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Autosomal recessive axonal neuropathy with neuromyotonia(NMAN)

MedGen UID:
1814513
Concept ID:
C5700127
Disease or Syndrome
Synonyms: Gamstorp-Wohlfart syndrome; MYOKYMIA, MYOTONIA, AND MUSCLE WASTING; Neuromyotonia and axonal neuropathy, autosomal recessive; NMAN
SNOMED CT: Autosomal recessive axonal neuropathy with neuromyotonia (711406009); Autosomal recessive neuromyotonia with axonal neuropathy (711406009); Myokymia, myotonia and muscle wasting (711406009); Gamstorp-Wohlfart syndrome (711406009)
Modes of inheritance:
Autosomal recessive inheritance
MedGen UID:
141025
Concept ID:
C0441748
Intellectual Product
Source: Orphanet
A mode of inheritance that is observed for traits related to a gene encoded on one of the autosomes (i.e., the human chromosomes 1-22) in which a trait manifests in individuals with two pathogenic alleles, either homozygotes (two copies of the same mutant allele) or compound heterozygotes (whereby each copy of a gene has a distinct mutant allele).
 
Gene (location): HINT1 (5q23.3)
 
Monarch Initiative: MONDO:0007646
OMIM®: 137200
Orphanet: ORPHA324442

Definition

NMAN is an autosomal recessive neurologic disorder characterized by onset in the first or second decade of a peripheral axonal neuropathy predominantly affecting motor more than sensory nerves. The axonal neuropathy is reminiscent of Charcot-Marie-Tooth disease type 2 (see, e.g., CMT2A1, 118210) and distal hereditary motor neuropathy (see, e.g., HMND1, 182960). Individuals with NMAN also have delayed muscle relaxation and action myotonia associated with neuromyotonic discharges on needle EMG resulting from hyperexcitability of the peripheral nerves (summary by Zimon et al., 2012). [from OMIM]

Additional description

From MedlinePlus Genetics
Autosomal recessive axonal neuropathy with neuromyotonia is a disorder that affects the peripheral nerves. Peripheral nerves connect the brain and spinal cord to muscles and to sensory cells that detect sensations such as touch, pain, heat, and sound.

Axonal neuropathy, a characteristic feature of this condition, is caused by damage to a particular part of peripheral nerves called axons, which are the extensions of nerve cells (neurons) that transmit nerve impulses. In people with autosomal recessive axonal neuropathy with neuromyotonia, the damage primarily causes progressive weakness and wasting (atrophy) of muscles in the feet, legs, and hands. Muscle weakness may be especially apparent during exercise (exercise intolerance) and can lead to an unusual walking style (gait), frequent falls, and joint deformities (contractures) in the hands and feet. In some affected individuals, axonal neuropathy also causes decreased sensitivity to touch, heat, or cold, particularly in the lower arms or legs.

Another feature of this condition is neuromyotonia (also known as Isaac syndrome). Neuromyotonia results from overactivation (hyperexcitability) of peripheral nerves, which leads to delayed relaxation of muscles after voluntary tensing (contraction), muscle cramps, and involuntary rippling movement of the muscles (myokymia).  https://medlineplus.gov/genetics/condition/autosomal-recessive-axonal-neuropathy-with-neuromyotonia

