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Spinal muscular atrophy-progressive myoclonic epilepsy syndrome(SMAPME)

MedGen UID:
371854
Concept ID:
C1834569
Disease or Syndrome
Synonyms: Hereditary myoclonus and progressive distal muscular atrophy; Jankovic Rivera syndrome; MYOCLONUS, HEREDITARY, WITH PROGRESSIVE DISTAL MUSCULAR ATROPHY; SPINAL MUSCULAR ATROPHY WITH PROGRESSIVE MYOCLONIC EPILEPSY
SNOMED CT: Jankovic-Rivera syndrome (703524005); Spinal muscular atrophy with progressive myoclonic epilepsy (703524005); Hereditary myoclonus with progressive distal muscular atrophy (703524005)
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): ASAH1 (8p22)
 
Monarch Initiative: MONDO:0008045
OMIM®: 159950
Orphanet: ORPHA2590

Disease characteristics

Excerpted from the GeneReview: ASAH1-Related Disorders
The spectrum of ASAH1-related disorders ranges from Farber disease (FD) to spinal muscular atrophy with progressive myoclonic epilepsy (SMA-PME). Classic FD is characterized by onset in the first weeks of life of painful, progressive deformity of the major joints; palpable subcutaneous nodules of joints and mechanical pressure points; and a hoarse cry resulting from granulomas of the larynx and epiglottis. Life expectancy is usually less than two years. In the other less common types of FD, onset, severity, and primary manifestations vary. SMA-PME is characterized by early-childhood-onset progressive lower motor neuron disease manifest typically between ages three and seven years as proximal lower-extremity weakness, followed by progressive myoclonic and atonic seizures, tremulousness/tremor, and sensorineural hearing loss. Myoclonic epilepsy typically begins in late childhood after the onset of weakness and can include jerking of the upper limbs, action myoclonus, myoclonic status, and eyelid myoclonus. Other findings include generalized tremor, and cognitive decline. The time from disease onset to death from respiratory complications is usually five to 15 years. [from GeneReviews]
Authors:
David A Dyment  |  Steffany AL Bennett  |  Jeffrey A Medin, et. al.   view full author information

Additional descriptions

From OMIM
Spinal muscular atrophy with progressive myoclonic epilepsy is an autosomal recessive neuromuscular disorder characterized by childhood onset of proximal muscle weakness and generalized muscular atrophy due to degeneration of spinal motor neurons, followed by the onset of myoclonic seizures. The disorder is progressive, and usually results in loss of ambulation and early death from respiratory insufficiency (summary by Zhou et al., 2012).  http://www.omim.org/entry/159950
From MedlinePlus Genetics
Spinal muscular atrophy with progressive myoclonic epilepsy (SMA-PME) is a neurological condition that begins in childhood. SMA-PME causes muscle weakness and wasting (atrophy) and a combination of seizures and uncontrollable muscle jerks (myoclonic epilepsy).

In individuals with SMA-PME, spinal muscular atrophy results from a loss of specialized nerve cells, called motor neurons, in the spinal cord and the part of the brain that is connected to the spinal cord (the brainstem). After a few years of normal development, affected children begin experiencing muscle weakness and atrophy in the lower limbs, causing difficulty walking and frequent falls. The muscles in the upper limbs are later affected, and soon the muscle weakness and atrophy spreads throughout the body. Once weakness reaches the muscles used for breathing and swallowing, affected individuals develop life-threatening breathing problems and increased susceptibility to pneumonia.

A few years after the muscle weakness begins, affected individuals start to experience recurrent seizures (epilepsy). Most people with SMA-PME have a variety of seizure types. In addition to myoclonic epilepsy, they may have  generalized tonic-clonic seizures (also known as grand mal seizures), which cause muscle rigidity, convulsions, and loss of consciousness. Affected individuals can also have absence seizures, which cause loss of consciousness for a short period that may or may not be accompanied by muscle jerks. In SMA-PME, seizures often increase in frequency over time and are usually not well-controlled with medication. Individuals with SMA-PME may also have episodes of rhythmic shaking (tremors), usually in the hands; these tremors are not thought to be related to epilepsy. Some people with SMA-PME develop hearing loss caused by nerve damage in the inner ear (sensorineural hearing loss).

