Presentation
Dental abnormalities were present in 88/101 patients for which the information was available (87%). Natal teeth were present in 18/94 (19%). [ncbi.nlm.nih.gov]
Hypodontia means that not all teeth are present. Other names of 4H syndrome include "Ataxia, hypodontia and hypomyelination (AHH)" and "Ataxia, delayed dentition and hypomyelination (ADDH)". [vumc.com]
Clinical findings are non-specific but patients often present with developmental delay, cerebellar signs or spasticity. Some disorders have additional clinical findings. [radiopaedia.org]
If only one copy of a gene’s pair has the mutation, a person will not present with symptoms of 4H leukodystrophy, but will be a carrier of the condition. [chop.edu]
Jaw & Teeth
- Delayed Dentition
Ataxia, delayed dentition and hypomyelination: a novel leukoencephalopathy. Neuropediatrics 2007; 38: 64-70. 4. Vazquez-Lopez M, Ruiz-Martin Y, de Castro-Castro P, Garzo-Fernandez C, Martin-del Valle F, Marquez-de la Plata L. [vumc.com]
GLOSSARY 4H 4H leukodystrophy ADDH ataxia, delayed dentition, and hypomyelination TACH tremor-ataxia with central hypomyelination Footnotes AUTHOR CONTRIBUTIONS Nicole I. [ncbi.nlm.nih.gov]
Skin
- Eruptions
[…] of teeth) is delayed, and the first teeth to erupt are the deciduous molars, not the incisors as usual. [vumc.com]
Childhood development was characterized by occurrence of a progressive cerebellar ataxia, short stature, mental development retardation (IQ = 46), and hypodontia (i.e., absence of deciduous teeth eruption and short tooth roots). [semanticscholar.org]
Delayed dentition with abnormal order of deciduous tooth eruption was reported in 65/91 (71%), with the upper median incisors erupting late or not at all. Hypodontia was present in 71/98 (72%) (figure 1). [ncbi.nlm.nih.gov]
Neurologic
- Cerebellar Sign
Clinical findings are non-specific but patients often present with developmental delay, cerebellar signs or spasticity. Some disorders have additional clinical findings. [radiopaedia.org]
Only one patient, a 21-year-old woman diagnosed at age 16 years when she developed optic neuritis, had no cerebellar signs. [ncbi.nlm.nih.gov]
- Dysarthria
[…] second decade have been described Neurological symptoms include: Late walking Early-onset ataxia (problems with balance and fine motor skills) Deterioration of ataxia with infections with complete or partial recovery Slow progression of ataxia over time Dysarthria [vumc.com]
Children with 4H can have difficult to understand speech (dysarthria) which impacts their ability to communicate even if they understand and know words and language. Learning disabilities. [chop.edu]
- Dysmetria
Many patients had severe intention tremor and dysmetria; in others, gait ataxia was evident, whereas appendicular ataxia was mild. Abnormal smooth pursuit and gaze-evoked nystagmus were present in most patients. [ncbi.nlm.nih.gov]
Treatment
Is There a Treatment? There is no known cure and treatment is symptomatic. Helpful Resources United Leukodystrophy Foundation Children’s Hospital of Philadelphia Leukodystrophy Care Network [huntershope.org]
There is no known cure for 4H leukodystrophy, but treatment is available to manage symptoms and improve the quality of children’s lives. [chop.edu]
Leukodystrophies: classification, diagnosis, and treatment. Neurologist. 2009; 15:319-28, http://dx.doi.org/10.1097/NRL.0b013e3181b287c8 [ Links ] 15. Yang E, Prabhu SP. [scielo.org.mx]
Архив. 3 Thus a statutory definition of deprivation of liberty should adhere to the qualification, life saving treatment, to prevent an expansive interpretation of R (Ferreira) v HM Senior Coroner for Inner South London and others in medical settings. [practicweb.md]
[…] communities does not equip them with the knowledge, skills, attitudes, and cultural capital essential for academic success in mainstream society. 3 Thus a statutory definition of deprivation of liberty should adhere to the qualification, life saving treatment [metroflash.ca]
Etiology
Etiology They can be etiologically subcategorised into those with and without typical peripheral nervous system involvement (usually based on nerve conduction studies): with typical peripheral nervous system involvement hypomyelination with congenital [radiopaedia.org]
Epidemiology
Fardet’s research focuses primarily on the epidemiologic use of glucocorticoids in the general population. To view Dr. Laurence Fardet's publications, visit PubMed Have feedback about this calculator? About the Creator Dr. [mdcalc.com]
Prevention
This prevents the body from completing normal myelination of the brain, and in some cases, the nerves outside the brain. 4H leukodystrophy is the combination of that myelin deficiency and two other conditions: hypogonadotropic hypogonadism (a condition [chop.edu]
Архив. 3 Thus a statutory definition of deprivation of liberty should adhere to the qualification, life saving treatment, to prevent an expansive interpretation of R (Ferreira) v HM Senior Coroner for Inner South London and others in medical settings. [practicweb.md]
[…] does not equip them with the knowledge, skills, attitudes, and cultural capital essential for academic success in mainstream society. 3 Thus a statutory definition of deprivation of liberty should adhere to the qualification, life saving treatment, to prevent [metroflash.ca]
As a few patients show signs of osteosclerosis,11 we hypothesize that a defect of osteoclasts is at the basis of the dentition abnormalities by preventing normal tooth eruption, which necessitates local bone resorption. [ncbi.nlm.nih.gov]