Neuropediatrics 2003; 34(4): 215-218
DOI: 10.1055/s-2003-42210
Short Communication

Georg Thieme Verlag Stuttgart · New York

Clinical and Genetic Heterogeneity in Megalencephalic Leukoencephalopathy with Subcortical Cysts (MLC)

R. Blattner 1 , A. von Moers 2 , P. A. J. Leegwater 3 , F. A. Hanefeld 4 , M. S. Van der Knaap 5 , W. Köhler 6
  • 1Department of Psychiatry, Manchester Royal Infirmary, Oxford Road, Manchester, United Kingdom
  • 2Department of Neuropaediatrics, Charité, Humboldt University, Berlin, Germany
  • 3Departments of Clinical Chemistry and Child Neurology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
  • 4Department of Paediatrics and Child Neurology, University of Göttingen, Göttingen, Germany
  • 5Department of Child Neurology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
  • 6Department of Neurology, Saxonian State Hospital Hubertusburg, Wermsdorf, Germany
Further Information

Publication History

Received: January 27, 2003

Accepted after Revision: May 16, 2003

Publication Date:
15 September 2003 (online)

Abstract

Background

Megalencephalic leukoencephalopathy with subcortical cysts (MLC) was recently localized on chromosome 22qtel and 26 different mutations of the gene MLC1 have been found. We report three siblings of non-consanguineous parents who presented with characteristic features of MLC, but did not have MLC1 mutations.

Methods

Clinical, laboratory and neuro-imaging findings of the siblings are described and similar patients with MLC are reviewed.

Results

All three siblings suffered from ataxia, progressive severe tetraparesis, dysarthria, dysphagia and epilepsy. Generalized dystonia occurred in one patient. Mental deterioration progressed more slowly than motor deterioration. The youngest male was the most severely affected and died at the age of 23 years. The two older females are now 34 and 35 years old. Our patients are among the oldest described with this clinical entity. No mutation of the MLC1 gene was found in our siblings and linkage with the MLC1 locus was excluded.

Conclusions

The genetic findings in our patients suggest at least a second gene locus for MLC.

