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Mucopolysaccharidosis 3

Sanfilippo Syndrome


Presentation

  • The disordered sleep in particular presents a significant problem to care providers.[checkorphan.org]
  • The documents contained in this web site are presented for information purposes only. The material is in no way intended to replace professional medical care by a qualified specialist and should not be used as a basis for diagnosis or treatment.[orpha.net]
  • Somatic features, such as mild organomegaly, little to no corneal clouding, and orthopedic abnormalities, may be present. Neurologic degeneration usually begins in children aged 6 years or older (sometimes even younger).[emedicine.medscape.com]
  • Most patients presenting beyond the neonatal period have increased urinary glycosaminoglycans and dysostosis multiplex.[news-medical.net]
Splenomegaly
  • […] signs and symptoms include coarse facial features, vision loss [ 29 ], hearing loss [ 30 ], decreased pulmonary function and obstructive sleep apnoea [ 31 ], frequent and recurrent respiratory infections, cardiac disease [ 32 , 33 ], hepatomegaly and splenomegaly[rheumatology.oxfordjournals.org]
Developmental Delay
  • It is characterized by behavioral changes, sleep disturbances and mental developmental delays.[icd10data.com]
  • Analyzes chromosomes in newborns and infants for changes that can explain certain birth defects or developmental delays. Multiple testing options providing information on the genetic health of your baby during the first and second trimesters.[integratedgenetics.com]
  • Patients usually present in infancy or early childhood with developmental delay, delayed speech, difficulty in feeding, hyperactivity or sleep disturbances.[genedx.com]
  • Developmental delay becomes more pronounced in the first years after symptoms have manifested.[socialstyrelsen.se]
  • Considerations for testing Testing for MPS III is appropriate for any individual with any combination of clinical features consistent with a MPS III including: progressive developmental delay, autistic features, sleep disturbances and mildly coarse facial[invitae.com]
Inguinal Hernia
  • Individuals with MPS III typically have mildly "coarse" facial features , a large head ( macrocephaly ), a slightly enlarged liver (mild hepatomegaly), and a soft out-pouching around the belly-button (umbilical hernia ) or lower abdomen (inguinal hernia[ghr.nlm.nih.gov]
  • Complications of Mucopolysaccharidosis Type III may include: Inguinal hernia causing a bulge on the side of the pubic bone, abdominal weakness, numbness in the groin, groin pain especially while coughing or lifting heavy objects Umbilical hernia causing[dovemed.com]
  • hernia Frequent upper respiratory infections, otitis media, hearing loss Sleep apnea Cloudy corneas and vision loss.[centogene.com]
  • hernias, chronic diarrhoea, CTS [ 34 ], communicating hydrocephalus and spinal cord compression.[rheumatology.oxfordjournals.org]
Delayed Speech Development
  • At this time, developmental abnormalities begin to manifest in the form of delayed speech development or autistic behaviour patterns. Developmental delay becomes more pronounced in the first years after symptoms have manifested.[socialstyrelsen.se]
Chronic Diarrhea
  • Chronic diarrhea, enlarged liver and spleen are also common. It is difficult to clinically distinguish differences among the four types of Sanfilippo syndrome.[en.wikipedia.org]
  • Affected children are prone to frequent sinus infections, ear infections, and chronic diarrhea. They may have cavities or chipped teeth from weak enamel and headaches from accumulated fluid pressure on the brain.[jonahsjustbegun.org]
  • Affected individuals often experience chronic diarrhea and recurrent upper respiratory and ear infections. People with MPS III may also have hearing loss and vision problems.[ghr.nlm.nih.gov]
  • Other symptoms may include: Behavioral problems, including hyperactivity Coarse facial features with heavy eyebrows that meet in the middle of the face above the nose Chronic diarrhea Enlarged liver and spleen Sleep difficulties Stiff joints that may[medlineplus.gov]
  • Most children with MPS type IIIA have severe neurological impairment by age 6 years Recurrent or chronic diarrhea and seizures occurs in some MPS III patients.[centogene.com]
Hepatosplenomegaly
