Presentation
This article presents an in-depth discussion of a case involving a nearly 10-year-old boy with a history of an unspecified form of MD, who presented for endodontic treatment of tooth No. 30 under deep sedation. [ncbi.nlm.nih.gov]
Entire Body System
- Epilepsy
Epilepsy is part of the clinical phenotype in nearly 40% of children with mitochondrial disease, yet the underlying molecular mechanisms remain poorly understood. [ncbi.nlm.nih.gov]
AND ragged red fibers Myoclonus epilepsy and ragged red fibers syndrome Myopathy, mitochondrial Neurogenic muscle weakness, ataxia and retinitis pigmentosa Pearson's syndrome R Kearns-Sayre syndrome Right Kearns-Sayre syndrome 277.87 Excludes Applies [icd9data.com]
If you would like to know more about epilepsy in general, please contact Epilepsy Action. [epilepsy.org.uk]
- Asymptomatic
These studies were initiated after two young, asymptomatic adults harbouring the m.3243A>G mutation died suddenly and unexpectedly. [ncbi.nlm.nih.gov]
Casademont J, Barrientos A, Cardellach F, Rotig A, Grau JM, Montoya J, Beltran B, Cervantes F, Rozman C, Estivill X: Multiple deletions of mtDNA in two brothers with sideroblastic anemia and mitochondrial myopathy and in their asymptomatic mother. [doi.org]
Children may be asymptomatic prior to this event or have varying degrees of underlying developmental disabilities. [clinicaladvisor.com]
- Crying
Although they cannot speak in words, cannot wrap their arms around me, hugging me tight, or wipe the tears I cry, they have an inner force and passion that surpasses their developmental limitations and age. [cnn.com]
Testing multiple blood samples is more sensitive than testing a single random sample, since lactate determination may be affected by several artifacts of collection, including tight tourniquet, patient crying or breath holding, or failure to transport [clinicaladvisor.com]
- Malaise
It is always important to not overdo, which can be tricky since the effects are not felt until later, i.e. post‐excertional malaise. Yet by not pushing oneself too far, improvements in movement will lead to both mental and physical benefits. [holtorfmed.com]
Respiratoric
- Dyspnea
However, the dyspnea and fatigue subsequently got worsened. Tracing back his family history, together with the electromyography, nerve conduction studies, and the result of muscle biopsy, mitochondrial disease was confirmed. [ncbi.nlm.nih.gov]
Patient 11 developed progressive exertional dyspnea; 2 years later, she developed intractable congestive heart failure. Her ECG showed ST depression with T-wave inversion, abnormal Q wave, and left axis deviation. [circ.ahajournals.org]
Cardiovascular
- Heart Disease
Depending on the specific type of mitochondrial disease, common symptoms include muscle weakness, imbalance, gastrointestinal problems, poor growth, liver disease, heart disease, diabetes, visual and hearing issues, lactic acidosis, and developmental [mayoclinic.org]
For example, in adults many “diseases of aging” have been found to have defects of mitochondrial function, including type 2 diabetes, Parkinson’s disease, atherosclerotic heart disease, stroke, Alzheimer’s disease and cancer. [draxe.com]
Mitochondrial diseases cause the most damage to organs that use the most energy. The brain, heart, liver, kidneys and muscles (including muscles of the heart, stomach and intestines) all have large energy needs. [cincinnatichildrens.org]
Eyes
- Visual Impairment
It is licensed for the treatment of visual impairment in adolescent and adult patients with Leber's Hereditary Optic Neuropathy ( SPC: Raxone ). It costs £6364.00 for 30 days' treatment ( MIMs, March 2017). [nice.org.uk]
Musculoskeletal
- Muscle Spasm
Muscle twitching, weakness, and lack of coordination are common. Other possible symptoms may include: seizures, hearing loss, eye and speech problems, as well as exercise intolerance (muscle cramping, spasms, fatigue), and short stature. [newenglandconsortium.org]
Neurologic
- Stroke
[…] syndrome, unspecified eye Approximate Synonyms Bilat Kearns-Sayre syndrome Bilateral Kearns-Sayre syndrome Defect, mitochondrial metabolism Disorder of mitochondrial respiratory chain complexes Juvenile myopathy, encephalopathy, lactic acidosis AND stroke [icd9data.com]
Patients with the m.3243A>G mutation remain at high risk of developing stroke-like episodes (1.16% per year). [ncbi.nlm.nih.gov]
- Ataxia
METHODS: We investigated NADH dehydrogenase [ubiquinone] 1 alpha subcomplex subunit 13 protein expression in 12 clinically and genetically defined patients with mitochondrial disease and ataxia and 10 age-matched controls. [ncbi.nlm.nih.gov]
The rating scales given for cerebellar ataxia at final clinical assessment are included in Table 1, thereby confirming that all the included patients had ataxia. [doi.org]
[…] metabolism disorder Mitochondrial mutation Mitochondrial myopathy Mitochondrial respiratory chain disorder Myoclonus epilepsy AND ragged red fibers Myoclonus epilepsy and ragged red fibers syndrome Myopathy, mitochondrial Neurogenic muscle weakness, ataxia [icd9data.com]
- Cerebellar Ataxia
