Neuropathy progression in CMT 1A

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NEUROLOGY 2008;70:378-383

Neuropathy progression in Charcot-Marie-Tooth disease type 1A

M. E. Shy, MD, L. Chen, MA, E. R. Swan, BS, R. Taube, K. M.

Krajewski, MS, D. Herrmann, MD, R. A. , MD and M. P. McDermott,

PhD

From the Department of Neurology (M.E.S., E.R.S., R.T., K.M.K.,

R.A.L.) and Center for Molecular Medicine and Genetics (M.E.S.),

Wayne State University, Detroit, MI; and Departments of Biostatistics

and Computational Biology (L.C., M.P.M.) and Neurology (D.H.,

M.D.M.), University of Rochester, NY.

Objective: To determine the rate of disease progression in Charcot-

Marie-Tooth disease type 1A (CMT1A).

Background: CMT1A is the most common inherited peripheral neuropathy,

affecting approximately 1:5,000 people irrespective of ethnic

background or gender. There is no cure for CMT1A. Clinical trials are

being initiated that use the CMT Neuropathy Score (CMTNS), a

composite score based on patient symptoms, signs, and

neurophysiologic abnormalities, as the primary outcome variable. The

sensitivity of the CMTNS or any other score to change over time, as a

measure of CMT1A progression, has yet to be determined.

Methods: We determined the CMTNS as well as the Neuropathy Impairment

Score (NIS) on 72 patients followed for up to 8 years. The rate of

disease progression was evaluated for the CMTNS and NIS using mixed

effects linear regression models, adjusting for age and gender.

Results: Both CMTNS and NIS showed changes over time. The CMTNS

increased an average of 0.686 points per year (95% CI 0.461 to 0.911,

p 0.0001). The NIS increased 1.368 points per year on average (95%

CI 0.616 to 2.121, p = 0.0005). There was a suggestion that the rate

of progression increased with age.

Conclusion: Progression of CMT1A can be detected by both the CMT

Neuropathy Score (CMTNS) and the Neuropathy Impairment Score (NIS).

This supports the feasibility of clinical trials to detect a slowing

of disease progression using either or both of these scales as

outcome measures. Since the CMTNS combines symptoms, signs, and

electrophysiology and the NIS is based solely on the neurologic

examination, the two scales may be complementary.