The disease presents in childhood, but often goes unnoticed for decades. [en.wikipedia.org]

In a 38-year-old male patient diagnosed with mitochondrial neurogastrointestinal encephalomyopathy an abnormally high duodenal contraction frequency of 20 per minute was found to be present. [ncbi.nlm.nih.gov]

• Nausea

  MNGIE is clinically characterized by ophthalmoparesis, peripheral neuropathy, leukoencephalopathy, gastrointestinal symptoms (recurrent nausea, vomiting, or diarrhea) with intestinal dysmotility, and histologically abnormal mitochondria in muscle. [ncbi.nlm.nih.gov]

  Additionally, gastrointestinal symptoms such as borborygmi, early satiety, diarrhea, constipation, gastroparesis, nausea, vomiting, weight loss, and diverticulitis may be present in MNGIE patients. [en.wikipedia.org]

  The main symptoms of Mitochondrial Neurogastrointestinal Encephalopathy Disease are progressive gastrointestinal symptoms such as nausea, inability to swallow, reflux, vomiting, abdominal pain and diarrhea. [thinkgenetic.com]

  These symptoms included: diarrhoea (11/36); abdominal pain (8/36); nausea/vomiting (6/36); abdominal cramps (6/36); weight loss (4/36); borborygmi (3/36); wasting/failure to thrive/thin (2/36); intestinal pseudo-obstruction (2/36); bloating (1/36); and [brain.oxfordjournals.org]

• Abdominal Pain

  Back to: « Mitochondrial DNA depletion syndrome Symptoms of Mitochondrial DNA depletion syndrome type 1 Clinical features : Imported from Human Phenotype Ontology (HPO) Abnormality of the abdomen Abdominal pain Constipation Gastrointestinal dysmotility [familydiagnosis.com]

  The main symptoms of Mitochondrial Neurogastrointestinal Encephalopathy Disease are progressive gastrointestinal symptoms such as nausea, inability to swallow, reflux, vomiting, abdominal pain and diarrhea. [thinkgenetic.com]

  Added to this are gastroparesis, constipation, vomiting, and intermittent diarrhea with abdominal pain. Many individuals develop diverticulosis and diverticulitis that may lead to intestinal perforations. [disorders.eyes.arizona.edu]

  The symptoms that affected patients present vary, but the most common presenting symptoms are gastrointestinal issues such as nausea, vomiting, abdominal pain, and diarrhea, and neurologic or ocular symptoms such as hearing loss, weakness, and peripheral [en.wikipedia.org]

  These symptoms included: diarrhoea (11/36); abdominal pain (8/36); nausea/vomiting (6/36); abdominal cramps (6/36); weight loss (4/36); borborygmi (3/36); wasting/failure to thrive/thin (2/36); intestinal pseudo-obstruction (2/36); bloating (1/36); and [brain.oxfordjournals.org]

• Abdominal Cramps

  The post-transplant clinical follow-up showed improvement in gastrointestinal dysmotility, abdominal cramps and diarrhea. Neurological assessment remained unchanged. [ncbi.nlm.nih.gov]

  These symptoms included: diarrhoea (11/36); abdominal pain (8/36); nausea/vomiting (6/36); abdominal cramps (6/36); weight loss (4/36); borborygmi (3/36); wasting/failure to thrive/thin (2/36); intestinal pseudo-obstruction (2/36); bloating (1/36); and [brain.oxfordjournals.org]

  More challenging is the treatment of cyclic vomiting syndrome during an episode, which may include lorazepam, ondansetron, or zolmitriptan in cases of abdominal cramping [Finsterer and Hayman, 2015]. [journals.sagepub.com]

• Borborygmi

  Additionally, gastrointestinal symptoms such as borborygmi, early satiety, diarrhea, constipation, gastroparesis, nausea, vomiting, weight loss, and diverticulitis may be present in MNGIE patients. [en.wikipedia.org]

  These symptoms included: diarrhoea (11/36); abdominal pain (8/36); nausea/vomiting (6/36); abdominal cramps (6/36); weight loss (4/36); borborygmi (3/36); wasting/failure to thrive/thin (2/36); intestinal pseudo-obstruction (2/36); bloating (1/36); and [brain.oxfordjournals.org]

  The specific symptoms will vary from case to case, but may include vomiting, nausea, diarrhea, abdominal pain, a feeling of early fullness (premature satiety), stomach rumblings (borborygmi), and difficulty swallowing (dysphagia). [rarediseases.org]