Individuals with SMA-PME have a shortened lifespan; they generally live into late childhood or early adulthood. Near the end of their lives, affected individuals often have limited mobility, difficulty swallowing, and decline in cognitive functioning. The cause of death is often respiratory failure or pneumonia.  https://medlineplus.gov/genetics/condition/spinal-muscular-atrophy-with-progressive-myoclonic-epilepsy

Clinical features

From HPO
Dysphagia
MedGen UID:
41440
Concept ID:
C0011168
Disease or Syndrome
Difficulty in swallowing.
Myoclonus
MedGen UID:
10234
Concept ID:
C0027066
Finding
Very brief, involuntary random muscular contractions occurring at rest, in response to sensory stimuli, or accompanying voluntary movements.
Tremor
MedGen UID:
21635
Concept ID:
C0040822
Sign or Symptom
An unintentional, oscillating to-and-fro muscle movement about a joint axis.
Areflexia
MedGen UID:
115943
Concept ID:
C0234146
Finding
Absence of neurologic reflexes such as the knee-jerk reaction.
Generalized-onset seizure
MedGen UID:
115963
Concept ID:
C0234533
Disease or Syndrome
A generalized-onset seizure is a type of seizure originating at some point within, and rapidly engaging, bilaterally distributed networks. The networks may include cortical and subcortical structures but not necessarily the entire cortex.
Dementia
MedGen UID:
99229
Concept ID:
C0497327
Mental or Behavioral Dysfunction
A loss of global cognitive ability of sufficient amount to interfere with normal social or occupational function. Dementia represents a loss of previously present cognitive abilities, generally in adults, and can affect memory, thinking, language, judgment, and behavior.
Degeneration of anterior horn cells
MedGen UID:
375215
Concept ID:
C1843505
Finding
Generalized myoclonic seizure
MedGen UID:
892704
Concept ID:
C4021759
Disease or Syndrome
A generalized myoclonic seizure is a type of generalized motor seizure characterized by bilateral, sudden, brief (<100 ms) involuntary single or multiple contraction of muscles or muscle groups of variable topography (axial, proximal limb, distal). Myoclonus is less regularly repetitive and less sustained than is clonus.
Spinal muscular atrophy
MedGen UID:
7755
Concept ID:
C0026847
Disease or Syndrome
Spinal muscular atrophy (SMA) is characterized by muscle weakness and atrophy resulting from progressive degeneration and irreversible loss of the anterior horn cells in the spinal cord (i.e., lower motor neurons) and the brain stem nuclei. The onset of weakness ranges from before birth to adulthood. The weakness is symmetric, proximal > distal, and progressive. Before the genetic basis of SMA was understood, it was classified into clinical subtypes based on maximum motor function achieved; however, it is now apparent that the phenotype of SMN1-associated SMA spans a continuum without clear delineation of subtypes. With supportive care only, poor weight gain with growth failure, restrictive lung disease, scoliosis, and joint contractures are common complications; however, newly available targeted treatment options are changing the natural history of this disease.
Scoliosis
MedGen UID:
11348
Concept ID:
C0036439
Disease or Syndrome
The presence of an abnormal lateral curvature of the spine.
Proximal muscle weakness
MedGen UID:
113169
Concept ID:
C0221629
Finding
A lack of strength of the proximal muscles.
Gowers sign
MedGen UID:
65865
Concept ID:
C0234182
Finding
A phenomenon whereby patients are not able to stand up without the use of the hands owing to weakness of the proximal muscles of the lower limbs.
Difficulty walking
MedGen UID:
86319
Concept ID:
C0311394
Finding
Reduced ability to walk (ambulate).
Facial palsy
MedGen UID:
87660
Concept ID:
C0376175
Disease or Syndrome
Facial nerve palsy is a dysfunction of cranial nerve VII (the facial nerve) that results in inability to control facial muscles on the affected side with weakness of the muscles of facial expression and eye closure. This can either be present in unilateral or bilateral form.
Muscular atrophy
MedGen UID:
892680
Concept ID:
C0541794
Pathologic Function
The presence of skeletal muscular atrophy (which is also known as amyotrophy).
Frequent falls
MedGen UID:
163408
Concept ID:
C0850703
Finding
Progressive distal muscular atrophy
MedGen UID:
870179
Concept ID:
C4024613
Disease or Syndrome
Progressive muscular atrophy affecting muscles in the distal portions of the extremities.
Respiratory insufficiency due to muscle weakness
MedGen UID:
812797
Concept ID:
C3806467
Finding
Recurrent respiratory infections
MedGen UID:
812812
Concept ID:
C3806482
Finding
An increased susceptibility to respiratory infections as manifested by a history of recurrent respiratory infections.
Elevated circulating creatine kinase concentration
MedGen UID:
69128
Concept ID:
C0241005
Finding
An elevation of the level of the enzyme creatine kinase (also known as creatine phosphokinase (CK; EC 2.7.3.2) in the blood. CK levels can be elevated in a number of clinical disorders such as myocardial infarction, rhabdomyolysis, and muscular dystrophy.
Tongue fasciculations
MedGen UID:
65987
Concept ID:
C0239548
Finding
Fasciculations or fibrillation affecting the tongue muscle.

