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From the Department of Neurology (Dr. van Domburg), Laurentius Hospital, Roermond; the Department of Paediatric Neurology (Drs. Willemsen, Rotteveel, and Gabreëls), the Laboratory of Paediatrics and Neurology (Dr. de Jong), the Departments of Radiology (Drs. Thijssen and Heerschap), Ophthalmology (Dr. Cruysberg), and Dermatology (Dr. Steijlen), University Hospital Nijmegen St. Radboud; and the Department of Clinical Biochemistry (Dr. Wanders), Academic Medical Centre, Amsterdam, the Netherlands.
Address correspondence and reprint requests to Dr. Peter van Domburg, Department of Neurology, Laurentius Hospital, PO Box 920, 6040 AX Roermond, the Netherlands.
OBJECTIVE: To determine the spectrum of clinical and MRI/1H MRS features of patients with fatty aldehyde dehydrogenase (FALDH) deficiency.
BACKGROUND: The Sjögren–Larsson syndrome (SLS) was originally defined as a clinical triad consisting of ichthyosis, spastic di- or tetraplegia, and mental retardation, with autosomal recessive inheritance. By now, both the deficiency of the enzyme FALDH, and the genetic mutations on chromosome 17 responsible for this deficiency, have been identified. SLS, defined by fibroblast FALDH deficiency, seems to be a much broader syndrome.
METHODS: The clinical findings of 11 FALDH-deficient patients of different ages and one patient with the characteristic SLS-like ichthyosis, but without FALDH deficiency, were evaluated in relation to their cerebral MRI, and to 1H MRS in six patients.
RESULTS: The severity of neurologic symptoms showed considerable variation. Fundoscopic perifoveal glistening dots and the characteristic SLS-like ichthyosis were present in all patients. Serial MRI findings showed evidence of retarded myelination and a variable degree of dysmyelination. 1H MRS showed an accumulation of free lipids in the periventricular white matter, even before the stage of visible dysmyelination.
CONCLUSIONS: The neurologic consequences of FALDH deficiency show considerable variation. The characteristic pattern of ichthyosis and retinal degeneration are seen consistently, yet they are not pathognomonic. MRI and 1H MRS findings suggest an accumulation of long-chain fatty alcohol intermediates, resulting in retarded myelination and dysmyelination.
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