U.S. flag

An official website of the United States government

Format

Send to:

Choose Destination

Megalencephalic leukoencephalopathy with subcortical cysts

MedGen UID:
347006
Concept ID:
C1858854
Disease or Syndrome
Synonym: VAN DER KNAAP DISEASE
SNOMED CT: Infantile leukoencephalopathy and megalencephaly (703536004); Megalencephalic leukoencephalopathy with subcortical cysts (703536004); Vacuolating leukoencephalopathy (703536004); Leukoencephalopathy with swelling and cysts (703536004); Vacuolating megalencephalic leukoencephalopathy with subcortical cysts (703536004); Van der Knapp disease (703536004)
Modes of inheritance:
Autosomal recessive inheritance
MedGen UID:
141025
Concept ID:
C0441748
Intellectual Product
Source: Orphanet
A mode of inheritance that is observed for traits related to a gene encoded on one of the autosomes (i.e., the human chromosomes 1-22) in which a trait manifests in individuals with two pathogenic alleles, either homozygotes (two copies of the same mutant allele) or compound heterozygotes (whereby each copy of a gene has a distinct mutant allele).
Autosomal dominant inheritance
MedGen UID:
141047
Concept ID:
C0443147
Intellectual Product
Source: Orphanet
A mode of inheritance that is observed for traits related to a gene encoded on one of the autosomes (i.e., the human chromosomes 1-22) in which a trait manifests in heterozygotes. In the context of medical genetics, an autosomal dominant disorder is caused when a single copy of the mutant allele is present. Males and females are affected equally, and can both transmit the disorder with a risk of 50% for each child of inheriting the mutant allele.
 
Genes (locations): HEPACAM (11q24.2); MLC1 (22q13.33)
 
Monarch Initiative: MONDO:0011391
OMIM®: 604004
Orphanet: ORPHA2478

Disease characteristics

Megalencephalic leukoencephalopathy with subcortical cysts (MLC) is characterized by two phenotypes: classic MLC and improving MLC. Individuals with classic MLC present with macrocephaly, often in association with seizures, gradual onset of ataxia, spasticity, and sometimes extrapyramidal findings, mild gross motor developmental delays, and late-onset cognitive deterioration. Macrocephaly, observed in most affected individuals, may be present at birth but more frequently develops during the first year of life. The degree of macrocephaly is variable, with head circumferences reaching four to six standard deviations greater than the mean. After the first year of life, head growth trajectory typically normalizes and growth follows a line parallel to, although several standard deviations above, the 98th centile. Initial mental and motor development is normal in most individuals. Walking is often unstable, followed by ataxia of the trunk and extremities, pyramidal dysfunction, and brisk deep tendon reflexes. Early-onset seizures are common, and approximately 60% of individuals have epilepsy that is typically well controlled with anti-seizure medication, but status epilepticus occurs relatively frequently. Cognitive deterioration occurs later in the course of the disease and is usually mild in severity. Overall disease severity varies, with some individuals being able to ambulate independently for only a few years from disease onset to other individuals continuing to independently walk in the fifth decade of life. Individuals with improving MLC have a similar initial presentation with delayed cognitive or motor development, followed by an improving clinical course: macrocephaly usually persists, but some children become normocephalic; motor function improves or normalizes; hypotonia and clumsiness may persist in some or neurologic examination may become normal. Some individuals have intellectual disability that is stable, with or without autism spectrum disorder. Epilepsy is much less frequent than in classic MLC. [from GeneReviews]
Authors:
Rogier Min  |  Truus EM Abbink  |  Marjo S van der Knaap   view full author information

Additional descriptions

From OMIM
Megalencephalic leukoencephalopathy with subcortical cysts is a leukodystrophy characterized by early-onset macrocephaly and delayed-onset neurologic deterioration, including cerebellar ataxia, spasticity, epilepsy, and mild cognitive decline (summary by Lopez-Hernandez et al., 2011). Genetic Heterogeneity of Megalencephalic Leukoencephalopathy with Subcortical Cysts See also MLC2A (613925), caused by homozygous or compound heterozygous mutation in the HEPACAM gene (611642) on chromosome 11q24; MLC2B (613926), caused by heterozygous mutation in the HEPACAM gene; MLC3 (620447), caused by mutation in the GPRC5B gene (605948) on chromosome 16p12; and MLC4 (620448), caused by mutation in the AQP4 gene (600308) on chromosome 18q11.  http://www.omim.org/entry/604004
From MedlinePlus Genetics
Megalencephalic leukoencephalopathy with subcortical cysts is a progressive condition that affects brain development and function. Individuals with this condition typically have an enlarged brain (megalencephaly) that is evident at birth or within the first year of life. Megalencephaly leads to an increase in the size of the head (macrocephaly). Affected people also have leukoencephalopathy, an abnormality of the brain's white matter. White matter consists of nerve fibers covered by a fatty substance called myelin. Myelin insulates nerve cells (neurons) and promotes the rapid transmission of nerve impulses. In megalencephalic leukoencephalopathy with subcortical cysts, the myelin is swollen and contains numerous fluid-filled pockets (vacuoles). Over time, the swelling decreases and the myelin begins to waste away (atrophy). Individuals affected with this condition may develop cysts in the brain; because these cysts form below an area of the brain called the cerebral cortex, they are called subcortical cysts. These cysts can grow in size and number.

