Table 1.
Key features of CMT1A and HNPP
|
CMT1A |
HNPP |
|
|---|---|---|
| Duplication of PMP22 | Deletion of PMP22 | |
|
Clinical features |
Age of onset mainly in first two decades |
Painless attacks of numbness, muscular weakness, and atrophy, recurrent and focal |
| Presenting symptom is difficulty walking or running | ||
| Preceded by minor compression on nerve | ||
| Distal symmetrical muscle weakness and wasting, legs > arms | ||
| Age at onset mostly in the second or third decade | ||
| Pes cavus very frequent |
Pes cavus found in 4-47% of patients |
|
| Sensory symptoms (stocking-glove distribution) usually less prominent, legs > arms | ||
| Full recovery in 50% of episodes, usually in days to weeks | ||
| Pain more common than previously recognized |
Sequelae rarely severe |
|
| Large intrafamilial clinical variability | ||
| |
Reflexes absent or depressed |
|
| Large clinical variability between patients, even within family | ||
|
Electrophysiological features |
Homogeneous and diffuse MCV and SCV slowing |
Increase in distal motor latencies, especially of median and peroneal nerve |
| CMAP amplitudes reduced, especially distally in the legs | ||
| Focal motor slowing at entrapment sites | ||
| SNAP amplitudes frequently reduced to absent | ||
| MCV normal to slightly reduced in other segments | ||
| SCV decreased and SNAP amplitudes often reduced | ||
| Neuropathological features | Abnormal myelination over the whole nerve length |
Segmental de-and remyelination |
| Onion bulbs |
Tomacula pathologic hallmark, but not pathognomonic |
|
| Decreased density of myelinated nerve fibres | ||
| Variable large-fibre loss |
CMAP = compound muscle action potential. MCV = motor conduction velocity. SCV = sensory conduction velocity. SNAP = sensory nerve action potentials.