A very rare neurodegenerative disorder. Clinical features include deafness, polyneuropathy, and optic atrophy. The distal muscular atrophy resembles those observed in Charcot-Marie-Tooth Disease.
Optic Atrophy Polyneuropathy and Deafness Syndrome.
Very rare, less than 20 patients identified.
Possible mutation of PRPS1 (phosphoribosyl pyrophosphate synthetase 1) which is an isoform of the PRPS gene family and is ubiquitously expressed in human tissues, including cochlea. The enzyme mediates the biochemical step critical for purine metabolism and nucleotide biosynthesis.
Diagnosis is based on clinical criteria, including a rapidly progressive polyneuropathy with distal muscular atrophy associated with blindness caused by optic nerve atrophy and neurosensorial deafness. Paraparesis is frequent.
Check respiratory function (clinical, chest radiographs, arterial blood gas analysis); postoperative ventilatory support may be necessary. Normal response to neuromuscular blocking agents (atracurium and mivacurium tested). Succinylcholine is best avoided considering muscle anomalies.
Other condition to be considered
☞Charcot-Marie-Tooth Disease: Characterized by muscle weakness and atrophy, most prominent in the legs and the small muscles of the hands. Patients may remain active and have a normal life span. Segmental demyelination of peripheral nervous system including the axons represents classic features of this medical condition. Symptoms usually begin gradually between middle childhood and age 30 years. The most incapacitating symptom is “foot drop,” producing a slapping gait and the associated paresthesias. A decrease in vibration, pain, and thermal sensation in the hand, foot, and lower part of the leg that manifest following a distribution pattern of glove and stocking shape. The disease is slowly progressive, but may arrest spontaneously.
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et al: Mutations in PRPS1, which encodes the phosphoribosyl pyrophosphate synthetase enzyme critical for nucleotide biosynthesis, cause hereditary peripheral neuropathy with hearing loss and optic neuropathy (cmtx5). Am J Hum Genet
A: Familial opticoacoustic nerve degeneration and polyneuropathy. Neurology