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Vanishing white matter disease(VWM1)

MedGen UID:
347037
Concept ID:
C1858991
Disease or Syndrome
Synonyms: CACH syndrome; CACH/VWM syndrome; Childhood Ataxia with Central Nervous System Hypomyelination/Vanishing White Matter; CHILDHOOD ATAXIA WITH CENTRAL NERVOUS SYSTEM HYPOMYELINIZATION; Childhood ataxia with diffuse central nervous system hypomyelination; Cree leukoencehalopathy; EIF2B1-Related Childhood Ataxia with Central Nervous System Hypomyelination/Vanishing White Matter; EIF2B2-Related Childhood Ataxia with Central Nervous System Hypomyelination/Vanishing White Matter; EIF2B3-Related Childhood Ataxia with Central Nervous System Hypomyelination/Vanishing White Matter; EIF2B4-Related Childhood Ataxia with Central Nervous System Hypomyelination/Vanishing White Matter; EIF2B5-Related Childhood Ataxia with Central Nervous System Hypomyelination/Vanishing White Matter; Leukoencephalopathy with vanishing white matter; LEUKOENCEPHALOPATHY WITH VANISHING WHITE MATTER 1; Myelinosis centralis diffusa; VWM1
SNOMED CT: Vanishing white matter disease (447351004); Myelinosis centralis diffusa (447351004); Childhood ataxia with diffuse central nervous system hypomyelination (447351004); CACH (childhood ataxia with diffuse central nervous system hypomyelination) syndrome (447351004); Leukoencephalopathy with vanishing white matter (447351004)
Modes of inheritance:
Autosomal recessive inheritance
MedGen UID:
141025
Concept ID:
C0441748
Intellectual Product
Source: Orphanet
A mode of inheritance that is observed for traits related to a gene encoded on one of the autosomes (i.e., the human chromosomes 1-22) in which a trait manifests in individuals with two pathogenic alleles, either homozygotes (two copies of the same mutant allele) or compound heterozygotes (whereby each copy of a gene has a distinct mutant allele).
 
Gene (location): EIF2B1 (12q24.31)
 
Monarch Initiative: MONDO:0011380
OMIM®: 603896
Orphanet: ORPHA135

Disease characteristics

Childhood ataxia with central nervous system hypomyelination / vanishing white matter (CACH/VWM) is characterized by ataxia, spasticity, and variable optic atrophy. The phenotypic range includes a prenatal/congenital form, a subacute infantile form (onset age <1 year), an early childhood-onset form (onset age 1 to <4 years), a late childhood-/juvenile-onset form (onset age 4 to <18 years), and an adult-onset form (onset ≥18 years). The prenatal/congenital form is characterized by severe encephalopathy. In the later-onset forms initial motor and intellectual development is normal or mildly delayed, followed by neurologic deterioration with a chronic progressive or subacute course. While in childhood-onset forms motor deterioration dominates, in adult-onset forms cognitive decline and personality changes dominate. Chronic progressive decline can be exacerbated by rapid deterioration during febrile illnesses or following head trauma or major surgical procedures, or by acute and extreme fright. [from GeneReviews]
Authors:
Marjo S van der Knaap  |  Anne Fogli  |  Odile Boespflug-Tanguy, et. al.   view full author information

Additional descriptions

From OMIM
Leukoencephalopathy with vanishing white matter is an autosomal recessive neurologic disorder characterized by variable neurologic features, including progressive cerebellar ataxia, spasticity, and cognitive impairment associated with white matter lesions on brain imaging. Age at onset ranges from early infancy to adulthood. Rapid neurologic deterioration can occur following minor head trauma. Female mutation carriers may additionally develop ovarian failure, manifest as primary amenorrhea or as secondary amenorrhea lasting more than 6 months, associated with elevated gonadotropin levels at age less than 40 years (summary by Van der Knaap et al., 1998 and Schiffmann et al., 1997). The association of vanishing white matter leukodystrophy with ovarian failure had been referred to as 'ovarioleukodystrophy.' Genetic Heterogeneity of Leukoencephalopathy with Vanishing White Matter Leukoencephalopathy with vanishing white matter may be caused by mutations in any of the 5 genes encoding the subunits of the eukaryotic translation factor initiation factor 2B. VWM2 (620312) is caused by mutation in the EIF2B2 gene (606454) on chromosome 14q24; VWM3 (620313) is caused by mutation in the EIF2B3 gene (606273) on chromosome 1p34; VWM4 (620314) is caused by mutation in the EIF2B4 gene (606687) on chromosome 2p23; and VWM5 (620315) is caused by mutation in the EIF2B5 gene (603945) on chromosome 3q27.  http://www.omim.org/entry/603896
From MedlinePlus Genetics
Leukoencephalopathy with vanishing white matter is a progressive disorder that mainly affects the brain and spinal cord (central nervous system). This disorder causes deterioration of the central nervous system's white matter, which consists of nerve fibers covered by myelin. Myelin is the fatty substance that insulates and protects nerves.

