Clinical and electrophysiologic features of HNPP patients with 17p11.2 deletion
1Department of Neurology, Clinical Research Institute, and Neuroscience Research Institute in Seoul National University Hospital, College of Medicine, Seoul National University, Korea.
Objectives:
Although the diagnosis of hereditary neuropathy with liability to pressure palsies (HNPP) is important for correct prognostic evaluation and genetic counseling, the diagnosis is frequently missed or delayed. Our main aim on undertaking this study was to characterize the electrodiagnostic features of HNPP.
Material And Methods:
Clinical, electrophysiologic and molecular studies were performed on Korean HNPP patients with 17p11.2 deletion. The results of electrophysiologic studies were compared with those of Charcot-Marie-Tooth disease type 1 A (CMT1A) patients carrying 17p11.2 duplication.
Results:
Eight HNPP (50 motor, 39 sensory nerves) and six CMT1A (28 motor, 16 sensory nerves) patients were included. Sensory nerve conduction was slow in 97% of HNPP nerves. Motor nerve conduction at common entrapment sites was also abnormally slow in 87.5%, whereas at non-entrapment sites conduction slowing was infrequent. Distal motor latency (DML) was prolonged in 80% of HNPP nerves, and terminal latency index (TLI) was significantly lower in HNPP than in normal controls and in CMT1A patients (P < 0.01). In contrast to CMT1A, where severity of nerve conduction slowing was not different among nerve groups, HNPP sensory nerve conduction was more slowed in the median and ulnar nerves than in the sural nerve (P < 0.01), and DML was more prolonged in the median nerve than in the other motor nerves (P < 0.01). TLIs were significantly lower in HNPP than in the normal control and CMT1A patients for the median and ulnar nerves (P < 0.01), and were also significantly reduced for the peroneal nerve (P < 0.05) compared with those of the normal controls.
Conclusion:
HNPP is characterized electrophysiologically by a generalized neuropathy, superimposed by focal entrapment neuropathies. The slowing of sensory conduction in nearly all nerves and the distal accentuation of motor conduction abnormalities are the main features of background polyneuropathy in HNPP. The distribution and severity of the background electrophysiologic abnormalities are closely related to the topography of common entrapment or compression sites, which suggests the possible pathogenetic role of subclinical pressure injury at these sites in the development of the distinct background polyneuropathy in HNPP.
