PEHO syndrome: Difference between revisions

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{{Technical|date=June 2009}}
{{Short description|A rare genetic disorder}}
{{Infobox medical condition (new)
{{Medical resources}}
| synonyms        = Progressive encephalopathy with edema, hypsarrhythmia and optic atrophy
| name            = PEHO syndrome
| image          = Autosomal recessive - en.svg
| caption        = PEHO syndrome is inherited in an autosomal recessive manner<ref>{{cite web|title=OMIM Entry - # 260565 - PEHO SYNDROME; PEHO|url=https://omim.org/entry/260565|website=omim.org|accessdate=4 August 2017|language=en-us}}</ref>
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'''PEHO syndrome''' is a progressive [[encephalopathy]] with [[edema]], [[hypsarrhythmia]] and [[optic atrophy]].  It is a very [[rare disease]], one of the [[Finnish heritage disease]]s, although approximately half of the cases reported so far are not-Finnish and have been described worldwide .<ref name="pmid12075493">{{cite journal| vauthors = Vanhatalo S, Somer M, Barth PG| title = Dutch patients with progressive encephalopathy with edema, hypsarrhythmia, and optic atrophy (PEHO) syndrome| journal = Neuropediatrics| volume = 33| issue = 2| pages = 100–4|date=April 2002| pmid = 12075493| doi = 10.1055/s-2002-32371| url =  }}</ref><ref name="pmid15542387">{{cite journal| vauthors = Klein A, Schmitt B, Boltshauser E| title = Progressive encephalopathy with edema, hypsarrhythmia and optic atrophy (PEHO) syndrome in a Swiss child| journal = European Journal of Paediatric Neurology| volume = 8| issue = 6| pages = 317–21| year = 2004| pmid = 15542387| doi = 10.1016/j.ejpn.2004.08.006| url =  }}</ref>
'''PEHO syndrome''' (Progressive Encephalopathy with Edema, Hypsarrhythmia, and Optic atrophy) is a rare [[genetic disorder]] characterized by a combination of neurological and developmental abnormalities. It was first described in 1991 by Finnish researchers.


It has been suggested that it may also be present in Australian and American populations.<ref name="pmid12949965">{{cite journal  |vauthors=Field MJ, Grattan-Smith P, Piper SM, etal |title=PEHO and PEHO-like syndromes: report of five Australian cases |journal=American Journal of Medical Genetics |volume=122A |issue=1 |pages=6–12 |date=September 2003 |pmid=12949965 |doi=10.1002/ajmg.a.20216}}</ref>
==Presentation==
PEHO syndrome typically presents in infancy, with symptoms appearing within the first few months of life. The hallmark features of the syndrome include:


==Aetiology==
* '''Progressive encephalopathy''': This refers to the progressive deterioration of brain function, leading to severe developmental delays and intellectual disability.
* '''Edema''': Swelling, particularly in the face and extremities, is a common feature.
* '''Hypsarrhythmia''': A specific pattern of chaotic brain wave activity seen on an [[electroencephalogram]] (EEG), often associated with [[infantile spasms]].
* '''Optic atrophy''': Degeneration of the [[optic nerve]], leading to vision impairment or blindness.


A mutation in the [[ZNHIT3]] gene - a nuclear zinc finger protein involved in transcriptional regulation and in small nucleolar ribonucleoprotein particle assembly has been shown to be the cause of the Finnish-type of PEHO syndrome.<ref name=Anttonen2017>Anttonen AK, Laari A, Kousi M, Yang YJ, Jääskeläinen T, Somer M, Siintola E, Jakkula E10, Muona M1,2,3,10, Tegelberg S, Lönnqvist T, Pihko H, Valanne L, Paetau A, Lun MP, Hästbacka J, Kopra O, Joensuu T, Katsanis N, Lehtinen MK, Palvimo JJ, Lehesjoki AE (2017) ZNHIT3 is defective in PEHO syndrome, a severe encephalopathy with cerebellar granule neuron loss. Brain doi: 10.1093/brain/awx040 </ref> However, the syndrome appear to be genetically heterogeneous and it might reflect an underlying genetic tubulinopathy, with biallelic mutations in the gene PRUNE1 also identified in non-Finnish patients with PEHO syndrome. <ref>Salpietro V, Zollo M, Vandrovcova J, Ryten M, Botia JA, Ferrucci V, Manole A, Efthymiou S, Al Mutairi F, Bertini E, Tartaglia M, SYNAPS Study Group, Houlden H (2017) The phenotypic and molecular spectrum of PEHO syndrome and PEHO-like Disorders. Brain DOI: 10.1093/brain/awx155</ref>
Additional symptoms may include [[seizures]], [[hypotonia]] (reduced muscle tone), and [[ataxia]] (lack of voluntary coordination of muscle movements).
 
==Genetics==
PEHO syndrome is believed to be inherited in an [[autosomal recessive]] manner, meaning that two copies of the mutated gene, one from each parent, are required for a child to be affected. The specific genetic mutations responsible for PEHO syndrome have not been fully elucidated, but research suggests involvement of genes related to [[neuronal development]] and function.


