Medicine:Walker–Warburg syndrome

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Walker–Warburg syndrome
Other namesHARD syndrome,Warburg syndrome
Walker–Warburg syndrome has an autosomal recessive pattern of inheritance.

Walker–Warburg syndrome (WWS), also called Warburg syndrome, Chemke syndrome, HARD syndrome (Hydrocephalus, Agyria and Retinal Dysplasia), Pagon syndrome, cerebroocular dysgenesis (COD) or cerebroocular dysplasia-muscular dystrophy syndrome (COD-MD),[1] is a rare form of autosomal recessive congenital muscular dystrophy.[2] It is associated with brain (lissencephaly, hydrocephalus, cerebellar malformations) and eye abnormalities.[3] This condition has a worldwide distribution. Walker-Warburg syndrome is estimated to affect 1 in 60,500 newborns worldwide.[4]

Presentation

This illustration shows patient’s brain MRI with Walker-Warburg syndrome. On MRI bilateral enlargement of the internal ventricles and cobblestone lissencephaly (Type 2) with lack of gyration can be seen.

The clinical manifestations present at birth are generalized hypotonia, muscle weakness, developmental delay with intellectual disability and occasional seizures.[5] The congenital muscular dystrophy is characterized by hypoglycosylation of α-dystroglycan. Those born with the disease also experience severe ocular and brain defects. Half of all children with WWS are born with encephalocele, which is a gap in the skull that will not seal. The meninges of the brain protrude through this gap due to the neural tube failing to close during development. A malformation of the a baby's cerebellum is often a sign of this disease. Common ocular issues associated with WWS are abnormally small eyes and retinal abnormalities cause by an underdeveloped light-sensitive area in the back of the eye.[6]

Genetics

Several genes have been implicated in the etiology of Walker–Warburg syndrome,[7] and others are as yet unknown. Several mutations were found in the protein O-Mannosyltransferase POMT1 and POMT2 genes, and one mutation was found in each of the fukutin and fukutin-related protein genes. Another gene that has been linked to this condition is Beta-1,3-N-acetylgalactosaminyltransferase 2 (B3GALNT2).[8]

Diagnosis

Laboratory investigations usually show elevated creatine kinase, myopathic/dystrophic muscle pathology and altered α-dystroglycan. Antenatal diagnosis is possible in families with known mutations. Prenatal ultrasound may be helpful for diagnosis in families where the molecular defect is unknown.[9]

Prognosis

No specific treatment is available. Management is only supportive and preventive. Those who are diagnosed with the disease often die within the first few months of life. Almost all children with the disease die by the age of three.[9]

Eponym

WWS is named for Arthur Earl Walker and Mette Warburg.[10][11][12] Its alternative names include Chemke’s syndrome and Pagon’s syndrome, named after Juan M. Chemke and Roberta A. Pagon.[10]

References

  1. ↑ "Muscular Dystrophy-Dystroglycanopathy (Congenital With Brain and Eye Anomalies), Type a, 1; MDDGA1". Online Mendelian Inheritance in Man (OMIM). https://omim.org/entry/236670. 
  2. ↑ "Walker-Warburg syndrome". Orphanet Journal of Rare Diseases 1. August 2006. doi:10.1186/1750-1172-1-29. PMID 16887026. 
  3. ↑ "Walker-Warburg syndrome" (in en). Genetic and Rare Diseases Information Center (GARD) – an NCATS Program. U.S. National Institutes of Health. https://rarediseases.info.nih.gov/diseases/2599/walker-warburg-syndrome. 
  4. ↑ "Walker-Warburg syndrome" (in en). MedlinePlus Genetics. U.S. National Library of Medicine. https://medlineplus.gov/genetics/condition/walker-warburg-syndrome/. 
  5. ↑ "Walker-Warburg syndrome" (in en). Genetics Home Reference. U.S. National Library of Medicine. https://medlineplus.gov/genetics/condition/walker-warburg-syndrome/. 
  6. ↑ "Walker-Warburg Syndrome - Facts and Information". Disabled World. 1 February 2023. http://www.disabled-world.com/disability/types/mobility/md/walker-warburg.php. 
  7. ↑ "Mutations in the O-mannosyltransferase gene POMT1 give rise to the severe neuronal migration disorder Walker-Warburg syndrome". American Journal of Human Genetics 71 (5): 1033–1043. November 2002. doi:10.1086/342975. PMID 12369018. 
  8. ↑ "B3GALNT2 mutations associated with non-syndromic autosomal recessive intellectual disability reveal a lack of genotype-phenotype associations in the muscular dystrophy-dystroglycanopathies". Genome Medicine 9 (1). December 2017. doi:10.1186/s13073-017-0505-2. PMID 29273094. 
  9. ↑ 9.0 9.1 "Walker-Warburg syndrome". Orphanet Journal of Rare Diseases 1. August 2006. doi:10.1186/1750-1172-1-29. PMID 16887026. 
  10. ↑ 10.0 10.1 "Walker-Warburg syndrome". Whonamedit?. http://www.whonamedit.com/synd.cfm/1202.html. 
  11. ↑ "Lissencephaly". Archives of Neurology and Psychiatry 48: 13–29. 1942. doi:10.1001/archneurpsyc.1942.02290070023002. 
  12. ↑ "The heterogeneity of microphthalmia in the mentally retarded". Birth Defects Original Article Series 7 (3): 136–154. March 1971. PMID 4950916. 

Further reading

Classification
External resources

Template:Diseases of myoneural junction and muscle



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