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Neurodevelopmental disorder and language delay with or without structural brain abnormalities(NEDLBA)

MedGen UID:
1677130
Concept ID:
C5193048
Disease or Syndrome
Synonyms: NEDLBA; NEURODEVELOPMENTAL DISORDER AND LANGUAGE DELAY WITH OR WITHOUT STRUCTURAL BRAIN ABNORMALITIES
 
Gene (location): PPP2CA (5q31.1)
 
Monarch Initiative: MONDO:0032697
OMIM®: 618354

Definition

Neurodevelopmental disorder and language delay with or without structural brain abnormalities (NEDLBA) is characterized by global developmental delay apparent from infancy. The phenotype is highly variable: patients may have hypotonia, behavioral abnormalities, and abnormalities on brain imaging, including enlarged ventricles, thin corpus callosum, and sometimes small brainstem. Many develop seizures, sometimes refractory, and some may have nonspecific dysmorphic features. Intellectual impairment can vary from mild to profound, and some patients may benefit from special education and respond well to speech therapy (summary by Reynhout et al., 2019). [from OMIM]

Clinical features

From HPO
Single transverse palmar crease
MedGen UID:
96108
Concept ID:
C0424731
Finding
The distal and proximal transverse palmar creases are merged into a single transverse palmar crease.
Abnormal cardiac septum morphology
MedGen UID:
6752
Concept ID:
C0018816
Congenital Abnormality
An anomaly of the intra-atrial or intraventricular septum.
Feeding difficulties
MedGen UID:
65429
Concept ID:
C0232466
Finding
Impaired ability to eat related to problems gathering food and getting ready to suck, chew, or swallow it.
Seizure
MedGen UID:
20693
Concept ID:
C0036572
Sign or Symptom
A seizure is an intermittent abnormality of nervous system physiology characterised by a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain.
Delayed ability to walk
MedGen UID:
66034
Concept ID:
C0241726
Finding
A failure to achieve the ability to walk at an appropriate developmental stage. Most children learn to walk in a series of stages, and learn to walk short distances independently between 12 and 15 months.
Hypoplasia of the corpus callosum
MedGen UID:
138005
Concept ID:
C0344482
Congenital Abnormality
Underdevelopment of the corpus callosum.
Delayed speech and language development
MedGen UID:
105318
Concept ID:
C0454644
Finding
A degree of language development that is significantly below the norm for a child of a specified age.
Global developmental delay
MedGen UID:
107838
Concept ID:
C0557874
Finding
A delay in the achievement of motor or mental milestones in the domains of development of a child, including motor skills, speech and language, cognitive skills, and social and emotional skills. This term should only be used to describe children younger than five years of age.
Autistic behavior
MedGen UID:
163547
Concept ID:
C0856975
Mental or Behavioral Dysfunction
Persistent deficits in social interaction and communication and interaction as well as a markedly restricted repertoire of activity and interest as well as repetitive patterns of behavior.
Delayed myelination
MedGen UID:
224820
Concept ID:
C1277241
Finding
Delayed myelination.
Hypoplasia of the brainstem
MedGen UID:
334226
Concept ID:
C1842688
Finding
Underdevelopment of the brainstem.
Ventriculomegaly
MedGen UID:
480553
Concept ID:
C3278923
Finding
An increase in size of the ventricular system of the brain.
Inguinal hernia
MedGen UID:
6817
Concept ID:
C0019294
Finding
Protrusion of the contents of the abdominal cavity through the inguinal canal.
Umbilical hernia
MedGen UID:
9232
Concept ID:
C0019322
Anatomical Abnormality
Protrusion of abdominal contents through a defect in the abdominal wall musculature around the umbilicus. Skin and subcutaneous tissue overlie the defect.
Plagiocephaly
MedGen UID:
78562
Concept ID:
C0265529
Congenital Abnormality
Asymmetric head shape, which is usually a combination of unilateral occipital flattening with ipsilateral frontal prominence, leading to rhomboid cranial shape.
