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Niemann-Pick disease type C.

Vanier MT - Orphanet J Rare Dis (2010)

Bottom Line: Symptomatic management of patients is crucial.A first product, miglustat, has been granted marketing authorization in Europe and several other countries for specific treatment of the neurological manifestations.The prognosis largely correlates with the age at onset of the neurological manifestations.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institut National de la Santé et de la Recherche Médicale, Unité 820, Faculté de Médecine Lyon-Est Claude Bernard, 7 Rue G, Paradin, F-69008, Lyon, France. marie-t.vanier@inserm.fr

ABSTRACT
Niemann-Pick C disease (NP-C) is a neurovisceral atypical lysosomal lipid storage disorder with an estimated minimal incidence of 1/120,000 live births. The broad clinical spectrum ranges from a neonatal rapidly fatal disorder to an adult-onset chronic neurodegenerative disease. The neurological involvement defines the disease severity in most patients but is typically preceded by systemic signs (cholestatic jaundice in the neonatal period or isolated spleno- or hepatosplenomegaly in infancy or childhood). The first neurological symptoms vary with age of onset: delay in developmental motor milestones (early infantile period), gait problems, falls, clumsiness, cataplexy, school problems (late infantile and juvenile period), and ataxia not unfrequently following initial psychiatric disturbances (adult form). The most characteristic sign is vertical supranuclear gaze palsy. The neurological disorder consists mainly of cerebellar ataxia, dysarthria, dysphagia, and progressive dementia. Cataplexy, seizures and dystonia are other common features. NP-C is transmitted in an autosomal recessive manner and is caused by mutations of either the NPC1 (95% of families) or the NPC2 genes. The exact functions of the NPC1 and NPC2 proteins are still unclear. NP-C is currently described as a cellular cholesterol trafficking defect but in the brain, the prominently stored lipids are gangliosides. Clinical examination should include comprehensive neurological and ophthalmological evaluations. The primary laboratory diagnosis requires living skin fibroblasts to demonstrate accumulation of unesterified cholesterol in perinuclear vesicles (lysosomes) after staining with filipin. Pronounced abnormalities are observed in about 80% of the cases, mild to moderate alterations in the remainder ("variant" biochemical phenotype). Genotyping of patients is useful to confirm the diagnosis in the latter patients and essential for future prenatal diagnosis. The differential diagnosis may include other lipidoses; idiopathic neonatal hepatitis and other causes of cholestatic icterus should be considered in neonates, and conditions with cerebellar ataxia, dystonia, cataplexy and supranuclear gaze palsy in older children and adults. Symptomatic management of patients is crucial. A first product, miglustat, has been granted marketing authorization in Europe and several other countries for specific treatment of the neurological manifestations. The prognosis largely correlates with the age at onset of the neurological manifestations.

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Niemann-Pick disease type C as a neurovisceral disease. Schematic representation of the main forms of the disease, with particular emphasis on type and age of onset of first neurological symptoms
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Figure 2: Niemann-Pick disease type C as a neurovisceral disease. Schematic representation of the main forms of the disease, with particular emphasis on type and age of onset of first neurological symptoms

Mentions: A description of the various clinical forms by age categories has been used in recent reviews [10,11,27] and will also be followed in this summary. Detailed complementary information can be obtained in [27]. For each age category except for the perinatal presentations, one should however distinguish patients entering the disease by systemic involvement [39] from those who are starting then their neurological disease (although they may have presented earlier with visceral symptoms). Of essential importance is to note that the age of onset of the systemic symptoms is not related with that of the neurological disease (the latter can occur many years or even decades later), while there is a correlation between the age of onset of the neurological symptoms and the general further course of the disease and lifespan (Fig. 1). Categorizing patients by forms based on the age range of onset of the neurological symptoms`[11,32,40], irrespective of the age of the first symptom, is very useful for genetic counseling, natural history studies and also in clinical practice. With an exception for the severe early infantile neurological form which is quite significantly distinct, recent large studies have however demonstrated an overlap between the neurological forms, and thus a continuum [27]. A schematic representation is proposed in Fig. 2.


Niemann-Pick disease type C.

