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Krabbé Disease

Metabolic defect: galactocerebrosidase deficiency

Other sphingolipid degradation diseases: acid sphingomyelinase deficiency | Fabry | Farber | Gaucher: type I, type II, type III | GM1 gangliosidosis: type I, type II, type III | Tay-Sachs: type I, type II, type III | Sandhoff: type I | metachromatic leukodystrophy: type I, type II, type III


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Krabbé disease

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Etiology & Pathogenesis[1]

One of a group of genetic disorders called the leukodystrophies that affect the growth of the myelin sheath, the fatty covering on nerve fibers in the brain that acts as an insulator. All patients are deficient in the lysosomal enzyme galactocerebrosidase and show evidence of storage in the central nervous system.

Key Symptom Images
Hypertonia/Ataxia Hypertonia/Ataxia Hypertonia/Ataxia
Clinical Description and Progression/Prognosis[1,2]

A rare degenerative disorder of the central and peripheral nervous systems. Symptoms vary in prevalence and severity, ranging from infantile onset to late-onset forms. The majority of cases are the infantile form and generally present with developmental delay, extreme irritability, and neurologic manifestations by 6 months of age. In late-onset patients, which can present between 6 months and 50 years of age, weakness, vision loss, and mental regression may occur.[3]

Inheritance pattern: autosomal recessive
Incidence: 1 in 141,000 live births[4]
Diagnosis: enzyme assay[3]
Conditions with similar presentations: metachromatic leukodystrophy, GM1 and GM2 gangliosidoses, X-linked adrenoleukodystrophy, Canavan disease, Pelizaeus-Merzbacher disease, Alexander disease[3]
Management:[2,5] bone marrow transplantation has been shown to have benefit for mild cases early in the course of the disease
Other medical care:[1,5] symptom management; physical therapy may help maintain or increase muscle tone and circulation

Signs and Symptoms[1,2]

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Neurologic
Myoclonic seizures
Hypertonia
Irritability
Developmental delays
Loss of previously attained developmental skills
Hypersensitivity
Temperature spikes
Tremor
Decerebration
Ataxia
Spasticity

Ocular
Vision loss leading to blindness

Gastrointestinal
Episodes of severe vomiting

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Other Resources

www.emedicine.com/ped/topic2892.htm



References


1. Clarke LA. Clinical diagnosis of lysosomal storage diseases. In: Applegarth DA, Dimmick JE, JG Hall. Organelle Diseases: Clinical Features, Diagnosis, Pathogenesis and Management. London: Chapman and Hall 1997; 37-71.

2. National Institute of Neurological Disorders and Stroke. www.ninds.nih.gov/health_and_medical/disorders/krabbe_doc.htm Accessed July 2004.

3. Kleta, Robert, MD, PhD; Gahl, William A, MD, PhD. “Krabbe Disease.” www.genetests.org. Updated 6 June 2003. Accessed July 2004.

4. Meikle PJ, Hopwood JJ, Clague AE, Carey WF. Prevalence of Lysosomal Storage Disorders. JAMA. 1999; 281: 249-254.

5. DL, Hauser SL, Longo DL, eds. Harrison’s Principles of Internal Medicine. 14th ed. New York: McGraw-Hill; 1998; p. 2170.