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Hereditary Neuropathies

By

Michael Rubin

, MDCM, New York Presbyterian Hospital-Cornell Medical Center

Last full review/revision Sep 2019| Content last modified Sep 2019
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NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version

Hereditary neuropathies include a variety of congenital degenerative peripheral neuropathies (eg, Charcot-Marie-Tooth disease).

Hereditary neuropathies are classified as

  • Motor and sensory

  • Sensory and autonomic

Hereditary neuropathies may be primary or secondary to other hereditary disorders, including Refsum disease, porphyria, and Fabry disease.

Motor and sensory neuropathies

There are 3 main types (I, II, and III) of motor and sensory neuropathies; all begin in childhood. Some less common types begin at birth and result in greater disability.

Types I and II (varieties of Charcot-Marie-Tooth disease, also called peroneal muscular atrophy) are the most common; they are usually autosomal dominant disorders but can be X-linked. Type I results from a duplication (extra copy) of the peripheral myelin protein-22 gene (PMP22), located on the short arm of chromosome 17.

Types I and II are characterized by weakness and atrophy, primarily in peroneal and distal leg muscles. Patients often have a family history of neuropathy. Natural history varies: Some patients are asymptomatic and have only slowed conduction velocities (detected on nerve conduction studies); others are more severely affected.

Patients with type I may present in middle childhood with footdrop and slowly progressive distal muscle atrophy, causing stork leg deformity. Intrinsic muscle wasting in the hands begins later. Vibration, pain, and temperature sensation decreases in a stocking-glove pattern. Deep tendon reflexes are absent. High pedal arches or hammertoes may be the only signs in family members who are carriers. Nerve conduction velocities are slow, and distal latencies are prolonged. Segmental demyelination and remyelination occur. Enlarged peripheral nerves may be palpated. The disease progresses slowly and does not affect life span. In one subtype, males have severe symptoms, and females have mild symptoms or may be unaffected.

Type II evolves more slowly; weakness usually develops later in life. Patients have relatively normal nerve conduction velocities but low amplitude sensory nerve action potentials and compound muscle action potentials. Biopsies detect axonal (wallerian) degeneration.

Type III (hypertrophic interstitial neuropathy, Dejerine-Sottas disease), a rare autosomal dominant or recessive disorder, begins in childhood with progressive weakness and sensory loss and absent deep tendon reflexes. Although initially it resembles Charcot-Marie-Tooth disease, the motor weakness progresses more quickly. Demyelination and remyelination occur, producing enlarged peripheral nerves and onion bulbs, detected by nerve biopsy.

Sensory and autonomic neuropathies

Hereditary sensory and autonomic neuropathies are rare. Five types have been described.

Loss of distal pain and temperature sensation is more prominent than loss of vibratory and position sense. The main complication is foot mutilation due to pain insensitivity, resulting in a high risk of infections and osteomyelitis.

Diagnosis

  • Clinical evaluation

  • Electrodiagnostic testing

The characteristic distribution of motor weakness, foot deformities, and family history suggests hereditary neuropathy, which should be confirmed by electrodiagnostic testing.

Genetic analysis is available.

Treatment

  • Supportive care

Bracing helps correct footdrop; orthopedic surgery to stabilize the foot may help.

Physical therapy (to strengthen muscles) and occupational therapy may help; vocational counseling may help prepare young patients to maintain vocational skills despite disease progression.

Key Points

  • Hereditary neuropathies may affect motor and sensory nerves, sensory nerves, sensory and autonomic nerves, or only motor nerves.

  • There are 3 main types of motor and sensory neuropathies, which vary in severity and rate of progression; all begin in childhood.

  • Use braces to correct footdrop and recommend physical and occupational therapy to help patients maintain function; sometimes orthopedic surgery is needed.

Click here for Patient Education
NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
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