In most cases, people with leukoencephalopathy with vanishing white matter show no signs or symptoms of the disorder at birth. Affected children may have slightly delayed development of motor skills such as crawling or walking. During early childhood, most affected individuals begin to develop motor symptoms, including abnormal muscle stiffness (spasticity) and difficulty with coordinating movements (ataxia). There may also be some deterioration of mental functioning, but this is not usually as pronounced as the motor symptoms. Some affected females may have abnormal development of the ovaries (ovarian dysgenesis). Specific changes in the brain as seen using magnetic resonance imaging (MRI) are characteristic of leukoencephalopathy with vanishing white matter, and may be visible before the onset of symptoms.

While childhood onset is the most common form of leukoencephalopathy with vanishing white matter, some severe forms are apparent at birth. A severe, early-onset form seen among the Cree and Chippewayan populations of Quebec and Manitoba is called Cree leukoencephalopathy. Milder forms may not become evident until adolescence or adulthood, when behavioral or psychiatric problems may be the first signs of the disease. Some females with milder forms of leukoencephalopathy with vanishing white matter who survive to adolescence exhibit ovarian dysfunction. This variant of the disorder is called ovarioleukodystrophy.

Progression of leukoencephalopathy with vanishing white matter is generally uneven, with periods of relative stability interrupted by episodes of rapid decline. People with this disorder are particularly vulnerable to stresses such as infection, mild head trauma or other injury, or even extreme fright. These stresses may trigger the first symptoms of the condition or worsen existing symptoms, and can cause affected individuals to become lethargic or comatose.  https://medlineplus.gov/genetics/condition/leukoencephalopathy-with-vanishing-white-matter

