Rinsho Shinkeigaku (Clinical Neurology)

Original Article

A clinical report of hereditary motor and sensory neuropathy with proximal dominance in Shiga prefecture

Mitsuo Takahashi, M.D.1), Yoshiyuki Mitsui, M.D.1), Shiro Yorifuji, M.D.2), Yuusaku Nakamura, M.D.3), Yoshihumi Tsukamoto, M.D.4) and Kazuhiro Nishimoto, M.D.5)

1)Department of Neurology, Kinki University School of Medicine
2)Course of Health Science, Graduate School of Medicine, Osaka University
3)Department of Neurology, Sakai Hospital, Kinki University School of Medicine
4)Physical Check Up Center, Sumitomo Hospital
5)Department of Neurology, Nara Kasuga Hospital

We followed eight hereditary motor and sensory neuropathy patients with proximal dominance (HMSN-P) in Shiga prefecture from 1984 to 2007. There were 4 men and 4 women from two families showing autosomal and dominant prepotency. These families were related by marriage. The average onset of disease was at 53.4±8.9 (40-68) years-old. Initial symptoms were difficulty of standing up, difficulty elevating their arms, limping, or numbness. The main feature was neurogenic muscular atrophy with proximal dominance. All deep tendon reflexes were decreased or nonexistent. Paresthesia in the hands and feet and/or decreased vibratory sense in the legs were found in six patients. High CK blood levels were recognized in three patients. EMG in four patients revealed neurogenic pattern. Nerve conduction study was conducted in two patients. MCV of the median nerve and of the tibial posterior nerve, also SCV of the median nerve and of the sural nerve were within normal range in all nerves. Amplitudes of sensory action potential or of M wave were decreased or nonexistent in five of eight nerves, and distal latency of M waves was delayed in three of four nerves. These data suggests dysfunction of distal parts of the peripheral nerve fibers and axonal degeneration of the nerve trunk. Seven patients have died, and their average death age was 69.1±8.2 (52-77) years-old. Their average affected period was 16.6 (4-30) years. Their clinical history resembles Okinawa-type HMSN-P, but without the painful muscle cramps which are distinctive Okinawa-type signs.

(CLINICA NEUROL, 47: 571－576, 2007)
key words: autosomal dominant heredity, proximal atrophy, sensory disturbance, adult onset, Shiga prefecture

(Received: 31-Mar-07)