Neuronal ceroid lipofuscinoses (NCL)

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Definition

Neuronal ceroid lipofuscinoses (NCL) refers to a group of rare disorders of the nerve cells. NCL is passed down through families (inherited).

These are the 3 main types of NCL:

  • Adult (Kufs or Parry disease)
  • Juvenile (Batten disease)
  • Late infantile (Jansky-Bielschowsky disease)

Alternative Names

Lipofuscinoses; Batten disease; Jansky-Bielschowsky; Kufs disease; Spielmeyer-Vogt

Causes

NCL involves the buildup of an abnormal material called lipofuscin in the brain. NCL is thought to be caused by problems with the brain's ability to remove and recycle proteins.

Lipofuscinoses are inherited as autosomal recessive traits. This means each parent passes on a nonworking copy of the gene for the child to develop the condition.

Symptoms

Symptoms of NCL include:

  • Abnormally increased muscle tone or spasm
  • Blindness or vision problems
  • Dementia
  • Lack of muscle coordination
  • Intellectual disability
  • Movement disorder
  • Seizures
  • Unsteady walk

Exams and Tests

The disorder may be seen at birth, but it is usually diagnosed much later in childhood.

Tests include:

  • Autofluorescence (a light technique)
  • EEG (measures electrical activity in the brain)
  • Electron microscopy of a skin biopsy
  • Electroretinogram (an eye test)
  • Genetic testing
  • MRI or CT scans of the brain
  • Tissue biopsy

Treatment

Treatment depends on the type of NCL and extent of symptoms. A person with NCL may need lifelong assistance and care.

Support Groups

For information and support, see the Batten Disease Support and Research Association at www.bdsra.org.

Outlook (Prognosis)

The younger the person is when the disease appears, the greater the risk for disability and early death. Those who develop the disease early can have vision problems that progress to blindness and problems with mental function that get worse. If the disease starts in the first year of life, death by age 10 is likely.

If the disease occurs in adulthood, symptoms will be milder, with no vision loss and a normal life expectancy.

Possible Complications

These complications can occur:

  • Vision impairment or blindness (with the early-onset forms of the disease)
  • Mental impairment, ranging from severe developmental delays at birth to dementia later in life
  • Rigid muscles (due to severe problems with the nerves that control muscle tone)

The person may become totally dependent on others for help with daily activities.

When to Contact a Medical Professional

Call your provider if your child shows symptoms of blindness or intellectual disability.

Prevention

Genetic counseling is recommended if your family has a known history of NCL. Prenatal tests, or a test called preimplantation genetic diagnosis (PGD), may be available, depending on the specific type of disease. In PGD, an embryo is tested for abnormalities before it is implanted in the woman's womb.

References

Kwon JM. Neuronal ceroid lipofuscinoses. In: Kliegman RM, Stanton BF, St Geme JW III, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 599.

Mole SE, Williams RE. Neuronal ceroid-lipofuscinoses. In: Pagon RA, Adam MP, Ardinger HH, et al, eds. GeneReviews. University of Washington, Seattle, WA. www.ncbi.nlm.nih.gov/books/NBK1428/. Updated: August 1, 2013. Accessed: October 25, 2015.

Version Info

  • Last reviewed on 10/27/2015
  • Chad Haldeman-Englert, MD, FACMG, Fullerton Genetics Center, Asheville, NC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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