Marie-Tooth; (2) X-linked intermediate Charcot-Marie-Tooth; and (3) X-linked Charcot-Marie-Tooth and electrophysiology. We retrieved 225 articles reporting X-linked CMT or intermediate CMT with electrophysiological information. After eligibility, 156 papers were used for this review. In assessing median MNCV, compound muscle action potential (CMAP) amplitudes were taken into account. In cases with attenuated CMAP and wherever possible, proximal median MNCV was used for accurate definition of conduction slowing in the intermediate range. In the vast majority of males with X-linked CMT associated with GJB1 mutation (CMTX1), median MNCV was intermediate. CMT associated with DRP2 mutation is another well-documented X-linked intermediate disorder. Autosomal dominant intermediate CMT (DI-CMT) encompasses 11 different types; six of them with assigned phenotype MIM number and the remaining five being unnumbered. Based on available electrophysiological information, we wonder if DI-CMTA should be reclassified within CMT2. Autosomal recessive intermediate CMT (RI-CMT) covers four numbered MIM phenotypes though, in accordance with reported electrophysiology, two of them (RI-CMTB and RI-CMTD) should probably be reclassified within AR-CMT2. We conclude that intermediate CMT is a complex inherited syndrome, whose characterization requires a specific electrophysiological protocol comprising evaluation of upper limb proximal nerve trunks when distal CMAP amplitudes are reduced, and that an updated version of MIM phenotype numbering is needed.

摘要

Charcot-Marie-Tooth 病(CMT)是最常见的遗传性周围神经病,具有多种表型、遗传模式和致病基因。根据运动神经传导速度(MNCV)的中位数,CMT 分为脱髓鞘(CMT1),MNCV 低于 38m/s,轴索(CMT2),MNCV 高于 38m/s,以及 MNCV 介于 25 至 45m/s 之间的中间型 CMT。在每个类别中,遗传方式可以是常染色体显性遗传、常染色体隐性遗传或 X 连锁遗传。中间型 CMT 的分类学存在争议,因为人们对电生理学的界定存在担忧。我们在 PubMed 上进行了一项基于计算机的系统文献检索,使用了以下 MeSH:(1)中间型 Charcot-Marie-Tooth;(2)X 连锁中间型 Charcot-Marie-Tooth;(3)X 连锁 Charcot-Marie-Tooth 和电生理学。我们检索了 225 篇报告 X 连锁 CMT 或具有电生理信息的中间型 CMT 的文章。经过资格审查,有 156 篇论文用于本综述。在评估中位数 MNCV 时,我们考虑了复合肌肉动作电位(CMAP)幅度。在 CMAP 幅度减弱的情况下,只要可能,我们就会使用近端正中神经 MNCV 来准确定义中间范围内的传导减慢。在大多数与 GJB1 突变(CMTX1)相关的 X 连锁 CMT 男性中,中位数 MNCV 为中间型。与 DRP2 突变相关的 CMT 是另一种有充分记录的 X 连锁中间性疾病。常染色体显性中间型 CMT(DI-CMT)包括 11 种不同类型;其中 6 种有指定的表型 MIM 编号,其余 5 种没有编号。根据现有的电生理信息,我们想知道 DI-CMTA 是否应该重新归类为 CMT2。常染色体隐性中间型 CMT(RI-CMT)涵盖了 4 种编号的 MIM 表型,尽管根据报告的电生理学,其中 2 种(RI-CMTB 和 RI-CMTD)可能应该重新归类为 AR-CMT2。我们的结论是,中间型 CMT 是一种复杂的遗传性综合征,其特征需要特定的电生理方案来评估,该方案包括在远端 CMAP 幅度降低时评估上肢近端神经干,如果近端神经干的 CMAP 幅度降低,需要评估近端神经干的电生理,并且需要更新 MIM 表型编号。

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