  • Symptoms may include DWARFISM , hepatosplenomegaly, gargoyle-like facies, corneal clouding, cardiac complications, and noisy breathing.[hon.ch]
  • Affected children are prone to sinus and ear infections, diarrhea, enlarged tonsils and hepatosplenomegaly. Children are hyper and agressive; frequent temper tantrums. Fearless. Minor bone deformities are common.[phoenixnestbiotech.com]
  • Clinical features and disease severity are variable, but usually include short stature, hepatosplenomegaly, dysostosis multiplex, stiff joints, corneal clouding, cardiac abnormalities and facial dysmorphism.[news-medical.net]
  • Developmental milestones were normal until 5 years old when she developed restless behavior, loss of motor skills, stiff gait, muscular spasticity, hepatosplenomegaly, and dysmorphic facies: bushy eyebrows, low forehead, and a short pouting upper lip.[bloodjournal.org]
  • Without the proper enzymatic degradation of the mucopolysaccharides, clinical symptoms, such as auditory and visual defects, cardiovascular pathologies, hepatosplenomegaly, and dysostosis multiplex, occur due to their accumulation in organ systems.[emedicine.medscape.com]
Hepatomegaly
  • […] progressive and severe neurological deterioration causing hyperactivity, sleep disorders and loss of speech accompanied by behavioral abnormalities, neuropsychiatric problems, mental retardation, hearing loss, and visceral manifestations, such as mild hepatomegaly[phoenixnestbiotech.com]
  • Individuals with MPS III typically have mildly "coarse" facial features , a large head ( macrocephaly ), a slightly enlarged liver (mild hepatomegaly), and a soft out-pouching around the belly-button (umbilical hernia ) or lower abdomen (inguinal hernia[ghr.nlm.nih.gov]
  • Somatic manifestations such as hepatomegaly, dysostosis multiplex, coarse facies and hypertrichosis are relatively mild compared to the other mucopolysaccharidoses.[invitae.com]
  • […] children Hyperactivity and aggression Lowered mental function and IQ levels, which progressively worsens Convulsions and movement disorders may develop over time Abnormally-shaped head with coarse facial features Disturbed sleep Mildly enlarged liver (hepatomegaly[dovemed.com]
  • Other signs and symptoms include coarse facial features, vision loss [ 29 ], hearing loss [ 30 ], decreased pulmonary function and obstructive sleep apnoea [ 31 ], frequent and recurrent respiratory infections, cardiac disease [ 32 , 33 ], hepatomegaly[rheumatology.oxfordjournals.org]
Hearing Impairment
  • MPS3A; MPSIIIA; Mucopolysaccharidosis type 3A; Sanfilippo syndrome type A See More Categories: This disease is grouped under: Mucopolysaccharidosis type IIIA (MPS IIIA) is a severe, progressive disorder that affects the central nervous system. 0001507 Hearing[rarediseases.info.nih.gov]
Hirsutism
  • The stiff joints, hirsuteness and coarse hair typical of other mucopolysaccharidoses are usually not present until late in the disease.[checkorphan.org]
  • Children with Sanfilippo syndrome are often described as having coarse hair, heavy eyebrows and increased hirsuteness (body hair) but many children with the syndrome do not develop these characteristics.[socialstyrelsen.se]
Joint Stiffness
  • stiffness, vertebral bodies and hypertrichosis.[phoenixnestbiotech.com]
  • Patients with MPS 7 may have abnormal coarsened facial features, enlargement of the liver and spleen, airway obstruction, lung disease, cardiovascular complications, joint stiffness, short stature, and skeletal disease.[ultragenyx.com]
  • Some people with MPS III have short stature, joint stiffness, or mild dysostosis multiplex, which refers to multiple skeletal abnormalities seen on x-ray.[ghr.nlm.nih.gov]
  • Symptoms usually become apparent between three and eight years of age and include coarse facial features, corneal clouding, joint stiffness, short stature and hepatosplenomegaly. Survival to adulthood is common.[news-medical.net]
  • For example, physical therapy may help preserve joint function for individuals with joint stiffness. Joint stiffness is present in all of the MPS disorders except MPS IV and MPS IX.[encyclopedia.com]
Skeletal Dysplasia
  • Dysplasia Society, Southeastern Regional Genetics Group Disclosure: Nothing to disclose.[emedicine.medscape.com]
  • The characteristic skeletal dysplasia includes short stature, dysostosis multiplex, and degenerative joint disease. Birth prevalence is between 1 in 43,261 and 1 in 1,505,160 live births 33.[centogene.com]
