Alexander disease

Alexander disease
Classification and external resources
ICD-9	331.89
OMIM	203450
MeSH	D038261

Alexander disease is a slowly progressing and fatal neurodegenerative disease. It is a very rare disorder which results from a genetic mutation and mostly affects infants and children, causing developmental delay and changes in physical characteristics.^[1][2][3]

Clinical features

Delays in development of some physical, psychological and behavioral skills, progressive enlargement of the head (macrocephaly), seizures, spasticity, in some cases also hydrocephalus, dementia.^[2]

Pathology

Alexander disease is a genetic disorder affecting the central nervous system (midbrain and cerebellum). It is caused by mutations in the gene for glial fibrillary acidic protein (GFAP) that maps to chromosome 17q21. The mutation is not carried by the parents,^[2][3][4] rather the mutation occurs de novo in the parental gametes that then develop into a child with Alexander disease.^[2]

Alexander disease belongs to leukodystrophies, a group of diseases which affect growth or development of the myelin sheath. The destruction of white matter in the brain is accompanied by the formation of fibrous, eosinophilic deposits known as Rosenthal fibers.^[2][3][5] Rosenthal fibers appear not to be present in healthy people,^[3][4] but occur in specific diseases, like some forms of cancer.^[3][4] The Rosenthal fibers found in Alexander disease are not distributed in the same areas or as concentrated when compared to other diseases and disorders.^[3]

CT shows:

• decreased density of white matter
• frontal lobe predominance
• +/- dilated lateral ventricles

Cause

The cause of Alexander disease is a mutation in the gene encoding glial fibrillary acidic protein.^{[2][3][4][5][6]}

Diagnosis

It is possible to detect the signs of Alexander disease with Magnetic Resonance Imaging, which looks for specific changes in the brain that may be tell-tale signs for the disease.^[4][7] It is even possible to detect adult-onset Alexander disease with MR imaging.^[6] Alexander disease may also be revealed by genetic testing for the known cause of Alexander disease.^[4] A rough diagnosis may also be made through revealing of clinical symptoms including, enlarged head size, along with radiological studies, and negative tests for other leukodystrophies.^[4]

Occurrence and prevalence

Its occurrence is very rare. The infantile form (63% of all cases) starts usually at the age of six months or within the first two years. The average duration of the infantile form of the illness is usually about 3 years. Onset of the juvenile form (24% of all cases) presents usually between four to ten years of age. Duration of this form is in most cases about 8 years. In younger patients, seizures, megalencephaly, developmental delay, and spasticity are usually present. Neonatal onset is also reported. Onset in adults is least frequent. In older patients, bulbar or pseudobulbar symptoms and spasticity predominate. Symptoms of the adult form may also resemble multiple sclerosis.^[2]

There are no more than 500 reported cases.^[2]

Treatment

There is currently no cure, or standard procedure taken for treatment.^[2][3][4] A bone marrow transplant has been attempted on a child, but did not cause the patient's condition to improve.^[4][8]

Prognosis

The prognosis is generally poor. With early onset, death usually occurs within 10 years after the onset of symptoms. Usually, the later the disease occurs, the slower its course is.^[2][3]

See also

• The Myelin Project
• The Stennis Foundation
• Glial fibrillary acidic protein

External Links

• GeneReviews/NCBI/NIH/UW entry on Alexander disease
• OMIM entries on Alexander disease
• http://www.myalexanderdisease.com

References

1. ^ "MUTATION KEY TO ALEXANDER DISEASE" - United Press International
2. ^ ^{a b c d e f g h i j} "Alexander Disease" - Gene Reviews
3. ^ ^{a b c d e f g h i} [1]
4. ^ ^{a b c d e f g h i} [2]
5. ^ ^{a b} "Cause of brain disease found" -BBC News
6. ^ ^{a b} "Can MR Imaging Diagnose Adult-Onset Alexander Disease?" - AJNR
7. ^ "Alexander Disease: Diagnosis with MR Imaging" - AJNR
8. ^ "Allogeneic bone marrow transplantation for Alexander's disease" - Nature