Neuropediatrics 2004; 35(5): 274-278
DOI: 10.1055/s-2004-821254
Original Article

Georg Thieme Verlag KG Stuttgart · New York

The Evaluation of Autonomic Nervous Function in a Patient with Hereditary Sensory and Autonomic Neuropathy Type IV with Novel Mutations of the TRKA Gene

T. Ohto1 , N. Iwasaki1 , J. Fujiwara2 , 3 , N. Ohkoshi4 , S. Kimura2 , K. Kawade1 , R. Tanaka1 , A. Matsui1
  • 1Department of Pediatrics, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
  • 2Tsukuba College of Technology, Tsukuba, Ibaraki, Japan
  • 3Department of Health Science, Health Science University, Yamanashi, Japan
  • 4Department of Neurology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
Further Information

Publication History

Received: October 15, 2003

Accepted after Revision: June 28, 2004

Publication Date:
08 November 2004 (online)

Abstract

We report on a 10-year-old girl with anhidrosis and insensibility to pain, but no severe mental retardation or self-mutilation, diagnosed as hereditary sensory and autonomic neuropathy type IV (HSAN IV). Genetic analysis of her TRKA gene, which is responsible for HSAN IV, revealed two novel missense mutations in the tyrosine kinase domain. Cardiovascular autonomic nervous system function tests showed normal muscle sympathetic nerve activity associated with arterial baroreflex, reduced skin sympathetic nerve activity in the second and fifth fingers and palms, and abnormal circadian rhythm of cardiovascular autonomic nervous system. These findings have never before been reported in HSAN IV and may provide a clue to the neurological pathophysiology of this disease.

References

  • 1 Fujiwara J, Kimura S, Tsukayama H, Nakahara S, Haibara S, Fujita M. et al . Evaluation of the autonomic nervous system function in children with primary monosymptomatic nocturnal enuresis - power spectrum analysis of heart rate variability using 24-hour Holter electrocardiograms.  Scand J Urol Nephrol. 2001;  35 350-356
  • 2 Hilz M J. Assessment and evaluation of hereditary sensory and autonomic neuropathies with autonomic and neurophysiological examinations.  Clin Auton Res. 2002;  12 (Suppl 1) 133-143
  • 3 Houlden H, King R H, Hashemi-Nejad A, Wood N W, Mathias C J, Reilly M. et al . A novel TRK A (NTRK1) mutation associated with hereditary sensory and autonomic neuropathy type V.  Ann Neurol. 2001;  49 521-525
  • 4 Indo Y, Tsuruta M, Hayashida Y, Karim M A, Ohta K, Kawano T. et al . Mutations in the TRKA/NGF receptor gene in patients with congenital insensitivity to pain with anhidrosis.  Nat Genet. 1996;  13 485-488
  • 5 Indo Y. Genetics of congenital insensitivity to pain with anhidrosis (CIPA) or hereditary sensory and autonomic neuropathy type IV. Clinical, biological and molecular aspects of mutations in TRKA(NTRK1) gene encoding the receptor tyrosine kinase for nerve growth factor.  Clin Auton Res. 2002;  12 (Suppl 1) 120-132
  • 6 Langer J, Goebel H H, Veit S. Eccrine sweat glands are not innervated in hereditary sensory neuropathy type IV. An electron-microscopic study.  Acta Neuropathol (Berl). 1981;  54 199-202
  • 7 Levi-Montalcini R. The nerve growth factor: thirty-five years later.  Biosci Rep. 1987;  7 681-699
  • 8 Maeda S, Fujiwara J, Tsukayama H. Study of thermogram during the postural change in normal puberty children (in Japanese).  Nippon-shounika-gakkai-zasshi. 1996;  100 1587-1593
  • 9 Martin-Zanca D, Oskam R, Mitra G, Copeland T, Barbacid M. Molecular and biochemical characterization of the human trk proto-oncogene.  Mol Cell Biol. 1989;  9 24-33
  • 10 Rafel E, Alberca R, Bautista J, Navarrete M, Lazo J. Congenital insensitivity to pain with anhidrosis.  Muscle Nerve. 1980;  3 216-220
  • 11 Smeyne R J, Klein R, Schnapp A, Long L K, Bryant S, Lewin A. et al . Severe sensory and sympathetic neuropathies in mice carrying a disrupted Trk/NGF receptor gene.  Nature. 1994;  368 246-249

MD, PhD Tatsuyuki Ohto

Institute of Clinical Medicine
University of Tsukuba

1 - 1 - 1 Tennodai

Tsukuba

Ibaraki 305-8575

Japan

Email: tohto@md.tsukuba.ac.jp

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