  • Of interest to the rheumatologist, the skeletal dysplasia is distinct from the dysostosis multiplex seen in MPS I, II and VII.[rheumatology.oxfordjournals.org]
Aggressive Behavior
  • In the toddler years, aggressive behaviors emerge, with marked hyperactivity and destructive tendencies. Somatic features, such as mild organomegaly, little to no corneal clouding, and orthopedic abnormalities, may be present.[emedicine.medscape.com]
  • Additional clinical symptoms include intellectual disability, progressive neurologic symptoms including aggressive behavior, poor coordination, seizures and hearing loss.[genedx.com]
Dyslexia
  • Association Autism Autosomal recessive Autosomal recessive inheritance Avenue behavioural difficulties bone Borough Council brain child Chromosome Abnormality Syndromes Congenital Curriculum David Fulton David Fulton Publishers Day Special Needs disorder Dyslexia[books.google.com]
Seizure
  • Seizures often occur after the age of 10. A few cases of attenuated forms have also been reported.[orpha.net]
  • In the final phase of the illness, children become increasingly immobile and unresponsive, often require wheelchairs, and develop swallowing difficulties and seizures.[checkorphan.org]
  • Box parents of children Park School physical disabilities Profound & Multiple publications pupils Residential Special Needs RNIB Road School:Day Special Needs Seealso seizures Severe Learning Difficulties skull Special Educational Needs Special School[books.google.com]
  • Some children have seizures others have visual and hearing problems. Over time, speech loss occurs and communication skills decline along with cognitive regression and loss of motor skills. Third stage: The disease will take its ultimate toll.[jonahsjustbegun.org]
Hyperactivity
  • The disease progresses to increasing behavioural disturbance including temper tantrums, hyperactivity, destructiveness, aggressive behaviour,pica and sleep disturbance.[checkorphan.org]
  • Behavioural abnormalities including hyperactivity, disturbed sleep patterns, screaming and destructive tendencies can be difficult to control with medication.[socialstyrelsen.se]
  • The clinical phenotype includes onset in infancy or early childhood, progressive and severe neurological deterioration causing hyperactivity, sleep disorders and loss of speech accompanied by behavioral abnormalities, neuropsychiatric problems, mental[phoenixnestbiotech.com]
  • The disease progresses to increasing behavioural disturbance including temper tantrums, hyperactivity, destructiveness, aggressive behaviour, pica and sleep disturbance.[en.wikipedia.org]
  • In the toddler years, aggressive behaviors emerge, with marked hyperactivity and destructive tendencies. Somatic features, such as mild organomegaly, little to no corneal clouding, and orthopedic abnormalities, may be present.[emedicine.medscape.com]
Sleep Disturbance
  • The disease progresses to increasing behavioural disturbance including temper tantrums, hyperactivity, destructiveness, aggressive behaviour,pica and sleep disturbance.[checkorphan.org]
  • It is characterized by behavioral changes, sleep disturbances and mental developmental delays.[icd10data.com]
  • The disease progresses to increasing behavioural disturbance including temper tantrums, hyperactivity, destructiveness, aggressive behaviour, pica and sleep disturbance.[en.wikipedia.org]
  • Sleep disturbance in mucopolysaccharidosis type III (Sanfilippo syndrome): a survey of managing clinicians. Clin Genet. 2002;62:418-21. Barone R, Fiumara A, Villani GR, et al. Extraneurologic symptoms as presenting signs of Sanfilippo disease.[rarediseases.org]
  • Phase 2 is characterized by a significant increase in behavioral issues, around 3-5 years of age, along with sleep disturbances and hyperactivity. Affected individuals may remain in this state for 5-10 years.[invitae.com]
Mental Deterioration
  • Management and treatment Allogenic bone marrow grafts are contraindicated as they do not slow the mental deterioration, even in patients engrafted pre-symptomatically.[orpha.net]
Neglect
  • […] are currently pursuing research on Chaperone therapy (IIIC) and NIH funded research on stem cell/ gene therapy (IIIB) and enzyme replacement therapies (IIID) Publications Ekins S and Wood J, Incentives for starting small companies focused on rare and neglected[phoenixnestbiotech.com]

