Facial onset sensory and motor neuropathy

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Facial onset sensory and motor neuropathy
Other namesFOSMN

Facial Onset Sensory and Motor Neurono[1]pathy syndrome is an extremely rare disease characterised by sensory and motor loss beginning in the face and spreading to involve an increasingly larger area including the upper arms. Details of the disease, and in particular its aetiology, are currently subject to debate, mainly because FOSMN syndrome is so rare. FOSMN was first described in four patients in 2006 [2] and subsequently in a further six patients [3][4][5] but so far, these ten represent the only reported cases.

Signs and symptoms[edit]

Sensory loss develops over the distribution of the trigeminal nerve and then spreads to involve the scalp and neck. Ultimately paraesthesiae spreads down to the arms. Sensory symptoms are followed by motor deficits which also begin in the face. Motor manifestations are characterised by weakness, atrophy, cramping and fasciculations. Difficulty swallowing and speaking may also develop. Neurophysiology studies show a generalized sensory motor neuronopathy which is most severe cranially.[2]

These features lead FOSMN syndrome to be classed as one of the 'syringomyelia-like' syndromes, a group which also includes Tangier disease.[citation needed]


An immune-mediated component to FOSMN has been suggested based on the response to treatment but so far this has only been described in a single patient.[4]

The specific neuronal subtypes involved in the disease are not clear. Although most features of FOSMN reflect lower motor neuron impairment some findings have suggested upper motor neuron impairment in FOSMN.[5] Involvement of both UMN and LMN might suggest a link between FOSMN and other, better characterised diseases such as amyotrophic lateral sclerosis.[citation needed]




  1. ^ Watanabe, M.; Shiraishi, W.; Yamasaki, R.; Isobe, N.; Sawatsubashi, M.; Yasumatsu, R.; Nakagawa, T.; Kira, J. (2018). "Oral phase dysphagia in facial onset sensory and motor neuronopathy". Brain and Behavior. 8 (6): e00999. doi:10.1002/brb3.999. PMC 5991595. PMID 29781209.
  2. ^ a b S. Vucic, D. Tian, P. Siao Tick Chong, M. E. Cudkowicz, E. T. Hedley-Whyte, and D. Cros Facial onset sensory and motor neuronopathy (FOSMN syndrome): a novel syndrome in neurology Brain (2006) 129(12): 3384-3390
  3. ^ Isoardo, G. and Troni, W. (2008), Sporadic bulbospinal muscle atrophy with facial-onset sensory neuropathy. Muscle Nerve, 37: 659–662. doi:10.1002/mus.20991
  4. ^ a b Toshihiro Hokonohara, Hiroshi Shigeto, Yuji Kawano, Yasumasa Ohyagi, Michiya Uehara, Jun-ichi Kira. Facial onset sensory and motor neuronopathy (FOSMN) syndrome responding to immunotherapies. Journal of the Neurological Sciences - 15 December 2008 (Vol. 275, Issue 1, Pages 157-158, doi:10.1016/j.jns.2008.07.021)
  5. ^ a b Fluchere, F., Verschueren, A., Cintas, P., Franques, J., Serratrice, J., Weiller, P. J., Azulay, J. P., Pouget, J. and Attarian, S. (2011), Clinical features and follow-up of four new cases of facial-onset sensory and motor neuronopathy. Muscle Nerve, 43: 136–140. doi:10.1002/mus.21884

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