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Charcot-Marie-Tooth Disease(s)

Charcot-Marie-Tooth Disease(s)

Patient Information

Characteristics

Background and History

Charcot-Marie-Tooth (CMT) disease consists of a group of disorders with progressive nerve degeneration causing difficulties in movement and sensation.  Many types caused by gene mutations have been described, often with overlapping symptoms and signs, and in some there is associated damage to the optic nerve.  Early-onset (congenital and juvenile) glaucoma can also be present.

Clinical Correlations

Symptoms of weakness, particularly in the arms and legs, often have their onset in late childhood or early adulthood.  The disease is relentlessly progressive and often the size of muscles decreases (atrophy).  The feet are frequently deformed (pes cavus with hammer toes).  Changes in sensation and sometimes numbness are common.  Diagnostic tests such the ability of nerves to carry signals (nerve conduction) can be helpful.  Mental impairment is uncommon.  A few patients suffer hearing loss.

Genetics

Inheritance

More than 40 gene mutations have been identified in Charcot-Marie-Tooth disease.  Inheritance patterns include autosomal dominant, autosomal recessive, X-linked dominant, and X-linked recessive.  Due to the overlapping signs and symptoms among the various types of CMT and the variable degrees of severity, gene testing may be the only way to determine which specific condition is present.  It may also be necessary to determine the risk of recurrence among subsequent generations.

Pedigree

Autosomal dominant

Autosomal dominant disorders require only one mutation for the disease to be expressed.  Since an affected parent has two chromosomes, only one of which has the mutant gene, parents can expect that half (50%) of their children will receive that one and inherit the disease.  It is common for individuals that inherit the mutation, however, to not have evidence of the disease (nonpenetrance).

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Sample pedigree of autosomal dominant inheritance

Autosomal dominant inheritance leads to a vertical pattern of transmission

Autosomal recessive

In order for autosomal recessive disorders to be expressed, offspring generally must inherit two mutations, one from each carrier parent.  Carriers with only one mutation, such as the parents, do not have clinical disease.  Note that carrier parents can expect that 1 in 4 children (25%) will inherit both mutations and have the disorder, 2 in 4 children (50%) will be carriers like their parents, while 1 in 4 children (25%) inherit neither mutation.

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Sample pedigree of autosomal recessive inheritance

In order for autosomal recessive disorders to be expressed, offspring generally must inherit two mutations, one from each carrier parent. Carriers with only one mutation, such as the parents, do not have clinical disease. Note that carrier parents can expect that 1 in 4 children (25%) will inherit both mutations and have the disorder, 2 in 4 children (50%) will be carriers like their parents, while 1 in 4 children (25%) inherit neither mutation.

X-linked dominant, father affected

X-linked inheritance patterns result when disease-causing mutations are located on the X chromosome.  Males have one X chromosome while females have two.  A mutation on the male's X chromosome frequently is lethal or renders him unable to reproduce.  However, in rare cases when males have children, they can expect that all of then will inherit the condition. 

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Sanple pedigree of X-linked dominant inheritance, father affected

X-linked inheritance patterns result when disease-causing mutations are located on the X chromosome. Males have one X chromosome while females have two. A mutation on the male's X chromosome frequently is lethal or at least renders them unable to reproduce. However, in rare cases when males have children, they can expect that all of then will inherit the condition.

X-linked dominant, mother affected

X-linked inheritance patterns result from mutations located on the X chromosome.  Females have two X chromosomes of which only one carries a mutation in X-linked dominant disorders.  This usually results in expression of the disease and women with a single mutation have the disorder caused by the mutation.  Half of their offspring, male and female, will inherit the mutation.  Men, with only one X chromosome, will always have the condition if they inherit the one with the mutation. Men would transmit it to all of their offspring.  Without a modifying normal gene on a second X chromosome, X-linked dominant conditions are frequently lethal in such males. The result is a vertical transmission pattern, usually from female to female.

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X-linked dominant, mother affected

X-linked inheritance patterns result from mutations located on the X chromosome. Females have two X chromosomes of which only one carries a mutation in X-linked dominant disorders. This usually results in expression of the disease and women with a single mutation have the disorder caused by the mutation. Half of their offspring, male and female, will inherit the mutation. Men, with only one X chromosome, will always have the condition if they inherit the one with the mutation. Men would transmit it to all of their offspring. Without a modifying normal gene on a second X chromosome, X-linked dominant conditions are frequently lethal in such males. The result is a vertical transmission pattern, usually from female to female.

X-linked recessive, father affected

X-linked disorders are caused by a mutation on the X chromosome and both sexes can pass this to their children.  If the mutation is in a recessive gene and carried by the father, he has the disease since his only X chromosome is mutant and he has no normal X to blunt the effects of the abnormal gene.  His sons only receive his Y chromosome and thus are all normal.  However, all his daughters receive his one and only X chromosome and will be healthy 'carriers'.  Thus such males will have no affected children but half their grandsons from those daughters will have the same disease as he does.

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Sample pedigree of X-linked recessive inheritance, father affected

X-linked disorders are caused by a mutation on the X chromosome and both sexes can pass this to their children. If the mutation is in a recessive gene and carried by the father, he has the disease since his only X chromosome is mutant and he has no normal X to blunt the effects of the abnormal gene. His sons only receive his Y chromosome and thus are all normal. However, all his daughters receive his one and only X chromosome and will be healthy 'carriers'. Thus such males will have no affected children but half their grandsons from those daughters will have the same disease as he does.

X-linked recessive, carrier mother

X-linked disorders are caused by a mutation on the X chromosome and both sexes can pass this to their children.  If the mutation is in a recessive gene and carried by the mother, she usually does not have the disease since the normal X chromosome without the mutation neutralizes the mutation in the abnormal X chromosome.  However, half her sons will inherit the mutation-containing X chromosome and therefore have the X-linked disease.  Half the daughters will inherit the mutation-bearing X chromosome and are usuallly healthy 'carriers'.

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Sample pedigree of X-linked recessive inheritance, carrier mother

X-linked disorders are caused by a mutation on the X chromosome and both sexes can pass this to their children. If the mutation is in a recessive gene and carried by the mother, she usually does not have the disease since the normal X chromosome without the mutation neutralizes the mutation in the abnormal X chromosome. However, half her sons will inherit the mutation-containing X chromosome and therefore have the X-linked disease. Half the daughters will inherit the mutation-bearing X chromosome and are usuallly healthy 'carriers'.

Diagnosis and Prognosis

A neurologist should be consulted to determine the diagnosis.  Management requires a multidisciplinary team of neurologists, orthopedic surgeons, physical and vocational therapists, pain specialists, and audiologists.  The foot deformities can be minimized with surgery and certain medications help with the nerve pain.  Ophthalmologists should be consulted to rule out or treat glaucoma.

Many individuals have only mild disease and lead nearly normal lives.  Most patients have some degree of disability (walking, manipulating objects, etc.) but longevity is generally not impacted.

Web Resources

Web Resource Printout Display
http://www.ninds.nih.gov/disorders/charcot_marie_tooth/detail_charcot_marie_tooth.htm
http://www.charcot-marie-tooth.org/
http://ghr.nlm.nih.gov/condition/charcot-marie-tooth-disease

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