• Investigative Magnetic Resonance Imaging
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• v.25 no.2
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• pp.101-108
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• 2021

Purpose: To identify characteristic magnetic resonance imaging (MRI) features to differentiate between Krabbe disease and metachromatic leukodystrophy (MLD) in young children. Materials and Methods: We collected all confirmed cases of Krabbe disease and MLD between October 2004 and September 2020 at Seoul National University Children's Hospital. Patients with initial MRI available were included. Their initial MRIs were retrospectively reviewed for the following: 1) presence of white matter signal abnormality involving the periventricular and deep white matter, subcortical white matter, internal capsule, brainstem, and cerebellum; 2) presence of volume decrease and signal alteration in the corpus callosum and thalamus; 3) presence of the tigroid sign; 4) presence of optic nerve hypertrophy; and 5) presence of enhancement or diffusion restriction. Results: Eleven children with Krabbe disease and 12 children with MLD were included in this study. There was no significant difference in age or symptoms at onset. Periventricular and deep white matter signal alterations sparing the subcortical white matter were present in almost all patients of the two groups. More patients with Krabbe disease had T2 hyperintensities in the internal capsule and brainstem than patients with MLDs. In contrast, more patients with MLD had T2 hyperintensities in the splenium and genu of the corpus callosum. No patient with Krabbe disease showed T2 hyperintensity in the corpus callosal genu. A decrease in volume in the corpus callosum and thalamus was more frequently observed in patients with Krabbe disease than in those with MLD. Other MRI findings including the tigroid sign and optic nerve hypertrophy were not significantly different between the two groups. Conclusion: Signal abnormalities in the internal capsule and brainstem, decreased thalamic volume, decreased splenial volume accompanied by signal changes, and absence of signal changes in the callosal genu portion were MRI findings suggestive of Krabbe disease rather than MLD based on initial MRI. Other MRI findings such as the tigroid sign could not help differentiate between these two diseases.

• Genomics & Informatics
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• v.20 no.2
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• pp.24.1-24.8
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• 2022

Hypomyelinating leukodystrophy type 2 (HLD2), is an inherited genetic disease of the central nervous system caused by recessive mutations in the gap junction protein gamma 2 (GJC2/GJA12). HLD2 is characterized by nystagmus, developmental delay, motor impairments, ataxia, severe speech problem, and hypomyelination in the brain. The GJC2 sequence encodes connexin 47 protein (Cx47). Connexins are a group of membrane proteins that oligomerize to construct gap junctions protein. In the present study, a novel missense mutation gene c.760G>A (p.Val254Met) was identified in a patient with HLD2 by performing whole exome sequencing. Following the discovery of the new mutation in the proband, we used Sanger sequencing to analyze his affected sibling and parents. Sanger sequencing verified homozygosity of the mutation in the proband and his affected sibling. The autosomal recessive inheritance pattern was confirmed since Sanger sequencing revealed both healthy parents were heterozygous for the mutation. PolyPhen2, SIFT, PROVEAN, and CADD were used to evaluate the function prediction scores of detected mutations. Cx47 is essential for oligodendrocyte function, including adequate myelination and myelin maintenance in humans. Novel mutation p.Val254Met is located in the second extracellular domain of Cx47, both extracellular loops are highly conserved and probably induce intramolecular disulfide interactions. This novel mutation in the Cx47 gene causes oligodendrocyte dysfunction and HLD2 disorder.

• Journal of The Korean Society of Inherited Metabolic disease
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• v.3 no.1
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• pp.38-44
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• 2003

• Journal of Veterinary Clinics
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• v.38 no.2
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• pp.89-93
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• 2021

2-Month-old, three related Perro de Presa Canario dogs were evaluated for similar neurological symptoms like circling, head pressing, depressed mental status, hypermetria, and vocalization. On magnetic resonance imaging (MRI) of the brain, there were large, bilaterally symmetrical lesions with involvement of thalamus, and brainstem that were T2- and FLAIR-hyperintense and T1-iso/hypointense. There was no inclusion of cerebellum. Single-voxel spectroscopy acquisition was located in the thalamus where abnormalities were found in MR images. The results of magnetic resonance spectroscopy (MRS) showed markedly decreased N-acetylaspartic acid value. Euthanasia was performed and lesions consistent with the canine spongy degeneration. Alteration in metabolites in the brain can be determined by MRS, which helps in diagnosing degeneration/leukodystrophy of the central nervous system in dogs.

