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Research paper
Natural history of transthyretin Val30Met familial amyloid polyneuropathy: analysis of late-onset cases from non-endemic areas
  1. Haruki Koike1,
  2. Fumiaki Tanaka1,
  3. Rina Hashimoto1,
  4. Minoru Tomita1,
  5. Yuichi Kawagashira1,
  6. Masahiro Iijima1,
  7. Junko Fujitake2,
  8. Toru Kawanami3,
  9. Takeo Kato3,
  10. Masahiko Yamamoto4,
  11. Gen Sobue1
  1. 1Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
  2. 2Department of Neurology, Kyoto City Hospital, Kyoto, Japan
  3. 3Third Department of Internal Medicine, Yamagata University Faculty of Medicine, Yamagata, Japan
  4. 4Department of Speech Pathology and Audiology, Aichi Gakuin University School of Health Science, Aichi, Japan
  1. Correspondence to Dr Haruki Koike, Department of Neurology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan; koike-haruki{at}


Objective The objective of this study was to elucidate the natural history of late-onset transthyretin Val30Met-associated familial amyloid polyneuropathy (FAP ATTR Val30Met) in non-endemic areas.

Methods The authors retrospectively assessed the development of major clinical landmarks and abnormalities of nerve conduction and cardiac examination indices in 50 patients with an age of onset older than 50 years and no relationship to endemic foci.

Results Once the neuropathic process was initiated, sensory and motor symptoms of both the upper and lower extremities appeared within a period of one and a half years. Digestive and orthostatic symptoms also tended to occur in the early phase of the disease, whereas urinary symptoms appeared in the middle of the disease progress. Along with pain in the extremities, these symptoms progressed over time and significantly disturbed the quality of life during the late phase of the disease, resulting in the need for wheelchair use. Although cardiomyopathy became clinically apparent only in the late phase of the disease, it was found to be the major cause of death. The mean duration of the disease onset to death was 7.3 years. Although values at the time of diagnosis were extremely variable, serial measurements of electrophysiological indices, the cardiothoracic ratio and interventricular septum thickness indicated a steady exacerbation in these outcomes among patients within a span of a couple of years.

Conclusions The ages of onset of each clinical landmark were extremely variable between patients. However, once an initial symptom appeared, the chronological sequence of other clinical landmarks tended to be uniform, occurring within a relatively short time span.

  • Amyloid
  • amyloidosis
  • familial amyloid polyeuropathy
  • natural history
  • transthyretin
  • neuropathy
  • GBS
  • peripheral neuropath
  • motor neuron disease

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  • See Editorial commentary p 121

  • Linked article 301582.

  • Funding This work was supported by grants from the Ministry of Health, Labour and Welfare (Research on intractable diseases, H23-012) and the Ministry of Education, Culture, Sports, Science and Technology of Japan (Grants-in-Aid for Scientific Research, 21591076).

  • Competing interests None.

  • Ethics approval The study was approved by the ethics committee of Nagoya University Graduate School of Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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