Vanier MT - Orphanet J Rare Dis (2010)

Niemann-Pick disease type C as a neurovisceral disease. Schematic representation of the main forms of the disease, with particular emphasis on type and age of onset of first neurological symptoms
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2902432&req=5

Figure 2: Niemann-Pick disease type C as a neurovisceral disease. Schematic representation of the main forms of the disease, with particular emphasis on type and age of onset of first neurological symptoms
Mentions: A description of the various clinical forms by age categories has been used in recent reviews [10,11,27] and will also be followed in this summary. Detailed complementary information can be obtained in [27]. For each age category except for the perinatal presentations, one should however distinguish patients entering the disease by systemic involvement [39] from those who are starting then their neurological disease (although they may have presented earlier with visceral symptoms). Of essential importance is to note that the age of onset of the systemic symptoms is not related with that of the neurological disease (the latter can occur many years or even decades later), while there is a correlation between the age of onset of the neurological symptoms and the general further course of the disease and lifespan (Fig. 1). Categorizing patients by forms based on the age range of onset of the neurological symptoms`[11,32,40], irrespective of the age of the first symptom, is very useful for genetic counseling, natural history studies and also in clinical practice. With an exception for the severe early infantile neurological form which is quite significantly distinct, recent large studies have however demonstrated an overlap between the neurological forms, and thus a continuum [27]. A schematic representation is proposed in Fig. 2.

Bottom Line: Symptomatic management of patients is crucial.A first product, miglustat, has been granted marketing authorization in Europe and several other countries for specific treatment of the neurological manifestations.The prognosis largely correlates with the age at onset of the neurological manifestations.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institut National de la Santé et de la Recherche Médicale, Unité 820, Faculté de Médecine Lyon-Est Claude Bernard, 7 Rue G, Paradin, F-69008, Lyon, France. marie-t.vanier@inserm.fr

ABSTRACT
Niemann-Pick C disease (NP-C) is a neurovisceral atypical lysosomal lipid storage disorder with an estimated minimal incidence of 1/120,000 live births. The broad clinical spectrum ranges from a neonatal rapidly fatal disorder to an adult-onset chronic neurodegenerative disease. The neurological involvement defines the disease severity in most patients but is typically preceded by systemic signs (cholestatic jaundice in the neonatal period or isolated spleno- or hepatosplenomegaly in infancy or childhood). The first neurological symptoms vary with age of onset: delay in developmental motor milestones (early infantile period), gait problems, falls, clumsiness, cataplexy, school problems (late infantile and juvenile period), and ataxia not unfrequently following initial psychiatric disturbances (adult form). The most characteristic sign is vertical supranuclear gaze palsy. The neurological disorder consists mainly of cerebellar ataxia, dysarthria, dysphagia, and progressive dementia. Cataplexy, seizures and dystonia are other common features. NP-C is transmitted in an autosomal recessive manner and is caused by mutations of either the NPC1 (95% of families) or the NPC2 genes. The exact functions of the NPC1 and NPC2 proteins are still unclear. NP-C is currently described as a cellular cholesterol trafficking defect but in the brain, the prominently stored lipids are gangliosides. Clinical examination should include comprehensive neurological and ophthalmological evaluations. The primary laboratory diagnosis requires living skin fibroblasts to demonstrate accumulation of unesterified cholesterol in perinuclear vesicles (lysosomes) after staining with filipin. Pronounced abnormalities are observed in about 80% of the cases, mild to moderate alterations in the remainder ("variant" biochemical phenotype). Genotyping of patients is useful to confirm the diagnosis in the latter patients and essential for future prenatal diagnosis. The differential diagnosis may include other lipidoses; idiopathic neonatal hepatitis and other causes of cholestatic icterus should be considered in neonates, and conditions with cerebellar ataxia, dystonia, cataplexy and supranuclear gaze palsy in older children and adults. Symptomatic management of patients is crucial. A first product, miglustat, has been granted marketing authorization in Europe and several other countries for specific treatment of the neurological manifestations. The prognosis largely correlates with the age at onset of the neurological manifestations.

Show MeSH
Related in: MedlinePlus