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Phakomatoses (or neuro-oculo-cutaneous syndromes, neurocutaneous disorders) are multisystem disorders that have characteristic central nervous system, ocular, and cutaneous lesions of variable severity.[1][2] The skin and the brain have a common ectodermal origin, so there are many genetic and acquired diseases that affect both tissues.[3] However, in some conditions, such as von Hippel-Lindau disease, ectodermal presentation is minimal.[4]
The term, from the Greek φακός, phakos, "spot, lens", suffix-(o)ma (-ωμα) and the suffix -osis, also called "Mother's spot" or "Birth mark" was introduced by Jan van der Hoeve in 1920, before the distinct genetic basis of each of these diseases was understood.[5]
Examples
[edit]Phakomatoses are inconsistently defined, and there is a lack of consensus about what conditions are included in this category.[6]
Conditions included are:
- Ataxia telangiectasia
- Incontinentia pigmenti
- Neurofibromatosis
- Nevoid basal cell carcinoma syndrome
- Sturge-Weber syndrome
- Tuberous sclerosis
- Wyburn-Mason syndrome (Bonnet–Dechaume–Blanc syndrome)
- von Hippel-Lindau disease
Signs and Symptoms
[edit]Phakomatoses are multi-system disorders that primarily cause changes in the central nervous system, ocular system, and lesions on skin. Four of the disorders being compared are ataxia telangiectasia, Sturge-Weber syndrome, tuberous sclerosis, and neurofibromatosis. These diseases all have commonalities among their signs and symptoms that cause them to be classified as phakomatoses.
Skin
[edit]- Sturge-Weber syndrome: birthmark known as a port-wine stain located on the forehead, upper eyelid of one side of the face, or both sides of the face.[7]
- Tuberous sclerosis: dermatological abnormalities such as facial angiofibromas, forehead plaques, and periungual fibromas.[8]
- Neurofibromatosis: brownish dermatological spots.[9]
- Ataxia telangiectasia: usually have clusters of blood vessels that form on the surface of the skin.[10]
Central Nervous System
[edit]- Sturge-Weber syndrome: can experience intellectual disability or developmental delays. This is due to cerebral malformations, known as ipsilateral leptomeningeal angioma, and cerebral blood flow abnormalities, which can also cause headaches.[7] Individuals are also prone to seizures that begin when the person is an infant and tend to intensify with age. These convulsions usually occur on the opposite side of the body from where their birthmark is located.
- Tuberous sclerosis: likely to be diagnosed with Attention-Deficit Hyperactivity Disorder (ADHD) as well as experience behavioral problems and learning disabilities. They can also experience seizures due to development delays and brain lesions.[11]
- Neurofibromatosis: experience learning and behavioral issues.[9]
- Ataxia telangiectasia: usually have slurred speech.Cite error: A
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Skeletal
[edit]- Sturge-Weber syndrome: muscle weakness, specifically on the opposite side of where the port-wine stain is located on the body.
- Neurofibromatosis: skeletal abnormalities and abnormal growths on the spinal cord.[9]
- Ataxia telangiectasia: can develop deformities of their feet[12] and can experience uncoordinated movements and muscle twitches.Cite error: A
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Treatment
[edit]- Sturge-Weber syndrome: treated partially with a laser treatment that aims at lightening or removing birthmarks. Additionally, symptoms are managed with medication to control seizures, physical therapy, and several different educational therapies.
- Tuberous sclerosis: variety of management options based on the symptoms one is experiencing; these may vary behaviorally, cognitively, and neurologicall[11]
- Neurofibromatosis: commonly treated with biological treatments, such as surgery, chemotherapy, or radiation.[9]
- Ataxia telangiectasia: managed through occupational therapy, speech therapy, medication for the neurological symptoms, immunizations, antibiotics for respiratory infections, chest physiotherapy to manage excess mucus, muscle training that aims at strengthening the respiratory muscles, eye surgery, and braces for the feet.[12]
Prognosis
[edit]- Sturge-Weber syndrome: individuals can experience birthmarks and atrophy in the cerebral cortex without symptoms. Symptomatic individuals will develop seizures within their first year of life. If the treatment for seizures is ineffective it is likely they will have increased intellectual impairment.[13]
- Tuberous sclerosis: individuals that experience mild symptoms have normal life expectancies. Those with more severe symptoms suffer from more serious disabilities. All individuals are at risk for developing life-threatening brain tumors, or kidney lesions. In addition, patients are also at risk for lymphangioleiomyomatosis (LAM) which may require lifelong monitoring.[11]
- Neurofibromatosis: individuals can experience symptoms in two ways, each with varying outcomes. Individuals with a mutation in the NF1 gene will experience mild symptoms and children are able to live a normal life. Individuals with a mutation in the NF2 gene experience damage to cranial nerves, which can cause severe health issues therefore a less positive prognosis.[9][14]
- Ataxia telangiectasia: those affected have an average life expectancy of about 25 years. Many individuals will eventually succumb to the conditions associated with the disease, such as lung disease and different types of cancers.[12]
Epidemiology
[edit]- Sturge-Weber syndrome: prevalent in 1 in 50,000 newborns.[13]
- Tuberous sclerosis: affects all ages, races, and genders equally. It has a prevalence rate of 7-12 in 100,000 people, however many cases go undetected.[11]
- Neurofibromatosis: prevalent in 1 in 2,500 live births.[14] It is more common in boys than girls and individuals with neurofibromatosis are at higher risk for early mortality.[14]
- Ataxia telangiectasia: prevalent in between 1 in 40,000 and 1 in 100,000 live births,<ref name=GHR-AtaxiaTel>/> with symptoms beginning to present between ages two and five.[12] In addition, it affects all races and ethnicities equally.
