Neurodegenerative disorder caused by cricoid lipofuscinosis and characterized by onset at 6 to 18 months of age with rapid psychomotor deterioration, hypotonia, microcephaly, blindness, loss of speech, seizures, and ataxia.
Acute Infantile Neuronal Ceroid-Lipofuscinosis; CLN Type I; Hagberg-Santavuori Disease; Infantile Finnish Type of Neuronal Ceroid-Lipofuscinosis; Infantile Neuronal Ceroid-Lipofuscinosis (INCL); Neuronal Ceroid Lipofuscinosis Type I (early infantile); Santavuori-Haltia Disease; Polyunsaturated Fatty Acid Lipidosis.
Inherited neurometabolic disorder characterized by abnormal storage of the autofluorescent proteolipopigments in neuronal and other structures as a consequence of low or absent activity of palmitoyl-protein thioesterase 1.
Average incidence of all lipofuscinoses is estimated at 1.5:100,000 live births. Haltia-Santavuori Syndrome is one of the least frequent and affects mainly Finnish people.
Autosomal recessive. Disorder caused by a defective gene (CLN1) coding for the palmitoyl-protein thioesterase, which is mapped to chromosome 1p32.
Palmitoyl-protein thioesterase is a small glycoprotein that removes palmitate groups from cysteine residues in lipid-modified proteins. It is thought to be involved in the catabolism of lipid-modified proteins and is involved in neuronal maturation processes.
Deposition of lipofuscin in neural perikaryon, hepatocytes, heart muscle, retina, conjunctiva, skin, and lymphocytes.
Haltia-Santavuori Syndrome is the infantile form of neuronal ceroid lipofuscinosis, which becomes clinically apparent between 6 and 18 months of age and presents as a rapidly progressive mental and psychomotor deterioration with hypotonia, microcephaly, convulsive disorders, blindness, and ataxia.
Precautions before anesthesia
Carefully evaluate neurologic status and seizure disorders (electroencephalography [EEG] recommended if not yet performed). Consider visual and somatosensory evoked potentials and electroretinogram to identify eye conditions. The presence of abnormal dark retinal patches are common at eye examinations.
Not reported. Same anesthetic management as described for other neuronal ceroid lipofuscinoses.
Antiepileptic drugs should be continued until day of surgery. Consider interaction between antiepileptic drugs and anesthesia. Cystagon might be a potential therapy for the disease.
Other conditions to be considered
Jansky-Bielschowsky Disease (☞Neuronal Ceroid Lipofuscinoses): Late infantile form of neuronal ceroid lipofuscinosis (NCF). It has an onset between 2 and 4 years of age. Until that time, children appear normal or may exhibit slight delays in psychomotor development. Clinical features include seizure episodes characterized by sudden breaks in action or thought, twitching of certain facial muscles, and petit mal seizures and/or grand mal seizures. Myoclonic seizures, ataxia, muscle hypotonia, gradual intellectual deterioration, and progressive blindness may be present. A variant has been identified in individuals of Finnish descent in whom the symptoms ...