- How can a doctor differentiate between carpal tunnel syndrome and the problems inherent in the hands and arms of CMT patients?
- I have advanced CMT and over the last 12 months have developed symptoms diagnosed as fibromyalgia. Is there a connection between the two? My age is 53 and my CMT has been obvious since my early teens, although not diagnosed until I was 30.
- A friend who works in a hospital is required to receive the hepatitis B immunization. She heard of a person whose CMT was supposed to be triggered by that immunization. She is refusing to be immunized. Should she?
- I am 35 years old and have CMT. Is it OK for me to use a hot tub, considering the high temperature? My mother thought she read that people with CMT should not use a hot tub.
- Question: My Dad has CMT and over the last several years he has suffered from periodic swelling of his feet. Now, his right hand is swollen. Is this a symptom of CMT?
- I'm 37 and have Charcot-Marie-Tooth disease (CMT). I have read that many people with CMT experience very cold and/or very hot feet, as I do, but I have never read an explanation as to why this occurs. Can you help me to understand? And is there any treatment or procedure I can use to alleviate this problem?
- I have a problem with food sticking and being uncomfortable when I eat. Is this something that CMT can cause, or is it likely to be something else?
The carpal tunnel syndrome does not appear to occur with increased frequency in patients with Charcot-Marie-Tooth disease. In the cases where I have diagnosed the condition in patients with CMT disease, I have found that it has been a result of cumulative or repetitive trauma.
The diagnosis is a clinical one, based on the occurrence of wrist and hand pain, numbness and tingling in the hand, intermittently, with activities, and at night. These symptoms are identical to those in patients without CMT disease.
Because CMT disease causes weakness and wasting of all the intrinsic hand muscles, and sensory deficits in all the digits, it is not possible to use those findings to confirm the diagnosis. However, it is possible to look for median nerve irritability at the wrist with provocative maneuvers.
Finally, nerve conduction studies may be helpful in confirming the diagnosis by examining for a relative prolongation of the median motor distal latency as compared to that of the ulnar motor distal latency.
2. I have advanced CMT and over the last 12 months have developed symptoms diagnosed as fibromyalgia. Is there a connection between the two? My age is 53 and my CMT has been obvious since my early teens, although not diagnosed until I was 30.
Most likely fibromyalgia (FM) and CMT are unrelated disorders. The symptoms of the two can overlap. For example, people who have CMT can have fatigue, muscle aches and pains and cramps, and lack of energy, which are common symptoms in FM. I am not sure the diagnosis of FM can be made with confidence in many persons who have CMT, unless the FM symptoms are quite pronounced, particularly in view of the fact that there is no general agreement about what FM is or its cause.
3. A friend who works in a hospital is required to receive the hepatitis B immunization. She heard of a person whose CMT was supposed to be triggered by that immunization. She is refusing to be immunized. Should she?
Some CMT patients also have an autoimmune polyneuropathy as well as CMT. For those patients, we must be concerned about vaccinations. Most CMT patients should not have a reaction other than might be expected in anyone. If the CMT patient has a common reaction to an immunization, the problem will be transitory. However, if the CMT patient has chronic inflammatory neuropathy as well as CMT, the patient could be left with a loss of motor and sensory function. There should not be anything neurotoxic in hepatitis B vaccine; however, there is a protein in some flu vaccines that might produce abnormal response. Unless the patient is hypersensitive or has an autoimmune problem, he/she should be able to tolerate the immunization.
For the person who works in a hospital setting, hepatitis might be a real threat. Hepatitis is a far more serious condition than a reaction to the immunization for hepatitis might be.
I know of no medical literature addressing the effect of ambient temperature on peripheral nerve function in patients with CMT. If you want to use the hot tub, please first discuss it with your neurologist and consider trying brief exposures at lower temperatures to determine whether perceptible changes occur.
Normally, swelling of extremities or joints is not a direct result of CMT, unless there is trauma to a numb joint. An evaluation for arthritis or even a systemic cause of extremity swelling, such as heart failure, would be in order.
6. I'm 37 and have Charcot-Marie-Tooth disease (CMT). I have read that many people with CMT experience very cold and/or very hot feet, as I do, but I have never read an explanation as to why this occurs. Can you help me to understand? And is there any treatment or procedure I can use to alleviate this problem?
Poor tolerance to cold weather is probably due to the loss of muscle mass in feet and legs. The loss of muscle mass due to nerve fiber loss is the reason for the wasting of the legs and feet in individuals with CMT. Decreased muscle mass decreases the amount of blood that goes to the lower limbs. The circulating blood is what keeps the normal temperature in the tissues. Bones, tendons and joints require less amount of blood. Cold feet and cold legs are frequent complaints in individuals with CMT. The only treatment is to use leg warmers and decrease exposure of the affected areas to cold weather.
Hot feet or burning feet is a sign of axonal neuropathy (loss of wiring of the nerves). Involvement of the axons is frequent in CMT. Pain due to the nerve damage in CMT responds to Neurontin (gabapentin) an anticonvulsant. This is a prescription medication that needs to be prescribed, preferably by a neurologist.
I do not think that swallowing problems are commonly related to CMT. There are no convincing reports in the literature to that effect and I have never seen it. Swallowing problems related to the esophagus are very common and this is probably a chance association.