Neuroacanthocytosis

Neuroacanthocytosis (also known as Levine-Critchley syndrome or chorea-acanthocytosis) is a rare movement disorder marked by progressive muscle weakness and atrophy, progressive cognitive loss, chorea (involuntary twisting movements of the body), and acanthocytosis (spiked red blood cells associated with several inherited neurological disorders). Other symptoms include facial tics, uncontrolled muscle movement, instability when walking, seizures, biting of the tongue and lips and changes in personality, comprehension and judgment. The disorder is due to degeneration of the basal ganglia (a part of the brain that helps control movement) and loss of neurons in the brain and spinal cord. Neuroacanthocytosis has adult and childhood varieties. In adults, onset of classic symptoms is usually begins between ages 20 and 50, while in children onset is typically seen in adolescence (but may occur earlier). Adult varieties can involve the heart and immune system. Neuroacanthocytosis is typically an inherited autosomal recessive disorder and is more common in males than in females. Some types of neuroacanthocytosis have been found to be caused by specific gene defects. Parkinsonism has been associated with the disorder in some patients.

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Differential Diagnosis

The following list of disorders are considered when diagnosing neuroacanthocytosis.^[1]

• Huntington's disease
• Gilles de la Tourette syndrome
• Tardive dyskinesia
• Lesch-Nyhan syndrome
• Seizures
• McLeod syndrome

Treatment

Treatment is symptomatic and supportive. Antipsychotic drugs that block dopamine, such as haloperidol, can provide temporary relief from tics and chorea. Drugs used to decrease anxiety, such as diazepam and benzodiazepine, can also decrease movement disorders, which are often made worse by associated stress. Injections of botulinum toxin can relax muscles and reduce unintentional movement. Other drug therapy may include anticonvulsants and antidepressants. Proper nutrition is required. A feeding tube may be needed for some patients as the disorder progresses. Speech therapy and physical therapy may provide some relief to select patients.

Prognosis

Neuroacanthocytosis is a progressive disease. It is often fatal, generally the result of symptoms that contribute to pneumonia, cardiomyopathy, eating problems or other complications. Life expectancy following onset of severe symptoms is typically 5-10 years. However, life span may be near normal for patients with no prominent neurologic or cardiac complications.

See also

• Institute for Neuroacanthocytosis operated by the Advocacy for Neuroacanthocytosis Patients: http://www.naadvocacy.org/. The Advocacy for Neuroacanthocytosis Patients is an international group of patients, their families and friends as well as clinicians and researchers seeking to find relief from these illnesses. The Advocacy publishes NANews, an e-newsletter, several times each year and encourages communication between those affected or concerned by this disease. Researchers will also find information about the Advocacy’s grants for research projects.

References

1. ^ Lakhan SE; Gross K. Progressive neuroacanthocytosis in brothers: a case report. Clinics 2007,62(5):665-668.

• Critchley EM, Clark DB, Wikler A (1967). "An adult form of acanthocytosis". Trans Am Neurol Assoc 92: 132-7. PMID 4255726.
• Levine IM, Estes JW, Looney JM (1968). "Hereditary neurological disease with acanthocytosis. A new syndrome". Arch Neurol 19 (4): 403-9. PMID 5677189.