Clinical features

From HPO
Premature ovarian insufficiency
MedGen UID:
9963
Concept ID:
C0025322
Disease or Syndrome
Amenorrhea due to loss of ovarian function before the age of 40. Primary ovarian inssuficiency (POI) is a state of female hypergonadotropic hypogonadism. It can manifest as primary amenorrhea with onset before menarche or secondary amenorrhea.
Primary amenorrhea
MedGen UID:
115918
Concept ID:
C0232939
Disease or Syndrome
Abnormally late or absent menarche in a female with normal secondary sexual characteristics.
Secondary amenorrhea
MedGen UID:
115919
Concept ID:
C0232940
Disease or Syndrome
The cessation of menstruation for six months or more in a female that is not pregnant, breastfeeding or menopausal.
Delusions
MedGen UID:
3715
Concept ID:
C0011253
Mental or Behavioral Dysfunction
A false belief that is held despite evidence to the contrary.
Dysarthria
MedGen UID:
8510
Concept ID:
C0013362
Mental or Behavioral Dysfunction
Dysarthric speech is a general description referring to a neurological speech disorder characterized by poor articulation. Depending on the involved neurological structures, dysarthria may be further classified as spastic, flaccid, ataxic, hyperkinetic and hypokinetic, or mixed.
Gliosis
MedGen UID:
4899
Concept ID:
C0017639
Pathologic Function
Gliosis is the focal proliferation of glial cells in the central nervous system.
Lethargy
MedGen UID:
7310
Concept ID:
C0023380
Sign or Symptom
A state of disinterestedness, listlessness, and indifference, resulting in difficulty performing simple tasks or concentrating.
Spasticity
MedGen UID:
7753
Concept ID:
C0026838
Sign or Symptom
A motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes with increased muscle tone, exaggerated (hyperexcitable) tendon reflexes.
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.
Unsteady gait
MedGen UID:
68544
Concept ID:
C0231686
Finding
A shaky or wobbly manner of walking.
Memory impairment
MedGen UID:
68579
Concept ID:
C0233794
Mental or Behavioral Dysfunction
An impairment of memory as manifested by a reduced ability to remember things such as dates and names, and increased forgetfulness.
Personality changes
MedGen UID:
66817
Concept ID:
C0240735
Mental or Behavioral Dysfunction
An abnormal shift in patterns of thinking, acting, or feeling.
Leukoencephalopathy
MedGen UID:
78722
Concept ID:
C0270612
Disease or Syndrome
This term describes abnormality of the white matter of the cerebrum resulting from damage to the myelin sheaths of nerve cells.
CNS demyelination
MedGen UID:
137898
Concept ID:
C0338474
Disease or Syndrome
A loss of myelin from nerve fibers in the central nervous system.
Gait disturbance
MedGen UID:
107895
Concept ID:
C0575081
Finding
The term gait disturbance can refer to any disruption of the ability to walk. In general, this can refer to neurological diseases but also fractures or other sources of pain that is triggered upon walking. However, in the current context gait disturbance refers to difficulty walking on the basis of a neurological or muscular disease.
Developmental regression
MedGen UID:
324613
Concept ID:
C1836830
Disease or Syndrome
Loss of developmental skills, as manifested by loss of developmental milestones.
Cerebral hypomyelination
MedGen UID:
383084
Concept ID:
C2677328
Finding
Reduced amount of myelin in the nervous system resulting from defective myelinogenesis in the white matter of the central nervous system.
Emotional lability
MedGen UID:
504567
Concept ID:
CN000669
Finding
Unstable emotional experiences and frequent mood changes; emotions that are easily aroused, intense, and/or out of proportion to events and circumstances.
Hypotonia
MedGen UID:
10133
Concept ID:
C0026827
Finding
Hypotonia is an abnormally low muscle tone (the amount of tension or resistance to movement in a muscle). Even when relaxed, muscles have a continuous and passive partial contraction which provides some resistance to passive stretching. Hypotonia thus manifests as diminished resistance to passive stretching. Hypotonia is not the same as muscle weakness, although the two conditions can co-exist.
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.
Cessation of head growth
MedGen UID:
870859
Concept ID:
C4025319
Anatomical Abnormality
Stagnation of head growth seen as flattening of the head circumference curve.
Fever
MedGen UID:
5169
Concept ID:
C0015967
Sign or Symptom
Body temperature elevated above the normal range.
Decreased circulating progesterone
MedGen UID:
347772
Concept ID:
C1858995
Finding
An reduced concentration of progesterone in the blood.
Primary gonadal insufficiency
MedGen UID:
349078
Concept ID:
C1859014
Finding
Optic atrophy
MedGen UID:
18180
Concept ID:
C0029124
Disease or Syndrome
Atrophy of the optic nerve. Optic atrophy results from the death of the retinal ganglion cell axons that comprise the optic nerve and manifesting as a pale optic nerve on fundoscopy.
Blindness
MedGen UID:
99138
Concept ID:
C0456909
Disease or Syndrome
Blindness is the condition of lacking visual perception defined as visual perception below 3/60 and/or a visual field of no greater than 10 degrees in radius around central fixation.

Professional guidelines

PubMed

Mahdieh N, Soveizi M, Tavasoli AR, Rabbani A, Ashrafi MR, Kohlschütter A, Rabbani B
Sci Rep 2021 Feb 5;11(1):3231. doi: 10.1038/s41598-021-82778-0. PMID: 33547378Free PMC Article
van der Lei HD, van Berkel CG, van Wieringen WN, Brenner C, Feigenbaum A, Mercimek-Mahmutoglu S, Philippart M, Tatli B, Wassmer E, Scheper GC, van der Knaap MS
Neurology 2010 Oct 26;75(17):1555-9. doi: 10.1212/WNL.0b013e3181f962ae. PMID: 20975056

Recent clinical studies

Etiology

Wu C, Wang M, Wang X, Li W, Li S, Chen B, Niu S, Tai H, Pan H, Zhang Z
Brain 2023 Jun 1;146(6):2364-2376. doi: 10.1093/brain/awac426. PMID: 36380532Free PMC Article
Güngör G, Güngör O, Çakmaklı S, Maraş Genç H, İnce H, Yeşil G, Dilber C, Aydın K
Childs Nerv Syst 2020 Feb;36(2):353-361. Epub 2019 Aug 5 doi: 10.1007/s00381-019-04334-6. PMID: 31385086
Zhou L, Zhang H, Chen N, Zhang Z, Liu M, Dai L, Wang J, Jiang Y, Wu Y
J Neurol 2018 Jun;265(6):1410-1418. Epub 2018 Apr 16 doi: 10.1007/s00415-018-8851-6. PMID: 29663120
Perlman SJ, Mar S
Adv Exp Med Biol 2012;724:154-71. doi: 10.1007/978-1-4614-0653-2_13. PMID: 22411242
Mathis S, Scheper GC, Baumann N, Petit E, Gil R, van der Knaap MS, Neau JP
Clin Neurol Neurosurg 2008 Dec;110(10):1035-7. Epub 2008 Aug 3 doi: 10.1016/j.clineuro.2008.06.002. PMID: 18678442

