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Charcot disease

Amyotrophic lateral sclerosis (ALS, sometimes called Lou Gehrig's disease) is a progressive, invariably fatal motor neurone disease. In ALS, both the upper motor neurons and the lower motor neurons degenerate or die, ceasing to send messages to muscles. Unable to function, the muscles gradually weaken, waste away (atrophy), and twitch (fasciculations). Eventually, the ability of the brain to start and control voluntary movement is lost. more...

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ALS causes weakness with a wide range of disabilities. Eventually, all muscles under voluntary control are affected, and patients lose their strength and the ability to move their arms, legs, and body. When muscles in the diaphragm and chest wall fail, patients lose the ability to breathe without help from mechanical ventilation. Most people with ALS die from respiratory failure, usually within 3 to 5 years from the onset of symptoms. However, about 10 % of ALS patients survive for 10 or more years.

Epidemiology

As many as 20,000 Americans have ALS, and an estimated 5,000 people in the United States are diagnosed with the disease each year. ALS is one of the most common neuromuscular diseases worldwide, and people of all races and ethnic backgrounds are affected. ALS most commonly strikes people between 40 and 60 years of age, but younger and older people also can develop the disease. Men are affected more often than women.

In 90 to 95 % of all ALS cases, the disease occurs apparently at random with no clearly associated risk factors. Patients do not have a family history of the disease, and their family members are not considered to be at increased risk for developing ALS.

About 5 to 10 % of all ALS cases are inherited. The familial form of ALS usually results from a pattern of inheritance that requires only one parent to carry the gene responsible for the disease. About 20 % of all familial cases result from a specific genetic defect that leads to mutation of the enzyme known as superoxide dismutase 1 (SOD1). Research on this mutation is providing clues about the possible causes of motor neuron death in ALS. Not all familial ALS cases are due to the SOD1 mutation, therefore other unidentified genetic causes clearly exist.

Symptoms

The onset of ALS may be so subtle that the symptoms are frequently overlooked. The earliest symptoms may include twitching, cramping, or stiffness of muscles; muscle weakness affecting an arm or a leg; slurred and nasal speech; or difficulty chewing or swallowing. These general complaints then develop into more obvious weakness or atrophy that may cause a physician to suspect ALS.

The parts of the body affected by early symptoms of ALS depend on which muscles in the body are damaged first. In some cases, symptoms initially affect one of the legs, and patients experience awkwardness when walking or running or they notice that they are tripping or stumbling more often. Some patients first see the effects of the disease on a hand or arm as they experience difficulty with simple tasks requiring manual dexterity such as buttoning a shirt, writing, or turning a key in a lock. Other patients notice speech problems.

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Duke Researchers Identify Cause Of Charcot-Marie-Tooth Disease
From PT Magazine, 8/1/04

Neurogeneticists at Duke University's Center for Human Genetics and their international colleagues have identified an abnormality in mitochondria, which produce energy for cells and fuels the nerves required for muscle control, as the cause of Charcot-Marie-Tooth disease (CMT).

There is no cure for CMT, one of the most common inherited disorders, affecting about 150,000 Americans. Symptoms include weakening of the feet and hands that gradually spreads to the arms and legs. The only treatments for the degenerative nerve disorder are physical therapy and moderate activity to maintain muscle strength. People with CMT often have to use leg braces, and some become wheelchair-dependent.

Researchers say the mitochondria finding could help in developing treatments for CMT and increase scientists' understanding of diseases affecting the peripheral nervous system, according to a Duke University press release.

The Duke study, published in the journal Nature Genetics, included seven families with a form of the disorder called CMT type 2A. Scientists found that the families had defects in a gene called mitofusin 2, which is critical to mitochondrial movement. Using gene therapy to restore lost gene function in people with CMT might serve as an effective treatment, the researchers suggest.

For more information, visit the Muscular Dystrophy Association Web site.

Copyright American Physical Therapy Association Aug 2004
Provided by ProQuest Information and Learning Company. All rights Reserved

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