Generalized hypotonia
MedGen UID:
346841
Concept ID:
C1858120
Finding
Generalized muscular hypotonia (abnormally low muscle tone).
Macrocephaly
MedGen UID:
745757
Concept ID:
C2243051
Finding
Occipitofrontal (head) circumference greater than 97th centile compared to appropriate, age matched, sex-matched normal standards. Alternatively, a apparently increased size of the cranium.
Microcephaly
MedGen UID:
1644158
Concept ID:
C4551563
Finding
Head circumference below 2 standard deviations below the mean for age and gender.
High palate
MedGen UID:
66814
Concept ID:
C0240635
Congenital Abnormality
Height of the palate more than 2 SD above the mean (objective) or palatal height at the level of the first permanent molar more than twice the height of the teeth (subjective).
Broad nasal tip
MedGen UID:
98424
Concept ID:
C0426429
Finding
Increase in width of the nasal tip.
Epicanthus
MedGen UID:
151862
Concept ID:
C0678230
Congenital Abnormality
Epicanthus is a condition in which a fold of skin stretches from the upper to the lower eyelid, partially covering the inner canthus. Usher (1935) noted that epicanthus is a normal finding in the fetus of all races. Epicanthus also occurs in association with hereditary ptosis (110100).
Broad forehead
MedGen UID:
338610
Concept ID:
C1849089
Finding
Width of the forehead or distance between the frontotemporales is more than two standard deviations above the mean (objective); or apparently increased distance between the two sides of the forehead.
Short philtrum
MedGen UID:
350006
Concept ID:
C1861324
Finding
Distance between nasal base and midline upper lip vermilion border more than 2 SD below the mean. Alternatively, an apparently decreased distance between nasal base and midline upper lip vermilion border.
Periorbital fullness
MedGen UID:
1710990
Concept ID:
C4760994
Finding
Increase in periorbital soft tissue.
Proptosis
MedGen UID:
41917
Concept ID:
C0015300
Disease or Syndrome
An eye that is protruding anterior to the plane of the face to a greater extent than is typical.
Hypertelorism
MedGen UID:
9373
Concept ID:
C0020534
Finding
Although hypertelorism means an excessive distance between any paired organs (e.g., the nipples), the use of the word has come to be confined to ocular hypertelorism. Hypertelorism occurs as an isolated feature and is also a feature of many syndromes, e.g., Opitz G syndrome (see 300000), Greig cephalopolysyndactyly (175700), and Noonan syndrome (163950) (summary by Cohen et al., 1995).
Megalocornea
MedGen UID:
138008
Concept ID:
C0344530
Congenital Abnormality
Megalocornea is an inherited eye disorder in which the corneal diameter is bilaterally enlarged (greater than 13 mm) without an increase in intraocular pressure. It may also be referred to as 'anterior megalophthalmos,' since the entire anterior segment is larger than normal. Features of megalocornea in addition to a deep anterior chamber include astigmatic refractive errors, atrophy of the iris stroma, miosis secondary to decreased function of the dilator muscle, iridodonesis, and tremulousness, subluxation, or dislocation of the lens. Whereas most affected individuals exhibit normal ocular function, complications include cataract development and glaucoma following lenticular dislocation or subluxation. X-linked recessive inheritance is the most common pattern, accounting for the male preponderance of the disorder (summary by Skuta et al., 1983). Megalocornea sometimes occurs as part of the Marfan syndrome (154700). Genetic Heterogeneity of Megalocornea Autosomal recessive megalocornea has been reported (249300).
Visual impairment
MedGen UID:
777085
Concept ID:
C3665347
Finding
Visual impairment (or vision impairment) is vision loss (of a person) to such a degree as to qualify as an additional support need through a significant limitation of visual capability resulting from either disease, trauma, or congenital or degenerative conditions that cannot be corrected by conventional means, such as refractive correction, medication, or surgery.

