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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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Charcot's joints
From Gale Encyclopedia of Medicine, 4/6/01 by Dorothy Elinor Stonely

Definition

Charcot's joints is a progressive degenerative disease of the joints caused by nerve damage resulting in the loss of ability to feel pain in the joint and instability of the joint.

Description

Charcot's joints, also called neuropathic joint disease, is the result of two conditions present in the joint. The first factor is the inability to feel pain in the joint due to nerve damage. The second factor is that injuries to the joint go unnoticed leading to instability and making the joint more susceptible to further injury. Repeated small injuries, strains and even fractures can go unnoticed until finally the joint is permanently destroyed. Loss of the protective sensation of pain is what leads to the disintegration of the joint and often leads to deformity in the joint.

Although this condition can affect any joint, the knee is the joint most commonly involved. In individuals with diabetes mellitus, the foot is most commonly affected. The disease can involve only one joint or it may affect two or three joints. More than three affected joints is very rare. In all cases, the specific joint(s) affected depends on the location of the nerve damage.

Causes & symptoms

Many diseases and injuries can interfere with the ability to feel pain. Conditions such as diabetes mellitus, spinal injuries and diseases, alcoholism, and even syphilis can all lead to a loss of the ability to feel pain in some areas. Lack of pain sensation may also be congenital.

The symptoms of Charcot's joints can go unnoticed for some time and may be confused with osteoarthritis in the beginning. Swelling and stiffness in a joint without the expected pain, or with less pain than would be expected, are the primary symptoms of this condition. As the condition progresses, however, the joint can become very painful due to fluid build-up and bony growths.

Diagnosis

Charcot's joints is suspected when a person with a disease that impairs pain sensation exhibits painless swelling and/or stiffness in a joint. Standard x rays will show damage to the joint, and may also show abnormal bone growth and calcium deposits. Floating bone fragments from previous injuries may also be visible.

Treatment

In the early stages of Charcot's joints, braces to stabilize the joints can help stop or minimize the damage. When the disease has progressed beyond braces, surgery can sometimes repair the joint. If the damage is extensive, an artificial joint may be necessary.

Prognosis

Treatment of the disease causing loss of pain perception may help to slow the damage to the joints.

Prevention

Preventing, or effectively managing the underlying disease can slow or in some cases reverse joint damage, but the condition cannot be prevented.

Further Reading

For Your Information

    Books

  • Resnick, Donald. Diagnosis of Bone and Joint Disorders. Philadelphia: W.B. Saunders, 1994.

Gale Encyclopedia of Medicine. Gale Research, 1999.

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