References
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- ^ Rook, Arthur; Burns, Tony (2004). Rook's Textbook of Dermatology. Wiley. pp. 5–. ISBN 9780632064298.
- ^ Barbagallo, Joseph S.; Kolodzieh, Meghan S.; Silverberg, Nanette B.; Weinberg, Jeffrey M. (2002-07-01). "Neurocutaneous disorders". Dermatologic Clinics. 20 (3): 547–560, viii. doi:10.1016/s0733-8635(02)00005-0. ISSN 0733-8635. PMID 12170887.
- ^ Neau, Jean-Philippe; Godeneche, Gaëlle; Mathis, Stéphane; Guillet, Gérard (2014-01-01). "Neurodermatology". Handbook of Clinical Neurology. 121: 1561–1594. doi:10.1016/B978-0-7020-4088-7.00104-8. ISBN 9780702040887. ISSN 0072-9752. PMID 24365436.
- ^ Neau, Jean-Philippe; Godeneche, Gaëlle; Mathis, Stéphane; Guillet, Gérard (2014-01-01). "Neurodermatology". Handbook of Clinical Neurology. 121: 1561–1594. doi:10.1016/B978-0-7020-4088-7.00104-8. ISBN 9780702040887. ISSN 0072-9752. PMID 24365436.
- ^ Enersen, Ole Daniel (2007-07-13). "Jan van der Hoeve". Who Named It?.
- ^ Yanoff, Myron; Duker, Jay (2009). Ophthalmology. Elsevier Health Sciences. pp. 937–. ISBN 9780323043328.
- ^ a b Sudarsanam, A; Ardern-Holmes, SL (May 2014). "Sturge-Weber syndrome: from the past to the present". European Journal of Paediatric Neurology : EJPN : Official Journal of the European Paediatric Neurology Society. 18 (3): 257–66. doi:10.1016/j.ejpn.2013.10.003. PMID 24275166.
- ^ Jahagirdar, PB; Eeraveni, R; Ponnuraj, S; Kamarthi, N (December 2011). "Tuberous sclerosis: a novel approach to diagnosis". Journal of the Indian Society of Pedodontics and Preventive Dentistry. 29 (6 Suppl 2): S52-5. doi:10.4103/0970-4388.90742. PMID 22169838.
{{cite journal}}
: CS1 maint: unflagged free DOI (link)[non-primary source needed] - ^ a b c d e Gutmann, DH; Ferner, RE; Listernick, RH; Korf, BR; Wolters, PL; Johnson, KJ (23 February 2017). "Neurofibromatosis type 1". Nature Reviews. Disease Primers. 3: 17004. doi:10.1038/nrdp.2017.4. PMID 28230061. S2CID 303166.
- ^ "Ataxia-telangiectasia". Genetics Home Reference. January 2013. Retrieved 2017-03-31.
- ^ a b c d Roach, ES; Gomez, MR; Northrup, H (December 1998). "Tuberous sclerosis complex consensus conference: revised clinical diagnostic criteria". Journal of Child Neurology. 13 (12): 624–8. doi:10.1177/088307389801301206. PMID 9881533. S2CID 22310240.
- ^ a b c d Rothblum-Oviatt, C; Wright, J; Lefton-Greif, MA; McGrath-Morrow, SA; Crawford, TO; Lederman, HM (25 November 2016). "Ataxia telangiectasia: a review". Orphanet Journal of Rare Diseases. 11 (1): 159. doi:10.1186/s13023-016-0543-7. PMC 5123280. PMID 27884168.
{{cite journal}}
: CS1 maint: unflagged free DOI (link) - ^ a b Zaki, SA; Lad, V (July 2011). "Sturge-Weber syndrome with bilateral facial nevus and early cerebral calcification". Journal of Pediatric Neurosciences. 6 (2): 114–5. doi:10.4103/1817-1745.92825 (inactive 2022-06-06). PMC 3296402. PMID 22408657.
{{cite journal}}
: CS1 maint: DOI inactive as of June 2022 (link) CS1 maint: unflagged free DOI (link) - ^ a b c Asthagiri, AR; Parry, DM; Butman, JA; Kim, HJ; Tsilou, ET; Zhuang, Z; Lonser, RR (6 June 2009). "Neurofibromatosis type 2". Lancet (London, England). 373 (9679): 1974–86. doi:10.1016/S0140-6736(09)60259-2. PMC 4748851. PMID 19476995.