title: NEFL N98S mutation: another cause of dominant intermediate Charcot-Marie-Tooth disease with heterogeneous early-onset phenotype.
abstract: The purpose of this study was to describe a pedigree with NEFL N98S mutation associated with a dominant intermediate Charcot-Marie-Tooth disease (DI-CMT) and heterogeneous early-onset phenotype. The pedigree comprised two patients, the proband and her son, aged 38 and 5 years. The proband, evaluated at age 31, showed delayed motor milestones that, as of the second decade, evolved into severe phenotype consisting of sensorimotor neuropathy, pes cavus, clawing hands, gait and kinetic cerebellar ataxia, nystagmus and dysarthria, she being wheelchair bound. By then, a working diagnosis of sporadic early onset cerebellar ataxia with peripheral neuropathy was established. Screening of mutations associated with SCA and autosomal recessive cerebellar ataxias was negative. Her son showed a mild phenotype characterized by delayed motor milestones, and lower-limb hypotonia and areflexia. Electrophysiology in both patients showed nerve conduction slowing in the intermediate range, both in proximal and distal nerve segments, but where compound muscle action potentials exhibited severe attenuation there was conduction slowing down to the demyelinating range. In the proband, cranial magnetic resonance imaging (MRI) showed cerebellar atrophy, electromyography disclosed active denervation in tibialis anterior, and MRI of lower-limb musculature demonstrated widespread and distally accentuated muscle fatty atrophy; furthermore, on water sensitive MRI sequences there was edema of calf muscles. We conclude that the NEFL N98S mutation is associated with a DI-CMT phenotype characterized by early-onset sensorimotor neuropathy delaying motor milestones, which may evolve into a severe and complex clinical picture including cerebellar ataxia.
authors.affiliation: Service of Neurology, University Hospital "Marqués de Valdecilla (IDIVAL)", University of Cantabria (UC), Santander, Spain. joseberciano51@hotmail.com.|"Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", Santander, Spain. joseberciano51@hotmail.com.
authors.forename: José
authors.initials: J
authors.lastname: Berciano
authors.affiliation: Molecular Neurogenomics Group, VIB Department of Molecular Genetics, University of Antwerp, Antwerp, Belgium.|Neurogenetics Laboratory, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium.
authors.forename: Kristien
authors.initials: K
authors.lastname: Peeters
authors.affiliation: "Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", Santander, Spain.|Service of Clinical Neurophysiology, University Hospital "Marqués de Valdecilla (IDIVAL)", UC, Santander, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: García
authors.affiliation: Service of Neurology, University Hospital of Salamanca, Salamanca, Spain.
authors.forename: Tomás
authors.initials: T
authors.lastname: López-Alburquerque
authors.affiliation: "Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", Santander, Spain.|Service of Radiology, University Hospital "Marqués de Valdecilla (IDIVAL)", UC, Santander, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Gallardo
authors.affiliation: Service of Pediatric Neurology, University Hospital of Salamanca, Salamanca, Spain.
authors.forename: Arantxa
authors.initials: A
authors.lastname: Hernández-Fabián
authors.affiliation: Service of Neurology, University Hospital "Marqués de Valdecilla (IDIVAL)", University of Cantabria (UC), Santander, Spain.|"Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", Santander, Spain.
authors.forename: Ana L
authors.initials: AL
authors.lastname: Pelayo-Negro
authors.affiliation: Molecular Neurogenomics Group, VIB Department of Molecular Genetics, University of Antwerp, Antwerp, Belgium.|Neurogenetics Laboratory, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium.
authors.forename: Els
authors.initials: E
authors.lastname: De Vriendt
authors.affiliation: Service of Neurology, University Hospital "Marqués de Valdecilla (IDIVAL)", University of Cantabria (UC), Santander, Spain.|"Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)", Santander, Spain.
authors.forename: Jon
authors.initials: J
authors.lastname: Infante
authors.affiliation: Molecular Neurogenomics Group, VIB Department of Molecular Genetics, University of Antwerp, Antwerp, Belgium.|Neurogenetics Laboratory, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium.
authors.forename: Albena
authors.initials: A
authors.lastname: Jordanova
mesh_terms: D000328:Adult; D017668:Age of Onset; D001284:Atrophy; D002524:Cerebellar Ataxia / Q000235:genetics* / Q000473:pathology; D002531:Cerebellum / Q000473:pathology; D002607:Charcot-Marie-Tooth Disease / Q000150:complications / Q000235:genetics* / Q000473:pathology; D002675:Child, Preschool; D004252:DNA Mutational Analysis; D004576:Electromyography; D005260:Female; D005838:Genotype; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D018482:Muscle, Skeletal / Q000473:pathology; D016900:Neurofilament Proteins / Q000235:genetics*; D010375:Pedigree; D010641:Phenotype; D016133:Polymerase Chain Reaction
chemical_list: D016900:Neurofilament Proteins; C044882:neurofilament protein L
keywords: Cerebellar ataxia; Charcot–Marie–Tooth disease types 2E and 1F; Dominant intermediate Charcot–Marie–Tooth disease; Muscle edema; Muscle fatty atrophy; NEFL N98S mutation