There are three types of megalencephalic leukoencephalopathy with subcortical cysts, which are distinguished by their signs and symptoms and genetic cause. Types 1 and 2A have different genetic causes but are nearly identical in signs and symptoms. Types 2A and 2B have the same genetic cause but the signs and symptoms of type 2B often begin to improve after one year. After improvement, individuals with type 2B usually have macrocephaly and may have intellectual disability.

The brain abnormalities in people with megalencephalic leukoencephalopathy with subcortical cysts affect the use of muscles and lead to movement problems. Affected individuals typically experience muscle stiffness (spasticity) and difficulty coordinating movements (ataxia). Walking ability varies greatly among those affected. Some people lose the ability to walk early in life and need wheelchair assistance, while others are able to walk unassisted well into adulthood. Minor head trauma can further impair movements and may lead to coma. Affected individuals may also develop uncontrolled muscle tensing (dystonia), involuntary writhing movements of the limbs (athetosis), difficulty swallowing (dysphagia), and impaired speech (dysarthria). More than half of all people with this condition have recurrent seizures (epilepsy). Despite the widespread brain abnormalities, people with this condition typically have only mild to moderate intellectual disability.  https://medlineplus.gov/genetics/condition/megalencephalic-leukoencephalopathy-with-subcortical-cysts

Professional guidelines

PubMed

DiBardino DM, Saqi A, Elvin JA, Greenbowe J, Suh JH, Miller VA, Ali SM, Stoopler M, Bulman WA
Clin Lung Cancer 2016 Nov;17(6):517-522.e3. Epub 2016 Jun 8 doi: 10.1016/j.cllc.2016.05.017. PMID: 27378171

Recent clinical studies

Etiology

De A, Lattier JM, Morales JE, Kelly JR, Zheng X, Chen Z, Sebastian S, Nassiri Toosi Z, Huse JT, Lang FF, McCarty JH
J Neurosci 2023 Nov 22;43(47):8043-8057. doi: 10.1523/JNEUROSCI.1401-23.2023. PMID: 37722850Free PMC Article
Zhang J, Ban T, Zhou L, Ji H, Yan H, Shi Z, Cao B, Jiang Y, Wang J, Wu Y
J Neurol 2020 Sep;267(9):2612-2618. Epub 2020 May 9 doi: 10.1007/s00415-020-09889-y. PMID: 32388833
Ashrafi MR, Amanat M, Garshasbi M, Kameli R, Nilipour Y, Heidari M, Rezaei Z, Tavasoli AR
Expert Rev Neurother 2020 Jan;20(1):65-84. Epub 2019 Dec 12 doi: 10.1080/14737175.2020.1699060. PMID: 31829048
Hamilton EMC, Tekturk P, Cialdella F, van Rappard DF, Wolf NI, Yalcinkaya C, Çetinçelik Ü, Rajaee A, Kariminejad A, Paprocka J, Yapici Z, Bošnjak VM, van der Knaap MS; MLC Research Group
Neurology 2018 Apr 17;90(16):e1395-e1403. Epub 2018 Mar 21 doi: 10.1212/WNL.0000000000005334. PMID: 29661901Free PMC Article
Perlman SJ, Mar S
Adv Exp Med Biol 2012;724:154-71. doi: 10.1007/978-1-4614-0653-2_13. PMID: 22411242

Diagnosis

Passchier EMJ, Kerst S, Brouwers E, Hamilton EMC, Bisseling Q, Bugiani M, Waisfisz Q, Kitchen P, Unger L, Breur M, Hoogterp L, de Vries SI, Abbink TEM, Kole MHP, Leurs R, Vischer HF, Brignone MS, Ambrosini E, Feillet F, Born AP, Epstein LG, Mansvelder HD, Min R, van der Knaap MS
Brain 2023 Aug 1;146(8):3444-3454. doi: 10.1093/brain/awad146. PMID: 37143309Free PMC Article
Ashrafi MR, Amanat M, Garshasbi M, Kameli R, Nilipour Y, Heidari M, Rezaei Z, Tavasoli AR
Expert Rev Neurother 2020 Jan;20(1):65-84. Epub 2019 Dec 12 doi: 10.1080/14737175.2020.1699060. PMID: 31829048
Renaud DL
Semin Neurol 2012 Feb;32(1):34-41. Epub 2012 Mar 15 doi: 10.1055/s-0032-1306384. PMID: 22422204
Perlman SJ, Mar S
Adv Exp Med Biol 2012;724:154-71. doi: 10.1007/978-1-4614-0653-2_13. PMID: 22411242
Singhal BS, Gorospe JR, Naidu S
J Child Neurol 2003 Sep;18(9):646-52. doi: 10.1177/08830738030180091201. PMID: 14572144

