What happens in this disease?
A change in the ARSA gene reduces the enzyme arylsulfatase A. This enzyme breaks down fats called sulfatides. Sulfatides build up in the cells that make the sheath around the nerves. This sheath is called myelin. Over time, myelin in the brain, spinal cord and nerves breaks down.
Which symptoms can occur?
The disease has three forms. The most common form usually begins in the second year of life.
- Difficulty walking, walking on tiptoe
- Loss of speech that had been learned
- Muscle weakness, followed by muscle stiffness
- Loss of feeling in the hands and feet
- Seizures (fits)
- In older children, falling school performance
- In teenagers and adults, changes in behavior and mental health
How is it diagnosed?
A brain MRI can show the loss of myelin. The enzyme is measured in the blood and sulfatides in the urine. A genetic test examines the ARSA and PSAP genes. In very young children, the first MRI may be normal.
Treatment and care
For some children diagnosed before symptoms begin or very early, there is an approved gene therapy. A stem cell transplant may also be considered for some children at this stage. In other situations, supportive treatment that eases the symptoms is given. This is why early diagnosis is so important. The doctor who follows the disease decides which treatment is suitable.
For the family: inheritance and genetic counselling
The disease is passed on through recessive inheritance. The mother and father are usually healthy carriers. For a couple who are both carriers, the chance of having an affected child is 1 in 4 in each pregnancy. Diseases of this kind may be more common in marriages between relatives. Genetic counselling guides the family.