References

  • 1 Ben-Zeev B, Brand N, Prass E. et al . Megalencephaly-leukodystrophy (Van der Knaap syndrome) in 11 children of Jewish-Libyan and Turkish families: an opening for genetic linkage study.  Brain Dev. 1998;  20 359-(Abstract)
  • 2 Biancheri R, Pisaturo C, Perrone M V, Pessagno A, Rossi A, Veneselli E. Presence of delayed myelination and macrocephaly in the sister of a patient with vacuolating leukoencephalopathy with subcortical cysts.  Neuropediatrics. 2000;  31 321-324
  • 3 Cartwright J D, Gottlich E. Megalencephaly and leukoencephalopathy of infantile onset with mild clinical course.  Brain Dev. 1998;  20 360 (Abstract)
  • 4 De Stefano N, Balestri P, Dotti M T. et al . Severe metabolic abnormalities in the white matter of patients with vacuolating megalencephalic leukoencephalopathy with subcortical cysts. A proton MR spectroscopic imaging study.  J Neurol. 2001;  248 403-409
  • 5 Goutières F, Boulloche J, Bourgeois M, Aicardi J. Leukoencephalopathy, megalencephaly and mild clinical course. A recently individualized familial leukodystrophy. Report on five new cases.  J Child Neurol. 1996;  11 439-444
  • 6 Gulati S, Kabra M, Gera S, Ghosh M, Menon P SN, Kalra V. Infantile-onset leukoencephalopathy with discrepant mild clinical course.  Indian J Pediatr. 2000;  67 769-773
  • 7 Harbord M G, Harden A, Harding B, Brett E M, Baraitser M. Megalencephaly with dysmyelination, spasticity, ataxia, seizures and distinctive neurophysiological findings in two siblings.  Neuropediatrics. 1990;  21 164-168
  • 8 Higuchi Y, Hattori H, Tsuji M, Asato R, Nakahata T. Partial seizures in leukoencephalopathy with swelling and a discrepantly mild clinical course.  Brain Dev. 2000;  22 387-389
  • 9 Klein E A, Anzil A P. Prominent white matter cavitation in an infant with Alexander's disease.  Clin Neuropathol. 1994;  13 31-38
  • 10 Koeda T, Takeshita K. Slowly progressive cystic leukencephalopathy with megalencephaly in a Japanese boy.  Brain Dev. 1998;  20 245-249
  • 11 Kyoya S, Irimichi H, Matsushima A, Kimura A. Case of megalencephaly with leukodystrophic findings in CT scans: Alexander's disease?.  No to Hattatsu. 1984;  16 76-78
  • 12 Leegwater P AJ, Yuan B Q, Van der Steen J. et al . Mutations of MLC1 (KIAA0027), encoding a putative membrane protein, cause megalencephalic leukoencephalopathy with subcortical cysts.  Am J Hum Genet. 2001;  68 831-838
  • 13 Leegwater P AJ, Boor P KI, Yuan B Q. et al . Identifications of novel mutations in MLC1 responsible for megalencephalic leukoencephalopathy with subcortical cysts.  Hum Genet. 2002;  110 279-283
  • 14 Mejaski-Bosniak V, Besenski N, Brockmann K, Pouwels P JW, Frahm J, Hanefeld F A. Cystic leukoencephalopathy in a megalencephalic child: Clinical and magnetic resonance imaging/magnetic resonance spectroscopy findings.  Pediatr Neurol. 1997;  16 347-350
  • 15 Pisaturo C, Biancheri R, Perrone M V, Rossi A, Veneselli E. Leucodistrofia con macrocefalia e decorso clinico sorprendentemente lieve [Leukencephalopathy with swelling, megalencephalopathy and surprisingly mild course].  Minerva Pediatr. 1999;  51 399-402
  • 16 Singhal B S, Gursahani R D, Udani V P, Biniwale A A. Megalencephalic leukodystrophy in an Asian Indian ethnic group.  Pediatr Neurol. 1996;  14 291-296
  • 17 Takanashi J, Sugita K, Kohno Y. Vacuolating leukencephalopathy with subcortical cysts with late onset athetotic movements.  J Neurol Sci. 1999;  165 90-93
  • 18 Thelle T, Balslev T, Christensen T. Van der Knaap's vacuolating leukoencephalopathy: two additional cases.  Eur J Paediatr Neurol. 1999;  3 83-86
  • 19 Topcu M, Saatci I, Topcuoglu M A, Kose G, Kunak B. Megalencephaly and leukodystrophy with mild clinical course: a report on 12 new cases.  Brain Dev. 1998;  20 142-153
  • 20 Topcu M, Gartioux C, Ribierre F. et al . Vacuolating megalencephalic leukencephalopathy with subcortical cysts mapped to chromosome 22qtel.  Am J Hum Genet. 2000;  66 733-739
  • 21 Van der Knaap M S, Barth P G, Stroink H. et al . Leukoencephalopathy with swelling and a discrepantly mild clinical course in eight children.  Ann Neurol. 1995;  37 324-334
  • 22 Van der Knaap M S, Naidu S, Breiter S N. et al . Alexander disease: diagnosis with MR imaging.  Am J Neuroradiol. 2001;  22 541-552
  • 23 Wiedemann H R, Kunze J. Atlas der klinischen Syndrome [Synopsis of Clinical Syndromes]. 5th ed. Stuttgart, New York; Schattauer Verlag 2001
  • 24 Yakinci C, Soylu H, Kutlu N O, Sener R N. Leukoencephalopathy with a mild clinical course: a case report.  Comput Med Im Graph. 1999;  23 169-172
  • 25 Yalcinkaya C, Comu S, Kocer N, Yüksel A, Gündüz E, Demirbilek V, Öcal A. Siblings with cystic leukoencephalopathy and megalencephaly.  J Child Neurol. 2000;  15 690-693
  • 26 Yapycy-Ucgul Z, Ucgul A, Deniz E, Barlas M, Eraksoy M. Cystic leukoencephalopathy with megalencephaly in two siblings: Clinical characteristics MRI and MRS findings.  Brain Dev. 1998;  20 376 (Abstract)
  • 27 Yoshimura N, Nishizawa M, Hozumi I, Yuasa T, Miyatake T. A case of leukodystrophy, suspected Alexander's disease and its magnetic resonance imaging.  Clin Neurol (Tokyo). 1987;  11 41-44

M. D., MRCPsych R. Blattner

Department of Psychiatry · Rawnsley Building · Manchester Royal Infirmary

Oxford Road

Manchester, M13 9WL

United Kingdom

Email: blattner@regine.fsnet.co.uk