What Is CMT2I?
CMT2I is a type of CMT caused by mutations in the MPZ gene. This gene provides instructions for making myelin protein zero, a crucial structural protein essential for the formation of normal peripheral nerve myelin. Mutations in the MPZ gene disrupt the formation and stability of myelin, leading to slowed nerve signal transmission, although signal transmission is only somewhat slowed in CMT2I.
CMT2I is autosomal dominant, meaning that just one of the gene’s two copies needs a mutation to cause this subtype.
Clinical Features
CMT2I is a late-onset subtype, with symptoms usually beginning in the thirties or later. Nerve conduction studies usually show somewhat slowed conduction velocities and reduced amplitudes, consistent with an axonal form of CMT.
CMT2I symptoms may include:
- Weakness in the feet and lower legs
- Muscle atrophy
- Foot drop
- A steppage-style walking pattern
- Foot deformities, including high arches and hammertoes (clawed toes)
- Reduced sensation
- Muscle cramping
- Reduced or absent reflexes
- Enlarged peripheral nerves (hypertrophic nerves)
- Clawing of the fingers
- Spinal curvature, including scoliosis or kyphoscoliosis
- Additional symptoms not listed here
Disease Course
CMT2I shows wide variability in severity and progression. Some individuals remain mildly affected, while others develop a more severe disease. Progression is generally slow, and life expectancy is not reduced.
Why Is the MPZ Gene Also Linked to Other CMT Subtypes?
CMT2I is one of four subtypes caused by mutations in the MPZ gene. The same gene is also associated with CMT1B, CMT2J, and dominant intermediate D (CMTDID). The diagnosis is based on nerve conduction study (NCS) results and certain clinical features at the time of diagnosis.
When NCS results show a demyelinating type of CMT, the diagnosis is typically CMT1B. When NCS results show an axonal type of CMT, the diagnosis is typically CMT2I. If axonal and includes pupil abnormalities (pupils that remain dilated or respond poorly to light) with sensorineural hearing loss, CMT2J is the diagnosis. When NCS results fall between demyelinating and axonal CMT, the diagnosis is dominant intermediate D (CMTDID).
All CMT subtypes lead to eventual axonal degeneration. Over time, nerve conduction results that begin as demyelinating may shift toward a more axonal pattern. In some cases, this can lead a clinician to reference both CMT1 and CMT2. This does not mean that someone has two different types of CMT or that CMT is changing types. Instead, the label reflects the clinical complexity that MPZ-related CMT often exhibits.
