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      CMT subtypes and disease burden in patients enrolled in the Inherited Neuropathies Consortium natural history study: a cross-sectional analysis

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          Abstract

          Background

          The international Inherited Neuropathy Consortium (INC) was created with the goal of obtaining much needed natural history data for patients with Charcot-Marie-Tooth (CMT) disease. We analysed clinical and genetic data from patients in the INC to determine the distribution of CMT subtypes and the clinical impairment associated with them.

          Methods

          We analysed data from 1652 patients evaluated at 13 INC centres. The distribution of CMT subtypes and pathogenic genetic mutations were determined. The disease burden of all the mutations was assessed by the CMT Neuropathy Score (CMTNS) and CMT Examination Score (CMTES).

          Results

          997 of the 1652 patients (60.4%) received a genetic diagnosis. The most common CMT subtypes were CMT1A/ PMP22 duplication, CMT1X/ GJB1 mutation, CMT2A/ MFN2 mutation, CMT1B/ MPZ mutation, and hereditary neuropathy with liability to pressure palsy/ PMP22 deletion. These five subtypes of CMT accounted for 89.2% of all genetically confirmed mutations. Mean CMTNS for some but not all subtypes were similar to those previously reported.

          Conclusions

          Our findings confirm that large numbers of patients with a representative variety of CMT subtypes have been enrolled and that the frequency of achieving a molecular diagnosis and distribution of the CMT subtypes reflects those previously reported. Measures of severity are similar, though not identical, to results from smaller series. This study confirms that it is possible to assess patients in a uniform way between international centres, which is critical for the planned natural history study and future clinical trials. These data will provide a representative baseline for longitudinal studies of CMT.

          Clinical trial registration

          ID number NCT01193075.

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          Most cited references25

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          Charcot-Marie-Tooth disease subtypes and genetic testing strategies.

          Charcot-Marie-Tooth disease (CMT) affects 1 in 2,500 people and is caused by mutations in more than 30 genes. Identifying the genetic cause of CMT is often necessary for family planning, natural history studies, and for entry into clinical trials. However genetic testing can be both expensive and confusing to patients and physicians. We analyzed data from 1,024 of our patients to determine the percentage and features of each CMT subtype within this clinic population. We identified distinguishing clinical and physiological features of the subtypes that could be used to direct genetic testing for patients with CMT. Of 1,024 patients evaluated, 787 received CMT diagnoses. A total of 527 patients with CMT (67%) received a genetic subtype, while 260 did not have a mutation identified. The most common CMT subtypes were CMT1A, CMT1X, hereditary neuropathy with liability to pressure palsies (HNPP), CMT1B, and CMT2A. All other subtypes accounted for less than 1% each. Eleven patients had >1 genetically identified subtype of CMT. Patients with genetically identified CMT were separable into specific groups based on age of onset and the degree of slowing of motor nerve conduction velocities. Combining features of the phenotypic and physiology groups allowed us to identify patients who were highly likely to have specific subtypes of CMT. Based on these results, we propose a strategy of focused genetic testing for CMT, illustrated in a series of flow diagrams created as testing guides. Copyright © 2010 American Neurological Association.
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            Reliability of the CMT neuropathy score (second version) in Charcot-Marie-Tooth disease.

            The Charcot-Marie-Tooth neuropathy score (CMTNS) is a reliable and valid composite score comprising symptoms, signs, and neurophysiological tests, which has been used in natural history studies of CMT1A and CMT1X and as an outcome measure in treatment trials of CMT1A. Following an international workshop on outcome measures in Charcot-Marie-Tooth disease (CMT), the CMTNS was modified to attempt to reduce floor and ceiling effects and to standardize patient assessment, aiming to improve its sensitivity for detecting change over time and the effect of an intervention. After agreeing on the modifications made to the CMTNS (CMTNS2), three examiners evaluated 16 patients to determine inter-rater reliability; one examiner evaluated 18 patients twice within 8 weeks to determine intra-rater reliability. Three examiners evaluated 63 patients using the CMTNS and the CMTNS2 to determine how the modifications altered scoring. For inter- and intra-rater reliability, intra-class correlation coefficients (ICCs) were ≥0.96 for the CMT symptom score and the CMT examination score. There were small but significant differences in some of the individual components of the CMTNS compared with the CMTNS2, mainly in the components that had been modified the most. A longitudinal study is in progress to determine whether the CMTNS2 is more sensitive than the CMTNS for detecting change over time. © 2011 Peripheral Nerve Society.
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              Charcot-Marie-Tooth disease: frequency of genetic subtypes and guidelines for genetic testing.

