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Nationwide survey of Alexander disease in Japan and proposed new guidelines for diagnosis.
[alexander disease]
Alexander
disease
(
AxD
)
is
a
rare
neurodegenerative
disorder
characterized
by
white
matter
degeneration
and
formation
of
cytoplasmic
inclusions
.
Glial
fibrillary
acidic
protein
(
GFAP
)
mutations
have
been
reported
in
various
forms
of
AxD
since
2001
.
However
,
a
definitive
diagnosis
remains
difficult
because
of
uncertain
prevalence
,
and
different
clinical
features
seen
in
infantile
AxD
and
adult
AxD
may
lead
to
confusion
and
misdiagnosis
.
Here
we
report
an
epidemiological
study
conducted
in
Japan
.
Two
nationwide
questionnaire-based
surveys
were
conducted
using
tentative
diagnostic
criteria
.
We
gathered
information
regarding
prevalence
,
neurological
findings
,
magnetic
resonance
imaging
(
MRI
)
findings
,
electrophysiological
findings
,
genetic
information
,
and
the
results
of
therapeutic
interventions
and
home
care
.
Prevalence
of
various
forms
of
AxD
was
determined
as
27
.
3
%
(
infantile
)
,
24
.
2
%
(
juvenile
)
,
and
48
.
5
%
(
adult
)
.
Prevalence
of
AxD
in
Japan
was
estimated
to
be
approximately
1
case
per
2
.
7
million
individuals
.
The
main
characteristics
of
infantile
and
juvenile
AxD
include
delayed
psychomotor
development
or
mental
retardation
,
convulsions
,
macrocephaly
,
and
predominant
cerebral
white
matter
abnormalities
in
the
frontal
lobe
on
brain
MRI
.
The
main
characteristics
of
adult
AxD
include
bulbar
signs
,
muscle
weakness
with
hyperreflexia
,
and
signal
abnormalities
and
/
or
atrophy
of
medulla
oblongata
and
cervical
spinal
cord
on
MRI
.
To
ensure
correct
diagnosis
of
AxD
,
the
physician
should
understand
the
importance
of
the
process
of
GFAP
genetic
testing
,
which
provides
definitive
diagnosis
.
Therefore
,
we
propose
new
clinical
guidelines
for
diagnosing
AxD
based
on
simplified
classifications
:
cerebral
AxD
(
type
1
)
,
bulbospinal
AxD
(
type
2
)
,
and
intermediate
form
(
type
3
)
.
Diseases
Validation
Diseases presenting
"mental retardation"
symptom
achondroplasia
alexander disease
alpha-thalassemia
aniridia
aromatase deficiency
canavan disease
classical phenylketonuria
coats disease
cohen syndrome
cowden syndrome
cystinuria
dentin dysplasia
familial hypocalciuric hypercalcemia
homocystinuria without methylmalonic aciduria
hydrocephalus with stenosis of the aqueduct of sylvius
kabuki syndrome
kallmann syndrome
lamellar ichthyosis
lymphangioleiomyomatosis
monosomy 21
phenylketonuria
primary hyperoxaluria type 1
proteus syndrome
pyruvate dehydrogenase deficiency
sneddon syndrome
triple a syndrome
wolf-hirschhorn syndrome
zellweger syndrome
This symptom has already been validated