Familial dysautonomia in a non-Jewish child

Precise genetic mapping and haplotype analysis of the familial dysautonomia gene on human chromosome 9q31

Familial dysautonomia (FD) is an autosomal recessive disorder characterized by developmental arrest in the sensory and autonomic nervous systems and by Ashkenazi Jewish ancestry. We previously had mapped the defective gene (DYS) to an 11-cM segment of chromosome 9q31-33, flanked by D9S53 and D9S105. By using 11 new polymorphic loci, we now have narrowed the location of DYS to <0.5 cM between the markers 43B1GAGT and 157A3. Two markers in this interval, 164D1 and D9S1677, show no recombination with the disease. Haplotype analysis confirmed this candidate region and revealed a major haplotype shared by 435 of 441 FD chromosomes, indicating a striking founder effect. Three other haplotypes, found on the remaining 6 FD chromosomes, might represent independent mutations. The frequency of the major FD haplotype in the Ashkenazim (5 in 324 control chromosomes) was consistent with the estimated DYS carrier frequency of 1 in 32, and none of the four haplotypes associated with FD was observed on 492 non-FD chromosomes from obligatory carriers. It is now possible to provide accurate genetic testing both for families with FD and for carriers, on the basis of close flanking markers and the capacity to identify >98% of FD chromosomes by their haplotype.

The congenital insensitivity-to-pain syndrome (analgesia congenita): report of a case

The congenital insensitivity-to-pain syndrome is one of several entities of sensory neuropathies in which pain sensation is absent from birth. This report describes a female child with the syndrome, who in all other aspects was normal. The most severe oral consequence of her disorder was self-inflicted exfoliation at an early age of all single-rooted primary teeth and one primary molar (a total of 13 teeth). The child was monitored from age 8. The primary aim in management was to monitor the eruption of the permanent teeth and occlusal development. At eruption of the mandibular incisors a protective splint was constructed to prevent their sharp edges injuring the tongue and the oral mucosa. The child was also instructed not to agitate her newly erupted teeth. Further occlusal development of the permanent dentition was uneventful.

Incidence of familial dysautonomia in Israel 1977-1981

The incidence of all diagnosed cases of familial dysautonomia in Israel among Ashkenazi Jews from 1977-1981 was 27/100,000 or 1/3703. This incidence is higher than that previously reported in Israel in 1967 or 8.3/100,000 (1/12,048) (Moses et al. 1967). It is also higher than that of North American Ashkenazi Jews in 1970, when the rate was 5-10/100,000 (1/10,000-20,000) (Brunt & McKusick 1970). This higher incidence could be explained by current awareness of the diagnosis, or by the emergence of more cases.

Child psychiatric problems in "autonomous dysfunction"

The Riley-Day syndrome, also known by the name Familial Dysautonomia, is characterized by a marked deficit in autonomic homeostatic function. A review of the literature and a case illustration describe the physical, emotional, social and learning problems. It is new known that sub-normal intelligence is not part of the syndrome. The impact of the symptoms on the child and on the mother-child relationship may aggravate the deficient emotional balance. Since marked improvement of the condition does occur, especially in patients who reach the age of six, a hopeful attitude in the guidance and treatment is justified and highly beneficial.

Corneal transplantation in familial dysautonomia

A 15-year-old girl with familial dysautonomia had acute corneal ulcerations while on a respiratory during a dysautonomic crisis. Within 18 days she developed irritating corneal ring calcifications. Subsequent corneal perforation in the left eye was treated successfully with a lamellar graft, followed later by a penetrating graft in the right eye under local anesthesia. Four days postoperatively, the patient died during a vomiting crisis. Neuropathologic studies showed marked cell reduction in the superior cervical and trigeminal ganglia, but slight in the ciliary. The foveas appeared immature and macular ganglion cells were mildly reduced. The corneal button and lamellar grafted cornea had severe thinning and superficial calcification. Keratoplasty in familial dysautonomia is considered hazardous because of the continual threat of vomiting crises, but with sufficient care may be worthwhile for corneal perforation or advanced corneal scarring.