• Journal of The Korean Dental Society of Anesthesiology
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• v.7 no.1
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• pp.18-21
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• 2007

Pelizaeus-Merzbacher disease (PMD) can be defined as an X-linked recessive leukodystrophy that is caused by a mutation in the proteolipid protein gene on chromosome Xq22. PMD is one of a group of progressive, degenerative disorders of the cerebral white matter known as the leukodystrophies. Due to the progressive nature of the disorders and their devastating effects on the central nervous system, these children frequently require anesthesia during imaging procedures such as MRI or during various surgical procedures. Anesthetic concerns in theses cases include high prevalence of seizure disorders, gastroesophageal reflux with the risk of aspiration, airway complications related to poor pharyngeal muscle control and copious oral secretions, and mental retardation. We report a successful anesthetic management in a patient with PMD for dental procedures.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.12 no.2
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• pp.96-100
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• 2016

Metachromatic leukodystrophy (MLD) is a progressive and degenerative neurological disease caused by a deficiency of the catabolic enzyme arylsulfatase A. Deficiency of arylsulfatase A results in accumulation of sulfatide in the white matter of the peripheral and central nervous system and it occurs demyelination as a result. The patient gradually goes through mental and motor failure. General symptoms of MLD include gait disturbance, mental deterioration, muscle rigidity and impaired swallowing. Inheritance of the disease is autosomal recessive. We report a dental caries treatment of a 3-year old boy with MLD. The patient underwent hematopoietic stem cell transplantation (HSCT) to slow the progression of the disease. He was suffered from difficulties of mastication and swallowing from the degenerative neurological symptom. He was ingesting food by both oral feeding and tubal feeding after he took percutaneous endoscopic gastrostomy (PEG). The cause of multiple caries was mainly presumed as patient's prolonged time of meal. The treatment was performed under general anesthesia considering patient's incompliance. Severely affected lower primary molars were treated with pulp treatment and restored with stainless steel crown. Others were restored with composite resin. There were no postoperative complications. MLD is life threatening progressive disease and also has an impact on unfavorable condition for oral health. Routine home oral care and periodic professional dental care should be emphasized to the caregiver of patient considering the susceptibility of dental caries. Not only the medical care, but periodic dental office visit would benefit the quality of life of the patient.

• Biomolecules & Therapeutics
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• v.22 no.2
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• pp.83-92
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• 2014

Fatty acids (FAs) are highly diverse in terms of carbon (C) chain-length and number of double bonds. FAs with C>20 are called very long-chain fatty acids (VLCFAs). VLCFAs are found not only as constituents of cellular lipids such as sphingolipids and glycerophospholipids but also as precursors of lipid mediators. Our understanding on the function of VLCFAs is growing in parallel with the identification of enzymes involved in VLCFA synthesis or degradation. A variety of inherited diseases, such as ichthyosis, macular degeneration, myopathy, mental retardation, and demyelination, are caused by mutations in the genes encoding VLCFA metabolizing enzymes. In this review, we describe mammalian VLCFAs by highlighting their tissue distribution and metabolic pathways, and we discuss responsible genes and enzymes with reference to their roles in pathophysiology.

• Journal of Yeungnam Medical Science
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• v.27 no.1
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• pp.47-51
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• 2010

We present here the case of a 13-year-old male patient with Alexander's disease who underwent surgical correction of a femur fracture. Alexander's disease is a rare and fatal disorder that affects the white matter in the brain and it causes developmental delay, psychomotor regression, spasticity, megaloencephaly and seizure. The patient had the possibility of a seizure attack during the perioperative period. We discuss the anesthetic management of a patient with Alexander's disease and we review the relevant literature.

