Charcot–Marie–Tooth disease

The symptoms of CMT often appear in childhood and adolescence, but in some cases, they may not develop until adulthood. The severity and progression of symptoms can vary widely between individuals even among members of the same family. as can difficulty chewing, swallowing, and speaking (due to atrophy of vocal cords). A tremor can develop as muscles waste. Pregnancy has been known to exacerbate CMT, as well as severe emotional stress. Patients with CMT must avoid periods of prolonged immobility, such as when recovering from a secondary injury, as prolonged periods of limited mobility can drastically accelerate symptoms of CMT. Pain is a common symptom experienced by individuals with Charcot-Marie-Tooth disease, often resulting from postural abnormalities, skeletal deformities, muscle fatigue, and cramping. This pain can typically be managed through a combination of physical therapy, orthopedic interventions, and the use of corrective or assistive devices. In cases where these approaches do not provide sufficient relief, analgesic medications may be necessary to alleviate discomfort and improve quality of life. Although the disease is typically slowly progressive and not life-threatening, the degree of disability can vary. Some people may live relatively normal lives with mild symptoms, while others may require orthopedic supports, physical therapy, or even surgery to manage complications. Charcot-Marie-Tooth disease type 1A (CMT1A) can also include mild enlargement or hypertrophy of leg muscles, particularly the calves, alongside typical symptoms of distal muscle weakness and atrophy. However, this muscle enlargement typically represents pseudohypertrophy due to fatty tissue infiltration rather than actual muscle growth. This hypertrophic type of CMT is not caused by the muscles enlarging directly, but by pseudohypertrophy of the legs as fatty tissue enters the leg muscles. == Causes and genetics ==

Charcot-Marie-Tooth (CMT) disease is an inherited neurological disorder primarily caused by genetic mutations that disrupt critical proteins within peripheral nerves. These mutations predominantly affect proteins essential for the structure and function of the myelin sheath, including peripheral myelin protein 22 (PMP22), myelin protein zero (P0/MPZ), connexin32 (Cx32/GJB1), and periaxin (PRX), leading to demyelination. Additionally, mutations in proteins involved in axonal integrity, such as neurofilament light chain (NF-L), dynamin 2 (DNM2), ganglioside-induced differentiation-associated protein 1 (GDAP1), and mitofusin 2 (MFN2), can cause axonal forms of CMT. Due to the close interaction between Schwann cells (which produce myelin) and axons, mutations affecting Schwann cells often result in secondary axonal degeneration, further complicating disease progression. Ultimately, the pathogenesis of CMT involves the disruption of essential cellular processes, including protein synthesis, sorting, intracellular transport, protein degradation, and mitochondrial function, highlighting the complex molecular mechanisms underlying this disorder. In some forms like X-linked CMT (CMTX), mutations in the GJB1 gene lead to dysfunction in gap junctions within Schwann cells, further impairing nerve signal transmission. == Classification ==

Charcot–Marie–Tooth (CMT) disease is a genetically heterogeneous disorder, meaning that it can be caused by mutations in many different genes. To date, dozens of genes have been linked to various forms of CMT, reflecting the complexity of its molecular basis. As a result, CMT is classified into several major types, such as CMT1, CMT2, CMT4, CMTX, and intermediate forms, based on the pattern of inheritance and whether the primary defect affects the myelin sheath or the axon. CMT1 involves demyelination and is most caused by duplication of the PMP22 gene, while CMT2 is primarily axonal and frequently linked to mutations in genes such as MFN2 or NEFL. X-linked and autosomal recessive forms, like CMTX and CMT4, are also recognized and often associated with more severe or early-onset symptoms. Each type is further divided into subtypes, defined by the specific gene that is mutated. This genetic classification helps guide diagnosis, prognosis, and, potentially, the development of targeted therapies. CMT2D is one of more than 31 recognized subtypes of Charcot–Marie–Tooth disease type 2 (CMT2) and is diagnosed when both motor and sensory deficits are present—such as loss of sensation caused by degeneration of sensory axons. In cases where only motor symptoms are observed without sensory involvement, the condition is classified as distal hereditary motor neuropathy type V (dHMN-V). The reason behind the variability in sensory involvement among patients with GARS1-related neuropathy remains unclear. Symptoms of CMT2D typically include muscle weakness, loss of sensation, reduced reflexes, and muscle atrophy, which are similar to those seen in both CMT1 and other CMT2 variants. The severity and combination of symptoms vary widely among patients, particularly regarding the extent of sensory involvement. and is thought to be caused by aberrant gain-of-function missense mutations. Many different mutations have been found in CMT2D patients, and how mutations in GARS1 cause CMT2D remains unclear. However, mutant glycyl-tRNA synthetase (GlyRS) is thought to interfere with transmembrane receptors, causing motor disease, and that mutations in the gene could disrupt the ability of GlyRS to interact with its cognate RNA, disrupting protein production. The GARS1 mutations present in CMT2D cause a deficient amount of glycyl-tRNA in cells, preventing the elongation phase of protein synthesis. Elongation is a key step in protein production, so when a deficiency of glycyl-tRNA exists, protein synthesis is unable to continue at glycine sites. GARS1 mutations also stall initiation of translation due to a stress response that is induced by glycine addition failure. By stalling elongation and initiation of translation, CMT2D mutations in GARS1 cause translational repression, meaning that overall translation is inhibited. GARS1-associated axonal neuropathy is a progressive condition that deteriorates over time. Although the precise mechanisms driving the chronic neurodegeneration caused by mutant glycyl-tRNA synthetase (GlyRS) remain unclear, one proposed theory involves disrupted vascular endothelial growth factor (VEGF) signaling. The mutant GlyRS aberrantly interacts with neuronal transmembrane receptors, such as neuropilin 1 (Nrp1) and VEGF receptors, interfering with normal signaling pathways and contributing to the development of neuropathy. The mutation can appear in the GJB1 gene coding for the connexin 32 protein, a gap junction protein expressed in Schwann cells. Because this protein is also present in oligodendrocytes, demyelination can appear in the CNS as well. Schwann cells create the myelin sheath by wrapping their plasma membranes around the axon. Demyelinating Schwann cells cause abnormal axon structure and function. They may cause axon degeneration, or they may simply cause axons to malfunction. ==Diagnosis==

