Hereditary neuropathy with liability to pressure palsy

Hereditary neuropathy with liability to pressure palsy (HNPP) is an autosomal dominant peripheral neuropathy, a condition that affects the nerves.[4] Pressure on the nerves can cause tingling sensations, numbness, pain, weakness, muscle atrophy and even paralysis of the affected area. In normal individuals, these symptoms disappear quickly, but in sufferers of HNPP even a short period of pressure can cause the symptoms to occur. Palsies can last from minutes or days to weeks or even months.[4][1]

Hereditary neuropathy with liability to pressure palsy
Other namesTomaculous neuropathy
Nerve with myelin sheath
SpecialtyNeurology 
CausesGenetic (autosomal dominant mutation in the PMP22 gene)[1]
Diagnostic methodFamily history, Electrophysiologic testing[2]
TreatmentOccupational therapist, ankle/wrist supports[3]

The symptoms may vary—some individuals report minor problems, whilst others experience severe discomfort and disability. In many cases, the symptoms are mild enough to go unnoticed. The time period between episodes is known to vary between individuals. HNPP has not been found to alter the lifespan, although in some cases a decline in quality of life is noticed. Some sufferers (10–15%) report various pains growing in severity with progression of the disease.[1] The nerves most commonly affected are the peroneal nerve at the fibular head (leg and feet), the ulnar nerve at the elbow (arm) and the median nerve at the wrist (palm, thumbs and fingers), but any peripheral nerve can be affected.

It is caused by a mutation in the gene PMP22, which makes peripheral myelin protein 22. This protein has a role in the maintenance of the myelin sheath that insulates nerves,[5] so this condition results in insufficient conductivity in the nerves. HNPP is part of the group of hereditary motor and sensory neuropathy (HMSN) disorders and is linked to Charcot–Marie–Tooth disease (CMT).

Signs and symptoms

Among the signs/symptoms of hereditary neuropathy with liability to pressure palsy are the following (different symptoms are caused by different nerves, such as the foot drop caused by the peroneal nerve[4]):

Causes

Myelinated neuron

The condition is caused by a mutation in one copy of the gene PMP22 (peripheral myelin protein 22, located at locus 17p11.2). This makes it autosomal dominant (which means one parent must be affected).[7] PMP22 is involved in maintaining the myelin sheath that surrounds nerves to facilitate conductivity.[5] A mutation in this gene causes haploinsufficiency, where the activity of the normal gene is insufficient to compensate for the loss of function of the other gene.[8]

Molecular biology/genetics

The peripheral myelin protein 22 gene encodes a 22-kD protein that comprises 2 to 5% of peripheral nervous system myelin.[9]

Overlap with Charcot–Marie–Tooth disease type 1A has been found in Gly94fsX222 (c.281_282insG), due to point mutations in PMP22 that occur in a minority of cases of HNPP. The point mutations missense, nonsense and splice-site have each been alluded to in HNPP.[10]

Diagnosis

In terms of diagnosis of HNPP, measuring nerve conduction velocity may give an indication of the presence of the disease. Other methods via which to ascertain the diagnosis of HNPP are:[4][3]

Treatment

Ankle foot orthosis

There is no current treatment, however management of HNPP can be done via:[3][10]

History

Inherited PNS disorders were first described by Charcot, Marie and Tooth (1886). De Jong (1947) first described HNPP in a Dutch family. Dyck and Lambert (1968) showed nerve conduction studies, and Chance et al. (1993) detected the chromosome deletion in most of the individuals with the HNPP condition.[2][10][11]

See also

References

  1. "Hereditary Neuropathy with Liability to Pressure Palsies". April 2007.
  2. RESERVED, INSERM US14 -- ALL RIGHTS. "Orphanet: Hereditary neuropathy with liability to pressure palsies". www.orpha.net. Retrieved 18 August 2016.
  3. "Hereditary neuropathy with pressure palsies (HNPP)". NHS. NHS.uk. Retrieved 18 August 2016.
  4. Bird, Thomas D. (1 January 1993). "Hereditary Neuropathy with Liability to Pressure Palsies". GeneReviews. Retrieved 6 August 2016.update 2014
  5. Watila MM, Balarabe SA (2015). "Molecular and clinical features of inherited neuropathies due to PMP22 duplication". Journal of the Neurological Sciences. 355 (1–2): 18–24. doi:10.1016/j.jns.2015.05.037. PMID 26076881.
  6. "OMIM Entry - # 162500 - NEUROPATHY, HEREDITARY, WITH LIABILITY TO PRESSURE PALSIES; HNPP". www.omim.org. Retrieved 18 August 2016.
  7. Kuhlenbäumer, G.; Stögbauer, F.; Ringelstein, E. B.; Young, P. (2006-01-16). Hereditary Peripheral Neuropathies. Springer Science & Business Media. pp. 96, 126. ISBN 9783798515864.
  8. Vallat, Jean-Michel; Weis, Joachim; Neuropathology, International Society of (2014-10-20). Peripheral Nerve Disorders: Pathology and Genetics. John Wiley & Sons. ISBN 9781118618431.
  9. "OMIM Entry - * 601097 - PERIPHERAL MYELIN PROTEIN 22; PMP22". omim.org. Retrieved 2016-08-18.
  10. van Paassen, Barbara W; Kooi, Anneke J van der; Spaendonck-Zwarts, Karin Y van; Verhamme, Camiel; Baas, Frank; Visser, Marianne de (19 March 2014). "PMP22 related neuropathies: Charcot-Marie-Tooth disease type 1A and Hereditary Neuropathy with liability to Pressure Palsies". Orphanet Journal of Rare Diseases. 9 (1): 38. doi:10.1186/1750-1172-9-38. ISSN 1750-1172. PMC 3994927. PMID 24646194.
  11. Sango, Kazunori; Yamauchi, Junji (2014-02-13). Schwann Cell Development and Pathology. Springer Science & Business Media. p. 83. ISBN 9784431547648. Retrieved 18 August 2016.

Further reading

Classification
External resources
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