• Abdominal Distension

  Case 2: This 6½-month-old boy born to a non-consanguineous couple presented with persistent jaundice and abdominal distension since four months of age. [indianpediatrics.net]

• Kinky Hair

  Danks DM, Cartwright E, Stevens BJ, Townley RRW (1973) Menkes' kinky hair disease: further definition of the defect in copper transport. Science 179:1140–1142 Google Scholar 6. [doi.org]

• Leg Cramp

  In our cohort, 9/63 (14%) patients presented with: peripheral neuropathy manifesting as numbness or foot drop (5/9); limb weakness and paraesthesia (1/9); leg cramps (1/9); tripping (1/9); or hearing loss (1/9). [brain.oxfordjournals.org]

• Hearing Impairment

  The disease can cause the slowing down of thoughts and a reduction in physical movement, hearing impairment and seizures. [thesun.co.uk]

  Hearing impairment associated to severe encephalomyopathy has been only reported in one family with MDS caused by SUCLA2 mutations ( 14 ). [nature.com]

  impairment and ophthalmoplegia [ 6 ]. [ijponline.biomedcentral.com]

• Amenorrhea

  Malnutrition caused anaemia in four patients and amenorrhea in two patients. Other sporadic findings included: pigmentary retinopathy (three patients); dry mouth/eyes (three patients); psoriasis (one patient); and coarse bronze skin (one patient). [brain.oxfordjournals.org]

• Foot Drop

  In our cohort, 9/63 (14%) patients presented with: peripheral neuropathy manifesting as numbness or foot drop (5/9); limb weakness and paraesthesia (1/9); leg cramps (1/9); tripping (1/9); or hearing loss (1/9). [brain.oxfordjournals.org]

  drop), decreased proprioception, and reduced or absent peripheral reflexes.50 Gastrointestinal beriberi is a lesser known form which manifests as abdominal pain, nausea, vomiting, and lactic acidosis.7 Infants between two and twelve months of age can [dovepress.com]

• Areflexia

  The myopathic form is characterized by progressive weakness, hypotonia, areflexia, and respiratory failure before 10 years of age. [pediatricneurologybriefs.com]

  Miller Fisher syndrome has findings that mimic WE including ataxia, areflexia, and ophthalmoplegia.63 However, descending paralysis and a preceding upper respiratory tract infection are distinguishing features. [dovepress.com]

• Memory Impairment

  Memory deficit of MHE seems to comprise short-term but not long-term memory impairment. This can be described as an encoding defect, in which memory recall is intact. [my.clevelandclinic.org]

  impairment, and dietary deficiencies. [dovepress.com]

• Cranial Neuropathy

  This finding may also explain the cranial neuropathies that patients with MNGIE have. [ncbi.nlm.nih.gov]

His weight was 6 kg and height was 60 cm (both His metabolic workup, including screening for Galactosemia, Tyrosinemia type 1, amino acids, organic acids and fatty acid oxidation defects, was normal. Plasma lactate was elevated on several occasions. [indianpediatrics.net]

When seizure activity must be ruled out, an EEG may be helpful in the initial workup of a patient with cirrhosis and altered mental status. EEG studies are not required to make a confident diagnosis of HE. [my.clevelandclinic.org]

• Amylase Increased

  The clinical course was complicated by an endocrine or exocrine pancreatic insufficiency in nine patients: diabetes (four patients); amylase increase (two patients); glucose intolerance (one patient); or exocrine insufficiency (two patients). [brain.oxfordjournals.org]

• Prolonged QT Interval

  Uncommon clinical features included short stature (five patients) and cardiopathy (three patients with prolonged QT interval, cardiac arrest or supraventricular tachycardia). [brain.oxfordjournals.org]

• White Matter Lesions

  BAEPs may be useful in the neurophysiological evaluation of central white matter lesions in MNGIE. Similar neurophysiological findings have been reported in other myelin disorders in the central nervous system. [ncbi.nlm.nih.gov]

  The white matter lesions appear hyperintense on T 2 -weighted or fluid-attenuated inversion recovery images and may initially be patchy, but eventually become diffuse and confluent. [brain.oxfordjournals.org]

• Muscle Biopsy showing Ragged-Red Fibers

  Cellular phenotype and pathology Skeletal muscle biopsy shows ragged red fibers, mtDNA depletion, and accumulation of abnormal mitochondria (summary by Echaniz-Laguna et al., 2012; pubmed:22187496 ). [flybase.org]

