Hereditary neuropathy with liability to pressure palsy

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Hereditary neuropathy with liability to pressure palsy
Other namesTomaculous neuropathy
Nerve.nida.jpg
Nerve with myelin sheath
Specialty Neurology   OOjs UI icon edit-ltr-progressive.svg
CausesGenetic (autosomal dominant PMP22 deletion) [1]
Diagnostic method Family history, Electrophysiologic testing [2]
TreatmentOccupational therapist, ankle/wrist supports [3]

Hereditary neuropathy with liability to pressure palsy (HNPP) is a peripheral neuropathy, a condition that affects the nerves. [4] Pressure on the nerves can cause tingling sensations, numbness, pain, weakness, muscle atrophy and even paralysis of the affected area. In normal individuals, these symptoms disappear quickly, but in sufferers of HNPP even a short period of pressure can cause the symptoms to occur. Palsies can last from minutes or days to weeks or even months. [4] [1]

Contents

HNPP is caused by a mutation in the gene PMP22 , which makes peripheral myelin protein 22. This protein has a role in the maintenance of the myelin sheath that insulates nerves, resulting in insufficient conductivity in the nerves. HNPP is part of the group of hereditary motor and sensory neuropathy (HMSN) disorders and is linked to Charcot–Marie–Tooth disease (CMT). [5]

Signs and symptoms

Symptoms and symptom onset vary; some individuals are diagnosed in childhood, others in adulthood, some report minor problems, whilst others experience severe discomfort and disability. In many cases, symptoms are mild enough to go unnoticed. The time period between episodes is known to vary between individuals. HNPP has not been found to alter the lifespan, although in some cases a decline in quality of life is noticed. Some sufferers (10–15%) report various pains growing in severity with progression of the disease. [1] The nerves most commonly affected are the peroneal nerve at the fibular head (leg and feet), the ulnar nerve at the elbow (arm) and the median nerve at the wrist (palm, thumbs and fingers), but any peripheral nerve can be affected. Among the signs/symptoms are the following (different symptoms are caused by different nerves, such as the foot drop caused by the peroneal nerve [4] ): Other HNPP symptoms can include: Partial hearing loss and facial numbness (cranial nerves can be afflicted by HNPP), intolerable fatigue and pain, sensation loss and muscle weakness in the hands and feet. There is a wide range in the severity of these symptoms [6]

Causes

Myelinated neuron Myelinated neuron.jpg
Myelinated neuron

HNPP is typically caused by autosomal dominant deletion of PMP22 (peripheral myelin protein 22 at locus 17p11.2). [8] PMP22 displays haploinsufficiency, such that the normal copy of the gene's activity is insufficient to compensate for loss of function of the affected copy. [9] PMP22 point mutations, such as the frameshift mutation Gly94fsX222 (c.281_282insG), can cause clinical overlap between PNPP and Charcot–Marie–Tooth disease type 1A. Missense, nonsense, and splice site mutations have been described. [10]

PMP22 encodes a 22-kD protein that comprises 2 to 5% of peripheral nervous system myelin. [11] It is involved in maintaining the myelin sheath that surrounds peripheral nerves to facilitate conductivity. [5]

Diagnosis

Diagnosis of HNPP is established via genetic testing. The diagnosis should be suspected in individuals who display the clinical syndrome, display abnormal nerve conduction study findings, and have known family history of HNPP. [4] [3]

Treatment

Ankle foot orthosis AFO Ankle Foot Orthosis Orthotic Brace.JPG
Ankle foot orthosis

There is no current treatment, however management of HNPP can be done via: [3] [10]

Epidemiology

HNPP is a rare disorder. Partly because it is so rare and partly because many people who have it only experience mild symptoms, it is difficult to tell what percentage of people have it. One range of estimates is from one in 50,000 up to about one in 33,333. [1] Another is from one in 119,049 up to one in 6,250. [12] In a study of newborns in Korea who all got a genetic test for the disorder, around one in 1,698 of the newborns had it. [12]

History

Inherited peripheral nervous system disorders were first described by Charcot, Marie and Tooth (1886). De Jong (1947) first described HNPP in a Dutch family. Dyck and Lambert (1968) showed nerve conduction studies, and Chance et al. (1993) detected the chromosome deletion in most of the individuals with the HNPP condition. [2] [10] [13]

See also

Related Research Articles

<span class="mw-page-title-main">Charcot–Marie–Tooth disease</span> Neuromuscular disease

Charcot–Marie–Tooth disease (CMT) is a hereditary motor and sensory neuropathy of the peripheral nervous system characterized by progressive loss of muscle tissue and touch sensation across various parts of the body. This disease is the most commonly inherited neurological disorder, affecting about one in 2,500 people. It is named after those who classically described it: the Frenchman Jean-Martin Charcot (1825–1893), his pupil Pierre Marie (1853–1940), and the Briton Howard Henry Tooth (1856–1925).