==Diagnosis==
==Diagnosis==
* Diagnosis is mainly clinical and depends on the presence of the following diagnostic criteria: early-onset severe [[hypotonia]]
Diagnosis of PEHO syndrome is primarily clinical, based on the characteristic symptoms and neurological findings. [[Magnetic resonance imaging]] (MRI) of the brain may show specific patterns of brain atrophy and other abnormalities. Genetic testing may be used to support the diagnosis, although specific genetic markers for PEHO syndrome are not always identifiable.
* The occurrence of [[seizures]], infantile [[spasm]]s and [[hypsarrhythmia]] after the first two weeks of life
* Onset of [[optic atrophy]] before two years of age, and failure to obtain any of the milestones for motor, visual and language development.
* An additional criterion is demonstration of cerebellar and brainstem atrophy by [[MRI]].
* A significant number of patients have been described who displayed most of the diagnostic criteria and features of PEHO syndrome, but did not appear to have cerebral atrophy on MRI, lacked the ophthalmologic signs and showed no reduction in [[CSF]] IGF-1 levels.
* This group of patients was diagnosed with PEHO-like syndrome.


'''Antenatal diagnosis'''
==Management==
[[Prenatal diagnosis]] is not available but early diagnosis is essential for genetic counseling of affected families.
There is currently no cure for PEHO syndrome, and treatment is primarily supportive and symptomatic. Management strategies may include:


==Treatment==
* [[Anticonvulsant]] medications to control seizures.
Treatment is symptomatic only. The infantile [[Spasm|spasms]] are refractory to [[Antiepileptic drug|antiepileptic drugs]] or [[Adrenocorticotropic hormone (ACTH)|adrenocorticotropic hormone]] (ACTH) therapy.
* Physical and occupational therapy to address motor skills and muscle tone.
* Vision and hearing support, including the use of assistive devices.
* Nutritional support and management of feeding difficulties.


==References==
==Prognosis==
{{reflist}}
The prognosis for individuals with PEHO syndrome is generally poor, with most affected children experiencing severe developmental delays and significant health challenges. Life expectancy is often reduced, with many children not surviving beyond early childhood.
== External links ==
{{Medical resources
|  DiseasesDB    = 33582
|  ICD10          = G31.8
|  ICD9          = 
|  ICDO          = 
|  OMIM          = 260565
|  MedlinePlus    = 
|  eMedicineSubj  = 
|  eMedicineTopic = 
|  MeshID        =
}}
[[Category:Rare syndromes]]


==Related pages==
* [[Genetic disorder]]
* [[Infantile spasms]]
* [[Optic atrophy]]
* [[Seizure disorder]]


{{nervoussystem-disease-stub}}
[[Category:Genetic disorders]]
[[Category:Neurological disorders]]
[[Category:Pediatric diseases]]

Revision as of 19:12, 22 March 2025

A rare genetic disorder



PEHO syndrome (Progressive Encephalopathy with Edema, Hypsarrhythmia, and Optic atrophy) is a rare genetic disorder characterized by a combination of neurological and developmental abnormalities. It was first described in 1991 by Finnish researchers.

Presentation

PEHO syndrome typically presents in infancy, with symptoms appearing within the first few months of life. The hallmark features of the syndrome include:

  • Progressive encephalopathy: This refers to the progressive deterioration of brain function, leading to severe developmental delays and intellectual disability.
  • Edema: Swelling, particularly in the face and extremities, is a common feature.
  • Hypsarrhythmia: A specific pattern of chaotic brain wave activity seen on an electroencephalogram (EEG), often associated with infantile spasms.
  • Optic atrophy: Degeneration of the optic nerve, leading to vision impairment or blindness.

Additional symptoms may include seizures, hypotonia (reduced muscle tone), and ataxia (lack of voluntary coordination of muscle movements).

Genetics

PEHO syndrome is believed to be inherited in an autosomal recessive manner, meaning that two copies of the mutated gene, one from each parent, are required for a child to be affected. The specific genetic mutations responsible for PEHO syndrome have not been fully elucidated, but research suggests involvement of genes related to neuronal development and function.

Diagnosis

Diagnosis of PEHO syndrome is primarily clinical, based on the characteristic symptoms and neurological findings. Magnetic resonance imaging (MRI) of the brain may show specific patterns of brain atrophy and other abnormalities. Genetic testing may be used to support the diagnosis, although specific genetic markers for PEHO syndrome are not always identifiable.

Management

There is currently no cure for PEHO syndrome, and treatment is primarily supportive and symptomatic. Management strategies may include:

  • Anticonvulsant medications to control seizures.
  • Physical and occupational therapy to address motor skills and muscle tone.
  • Vision and hearing support, including the use of assistive devices.
  • Nutritional support and management of feeding difficulties.

Prognosis

The prognosis for individuals with PEHO syndrome is generally poor, with most affected children experiencing severe developmental delays and significant health challenges. Life expectancy is often reduced, with many children not surviving beyond early childhood.

Related pages