Charcot–Marie–Tooth (CMT) disease can be diagnosed using a combination of three primary methods: nerve conduction studies, nerve biopsy, and genetic testing. Nerve conduction studies assess the velocity of electrical impulses traveling through nerves, whereas nerve biopsy entails the examination of small samples of nerve tissue. Genetic testing can conclusively diagnose CMT by identifying specific known mutations linked to the condition though not all genetic markers for CMT are currently known. Initial signs of CMT often include lower leg weakness, such as foot drop, and foot deformities like high arches or hammertoes. However, these symptoms alone do not provide enough information for a diagnosis. Individuals showing signs of CMT should be referred to a neurologist or rehabilitation medicine specialist for further evaluation and treatment. During a physical examination, the physician may assess muscle strength such as asking the patient to walk on their heels or resist applied pressure on their legs and check for sensory loss and reduced deep-tendon reflexes, such as the knee-jerk response. A detailed family history is also important, as CMT is an inherited condition. While the absence of a family history does not rule out CMT, it can help the physician distinguish it from other causes of neuropathy, such as diabetes, toxin exposure, or certain medications. == Treatment and management ==

There is no cure for CMT, but its symptoms can be managed to maintain quality of life. Physical and occupational therapy can help preserve muscle strength, flexibility, and mobility Treadmill training in patients has especially been shown to improve walking and balancing over time. Strength training paired with creatine supplements can also help as it compensates for weak distal muscles. This can then help alleviate the chronic fatigue that comes with CMT. == History ==

Charcot-Marie-Tooth disease was first discovered in 1886 by three scientists: Jean-Martin Charcot (1825–1893) and his assistant Pierre Marie (1853–1940), In their original publication, titled “Concerning a Special Form of Progressive Muscular Atrophy,” Charcot and Marie acknowledged that similar cases had been previously published in medical literature. Their findings described hereditary neuropathy, marked by gradual muscle wasting and diminished sensation in the extremities. This crucial discovery helped establish CMT as a distinct clinical entity, differentiating it from other neuromuscular conditions such as muscular dystrophies. Over the years, advancements in neurogenetics have led to the identification of various genetic mutations responsible for the disease, significantly enhancing our understanding of its pathogenesis and classification. Charcot also noted that prior descriptions of the disease were neither objective nor thorough. Most of the earlier accounts merely mentioned that CMT was hereditary. As a result, Charcot felt it was essential to provide a comprehensive description of the disease, ensuring that it received the attention it deserved. == Public figures with CMT ==

• US country music singer Alan Jackson. Jackson was definitively diagnosed in his early 50s. • US actor Julie Newmar. She played the original Catwoman in the 1960s Batman television series. • US Paralympic cyclist Anthony Zahn. He won a bronze medal at the 2008 Beijing Paralympic Games. • UK cultural and disability studies academic Professor George McKay. His books include ''Shakin' All Over: Popular Music and Disability'' (2014). • US Paralympic swimmer Jamal Hill, bronze medallist at the Tokyo 2021 Paralympic Games. • US actress Isabelle Tate was reported to have died of a rare variant of the disease in 2025. == See also ==