Hereditary spastic paraplegia (HSP) is a group of inherited diseases whose main feature is a progressive gait disorder. The disease presents with progressive stiffness (spasticity) and contraction in the lower limbs. HSP is also known as hereditary spastic paraparesis, familial spastic paraplegia, French settlement disease, Strumpell disease, or Strumpell-Lorrain disease. The symptoms are a result of dysfunction of long axons in the spinal cord. The affected cells are the primary motor neurons; therefore, the disease is an upper motor neuron disease. HSP is not a form of cerebral palsy even though it physically may appear and behave much the same as spastic diplegia. The origin of HSP is different from cerebral palsy. Despite this, some of the same anti-spasticity medications used in spastic cerebral palsy are sometimes used to treat HSP symptoms.

<span class="mw-page-title-main">Somatic nervous system</span> Part of the peripheral nervous system

The somatic nervous system (SNS) is made up of nerves that link the brain and spinal cord to voluntary or skeletal muscles that are under conscious control as well as to skin sensory receptors. Specialized nerve fiber ends called sensory receptors are responsible for detecting information within and outside of the body.

<span class="mw-page-title-main">Peripheral neuropathy</span> Nervous system disease affecting nerves beyond the brain and spinal cord

Peripheral neuropathy, often shortened to neuropathy, refers to damage or disease affecting the nerves. Damage to nerves may impair sensation, movement, gland function, and/or organ function depending on which nerves are affected. Neuropathies affecting motor, sensory, or autonomic nerves result in different symptoms. More than one type of nerve may be affected simultaneously. Peripheral neuropathy may be acute or chronic, and may be reversible or permanent.

<span class="mw-page-title-main">Demyelinating disease</span> Any neurological disease in which the myelin sheath of neurons is damaged

A demyelinating disease refers to any disease affecting the nervous system where the myelin sheath surrounding neurons is damaged. This damage disrupts the transmission of signals through the affected nerves, resulting in a decrease in their conduction ability. Consequently, this reduction in conduction can lead to deficiencies in sensation, movement, cognition, or other functions depending on the nerves affected.

<span class="mw-page-title-main">Polyneuropathy</span> Medical condition

Polyneuropathy is damage or disease affecting peripheral nerves in roughly the same areas on both sides of the body, featuring weakness, numbness, and burning pain. It usually begins in the hands and feet and may progress to the arms and legs and sometimes to other parts of the body where it may affect the autonomic nervous system. It may be acute or chronic. A number of different disorders may cause polyneuropathy, including diabetes and some types of Guillain–Barré syndrome.

<span class="mw-page-title-main">Osteochondroma</span> Medical condition

Osteochondromas are the most common benign tumors of the bones. The tumors take the form of cartilage-capped bony projections or outgrowth on the surface of bones exostoses. It is characterized as a type of overgrowth that can occur in any bone where cartilage forms bone. Tumors most commonly affect long bones about the knee and in the forearm. Additionally, flat bones such as the pelvis and scapula may be affected. Hereditary multiple exostoses usually present during childhood. Yet, the vast majority of affected individuals become clinically manifest by the time they reach adolescence. Osteochondromas occur in 3% of the general population and represent 35% of all benign tumors and 8% of all bone tumors. The majority of these tumors are solitary non-hereditary lesions and approximately 15% of osteochondromas occur as hereditary multiple exostoses preferably known as hereditary multiple osteochondromas (HMOs). Osteochondromas do not result from injury and the exact cause remains unknown. Recent research has indicated that multiple osteochondromas is an autosomal dominant inherited disease. Germ line mutations in EXT1 and EXT2 genes located on chromosomes 8 and 11 have been associated with the cause of the disease. The treatment choice for osteochondroma is surgical removal of solitary lesion or partial excision of the outgrowth, when symptoms cause motion limitations or nerve and blood vessel impingements. In hereditary multiple exostoses the indications of surgery are based upon multiple factors that are taken collectively, namely: patient's age, tumor location and number, accompanying symptomatology, esthetic concerns, family history and underlying gene mutation. A variety of surgical procedures have been employed to remedy hereditary multiple exostoses such as osteochondroma excision, bone lengthening, corrective osteotomy and hemiepiphysiodesis. Sometimes a combination of the previous procedures is used. The indicators of surgical success in regard to disease and patient characteristics are greatly disputable. Because most studies of hereditary multiple exostoses are retrospective and of limited sample size with missing data, the best evidence for each of the currently practiced surgical procedures is lacking.

