[Neuronal ceroid lipofuscinoses]

BACKGROUND

Neuronal ceroid lipofuscinoses (NCL) is a group of degenerative neurological diseases. The diseases are autosomally recessively inherited and are characterized by the accumulation of fluorescent ceroid and lipofuscin in neuronal cells in the brain and in extraneuronal cells. The aim of this review was to assess and to summarize research related to diagnostics and treatment of NCL.

MATERIAL AND METHODS

The article is built on own experience and systematic searches on PubMed, Medline, PsychInfo and the Internet.

RESULTS AND INTERPRETATION

Three main types of NCL with childhood onset are recognised; an infantile, a late infantile, and a juvenile type. One NCL type starts in adulthood. In Norway the juvenile type is diagnosed most frequently. The diseases are rare. The incidence rates in different countries range from 0.5 to 8.0 per 100,000 live births. The main features include impaired vision, failure of psychomotor development, seizures and premature death. Prior to availability of genetic testing, the clinical status, ophthalmologic examination, examination of blood cells for deposited material (vacuolised lymphocytes) and neurophysiological examinations were the most important methods of confirming the diagnosis. Recent genetic findings have established that defects in at least six different genes underlie the various forms of NCL. There is no curative treatment. Scientists are trying to develop treatment using enzyme replacement, gene therapy, stem cell transplantation and pharmacotherapy. Symptomatic and palliative treatment is therefore essential.

[Cerebral visual impairment in children]

Visual handicaps in children are often difficult to diagnose in early age and several etiological possibilities have to be ruled out. Cerebral visual impairments are of greater importance than most epidemiological studies indicate. Children with low birth weight are at special risk for visual disturbancies. Children with developmental dysfunctions and retardation and with neurohandicaps may have combined anterior ocular pathology and cerebral visual impairment. Health professionals responsible for the investigation of children with learning disabilities and visuomotor problems, must have a good understanding of visual development and processing.

[Delayed visual maturation--a differential diagnostic challenge. A follow-up study of 13 children with delayed visual development with or without other developmental disorders]

Early visual impairment represents several diagnostic possibilities from specific delayed visual maturation (type 1) with an excellent prognosis to more complex conditions with other ocular or neurological signs (type 2-4). Visual attention and interaction has been an interesting field of study in the interaction between biologically pre-programmed neonatal competencies and social facilitation. From these studies we can probably learn more about ((cloudy)) diagnoses such as cortical visual impairment, attention deficit hyperactivity disorder and autism. Investigations and follow-up of 13 infants who did not show any visual interest at 6 - 12 weeks old are presented, along with proposals for the clinical management of these problems.

The handicap code of the ICIDH, adapted for children aged 6-7 years. Classification Group of the Nordic Neuropediatric Association

The handicap section of the ICIDH was developed with the experience of adults in mind. In its original form the H Code is not immediately applicable to young children with disabilities. The Classification Group of the Nordic Neuropediatric Association has developed an adaptation of the H Code for use in children aged 6-7 years, and the adaptation is presented in this paper.

Attention deficit disorders: a study of peptide-containing urinary complexes

In several behavioral disorders, we have observed that abnormal amounts of peptides and protein-associated peptide complexes are excreted in the urine. The gel filtration patterns of these excreted substances have some specificity for the different disorders. The urinary excretion of peptide-containing complexes was studied in 91 boys and 13 girls (mean age 9.4 years, range 1-23) with the clinical diagnosis of attention deficit disorder (ADD), with or without hyperactivity. The gel filtration of urine precipitate showed patterns in all patients that were different from those seen in 36 normal controls. Sixty-four patients had increased benzoic acid-glycoprotein-peptide complexes in the late peaks. The symptoms of all these patients fit the criteria for diagnosis of attention deficit disorder with hyperactivity (ADDH). Thirty-five patients showed reduced amounts of uric acid complexes in the late peaks. Clinically, this group, with the exception of three patients, fit the criteria for diagnosis of attention deficit disorder without hyperactivity. Five patients showed reduced amounts of all urinary complexes; four of these were hyperactive. Moderate exercise in control children did not change the urinary pattern. One urinary peptide fraction from hyperactive patients, purified to homogeneity, increased the uptake of 14C[5-HT] in platelets. Strict clinical, neuropsychological, and psychophysiological selection of the patients reduced the heterogeneity of the patterns. Although more studies are needed, the findings seem promising for the possibility of developing biochemical tests that may be helpful diagnostically.

A new syndrome: thrombocytopathia, muscle fatigue, asplenia, miosis, migraine, dyslexia and ichthyosis

A new multifacetted syndrome inherited as an autosomal, dominant trait is described encompassing not only two hitherto undescribed hereditary defects--thrombocytopathia and asplenia--but also muscle contractile defect, migraine-like headache, miosis, dyslexia and ichthyosis. None of these defects has so far been assigned to a specific chromosome or linkage group. Further studies on the various aspects of the syndrome are in progress.