Workup

  • Precise identification of the specific form of Sanfilippo syndrome relies on enzymatic assays (see Workup).[emedicine.medscape.com]
Enlargement of the Spleen
  • Although the clinical features of the disease are mainly neurological, patients may also develop diarrhea, carious teeth, and an enlarged liver and spleen. There is a broad range of clinical severity.[checkorphan.org]
  • Chronic diarrhea, enlarged liver and spleen are also common. It is difficult to clinically distinguish differences among the four types of Sanfilippo syndrome.[en.wikipedia.org]
  • Other symptoms may include: Behavioral problems, including hyperactivity Coarse facial features with heavy eyebrows that meet in the middle of the face above the nose Chronic diarrhea Enlarged liver and spleen Sleep difficulties Stiff joints that may[medlineplus.gov]
  • Most males with Hunter syndrome develop joint stiffness, chronic diarrhea, enlarged liver and spleen, heart valve problems, hearing loss, and kyphosis. They also tend to be shorter than expected.[healthofchildren.com]
  • Most males with Hunter syndrome develop joint stiffness, chronic diarrhea, enlarged liver and spleen, heart valve problems, hearing loss, kyphosis, and tend to be shorter than expected.[encyclopedia.com]
Enlargement of the Liver
  • Patients with MPS 7 may have abnormal coarsened facial features, enlargement of the liver and spleen, airway obstruction, lung disease, cardiovascular complications, joint stiffness, short stature, and skeletal disease.[ultragenyx.com]
  • Most males with Hunter syndrome develop joint stiffness, chronic diarrhea, enlarged liver and spleen, heart valve problems, hearing loss, and kyphosis. They also tend to be shorter than expected.[healthofchildren.com]
  • Most males with Hunter syndrome develop joint stiffness, chronic diarrhea, enlarged liver and spleen, heart valve problems, hearing loss, kyphosis, and tend to be shorter than expected.[encyclopedia.com]
  • Most males with Hunter syndrome develop joint stiffness, chronic diarrhea , enlarged liver and spleen, heart valve problems, hearing loss, kyphosis, and tend to be shorter than expected.[medical-dictionary.thefreedictionary.com]

Treatment

  • The neurological degradation accompanied by multiple complications requires a multidisciplinary management to allow adapted symptomatic treatment.[orpha.net]
  • […] care or treatment that concentrates on reducing the severity of disease symptoms.[mpssociety.org]
  • MPS III treatment must gain access to the brain.[phoenixnestbiotech.com]
  • Treatment [ edit ] Treatment remains largely supportive. The behavioral disturbances of MPS-III respond poorly to medication. If an early diagnosis is made, bone marrow replacement may be beneficial.[en.wikipedia.org]
  • Treatment/interventions There is currently no cure for Sanfilippo syndrome.[socialstyrelsen.se]

Prognosis

  • Prognosis The prognosis is poor with death occurring in most cases of type IIIA at the end of the second decade. Longer survival times (30/40 years) have been reported for the B and D subtypes.[orpha.net]
  • Along with the current prevalence, the report also contains a disease overview of the risk factors, disease diagnosis and prognosis along with specific variations by geography and ethnicity.[globenewswire.com]
  • Prognosis Sanfilippo syndrome is a progressive disorder with a very poor prognosis. Severe CNS degeneration occurs, with progression to a vegetative state.[emedicine.medscape.com]
  • However, the prognosis also depends upon the severity of the signs and symptoms and the subtype of MPS Type III (whether A, B, C, or D).[dovemed.com]
  • The prognosis (long-term outlook) depends upon the particular type of MPS. There are a number of different types of MPS that are designated somewhat confusingly by number (and letter), by syndrome name, and by precising what enzyme is lacking.[medicinenet.com]

