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腓骨肌萎缩症的诊断和治疗指南(2024)

制定者:
国外神经外科专家编写小组

2024年2月29日

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摘要:

中英对照

Introduction: Charcot-Marie-Tooth (CMT) disease is classified considering the neurophysiological and histological findings, the inheritance pattern and the underlying genetic defect. In recent years, with the advent of next generation sequencing, genetic complexity has increased exponentially, expanding the knowledge about disease pathways, and having an impact in clinical management. The aim of this guide is to offer recommendations for the diagnosis, prognosis, monitoring and treatment of this disease in Spain.

Material and methods: This consensus guideline has been developed by a multidisciplinary panel encompassing a broad group of professionals including neurologists, neuropediatricians, geneticists, rehabilitators, and orthopaedic surgeons.

Recommendations: The diagnosis is based in the clinical characterization, usually presenting with a common phenotype. It should be followed by an appropriate neurophysiological study that allows for a correct classification, specific recommendations are established for the parameters that should be included. Genetic diagnosis must be approached in sequentially, once the PMP22 duplication has been ruled out if appropriate, a next generation sequencing should be considered taking into account the limitations of the available techniques. To date, there is no pharmacological treatment that modifies the course of the disease, but symptomatic managementis important, as are the rehabilitation and orthopaedic considerations. The latter should be initiated early to identify and improve the patient’s functional impairments, including individualised exercise guidelines, orthotic adaptation, and assessment of conservative surgeries such as tendon transpositions. The follow-up of patients with CMT is exclusively clinical, ancillary testing are not necessary in routine clinical practice.

引言:考虑到神经生理学和组织学结果、遗传模式和潜在的遗传缺陷,对腓骨肌萎缩症(CMT)进行分类。近年来,随着下一代测序的出现,遗传复杂性成倍增加,扩大了关于疾病通路的知识,并在临床管理中产生了影响。本指南的目的是为西班牙本病的诊断、预后、监测和治疗提供建议。
材料和方法:本共识指南由多学科专家小组制定,包括神经科医生、神经儿科医生、遗传学家、康复师和骨科医生等广泛的专业人员。
建议:诊断是基于临床特征,通常表现为常见表型。随后应进行适当的神经生理学研究,以便进行正确分类,并对应纳入的参数制定具体建议。基因诊断必须按顺序进行,一旦适当排除了PMP22重复,应考虑到现有技术的局限性,进行下一代测序。迄今为止,尚无改变病程的药物治疗,但对症治疗很重要,康复和骨科考虑也很重要。后者应早期开始,以识别和改善患者的功能障碍,包括个体化运动指南、矫形器适应和保守手术(如肌腱转位)的评估。CMT患者的随访仅为临床随访,在常规临床实践中无需进行辅助检测。
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腓骨肌萎缩症的诊断和治疗指南(2024)
发布时间:  2024年2月29日
制定者:  
国外神经外科专家编写小组

323人浏览

0收藏

1次下载

摘要

Introduction: Charcot-Marie-Tooth (CMT) disease is classified considering the neurophysiological and histological findings, the inheritance pattern and the underlying genetic defect. In recent years, with the advent of next generation sequencing, genetic complexity has increased exponentially, expanding the knowledge about disease pathways, and having an impact in clinical management. The aim of this guide is to offer recommendations for the diagnosis, prognosis, monitoring and treatment of this disease in Spain.

Material and methods: This consensus guideline has been developed by a multidisciplinary panel encompassing a broad group of professionals including neurologists, neuropediatricians, geneticists, rehabilitators, and orthopaedic surgeons.

Recommendations: The diagnosis is based in the clinical characterization, usually presenting with a common phenotype. It should be followed by an appropriate neurophysiological study that allows for a correct classification, specific recommendations are established for the parameters that should be included. Genetic diagnosis must be approached in sequentially, once the PMP22 duplication has been ruled out if appropriate, a next generation sequencing should be considered taking into account the limitations of the available techniques. To date, there is no pharmacological treatment that modifies the course of the disease, but symptomatic managementis important, as are the rehabilitation and orthopaedic considerations. The latter should be initiated early to identify and improve the patient’s functional impairments, including individualised exercise guidelines, orthotic adaptation, and assessment of conservative surgeries such as tendon transpositions. The follow-up of patients with CMT is exclusively clinical, ancillary testing are not necessary in routine clinical practice.

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