Respiratory chain deficiencies detected in Purkinje cell bodies and their synapses and structural synaptic changes are likely to contribute to altered cerebellar circuitry and progression of ataxia. © 2015 The Authors. [ncbi.nlm.nih.gov]
Cerebellar ataxia is often progressive in these patients and is a major cause of disability. [doi.org]
- Peripheral Neuropathy
CONCLUSIONS: This is the largest study to date of peripheral neuropathy in genetically- classified childhood mitochondrial disease. [ncbi.nlm.nih.gov]
Arginine at high levels can cause peripheral nerve damage. Dichloroacetate can lead to hepatic failure and peripheral neuropathy. [clinicaladvisor.com]
Peripheral neuropathy, which may be symptomatic or only detected on physical examination or through nerve conduction studies, is also a frequent manifestation of mitochondrial diseases. [bcmj.org]
A similar situation appears to apply in diabetic patients with peripheral neuropathy and/or allodynia. [cortjohnson.org]
Their mother has a new-onset seizure disorder, migraine and peripheral neuropathy. [web.archive.org]
- Confusion
Gastrointestinal disorders, such as severe constipation Diabetes Respiratory disorders Increased risk of infection Thyroid and/or adrenal dysfunction Dysfunction of the autonomic nervous system Neuropsychological changes or dementia characterized by confusion [chop.edu]
The pain, confusion, frustration, and lack of information about mitochondrial disease makes it a very lonely disease for a person to have. It is very easy for sufferers to feel like no one else understands what they are going through. [physicianpartnersofamerica.com]
Developmental delays, learning disabilities Heart, liver or kidney disease Gastrointestinal disorders, severe constipation Diabetes Increased risk of infection Thyroid and/or adrenal dysfunction Autonomic dysfunction Neuropsychological changes characterized by confusion [mitoaction.org]
Treatment
In addition, specific and supportive treatments are discussed. KEYWORDS: Acute and chronic neurological presentations; Mitochondrial DNA (mtDNA); Mitochondrial disease; Nuclear genes; Treatment [ncbi.nlm.nih.gov]
Prognosis
What is the prognosis for mitochondrial disease? The prognosis for patients with mitochondrial myopathies varies greatly, depending largely on the type of disease and the degree of involvement of various organs. [medicinenet.com]
Meet other parents and patients in our closed Facebook group. back to top What is the Prognosis for Someone? The prognosis is variable. Some people live a normal life and are minimally affected; others can be severely compromised with the disease. [mitoaction.org]
The diagnostic journey may be characterized by heightened levels of uncertainty due to the delayed diagnosis and the absence of a clear prognosis, among other factors. [ncbi.nlm.nih.gov]
PROGNOSIS Prognosis depends upon which disorder, which symptoms and the severity of those symptoms. Some of the conditions we thought were uniformly progressive and fatal are not (Leigh syndrome, for example). [childneurologyfoundation.org]
Etiology
Sensory ataxic neuropathy may be the predominant and presenting manifestation of a mitochondrial disorder, and a mitochondrial etiology should be included in its differential diagnosis. [ncbi.nlm.nih.gov]
However, most other etiologies are due to one or more deficiencies in Complexes I – V of the respiratory chain that ultimately reduce molecular oxygen to water and synthesize ATP from ADP and inorganic phosphate. [aasmnet.org]
Epidemiology
The stage has now been reached at which there is a good understanding of both the genetic basis of the disease and its epidemiology, but just how the blindness that follows from the death of cells in the optic nerve can be prevented remains to be a pharmacological [ncbi.nlm.nih.gov]
The epidemiology of Leber hereditary optic neuropathy in the north east of England. Am. J. Hum. Genet. 72, 333–339 (2003) 10. Taylor, R. W. & Turnbull, D. M. Mitochondrial DNA mutations in human disease. Nature Rev. Genet. 6, 389–402 (2005) 11. [doi.org]
The epidemiology of Leber hereditary optic neuropathy in the North East of England. American Journal of Human Genetics 72, 333-339 (2003) Owens, K. N., et al. Genomic sequencing in the service of human rights. [nature.com]
Recent epidemiological studies indicate a population prevalence of ASD in about one in 166 children [2] and of mitochondrial disease in about one in 5–10,000 children [30], [31]. [journals.plos.org]
Pathophysiology
We report on the anaesthetic management of a paediatric patient with mitochondrial disease, and briefly discuss the pathophysiology and anaesthetic implications of these disorders. [ncbi.nlm.nih.gov]
We then discuss more controversial issues, including the functional or pathological role of mtDNA haplotypes, the pathogenicity of homoplasmic mutations and the still largely obscure pathophysiology of mtDNA mutations. [doi.org]
Prevention
In this review, we will interrogate the different NT techniques, including a discussion on the available safety and efficacy data of these technologies for mtDNA disease prevention. [ncbi.nlm.nih.gov]
"We have no way of curing these diseases at the moment, but this technique could allow us to prevent the diseases occurring in the first place. [theguardian.com]