Management and treatment Management is mainly symptomatic, involving treatment of the chronic intestinal pseudo-obstruction. Thymidine and deoxyguanosine clearance appears to be an efficient approach. [orpha.net]

Because of the intense rarity of the condition, there are currently no widely available treatments for patients like Charlie. [frontlinegenomics.com]

Acute medical events such as infections often provoked worsening of symptoms, suggesting that careful monitoring and early treatment of intercurrent illnesses may be beneficial. [ncbi.nlm.nih.gov]

Very few people who develop the condition in infancy survive to their teenage years, and there is currently no known treatment for it. [metro.co.uk]

Prognosis The prognosis is unfavorable due to the severity of the digestive involvement with infections and the need for permanent parenteral nutrition. The documents contained in this web site are presented for information purposes only. [orpha.net]

These are severe disorders with poor prognosis in the majority of cases. So far, no therapy or cure exists to help patients, although nutritional interventions or supplementation can be beneficial for some children. [ibtimes.co.uk]

Conversely, the absence of eye abnormalities may portend a better prognosis and a possible beneficial effect of liver transplantation. [journals.lww.com]

The prognosis for MELAS is poor. Typically, the age of death is between 10 to 35 years, although some patients may live longer. [umdf.org]

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 MNGIE syndrome is inherited in an autosomal recessive manner and is caused by mutations in the TYMP gene (22q13.32-qter), encoding a protein involved in thymidine phosphorylation. [orpha.net]

Other genes may also be involved in the etiology of myopathic MDS. [pediatricneurologybriefs.com]

Liver transplant was not performed in view of mitochondrial etiology and neurological involvement (as evident on neuroimaging). [indianpediatrics.net]

Table 1 summarizes the main clinical manifestations and molecular etiologies associated with these different forms. [ijponline.biomedcentral.com]

Houston Recruiting NCT02023866 Open-Label, Dose-Escalating Study to Assess Safety, Tolerability, Efficacy, PK and PD of RP103 in Children With Inherited Mitochondrial Disease Genetically diagnosed mitochondrial disease Raptor Pharma Completed NCT02003170 Etiology [mitoaction.org]

Summary Epidemiology So far, just under 100 sporadic and familial cases have been reported. Clinical description The first clinical manifestations generally appear between the ages of 10 and 40 (most often before 20 years of age). [orpha.net]

Results Epidemiology A cohort of 102 patients (50 females) with an average age of 32.4 years (range 11–59 years) was collected between 1988 and 2011. [brain.oxfordjournals.org]

The incidence is unknown, although the epidemiological studies of the MELAS-3243 mtDNA mutation have estimated the prevalence to be 1-16/100,000 in the adult population. There is no cure or specific treatment for MELAS. [umdf.org]

TP deficiency alone is unlikely to explain all clinical signs, and other factors, including the possible development of anti-TP antibodies, which may play a role in the pathophysiology. [ncbi.nlm.nih.gov]

Pathophysiology Pathophysiology While the precise molecular mechanisms that result in these morphological changes in the brain are yet to be identified, many factors have been elucidated, especially the role of ammonia, false neurotransmitters, astrocyte [my.clevelandclinic.org]

The natural history and pathophysiology of Wernicke’s encephalopathy and Kosakoff’s psychosis. Alcohol Alcohol. 2006;41(2):151–158. doi:10.1093/alcalc/agh249 56. Thomson AD, Cook CC, Touquet R, Henry JA. [dovepress.com]

Gastroesophageal reflux is common in MIDs and is pathophysiologically the opposite of achalasia. [journals.sagepub.com]

We used formulas enriched with medium-chain triglyceride content and fractional meals with enteral nutrition at night for adequate nutrition to prevent hypoglycemia. He continued to deteriorate rapidly, leading to death at 4 months of age. [journals.lww.com]

The current recommendation to prevent CTE is to reduce mild traumatic brain injuries and prevent additional injury after a concussion. [mayoclinic.org]

Our report has thus direct important implications for clinical practice: it prevents a burdensome, long-term invasive, but finally probably ineffective procedure in MNGIE patients. [ncbi.nlm.nih.gov]

: Mitochondrial DNA depletion can be prevented by dGMP and dAMP supplementation in a resting culture of deoxyguanosine kinase-deficient fibroblasts. Hum. Molec. Genet. 12: 1839-1845, 2003. PubMed ID : 12874104 Tadiboyina, V. [humpath.com]

Prevention There are no current guidelines to prevent mitochondrial myopathies. If you have a family history of the disorder, you can talk to a genetic counselor when deciding whether to have children. [azkrmc.com]