Diagnosis

Wu C, Wang M, Wang X, Li W, Li S, Chen B, Niu S, Tai H, Pan H, Zhang Z
Brain 2023 Jun 1;146(6):2364-2376. doi: 10.1093/brain/awac426. PMID: 36380532Free PMC Article
Deginet E, Tilahun R, Bishaw S, Eshetu K, Moges A
Ethiop J Health Sci 2021 Nov;31(6):1307-1310. doi: 10.4314/ejhs.v31i6.28. PMID: 35392331Free PMC Article
Güngör G, Güngör O, Çakmaklı S, Maraş Genç H, İnce H, Yeşil G, Dilber C, Aydın K
Childs Nerv Syst 2020 Feb;36(2):353-361. Epub 2019 Aug 5 doi: 10.1007/s00381-019-04334-6. PMID: 31385086
Perlman SJ, Mar S
Adv Exp Med Biol 2012;724:154-71. doi: 10.1007/978-1-4614-0653-2_13. PMID: 22411242
van der Knaap MS, Pronk JC, Scheper GC
Lancet Neurol 2006 May;5(5):413-23. doi: 10.1016/S1474-4422(06)70440-9. PMID: 16632312

Therapy

Singh RR, Livingston J, Lim M, Berry IR, Siddiqui A
Eur J Paediatr Neurol 2017 Mar;21(2):410-413. Epub 2016 Sep 6 doi: 10.1016/j.ejpn.2016.08.012. PMID: 27665184
Clayton BLL, Popko B
Brain Res 2016 Oct 1;1648(Pt B):594-602. Epub 2016 Apr 4 doi: 10.1016/j.brainres.2016.03.046. PMID: 27055915Free PMC Article
Eichler F, Van Haren K
Pediatr Neurol 2007 Oct;37(4):235-44. doi: 10.1016/j.pediatrneurol.2007.06.011. PMID: 17903666

Prognosis

Nourmohammadi P, Asadollahi M, Karamzade A, Eshaghkhani Y, Babaei M, Golchehre Z, Taheri SR, Hasani S, Taghizadeh M, Keramatipour M
J Genet 2023;102 PMID: 37674283
Zhou L, Zhang H, Chen N, Zhang Z, Liu M, Dai L, Wang J, Jiang Y, Wu Y
J Neurol 2018 Jun;265(6):1410-1418. Epub 2018 Apr 16 doi: 10.1007/s00415-018-8851-6. PMID: 29663120
Perlman SJ, Mar S
Adv Exp Med Biol 2012;724:154-71. doi: 10.1007/978-1-4614-0653-2_13. PMID: 22411242
Eichler F, Van Haren K
Pediatr Neurol 2007 Oct;37(4):235-44. doi: 10.1016/j.pediatrneurol.2007.06.011. PMID: 17903666
van der Knaap MS, Pronk JC, Scheper GC
Lancet Neurol 2006 May;5(5):413-23. doi: 10.1016/S1474-4422(06)70440-9. PMID: 16632312

Clinical prediction guides

Bugiani M, Postma N, Polder E, Dieleman N, Scheffer PG, Sim FJ, van der Knaap MS, Boor I
Brain 2013 Jan;136(Pt 1):209-22. doi: 10.1093/brain/aws320. PMID: 23365098
Bugiani M, Boor I, van Kollenburg B, Postma N, Polder E, van Berkel C, van Kesteren RE, Windrem MS, Hol EM, Scheper GC, Goldman SA, van der Knaap MS
J Neuropathol Exp Neurol 2011 Jan;70(1):69-82. doi: 10.1097/NEN.0b013e318203ae74. PMID: 21157376Free PMC Article
van der Lei HD, van Berkel CG, van Wieringen WN, Brenner C, Feigenbaum A, Mercimek-Mahmutoglu S, Philippart M, Tatli B, Wassmer E, Scheper GC, van der Knaap MS
Neurology 2010 Oct 26;75(17):1555-9. doi: 10.1212/WNL.0b013e3181f962ae. PMID: 20975056
Mathis S, Scheper GC, Baumann N, Petit E, Gil R, van der Knaap MS, Neau JP
Clin Neurol Neurosurg 2008 Dec;110(10):1035-7. Epub 2008 Aug 3 doi: 10.1016/j.clineuro.2008.06.002. PMID: 18678442
Pronk JC, van Kollenburg B, Scheper GC, van der Knaap MS
Ment Retard Dev Disabil Res Rev 2006;12(2):123-8. doi: 10.1002/mrdd.20104. PMID: 16807905

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