Krabbe disease is a rare autosomal recessive neurodegenerative disorder caused by mutations in the galactocerebrosidase(GALC) gene. The deficiency of GALC activity leads to the accumulation of psychosine, resulting in apoptosis of myelin-forming cells of the central and peripheral nervous system. The patients with typical infantile onset Krabbe disease have extreme irritability, developmental regression, spasticity, and seizures with an onset prior to six months of age. These children usually die within two years after birth. We report a female infant who showed the characteristic clinical manifestations, disease course, and neuroimaging features of infantile onset Krabbe disease that was confirmed by the identification of a compound heterozygous mutation of the GALC gene.
Apoptosis ; Child ; Female ; Galactosylceramidase ; Humans ; Infant ; Leukodystrophy, Globoid Cell ; Muscle Spasticity ; Neurodegenerative Diseases ; Neuroimaging ; Parturition ; Peripheral Nervous System ; Psychosine ; Seizures

Krabbe disease is an autosomal recessive disorder involving white matter caused by deficient activity of the lysosomal galactocerebrosidase (GALC). A typical infantile-onset patient shows developmental regression, spasticity, and seizure before 6 months of age, and dies within 2 years. Previously, one case was confirmed by an enzyme test in Korea. We herein report a 2 year-old girl who showed the characteristic clinical course and neuroimaging features of infantile-onset Krabbe disease. Genetic testing identified the compound heterozygote mutations in the GALC gene; NLWE212_215TP/302A.
beta-Galactosidase* ; Child, Preschool ; Female ; Galactosylceramidase ; Genetic Testing ; Heterozygote ; Humans ; Korea ; Leukodystrophy, Globoid Cell* ; Muscle Spasticity ; Neuroimaging ; Seizures

Krabbe disease is an autosomal recessive neurodegenerative disorder that affects both the central and peripheral nerve system due to an enzymatic defect of galactocerebroside bata-galactosidase. The patient had typical clinical features of Krabbe disease, with irritability, hypertonicity, failure to thrive, and opisthotonic posturing. A brain MRI demonstrates profound white matter demyelination. The diagnosis of Krabbe disease is suspected on the basis of clinical pictures and confirmed by finding markedly reduced galactocerebroside bata-galactosidase activity in leukocyte or cultured fibroblast. Here we present the first reported case of Krabbe disease in Korea confirmed by decreased activity of galactocerebroside bata-galactosidase enzyme in leukocyte.
Brain ; Demyelinating Diseases ; Diagnosis ; Failure to Thrive ; Fibroblasts ; Humans ; Korea ; Leukocytes ; Leukodystrophy, Globoid Cell* ; Magnetic Resonance Imaging ; Neurodegenerative Diseases ; Peripheral Nerves

OBJECTIVE: To explore the clinical, electrophysiological and imaging features of a patient with Krabbe disease caused by GALC mutation. METHODS: A comprehensive analysis including clinical investigation and genetic testing was carried out. RESULTS: The patient presented with peripheral neuropathy with electrophysiological anomaly suggestive of asymmetric demyelinating neuropathy. Brain imaging revealed leukoencephalopathy. Genetic analysis has identified compound heterozygous mutations in exons 5 and 11 of the GALC gene, namely c.461C>A and c.1244G>A. CONCLUSION Krabbe disease is a group of disorders featuring substantial phenotypic heterogeneity. Genetic and enzyme testing has become indispensable for accurate diagnosis for this disease.
DNA Mutational Analysis ; Galactosylceramidase ; genetics ; Genetic Testing ; Humans ; Leukodystrophy, Globoid Cell ; complications ; genetics ; Mutation ; Peripheral Nervous System Diseases ; etiology

Globoid cell leukodystrophy is a rare autosomal recessive disorder of the brain white-matter caused by galactosylceramidase deficiency; the disorder is classified into four types based on the age of onset. Approximately 80–85% of patients have an early infantile form, while 10–15% has a late infantile form. Globoid cell leukodystrophy leads to a progressive neurological deterioration, and affected patients rarely survive more than 2–3 years. Although many different treatments have been investigated over several decades, further research is still needed. Hematopoietic stem cell transplantation is the standard treatment for globoid cell leukodystrophy. Here, we report a case of symptomatic late-infantile globoid cell leukodystrophy treated with stem cell transplantation. After transplantation, disease progression ceased and cognitive and motor function improved. And a 6 months follow-up study using brain magnetic resonance imaging showed white matter involvement was increased. After that, annual follow-up brain magnetic resonance imaging showed a stable status of disease.
Age of Onset ; Brain ; Disease Progression ; Follow-Up Studies ; Galactosylceramidase ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Leukodystrophy, Globoid Cell* ; Magnetic Resonance Imaging ; Stem Cell Transplantation ; White Matter

Sphingolipidoses are a subgroup of lysosomal storage disorders. They are characterized by relentless progressive storage in affected organs and concomitant functional impairments. No overall screening procedure for these disorders is available. Their course and appearance, however, are usually characteristic and, together with relevant technical procedures such as magnetic resonance imaging (MRI), clinical neurophysiology, ophthalmologic examination, etc., a provisional diagnosis can be made, after which enzymatic diagnosis can close the gap in the diagnostic process. Subgroups of sphingolipidoses are grouped together, such as disorders with prominent hepatosplenomegaly (Niemann-Pick A, B and Gaucher disease) and disorders with central and peripheral demyelination (metachromic leukodystrophy and Krabbe disease). Farber disease and Fabry disease are unique in themselves. The last decade has seen hopeful progress in therapeutic strategies, especially for Gaucher disease. Therefore, emphasis of this review has been placed on these new developments.
Demyelinating Diseases ; Diagnosis ; Fabry Disease ; Farber Lipogranulomatosis ; Gangliosidoses, GM2 ; Gangliosidosis, GM1 ; Gaucher Disease ; Hope ; Leukodystrophy, Globoid Cell ; Magnetic Resonance Imaging ; Mass Screening ; Neurophysiology ; Niemann-Pick Diseases ; Sphingolipidoses*

OBJECTIVETo investigate clinical and imaging features of a patient with adult-onset Krabbe disease and to detect the underlying genetic mutations.