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVSpinal muscular atrophy-progressive myoclonic epilepsy syndrome
Follow this link to review classifications for Spinal muscular atrophy-progressive myoclonic epilepsy syndrome in Orphanet.

Professional guidelines

PubMed

Schuchman EH
Biochim Biophys Acta 2016 Sep;1862(9):1459-71. Epub 2016 May 4 doi: 10.1016/j.bbadis.2016.05.001. PMID: 27155573

Recent clinical studies

Etiology

Lee MM, McDowell GSV, De Vivo DC, Friedman D, Berkovic SF, Spanou M, Dinopoulos A, Grand K, Sanchez-Lara PA, Allen-Sharpley M, Warman-Chardon J, Solyom A, Levade T, Schuchman EH, Bennett SAL, Dyment DA, Pearson TS
Ann Clin Transl Neurol 2022 Dec;9(12):1941-1952. Epub 2022 Nov 3 doi: 10.1002/acn3.51687. PMID: 36325744Free PMC Article
Schuchman EH
Biochim Biophys Acta 2016 Sep;1862(9):1459-71. Epub 2016 May 4 doi: 10.1016/j.bbadis.2016.05.001. PMID: 27155573
Striano P, Boccella P, Sarappa C, Striano S
Seizure 2004 Dec;13(8):582-6. doi: 10.1016/j.seizure.2004.01.008. PMID: 15519918
Haliloglu G, Chattopadhyay A, Skorodis L, Manzur A, Mercuri E, Talim B, Akçören Z, Renda Y, Muntoni F, Topaloğlu H
Neuropediatrics 2002 Dec;33(6):314-9. doi: 10.1055/s-2002-37087. PMID: 12571787
Marjanovic B, Todorovic S, Dozic S
Pediatr Neurol 1993 Mar-Apr;9(2):147-50. doi: 10.1016/0887-8994(93)90053-f. PMID: 8499046

Diagnosis

Najafi A, Tasharrofi B, Zandsalimi F, Rasulinezhad M, Ghahvechi Akbari M, Zamani G, Ashrafi MR, Heidari M
Ital J Pediatr 2023 Jun 6;49(1):64. doi: 10.1186/s13052-023-01474-z. PMID: 37280710Free PMC Article
Yildiz EP, Yesil G, Bektas G, Caliskan M, Tatlı B, Aydinli N, Ozmen M
Clin Neurol Neurosurg 2018 Jan;164:47-49. Epub 2017 Nov 21 doi: 10.1016/j.clineuro.2017.11.008. PMID: 29169047
Striano P, Boccella P, Sarappa C, Striano S
Seizure 2004 Dec;13(8):582-6. doi: 10.1016/j.seizure.2004.01.008. PMID: 15519918
Haliloglu G, Chattopadhyay A, Skorodis L, Manzur A, Mercuri E, Talim B, Akçören Z, Renda Y, Muntoni F, Topaloğlu H
Neuropediatrics 2002 Dec;33(6):314-9. doi: 10.1055/s-2002-37087. PMID: 12571787
Marjanovic B, Todorovic S, Dozic S
Pediatr Neurol 1993 Mar-Apr;9(2):147-50. doi: 10.1016/0887-8994(93)90053-f. PMID: 8499046

Therapy

Schuchman EH
Biochim Biophys Acta 2016 Sep;1862(9):1459-71. Epub 2016 May 4 doi: 10.1016/j.bbadis.2016.05.001. PMID: 27155573
Striano P, Boccella P, Sarappa C, Striano S
Seizure 2004 Dec;13(8):582-6. doi: 10.1016/j.seizure.2004.01.008. PMID: 15519918

Prognosis

Haliloglu G, Chattopadhyay A, Skorodis L, Manzur A, Mercuri E, Talim B, Akçören Z, Renda Y, Muntoni F, Topaloğlu H
Neuropediatrics 2002 Dec;33(6):314-9. doi: 10.1055/s-2002-37087. PMID: 12571787
Marjanovic B, Todorovic S, Dozic S
Pediatr Neurol 1993 Mar-Apr;9(2):147-50. doi: 10.1016/0887-8994(93)90053-f. PMID: 8499046

Clinical prediction guides

Lee MM, McDowell GSV, De Vivo DC, Friedman D, Berkovic SF, Spanou M, Dinopoulos A, Grand K, Sanchez-Lara PA, Allen-Sharpley M, Warman-Chardon J, Solyom A, Levade T, Schuchman EH, Bennett SAL, Dyment DA, Pearson TS
Ann Clin Transl Neurol 2022 Dec;9(12):1941-1952. Epub 2022 Nov 3 doi: 10.1002/acn3.51687. PMID: 36325744Free PMC Article
Hayashi M
Neuropathology 2009 Feb;29(1):1-8. doi: 10.1111/j.1440-1789.2008.00888.x. PMID: 19154320

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