Therapy

Sharawat IK, Suthar R
Pediatr Neurol 2019 Aug;97:80-81. Epub 2019 Jan 30 doi: 10.1016/j.pediatrneurol.2019.01.011. PMID: 30808533
Siva K, Covello G, Denti MA
Nucleic Acid Ther 2014 Feb;24(1):69-86. doi: 10.1089/nat.2013.0461. PMID: 24506781Free PMC Article
Grosso S, Verrotti A, Messina M, Sacchini M, Balestri P
Eur J Paediatr Neurol 2012 Jul;16(4):390-5. Epub 2012 Jan 12 doi: 10.1016/j.ejpn.2011.12.007. PMID: 22244366

Prognosis

Bravo-Oro A, Reyes-Vaca JG, Noriega-Reyes MF, Esmer C
Bol Med Hosp Infant Mex 2022;79(2):129-134. doi: 10.24875/BMHIM.21000069. PMID: 35468122
Ishikawa M, Omachi Y, Sato N, Nakagawa E
BMC Psychiatry 2020 Jul 3;20(1):349. doi: 10.1186/s12888-020-02750-6. PMID: 32620087Free PMC Article
Abdel-Salam GM, Abdel-Hamid MS, Ismail SI, Hosny H, Omar T, Effat L, Aglan MS, Temtamy SA, Zaki MS
Metab Brain Dis 2016 Oct;31(5):1171-9. Epub 2016 Jul 7 doi: 10.1007/s11011-016-9861-7. PMID: 27389245
Perlman SJ, Mar S
Adv Exp Med Biol 2012;724:154-71. doi: 10.1007/978-1-4614-0653-2_13. PMID: 22411242
Riel-Romero RM, Smith CD, Pettigrew AL
J Child Neurol 2005 Mar;20(3):230-4. doi: 10.1177/088307380502000301. PMID: 15832614

Clinical prediction guides

Sadek AA, Aladawy MA, Mansour TMM, Ibrahim MF, Mohamed MM, Gad EF, Othman AA, Ahmed HA, Kasim AK, Wagdy WM, Hasan MHT, Abdelkreem E
J Child Neurol 2022 Apr;37(5):380-389. Epub 2022 Mar 24 doi: 10.1177/08830738221078683. PMID: 35322718
Zhang J, Ban T, Zhou L, Ji H, Yan H, Shi Z, Cao B, Jiang Y, Wang J, Wu Y
J Neurol 2020 Sep;267(9):2612-2618. Epub 2020 May 9 doi: 10.1007/s00415-020-09889-y. PMID: 32388833
Brignone MS, Lanciotti A, Serafini B, Mallozzi C, Sbriccoli M, Veroni C, Molinari P, Elorza-Vidal X, Petrucci TC, Estévez R, Ambrosini E
Mol Neurobiol 2019 Dec;56(12):8237-8254. Epub 2019 Jun 17 doi: 10.1007/s12035-019-01657-y. PMID: 31209783
Hamilton EMC, Tekturk P, Cialdella F, van Rappard DF, Wolf NI, Yalcinkaya C, Çetinçelik Ü, Rajaee A, Kariminejad A, Paprocka J, Yapici Z, Bošnjak VM, van der Knaap MS; MLC Research Group
Neurology 2018 Apr 17;90(16):e1395-e1403. Epub 2018 Mar 21 doi: 10.1212/WNL.0000000000005334. PMID: 29661901Free PMC Article
Lanciotti A, Brignone MS, Visentin S, De Nuccio C, Catacuzzeno L, Mallozzi C, Petrini S, Caramia M, Veroni C, Minnone G, Bernardo A, Franciolini F, Pessia M, Bertini E, Petrucci TC, Ambrosini E
Hum Mol Genet 2016 Apr 15;25(8):1543-58. Epub 2016 Feb 9 doi: 10.1093/hmg/ddw032. PMID: 26908604

Supplemental Content

Table of contents

    Clinical resources

    Practice guidelines

    • PubMed
      See practice and clinical guidelines in PubMed. The search results may include broader topics and may not capture all published guidelines. See the FAQ for details.

    Recent activity

    Your browsing activity is empty.

    Activity recording is turned off.

    Turn recording back on

    See more...