Metachromatic leukodystrophy

Metachromatic leukodystrophy is an inherited metabolic storage disease characterized by the absence of the enzyme arylsulfatase A and increased storage of sulfatide.

Alternative Names

MLD; Arylsulfatase A deficiency

Causes, incidence, and risk factors

Metachromatic leukodystrophy (MLD) is transmitted as an autosomal recessive trait. MLD has a wide range of symptoms. As with many other storage diseases, there are forms of early and delayed onset (late infant, juvenile and adult types). The most common (and the most severe form) is the late infant onset form, which has symptoms such as irritability , decreased muscle tone , muscle wasting , the loss of the ability to walk. Debility is progressive with blindness , seizures , and partial paralysis . Death occurs usually before age 10. Both the juvenile and adult forms have later onset but similar symptoms. In the adult and juvenile forms, psychosis and emotional disturbances are an important part of the illness. The juvenile form is fatal within a few years of diagnosis. The adult form may be drawn out over many years.

Signs and tests

  • decreased or absent deep tendon reflexes
  • nystagmus
  • (abnormal eye movements)
  • poor visual fixation
  • optic nerve atrophy
  • decorticate posturing
  • coma
  • Tests:
  • nerve velocity conduction studies
  • MRI
  • CT
  • scan
  • lumbar puncture
  • and examination of the cerebrospinal fluid showing increased
  • CSF total protein
  • nerve biopsy
  • (usually performed on the sural nerve) showing metachromatic deposits
  • urine chemistry
  • showing markedly increased sulfatide levels
  • urinalysis
  • showing metachromatic granules in the urine sediment
  • culture of skin fibroblasts or white blood cells for decreased arylsulfatase A activity
  • Treatment

    At present, there is no treatment for metachromatic leukodystrophy itself. Symptomatic treatments may provide mild relief.

    Support groups

    The United Leukodystrophy Association can be reached at www.ulf.org .

    Expectations (prognosis)

    Metachromatic leukodystrophy is a severely debilitating progressive disease whose outcome is fatal.

    Complications

  • bronchopneumonia
  • Calling your health care provider

    Call your health care provider if you have a family history of this disease or if you notice symptoms suggestive of this disorder.

    Prevention

    Genetic counseling is recommended for parents with a family history of metachromatic leukodystrophy.

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