<span class="mw-page-title-main">Fazio–Londe disease</span> Medical condition

Fazio–Londe disease (FLD), also called progressive bulbar palsy of childhood, is a very rare inherited motor neuron disease of children and young adults and is characterized by progressive paralysis of muscles innervated by cranial nerves. FLD, along with Brown–Vialetto–Van Laere syndrome (BVVL), are the two forms of infantile progressive bulbar palsy, a type of progressive bulbar palsy in children.

<span class="mw-page-title-main">Dejerine–Sottas disease</span> Medical condition

Dejerine–Sottas disease, also known as, Dejerine–Sottas syndrome, hereditary motor and sensory polyneuropathy type III, and Charcot–Marie–Tooth disease type 3, is a hereditary neurological disorder characterized by damage to the peripheral nerves, demyelination, and resulting progressive muscle wasting and somatosensory loss. The condition is caused by mutations in various genes and currently has no known cure.

<span class="mw-page-title-main">Myelin protein zero</span> Protein-coding gene in the species Homo sapiens

Myelin protein zero is a single membrane glycoprotein which in humans is encoded by the MPZ gene. P0 is a major structural component of the myelin sheath in the peripheral nervous system (PNS). Myelin protein zero is expressed by Schwann cells and accounts for over 50% of all proteins in the peripheral nervous system, making it the most common protein expressed in the PNS. Mutations in myelin protein zero can cause myelin deficiency and are associated with neuropathies like Charcot–Marie–Tooth disease and Dejerine–Sottas disease.

<span class="mw-page-title-main">GJB1</span> Protein-coding gene in humans

Gap junction beta-1 protein (GJB1), also known as connexin 32 (Cx32), is a transmembrane protein that in humans is encoded by the GJB1 gene. Gap junction beta-1 protein is a member of the gap junction connexin family of proteins that regulates and controls the transfer of communication signals across cell membranes, primarily in the liver and peripheral nervous system. However, the protein is expressed in multiple organs, including in oligodendrocytes in the central nervous system.

<span class="mw-page-title-main">Peripheral myelin protein 22</span> Protein-coding gene in the species Homo sapiens

Peripheral myelin protein 22 (PMP22), also called Growth arrest-specific protein 3 (GAS-3), is a protein which in humans is encoded by the PMP22 gene. Mutations in PMP22 cause changes in the expression of peripheral myelin protein 22 which can result in several neuropathies.

<span class="mw-page-title-main">Hereditary motor and sensory neuropathy</span> Medical condition

Hereditary motor and sensory neuropathies (HMSN) is a name sometimes given to a group of different neuropathies which are all characterized by their impact upon both afferent and efferent neural communication. HMSN are characterised by atypical neural development and degradation of neural tissue. The two common forms of HMSN are either hypertrophic demyelinated nerves or complete atrophy of neural tissue. Hypertrophic condition causes neural stiffness and a demyelination of nerves in the peripheral nervous system, and atrophy causes the breakdown of axons and neural cell bodies. In these disorders, a patient experiences progressive muscle atrophy and sensory neuropathy of the extremities.

Hereditary sensory and autonomic neuropathy (HSAN) or hereditary sensory neuropathy (HSN) is a condition used to describe any of the types of this disease which inhibit sensation.

Neuropathy may refer to:

Roussy–Lévy syndrome, also known as Roussy–Lévy areflexic dystasia, is a rare disorder of humans that results in progressive muscle wasting. It is caused by mutation the s that code for proteins necessary for the functioning of the myelin sheath of the, affecting the conductance of nerve signals and resulting in loss of muscles' ability to move.

