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2.1
Mitochondrial Neurogastrointestinal Encephalomyopathy
Mitochondrial DNA Depletion Syndrome Type 1

Images

WIKIDATA, Public Domain
WIKIDATA, Public Domain

Presentation

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

The case reported here is of an 18-year-old male with MNGIE syndrome who presented for two different operations on two different occasions under regional anesthesia. The patient presented with urinary incontinence and abdominal pain. [bjan-sba.org]

We present the first detailed report of a Brazilian MNGIE patient, harboring a novel ECGF1 homozygous mutation (C4202A, leading to a premature stop codon, S471X). Multiple deletions and the T5814C change were found in mitochondrial DNA. [ncbi.nlm.nih.gov]

Gastrointestinal

  • Nausea

    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]

    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]

    Specific treatments may include drug therapies for nausea and vomiting and for symptoms secondary to nerve dysfunction (neuropathy) such as pain. [rarediseases.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]

  • 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 patient presented with urinary incontinence and abdominal pain. A cystoscopy under spinal anesthesia was scheduled. [bjan-sba.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]

    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]

    Pain affecting certain organs of the gastrointestinal tract (abdominal viscera) may be treated by a procedure known as celiac plexus neurolysis. During this procedure, nerve impulses are temporarily disrupted thereby lessening pain. [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]

Musculoskeletal

  • Short Arm

    Each chromosome has a short arm designated “p” and a long arm designated “q”. Chromosomes are further sub-divided into many bands that are numbered. [rarediseases.org]

Ears

  • Hearing Impairment

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

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

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

Neurologic

  • 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]

Workup

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]

Treatment

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]

Standard Therapies Treatment The treatment of MNGIE is directed toward the specific symptoms that are apparent in each individual. Treatment may require the coordinated efforts of a team of specialists. [rarediseases.org]

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]

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

Prognosis

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]

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]

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]

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]

Life Expectancy The prognosis for people who have Mitochondrial Disease is greatly influenced by the degree of involvement of various organs and they type of Mitochondrial Disease the person has. [hubpages.com]

Etiology

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]

Epidemiology

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. [ncbi.nlm.nih.gov]

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]

Pathophysiology

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. © BMJ Publishing Group Ltd (unless otherwise stated in the text of [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]

Prevention

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

: 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]

Can we prevent Mitochondrial Disease? Yes. [mitochondrialdisease.nhs.uk]

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]

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