• Proceedings of the KSMRM Conference
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• 1999.04a
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• pp.99-108
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• 1999

선천성 대사 이상은 다양한 뇌질환으로 나타낸다. 일반적으로 이 질환들은 하나 또는 둘이상의 대사경로에 대한 생화학적 이상에 원인이 있다. 정상적 생화학적 산물의 결핍이나 비정상적 산물의 축적에 의한 뇌기능 이상에 의해 임상증상이 나타내게 되는데 그 증상은 대개 경기, 경직성, 발육지연 등으로 비특이적이고 영상소견도 마찬가지로 비특이적이다. 대사 이상에 있어서의 신경병변은 일부 뇌백질을 주로 침범하는 경우를 제외하면 대부분 뇌백질을 침범하고 따라서 일반적으로 일차성 뇌백질 질환이 대사성 뇌질환을 일컫는다고 할 수가 있다. 뇌백질 질환은 뇌백질의 구성원중 가장 큰 부분을 차지하는 수초(myelin)를 침범하는 질환을 일컫는다. 중추신경계의 백질은 수초로 싸여있는 축삭(axon)과 선경교세포 (neuroglial cell) 및 혈관 등으로 구성되어 있으며, 이중 대부분을 수초가 차지하고 이 수초로 인하여 정상 뇌백질이 흰색을 나타낸다. 백질내의 신경교세포로는 성상세포 (astrocyte) 와 핍지세포 (oligodendrocyte)가 있으며 신 경교세포의 가장 중요한 기능은 핍지세포에 의한 축삭의 외피화 (ensheathment) 즉, 수초이다. 수초는 핍지세포의 세포질 돌기 (cytoplasmic process)의 일부이며 따라서 수초의 생존과 대사는 핍지세포와 운명을 같이한다. 일반적으로 세포의 생존, 대사와 가장 관련있는 기능은 세포질내에 함유되어 있는 구조물인 소기관(organelle)에 의하여 수행된다. 따라서, 비록 모든 소기관들이 백질 질환을 이르키는데 직접 연관되어 있지는 않더라도 수초의 생존과 대사에는 핍지세포의 소기관들이 매우 중요한 역할을 하게 된다. 세포질내 중요한 소기관으로는 세포 막, 미토콘드리아 (mitochondria), endoplasmic reticulum, Golgi 체, lysosome, peroxisome 그리고 세포질등이 있으며, 이들중에서 lysosomes, peroxisomes, 그리고 미토콘드리아가 특정한 유전성 백질질환에 중요한 역할을 하는 것이 밝혀졌다. 이러한 질환들은 최소한 각 소기관에 의한 질환군으로 분류될 수 있다.

• Annals of Clinical Neurophysiology
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• v.8 no.1
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• pp.36-39
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• 2006

Background: Floppy infant syndrome has a number of different etiologies. Methods: One hundred twenty-three consecutive patients of floppy infant syndrome were included in this study. We reviewed all the electrophysiologic tests of these patients and the medical record of patients showing abnormalities in the electrophysiologic studies. Results: Of the 123 patients, twenty-six (21.1%) showed definite abnormalities in electrophysiologic tests; 8 myopathies, 14 neuropathies and 4 unclassified. The neuropathy was further classified as 5 neuronopathies and 9 sensorimotor polyneuropathies. With muscle or sural nerve biopsy and genetic test, a final diagnosis was made of Duchenne muscular dystrophy in 4, Becker muscular dystrophy in 1, spinal muscular atrophy in 2, and metachromatic leukodystrophy in 1. Conclusions: About 21% of patients presented with floppy infant syndrome showed abnormalities in the neuromuscular system. The electrophysiologic test is valuable to guide further investigations in diagnosing the cause of floppy infant syndrome.