Professional guidelines

PubMed

Ziobro J, Shellhaas RA
Semin Neurol 2020 Apr;40(2):246-256. Epub 2020 Mar 6 doi: 10.1055/s-0040-1702943. PMID: 32143234
Arvanitakis Z, Shah RC, Bennett DA
JAMA 2019 Oct 22;322(16):1589-1599. doi: 10.1001/jama.2019.4782. PMID: 31638686Free PMC Article
Sanchack KE, Thomas CA
Am Fam Physician 2016 Dec 15;94(12):972-979. PMID: 28075089

Recent clinical studies

Etiology

Caporale N, Leemans M, Birgersson L, Germain PL, Cheroni C, Borbély G, Engdahl E, Lindh C, Bressan RB, Cavallo F, Chorev NE, D'Agostino GA, Pollard SM, Rigoli MT, Tenderini E, Tobon AL, Trattaro S, Troglio F, Zanella M, Bergman Å, Damdimopoulou P, Jönsson M, Kiess W, Kitraki E, Kiviranta H, Nånberg E, Öberg M, Rantakokko P, Rudén C, Söder O, Bornehag CG, Demeneix B, Fini JB, Gennings C, Rüegg J, Sturve J, Testa G
Science 2022 Feb 18;375(6582):eabe8244. doi: 10.1126/science.abe8244. PMID: 35175820
Othman A
FP Essent 2021 Nov;510:17-21. PMID: 34709025
McGregor KK
Lang Speech Hear Serv Sch 2020 Oct 2;51(4):981-992. Epub 2020 Aug 5 doi: 10.1044/2020_LSHSS-20-00003. PMID: 32755505Free PMC Article
González MC, Vásquez M, Hernández-Chávez M
Rev Chil Pediatr 2019 Oct;90(5):485-491. doi: 10.32641/rchped.v90i5.872. PMID: 31859731
Duncan AF, Matthews MA
Clin Perinatol 2018 Sep;45(3):377-392. doi: 10.1016/j.clp.2018.05.001. PMID: 30144844

Diagnosis

Othman A
FP Essent 2021 Nov;510:17-21. PMID: 34709025
McGregor KK
Lang Speech Hear Serv Sch 2020 Oct 2;51(4):981-992. Epub 2020 Aug 5 doi: 10.1044/2020_LSHSS-20-00003. PMID: 32755505Free PMC Article
González MC, Vásquez M, Hernández-Chávez M
Rev Chil Pediatr 2019 Oct;90(5):485-491. doi: 10.32641/rchped.v90i5.872. PMID: 31859731
Friedman L, Sterling A
Semin Speech Lang 2019 Aug;40(4):291-304. Epub 2019 Jul 16 doi: 10.1055/s-0039-1692964. PMID: 31311054Free PMC Article
O'Hare A, Bremner L
Arch Dis Child 2016 Mar;101(3):272-7. Epub 2015 Jul 24 doi: 10.1136/archdischild-2014-307394. PMID: 26208514

Therapy

Brignell A, Chenausky KV, Song H, Zhu J, Suo C, Morgan AT
Cochrane Database Syst Rev 2018 Nov 5;11(11):CD012324. doi: 10.1002/14651858.CD012324.pub2. PMID: 30395694Free PMC Article
Veroniki AA, Rios P, Cogo E, Straus SE, Finkelstein Y, Kealey R, Reynen E, Soobiah C, Thavorn K, Hutton B, Hemmelgarn BR, Yazdi F, D'Souza J, MacDonald H, Tricco AC
BMJ Open 2017 Jul 20;7(7):e017248. doi: 10.1136/bmjopen-2017-017248. PMID: 28729328Free PMC Article
Mukherjee SB
Indian J Pediatr 2017 Apr;84(4):307-314. Epub 2017 Jan 19 doi: 10.1007/s12098-016-2272-2. PMID: 28101829
Sanchack KE, Thomas CA
Am Fam Physician 2016 Dec 15;94(12):972-979. PMID: 28075089
Blackmer AB, Feinstein JA
Pharmacotherapy 2016 Jan;36(1):84-98. doi: 10.1002/phar.1686. PMID: 26799351