Clinical features

From HPO
Foot dorsiflexor weakness
MedGen UID:
356163
Concept ID:
C1866141
Finding
Weakness of the muscles responsible for dorsiflexion of the foot, that is, of the movement of the toes towards the shin. The foot dorsiflexors include the tibialis anterior, the extensor hallucis longus, the extensor digitorum longus, and the peroneus tertius muscles.
Abnormal foot morphology
MedGen UID:
1762829
Concept ID:
C5399834
Anatomical Abnormality
An abnormality of the skeleton of foot.
Fasciculations
MedGen UID:
5124
Concept ID:
C0015644
Sign or Symptom
Fasciculations are observed as small, local, involuntary muscle contractions (twitching) visible under the skin. Fasciculations result from increased irritability of an axon (which in turn is often a manifestation of disease of a motor neuron). This leads to sporadic discharges of all the muscle fibers controlled by the axon in isolation from other motor units.
Isaac syndrome
MedGen UID:
116151
Concept ID:
C0242287
Disease or Syndrome
Peripheral nerve hyperexcitability manifesting as spontaneous discharges originating from motor axons or their terminals, lead to overactivity of muscles, typically manifesting as twitches, cramps and stiffness.
Myokymia
MedGen UID:
146882
Concept ID:
C0684219
Sign or Symptom
Myokymia consists of involuntary, fine, continuous, undulating contractions that spread across the affected striated muscle.
Sensory axonal neuropathy
MedGen UID:
334116
Concept ID:
C1842587
Finding
An axonal neuropathy of peripheral sensory nerves.
Distal sensory impairment
MedGen UID:
335722
Concept ID:
C1847584
Finding
An abnormal reduction in sensation in the distal portions of the extremities.
Muscle spasm
MedGen UID:
52431
Concept ID:
C0037763
Sign or Symptom
Sudden and involuntary contractions of one or more muscles.
Muscle stiffness
MedGen UID:
113151
Concept ID:
C0221170
Sign or Symptom
A condition in which muscles cannot be moved quickly without accompanying pain or spasm.
Muscular atrophy
MedGen UID:
892680
Concept ID:
C0541794
Pathologic Function
The presence of skeletal muscular atrophy (which is also known as amyotrophy).
Elevated circulating creatine kinase concentration
MedGen UID:
69128
Concept ID:
C0241005
Finding
An elevation of the level of the enzyme creatine kinase (also known as creatine phosphokinase (CK; EC 2.7.3.2) in the blood. CK levels can be elevated in a number of clinical disorders such as myocardial infarction, rhabdomyolysis, and muscular dystrophy.
Hyperhidrosis
MedGen UID:
5690
Concept ID:
C0020458
Finding
Abnormal excessive perspiration (sweating) despite the lack of appropriate stimuli like hot and humid weather.

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVAutosomal recessive axonal neuropathy with neuromyotonia

Professional guidelines

PubMed

Xu L, Wang G, Lv X, Zhang D, Yan C, Lin P
Acta Neurol Belg 2022 Oct;122(5):1305-1312. Epub 2022 Jun 29 doi: 10.1007/s13760-022-02006-y. PMID: 35767146

Recent clinical studies

Etiology

Laššuthová P, Brožková DŠ, Krůtová M, Neupauerová J, Haberlová J, Mazanec R, Dvořáčková N, Goldenberg Z, Seeman P
Neurogenetics 2015 Jan;16(1):43-54. Epub 2014 Oct 24 doi: 10.1007/s10048-014-0427-8. PMID: 25342199

Diagnosis

Xu L, Wang G, Lv X, Zhang D, Yan C, Lin P
Acta Neurol Belg 2022 Oct;122(5):1305-1312. Epub 2022 Jun 29 doi: 10.1007/s13760-022-02006-y. PMID: 35767146
Fang J, Huang H, Lei Q, Luo Y, Tang Z, Shi X, Tang JG
BMC Neurol 2022 May 3;22(1):168. doi: 10.1186/s12883-022-02690-6. PMID: 35501818Free PMC Article
Wang Z, Lin J, Qiao K, Cai S, Zhang VW, Zhao C, Lu J
Eur J Med Genet 2019 Mar;62(3):190-194. Epub 2018 Jul 11 doi: 10.1016/j.ejmg.2018.07.009. PMID: 30006059
Laššuthová P, Brožková DŠ, Krůtová M, Neupauerová J, Haberlová J, Mazanec R, Dvořáčková N, Goldenberg Z, Seeman P
Neurogenetics 2015 Jan;16(1):43-54. Epub 2014 Oct 24 doi: 10.1007/s10048-014-0427-8. PMID: 25342199
Caetano JS, Costa C, Baets J, Zimon Phd M, Venâncio Phd M, Saraiva Phd J, Negrão L, Fineza I
Pediatr Neurol 2014 Jan;50(1):104-7. Epub 2013 Oct 13 doi: 10.1016/j.pediatrneurol.2013.08.028. PMID: 24131582

Therapy

Xu L, Wang G, Lv X, Zhang D, Yan C, Lin P
Acta Neurol Belg 2022 Oct;122(5):1305-1312. Epub 2022 Jun 29 doi: 10.1007/s13760-022-02006-y. PMID: 35767146

Prognosis

Xu L, Wang G, Lv X, Zhang D, Yan C, Lin P
Acta Neurol Belg 2022 Oct;122(5):1305-1312. Epub 2022 Jun 29 doi: 10.1007/s13760-022-02006-y. PMID: 35767146
Fang J, Huang H, Lei Q, Luo Y, Tang Z, Shi X, Tang JG
BMC Neurol 2022 May 3;22(1):168. doi: 10.1186/s12883-022-02690-6. PMID: 35501818Free PMC Article

Clinical prediction guides

Xu L, Wang G, Lv X, Zhang D, Yan C, Lin P
Acta Neurol Belg 2022 Oct;122(5):1305-1312. Epub 2022 Jun 29 doi: 10.1007/s13760-022-02006-y. PMID: 35767146

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