Autosomal dominant Charcot–Marie–Tooth disease type 2 with giant axons is a rare subtype of hereditary motor and sensory neuropathy of the axons which is characterized by symptoms similar to those from Charcot–Marie–Tooth disease and autosomal dominant inheritance.

<span class="mw-page-title-main">Hypomyelination-congenital cataract syndrome</span> Medical condition

Hypomyelination-congenital cataract syndrome is a rare autosomal recessive hereditary disorder that affects the brain's white matter and is characterized by congenital cataract, psychomotor development delays, and moderate intellectual disabilities. It is a type of leukoencephalopathy.

X-linked Charcot–Marie–Tooth disease is a group of genetic disorders and a type of Charcot–Marie–Tooth disease characterized by sensory loss associated with muscle weakness and atrophy alongside many other symptoms.

References

  1. 1 2 3 4 Genetics Home Reference (April 2007). "Hereditary neuropathy with liability to pressure palsies". NIH.gov. Retrieved 2020-02-09.
  2. 1 2 3 4 RESERVED, INSERM US14 -- ALL RIGHTS. "Orphanet: Hereditary neuropathy with liability to pressure palsies". www.orpha.net. Retrieved 18 August 2016.{{cite web}}: CS1 maint: numeric names: authors list (link)
  3. 1 2 3 4 5 "Hereditary neuropathy with pressure palsies (HNPP)". NHS. NHS.uk. Retrieved 18 August 2016.
  4. 1 2 3 4 Bird, Thomas D. (1 January 1993). "Hereditary Neuropathy with Liability to Pressure Palsies". GeneReviews. PMID   20301566 . Retrieved 6 August 2016.update 2014
  5. 1 2 Watila MM, Balarabe SA (2015). "Molecular and clinical features of inherited neuropathies due to PMP22 duplication". Journal of the Neurological Sciences. 355 (1–2): 18–24. doi:10.1016/j.jns.2015.05.037. PMID   26076881. S2CID   40080925.
  6. "Hereditary Neuropathy with Liability to Pressure Palsies (HNPP)". Charcot–Marie–Tooth Association. Retrieved 2023-05-03.
  7. "OMIM Entry - # 162500 - NEUROPATHY, HEREDITARY, WITH LIABILITY TO PRESSURE PALSIES; HNPP". www.omim.org. Retrieved 18 August 2016.
  8. Kuhlenbäumer, G.; Stögbauer, F.; Ringelstein, E. B.; Young, P. (2006-01-16). Hereditary Peripheral Neuropathies. Springer Science & Business Media. pp. 96, 126. ISBN   9783798515864.
  9. Vallat, Jean-Michel; Weis, Joachim (2014-10-20). Peripheral Nerve Disorders: Pathology and Genetics. John Wiley & Sons. ISBN   9781118618431.
  10. 1 2 3 van Paassen, Barbara W; Kooi, Anneke J van der; Spaendonck-Zwarts, Karin Y van; Verhamme, Camiel; Baas, Frank; Visser, Marianne de (19 March 2014). "PMP22 related neuropathies: Charcot-Marie-Tooth disease type 1A and Hereditary Neuropathy with liability to Pressure Palsies". Orphanet Journal of Rare Diseases. 9 (1): 38. doi: 10.1186/1750-1172-9-38 . ISSN   1750-1172. PMC   3994927 . PMID   24646194.
  11. "OMIM Entry - * 601097 - PERIPHERAL MYELIN PROTEIN 22; PMP22". omim.org. Retrieved 2016-08-18.
  12. 1 2 Park, Jong Eun; Noh, Seung-Jae; Oh, Mijin; Cho, Dae-Yeon; Kim, So Young; Ki, Chang-Seok (2018-03-15). "Frequency of hereditary neuropathy with liability to pressure palsies (HNPP) due to 17p11.2 deletion in a Korean newborn population". Orphanet Journal of Rare Diseases. 13 (1): 40. doi: 10.1186/s13023-018-0779-5 . ISSN   1750-1172. PMC   5856277 . PMID   29544507.
  13. Sango, Kazunori; Yamauchi, Junji (2014-02-13). Schwann Cell Development and Pathology. Springer Science & Business Media. p. 83. ISBN   9784431547648 . Retrieved 18 August 2016.

Further reading