Prognosis

Snijders Blok L, Verseput J, Rots D, Venselaar H, Innes AM, Stumpel C, Õunap K, Reinson K, Seaby EG, McKee S, Burton B, Kim K, van Hagen JM, Waisfisz Q, Joset P, Steindl K, Rauch A, Li D, Zackai EH, Sheppard SE, Keena B, Hakonarson H, Roos A, Kohlschmidt N, Cereda A, Iascone M, Rebessi E, Kernohan KD, Campeau PM, Millan F, Taylor JA, Lochmüller H, Higgs MR, Goula A, Bernhard B, Velasco DJ, Schmanski AA, Stark Z, Gallacher L, Pais L, Marcogliese PC, Yamamoto S, Raun N, Jakub TE, Kramer JM, den Hoed J, Fisher SE, Brunner HG, Kleefstra T
HGG Adv 2023 Jan 12;4(1):100157. Epub 2022 Nov 1 doi: 10.1016/j.xhgg.2022.100157. PMID: 36408368Free PMC Article
Pickles A, Wright N, Bedford R, Steiman M, Duku E, Bennett T, Georgiades S, Kerns CM, Mirenda P, Smith IM, Ungar WJ, Vaillancourt T, Waddell C, Zaidman-Zait A, Zwaigenbaum L, Szatmari P, Elsabbagh M; Pathways in ASD Study Team
J Child Psychol Psychiatry 2022 Nov;63(11):1243-1251. Epub 2022 Jan 30 doi: 10.1111/jcpp.13565. PMID: 35098539Free PMC Article
Synnes AR, Petrie J, Grunau RE, Church P, Kelly E, Moddemann D, Ye X, Lee SK, O'Brien K; Canadian Neonatal Network Investigators; Canadian Neonatal Follow-Up Network Investigators
Arch Dis Child Fetal Neonatal Ed 2022 Jan;107(1):76-81. Epub 2021 Jun 18 doi: 10.1136/archdischild-2020-321055. PMID: 34145042
Bishop DVM, Snowling MJ, Thompson PA, Greenhalgh T; and the CATALISE-2 consortium
J Child Psychol Psychiatry 2017 Oct;58(10):1068-1080. Epub 2017 Mar 30 doi: 10.1111/jcpp.12721. PMID: 28369935Free PMC Article
Singhania R
Indian J Pediatr 2005 Apr;72(4):343-51. doi: 10.1007/BF02724019. PMID: 15876765