Etiology

  • Etiology Deficiencies in one of the four enzymes required for HS degradation are responsible for each of the MPS III subtypes: heparan sulfamidase for MPS IIIA, alpha-N-acetylglucosaminidase for MPS IIIB, alpha-glucosaminide N-acetyltransferase for MPS[orpha.net]
  • (Etiology) Mucopolysaccharidosis Type III is caused by inheriting faulty genes that prevents the body from producing certain enzymes.[dovemed.com]

Epidemiology

  • Summary Epidemiology The disorder is underdiagnosed (due to the generally very mild dysmorphism); it is the most frequent MPS in the Netherlands and Australia with respective prevalences of 1/53 0000 and 1/67 000.[orpha.net]
  • To generate accurate patient population estimates, the database utilizes a combination of several world class sources that deliver the most up to date information form patient registries, clinical trials and epidemiology studies.[globenewswire.com]
  • Epidemiology of lysosomal storage diseases: an overview. In: Mehta A, Beck M, Sunder-Plassmann G, editors. Fabry Disease: Perspectives from 5 Years of FOS. Oxford: Oxford PharmaGenesis; 2006;Chapter 2. Clarke JTR.[rarediseases.org]
  • Epidemiology Frequency International In 1997, Nelson reported an incidence of 1 case per 280,000 live births (0.36 cases per 100,000 live births) for Sanfilippo syndrome in Northern Ireland. [7] In 1999, Poorthuis and others reported an incidence of 4.5[emedicine.medscape.com]
  • The overall frequency of either p.R59H or 1622-1627insG was 57.7% of the disease-causing alleles, and this epidemiological study suggested a carrier frequency of 1:58 for this population 31.[centogene.com]
Sex distribution
Age distribution

Pathophysiology

  • Some children with MPS III may have a blood-clotting problem during and after surgery. [6] Pathophysiology [ edit ] Glycosaminoglycans (GAGs) are polysaccharides that contain repeating disaccharides and sulfate groups.[en.wikipedia.org]
  • Pathophysiology The clinical features of Sanfilippo syndrome, including the significant CNS component (brain and spinal cord), result from the progressive lysosomal accumulation of the GAG heparan sulfate. [5] Four enzymes are involved in the different[emedicine.medscape.com]
  • Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test Mucopolysaccharidosis type III (MPS-III), also known as Sanfilippo syndrome, is an autosomal recessive condition that consists[mayomedicallaboratories.com]
  • Pathophysiology of the MPS disorders The MPSs are chronic and progressive syndromes that produce a spectrum of signs and symptoms in multiple organ systems. A good example of this is seen in individuals with MPS I.[rheumatology.oxfordjournals.org]

Prevention

  • Risk Factors & Prevention 4. Diagnosis of the Disease 5. Variation by Geography/Ethnicity 6. Disease Prognosis & Clinical Course 7. Key comorbid conditions/Features associated with the disease 8. Methodology for quantification of patient numbers 9.[globenewswire.com]
  • The goal is to prevent and relieve suffering and to improve quality of life for people facing serious, complex illness. This includes respite care, symptom management and bereavement support and may extend over a period of time.[mpssociety.org]
  • (Etiology) Mucopolysaccharidosis Type III is caused by inheriting faulty genes that prevents the body from producing certain enzymes.[dovemed.com]
  • MPS IIIC is a good candidate for chaperone therapy because it is estimated that a threshold activity of approximately 10% is sufficient to prevent storage.[phoenixnestbiotech.com]
  • […] under the leadership of Paris-based biotechnology company Lysogene. [8] [9] Other potential therapies include chemical modification of deficient enzymes to allow them to penetrate the blood–brain barrier, stabilisation of abnormal but active enzyme to prevent[en.wikipedia.org]

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