Diagnostic value of ultrastructural nerve examination in Charcot-Marie-Tooth disease: two CMT 1B cases with pseudo-recessive inheritance

Acta Neuropathol. 2007 Apr;113(4):443-9. doi: 10.1007/s00401-007-0196-7. Epub 2007 Feb 10.

Abstract

We report two sporadic patients of CMT disease in different consanguineous families. The electrophysiological examination led to the diagnosis of a severe demyelinating neuropathy. The nerve biopsies exhibited numerous outfoldings of the myelin sheaths and onion-bulb proliferations. The consanguinity and the histological findings pointed to a diagnosis of CMT 4B. However, the detection of abnormal and regular widenings between the major dense lines of the myelin lamellae by electron microscopy led us to search for a P0 gene mutation. Two heterozygous mutations of this gene were identified: S63F and N131Y. Different aspects of uncompacted myelin lamellae have been described in some cases of P0 mutations and a few now appear to be quite specific to it. More than 30 genes are implicated in CMT and as mutation search is time- and money-consuming, we believe that in some selected patients ultrastructural examination of nerves, among other criteria, helps orientate the molecular diagnosis of CMT.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Asparagine / genetics
  • Charcot-Marie-Tooth Disease / diagnosis*
  • Charcot-Marie-Tooth Disease / genetics*
  • Child
  • Consanguinity
  • DNA Mutational Analysis / methods
  • Demyelinating Diseases / genetics*
  • Demyelinating Diseases / physiopathology
  • Female
  • Genes, Recessive*
  • Humans
  • Microscopy, Electron, Transmission
  • Mutation
  • Myelin P0 Protein / genetics*
  • Myelin Sheath / ultrastructure
  • Peripheral Nerves / pathology
  • Peripheral Nerves / ultrastructure
  • Phenylalanine / genetics
  • Serine / genetics
  • Tyrosine / genetics

Substances

  • Myelin P0 Protein
  • Tyrosine
  • Serine
  • Phenylalanine
  • Asparagine