Clinical prediction guides

Snijders Blok L, Verseput J, Rots D, Venselaar H, Innes AM, Stumpel C, Õunap K, Reinson K, Seaby EG, McKee S, Burton B, Kim K, van Hagen JM, Waisfisz Q, Joset P, Steindl K, Rauch A, Li D, Zackai EH, Sheppard SE, Keena B, Hakonarson H, Roos A, Kohlschmidt N, Cereda A, Iascone M, Rebessi E, Kernohan KD, Campeau PM, Millan F, Taylor JA, Lochmüller H, Higgs MR, Goula A, Bernhard B, Velasco DJ, Schmanski AA, Stark Z, Gallacher L, Pais L, Marcogliese PC, Yamamoto S, Raun N, Jakub TE, Kramer JM, den Hoed J, Fisher SE, Brunner HG, Kleefstra T
HGG Adv 2023 Jan 12;4(1):100157. Epub 2022 Nov 1 doi: 10.1016/j.xhgg.2022.100157. PMID: 36408368Free PMC Article
Pavinato L, Delle Vedove A, Carli D, Ferrero M, Carestiato S, Howe JL, Agolini E, Coviello DA, van de Laar I, Au PYB, Di Gregorio E, Fabbiani A, Croci S, Mencarelli MA, Bruno LP, Renieri A, Veltra D, Sofocleous C, Faivre L, Mazel B, Safraou H, Denommé-Pichon AS, van Slegtenhorst MA, Giesbertz N, van Jaarsveld RH, Childers A, Rogers RC, Novelli A, De Rubeis S, Buxbaum JD, Scherer SW, Ferrero GB, Wirth B, Brusco A
Brain 2023 Feb 13;146(2):534-548. doi: 10.1093/brain/awac278. PMID: 35979925Free PMC Article
Guo H, Bettella E, Marcogliese PC, Zhao R, Andrews JC, Nowakowski TJ, Gillentine MA, Hoekzema K, Wang T, Wu H, Jangam S, Liu C, Ni H, Willemsen MH, van Bon BW, Rinne T, Stevens SJC, Kleefstra T, Brunner HG, Yntema HG, Long M, Zhao W, Hu Z, Colson C, Richard N, Schwartz CE, Romano C, Castiglia L, Bottitta M, Dhar SU, Erwin DJ, Emrick L, Keren B, Afenjar A, Zhu B, Bai B, Stankiewicz P, Herman K; University of Washington Center for Mendelian Genomics, Mercimek-Andrews S, Juusola J, Wilfert AB, Abou Jamra R, Büttner B, Mefford HC, Muir AM, Scheffer IE, Regan BM, Malone S, Gecz J, Cobben J, Weiss MM, Waisfisz Q, Bijlsma EK, Hoffer MJV, Ruivenkamp CAL, Sartori S, Xia F, Rosenfeld JA, Bernier RA, Wangler MF, Yamamoto S, Xia K, Stegmann APA, Bellen HJ, Murgia A, Eichler EE
Nat Commun 2019 Oct 15;10(1):4679. doi: 10.1038/s41467-019-12435-8. PMID: 31616000Free PMC Article
Marrus N, Hall LP, Paterson SJ, Elison JT, Wolff JJ, Swanson MR, Parish-Morris J, Eggebrecht AT, Pruett JR Jr, Hazlett HC, Zwaigenbaum L, Dager S, Estes AM, Schultz RT, Botteron KN, Piven J, Constantino JN; IBIS Network
J Neurodev Disord 2018 Oct 22;10(1):29. doi: 10.1186/s11689-018-9247-8. PMID: 30348077Free PMC Article
Johannesen KM, Gardella E, Linnankivi T, Courage C, de Saint Martin A, Lehesjoki AE, Mignot C, Afenjar A, Lesca G, Abi-Warde MT, Chelly J, Piton A, Merritt JL 2nd, Rodan LH, Tan WH, Bird LM, Nespeca M, Gleeson JG, Yoo Y, Choi M, Chae JH, Czapansky-Beilman D, Reichert SC, Pendziwiat M, Verhoeven JS, Schelhaas HJ, Devinsky O, Christensen J, Specchio N, Trivisano M, Weber YG, Nava C, Keren B, Doummar D, Schaefer E, Hopkins S, Dubbs H, Shaw JE, Pisani L, Myers CT, Tang S, Tang S, Pal DK, Millichap JJ, Carvill GL, Helbig KL, Mecarelli O, Striano P, Helbig I, Rubboli G, Mefford HC, Møller RS
Epilepsia 2018 Feb;59(2):389-402. Epub 2018 Jan 8 doi: 10.1111/epi.13986. PMID: 29315614Free PMC Article

Recent systematic reviews

Ninan K, Liyanage SK, Murphy KE, Asztalos EV, McDonald SD
JAMA Pediatr 2022 Jun 1;176(6):e220483. Epub 2022 Jun 6 doi: 10.1001/jamapediatrics.2022.0483. PMID: 35404395Free PMC Article
Black N, Stockings E, Campbell G, Tran LT, Zagic D, Hall WD, Farrell M, Degenhardt L
Lancet Psychiatry 2019 Dec;6(12):995-1010. Epub 2019 Oct 28 doi: 10.1016/S2215-0366(19)30401-8. PMID: 31672337Free PMC Article
Chandra A, Dervenoulas G, Politis M; Alzheimer’s Disease Neuroimaging Initiative
J Neurol 2019 Jun;266(6):1293-1302. Epub 2018 Aug 17 doi: 10.1007/s00415-018-9016-3. PMID: 30120563Free PMC Article
Morgan AT, Murray E, Liégeois FJ
Cochrane Database Syst Rev 2018 May 30;5(5):CD006278. doi: 10.1002/14651858.CD006278.pub3. PMID: 29845607Free PMC Article
Veroniki AA, Rios P, Cogo E, Straus SE, Finkelstein Y, Kealey R, Reynen E, Soobiah C, Thavorn K, Hutton B, Hemmelgarn BR, Yazdi F, D'Souza J, MacDonald H, Tricco AC
BMJ Open 2017 Jul 20;7(7):e017248. doi: 10.1136/bmjopen-2017-017248. PMID: 28729328Free PMC Article

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