METHODSClinical and cranial MRI features of the patient were analyzed. Pathogenesis, clinical manifestation, cranial MRI features and diagnostic criteria for the disease were discussed.

RESULTSThe patient had presented asymmetric limb weakness and difficulty in walking. Electromyography suggested peripheral nerve demyelination. Cranial MRI showed increased signal intensity in white matter with involvement of the corticospinal tracts. Screening of GALC gene mutation has found the patient to be heterozygous for T1685C (Ile562Thr) and homozygous for A1921G (Thr641Ala), both of which were considered to be polymorphisms. In addition, he was heterozygous for G136T (Asp46Tyr), which had not been described previously.

CONCLUSIONClinical manifestations of adult-onset Krabbe disease may be atypical. Cranial MRI and galactocerebroside activity assay should be carried out for patients featuring chronic progressive corticospinal tract injury. An Asp46Tyr mutation probably underlies the disease in the current case.

Adult ; Base Sequence ; Brain ; diagnostic imaging ; Female ; Humans ; Leukodystrophy, Globoid Cell ; diagnosis ; diagnostic imaging ; genetics ; Magnetic Resonance Imaging ; Molecular Sequence Data ; Point Mutation ; Radiography

Brain ; diagnostic imaging ; pathology ; DNA Mutational Analysis ; Exons ; Galactosylceramidase ; genetics ; metabolism ; Humans ; Infant ; Leukodystrophy, Globoid Cell ; diagnosis ; enzymology ; genetics ; pathology ; Magnetic Resonance Imaging ; Male ; Mutation ; Radiography

PURPOSE: Leukodystrophies have been defined as inherited metabolic disorders of myelin resulting in abnormal development or progressive destruction of the white matter. This study was performed to investigate the clinical manifestations and treatments of leukodystrophies in a single Korean tertiary center. METHODS: We retrospectively analysed the medical records of patients who had been diagnosed with leukodystrophy from May 1995 to May 2010 at the Asan Medical Center. RESULTS: During the 15-year study period, 36 cases of leukodystrophies were diagnosed with an verage age at symptom presentation of 49 months. Prominent symptoms at presentation were developmental delay (41%) and seizure (25%); however, nystagmus, developmental regression, hearing loss, gait disturbance, visual disturbance, attention deficit, hypotonia, hyperpigmentation, and hemiparesis were also observed. On MRI, periventricular involvement was noted frequently. The most common diagnoses were adrenoleukodystophy (25%), metachromatic leukodystrophy (11%), Krabbe disease (11%), and Pelizaeus-Merzbacher disease (8.3%). No final diagnosis was made in 14 cases (41%). Bone marrow transplantation was performed in 4 patients and showed favorable prognoses. CONCLUSION: Clinical features of leukodystrophies are not specific to diagnosis and most leukodystrophies remain undiagnosed; however, a logical algorithm based on prevalence could aid the laboratory testing. Because early detection and diagnosis is crucial for treatment and prognosis, it is important to have a high index of suspicion and watchful screening of familial history.
Adrenoleukodystrophy ; Bone Marrow Transplantation ; Canavan Disease ; European Continental Ancestry Group ; Gait ; Hearing Loss ; Humans ; Hyperpigmentation ; Leukodystrophy, Globoid Cell ; Leukodystrophy, Metachromatic ; Logic ; Mass Screening ; Medical Records ; Muscle Hypotonia ; Myelin Sheath ; Paresis ; Pelizaeus-Merzbacher Disease ; Prevalence ; Prognosis ; Retrospective Studies ; Seizures

Krabbe's disease is a rare autosomal recessive disorder characterized by hemiplegia, paraplegia, ataxia, cortical blindness, and peripheral neuropathy. This disease is caused by deficiency of the lysosomal enzyme galactocerebroside beta-galactosidase(GALC), resulting in demyelination of white matter of brain and peripheral nerve. We reported a 38-year-old female developed a slowly progressive weakness of lower extremities and gait disturbance since age of 10. Neurological examination revealed spastic weakness of both lower extremities, hyperactive deep tendon reflexes and intrinsic muscle atrophy of both hands and feet. Electrophysiologic study showed uniform demyelinating sensorimotor peripheral neuropathy. T2-weighted brain MRI (magnetic resonance imaging) findings revealed symmetric high signal intensity along the bilateral corticospinal tract. The diagnosis of Krabbe's disease was confirmed by finding of markedly reduced GALC activity in leukocyte. We recommended to consider Krabbe's disease in the diagnosis of patients affecting both central and peripheral nervous system.
Adult ; Ataxia ; Blindness, Cortical ; Brain ; Demyelinating Diseases ; Diagnosis ; Female ; Foot ; Gait ; Hand ; Hemiplegia ; Humans ; Leukocytes ; Leukodystrophy, Globoid Cell* ; Lower Extremity ; Magnetic Resonance Imaging ; Muscle Spasticity ; Muscular Atrophy ; Neurologic Examination ; Paraplegia ; Peripheral Nerves ; Peripheral Nervous System ; Peripheral Nervous System Diseases ; Pyramidal Tracts ; Reflex, Stretch