Article Text

other Versions

Download PDFPDF
Research paper
Is overwork weakness relevant in Charcot–Marie–Tooth disease?
  1. G Piscosquito1,
  2. M M Reilly2,
  3. A Schenone3,
  4. G M Fabrizi4,
  5. T Cavallaro4,
  6. L Santoro5,
  7. G Vita6,
  8. A Quattrone7,
  9. L Padua8,
  10. F Gemignani9,
  11. F Visioli10,11,
  12. M Laurà2,
  13. D Calabrese1,
  14. R A C Hughes2,
  15. D Radice12,
  16. A Solari1,
  17. D Pareyson1,
  18. for the CMT-TRIAAL & CMT-TRAUK Group
  1. 1IRCCS Foundation, C. Besta Neurological Institute, Milan, Italy
  2. 2MRC Centre for Neuromuscular diseases, UCL Institute of Neurology, London, UK
  3. 3Department of Neurology, Ophthalmology and Genetics, University of Genoa, Genoa, Italy
  4. 4Department of Neurological, Neuropsychological, Morphological and Motor Sciences, University of Verona, Verona, Italy
  5. 5Federico II University Department of Neurological Sciences, Naples, Italy
  6. 6Department of Neurosciences, University of Messina, and Clinical Centre NEMO SUD, Fondazione Aurora Onlus, Messina, Italy
  7. 7Neurology Clinic, Magna Graecia University, and Neuroimaging Research Unit, National Research Council, Catanzaro, Italy
  8. 8Department of Neurosciences, Catholic University and Don Gnocchi Foundation, Rome, Italy
  9. 9Department of Neurosciences, University of Parma, Parma, Italy
  10. 10Department of Pharmacological Sciences, University School of Pharmacy, Milan, Italy
  11. 11IMDEA-Food, Madrid, Spain
  12. 12Department of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
  1. Correspondence to Dr Davide Pareyson, Clinic of Central and Peripheral Degenerative Neuropathies Unit, Department of Clinical Neurosciences—IRCCS Foundation, C. Besta Neurological Institute, via Celoria 11, Milan 20133, Italy; davide.pareyson{at}


Background In overwork weakness (OW), muscles are increasingly weakened by exercise, work or daily activities. Although it is a well-established phenomenon in several neuromuscular disorders, it is debated whether it occurs in Charcot–Marie–Tooth disease (CMT). Dominant limb muscles undergo a heavier overload than non-dominant and therefore if OW occurs we would expect them to become weaker. Four previous studies, comparing dominant and non-dominant hand strength in CMT series employing manual testing or myometry, gave contradictory results. Moreover, none of them examined the behaviour of lower limb muscles.

Methods We tested the OW hypothesis in 271 CMT1A adult patients by comparing bilateral intrinsic hand and leg muscle strength with manual testing as well as manual dexterity.

Results We found no significant difference between sides for the strength of first dorsal interosseous, abductor pollicis brevis, anterior tibialis and triceps surae. Dominant side muscles did not become weaker than non-dominant with increasing age and disease severity (assessed with the CMT Neuropathy Score); in fact, the dominant triceps surae was slightly stronger than the non-dominant with increasing age and disease severity.

Discussion Our data does not support the OW hypothesis and the consequent harmful effect of exercise in patients with CMT1A. Physical activity should be encouraged, and rehabilitation remains the most effective treatment for CMT patients.


Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles

  • Editorial commentary
    Satoshi Kuwabara Sonoko Misawa