              Charcot-Marie-Tooth disease (CMT) is a clinically and genetically heterogeneous group of diseases with approximately 45 different causative genes described. The aims of this study were to determine the frequency of different genes in a large cohort of patients with CMT and devise guidelines for genetic testing in practice. The genes known to cause CMT were sequenced in 1607 patients with CMT (425 patients attending an inherited neuropathy clinic and 1182 patients whose DNA was sent to the authors for genetic testing) to determine the proportion of different subtypes in a UK population. A molecular diagnosis was achieved in 62.6% of patients with CMT attending the inherited neuropathy clinic; in 80.4% of patients with CMT1 (demyelinating CMT) and in 25.2% of those with CMT2 (axonal CMT). Mutations or rearrangements in PMP22, GJB1, MPZ and MFN2 accounted for over 90% of the molecular diagnoses while mutations in all other genes tested were rare. Four commonly available genes account for over 90% of all CMT molecular diagnoses; a diagnostic algorithm is proposed based on these results for use in clinical practice. Any patient with CMT without a mutation in these four genes or with an unusual phenotype should be considered for referral for an expert opinion to maximise the chance of reaching a molecular diagnosis.
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                Author and article information

                Journal
                J Neurol Neurosurg Psychiatry
                J. Neurol. Neurosurg. Psychiatr
                jnnp
                jnnp
                Journal of Neurology, Neurosurgery, and Psychiatry
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0022-3050
                1468-330X
                August 2015
                27 November 2014
                : 86
                : 8
                : 873-878
                Affiliations
                [1 ]Departments of Neurology, Massachusetts General Hospital , Boston, Massachusetts, USA
                [2 ]University of South Florida Epidemiology Center , Tampa, Florida, USA
                [3 ]MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology , London, UK
                [4 ]Departments of Neurology, IRCCS Foundation, Carlo Besta Neurological Institute , Milan, Italy
                [5 ]Departments of Neurology, University of Iowa Hospitals and Clinics , Iowa City, Iowa, USA
                [6 ]Departments of Neurology, University of Sydney & Children's Hospital , Sydney, Australia
                [7 ]Departments of Neurology, Stanford University , Stanford, California, USA
                [8 ]Departments of Neurology, Wayne State University , Detroit, Michigan, USA
                [9 ]Departments of Neurology, Nemours Children's Hospital , Orlando, Florida, USA
                [10 ]Departments of Neurology, University of Rochester , Rochester, New York, USA
                [11 ]Departments of Neurology, Vanderbilt University , Nashville, Tennessee, USA
                [12 ]Departments of Neurology, John Hopkins University , Baltimore, Maryland, USA
                [13 ]Departments of Neurology, UCL Institute of Child Health & Great Ormond Street Hospital , London, UK
                [14 ]Departments of Neurology, University of Michigan , Ann Arbor, Michigan, USA
                [15 ]Departments of Neurology, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania, USA
                [16 ]Departments of Neurology, Hospital of the University of Pennsylvania , Philadelphia, Pennsylvania, USA
                [17 ]Departments of Neurology, Center for Human Molecular Genomics, University of Miami , Miami, Florida, USA
                Author notes
                [Correspondence to ] Dr Vera Fridman, 165 Cambridge St. Boston, MA 02114, USA; vfridman@ 123456partners.org
                Article
                jnnp-2014-308826
                10.1136/jnnp-2014-308826
                4516002
                25430934
                ec1e07a1-8c30-4faa-9ebb-9b4ecd8f37a4
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 25 July 2014
                : 6 October 2014
                : 24 October 2014
                Categories
                1506
                Neurogenetics
                Research paper
                Custom metadata
                unlocked

                Surgery
                genetics,neurogenetics,neuropathy
                Surgery
                genetics, neurogenetics, neuropathy

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