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Neurodegeneration with brain iron accumulation 6(NBIA6)

MedGen UID:
1387791
Concept ID:
C4517377
Disease or Syndrome
Synonyms: COASY protein-associated neurodegeneration; NBIA6
SNOMED CT: Coenzyme A synthase protein associated neurodegeneration (732264002); COASY protein-associated neurodegeneration (732264002); CoPAN - coenzyme A synthase protein associated neurodegeneration (732264002); Neurodegeneration with brain iron accumulation due to COASY mutation (732264002)
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).
 
Gene (location): COASY (17q21.2)
 
Monarch Initiative: MONDO:0014290
OMIM®: 615643
Orphanet: ORPHA397725

Definition

Neurodegeneration with brain iron accumulation refers to a group of neurodegenerative disorders characterized by progressive motor and cognitive dysfunction beginning in childhood or young adulthood. Patients show extrapyramidal motor signs, such as spasticity, dystonia, and parkinsonism. Brain imaging shows iron accumulation in the basal ganglia (summary by Dusi et al., 2014). For a general phenotypic description and a discussion of genetic heterogeneity of NBIA, see NBIA1 (234200). [from OMIM]

Clinical features

From HPO
Pes cavus
MedGen UID:
675590
Concept ID:
C0728829
Congenital Abnormality
An increase in height of the medial longitudinal arch of the foot that does not flatten on weight bearing (i.e., a distinctly hollow form of the sole of the foot when it is bearing weight).
Areflexia of lower limbs
MedGen UID:
347285
Concept ID:
C1856694
Finding
Inability to elicit tendon reflexes in the lower limbs.
Depression
MedGen UID:
4229
Concept ID:
C0011581
Mental or Behavioral Dysfunction
Frequently experiencing feelings of being down, miserable, and/or hopeless; struggling to recover from these moods; having a pessimistic outlook on the future; feeling a pervasive sense of shame; having a low self-worth; experiencing thoughts of suicide and engaging in suicidal behavior.
Dysarthria
MedGen UID:
8510
Concept ID:
C0013362
Mental or Behavioral Dysfunction
Dysarthric speech is a general description referring to a neurological speech disorder characterized by poor articulation. Depending on the involved neurological structures, dysarthria may be further classified as spastic, flaccid, ataxic, hyperkinetic and hypokinetic, or mixed.
Dystonic disorder
MedGen UID:
3940
Concept ID:
C0013421
Sign or Symptom
An abnormally increased muscular tone that causes fixed abnormal postures. There is a slow, intermittent twisting motion that leads to exaggerated turning and posture of the extremities and trunk.
Neurodegeneration
MedGen UID:
17999
Concept ID:
C0027746
Cell or Molecular Dysfunction
Progressive loss of neural cells and tissue.
Spastic paraparesis
MedGen UID:
52432
Concept ID:
C0037771
Sign or Symptom
Mild or moderate loss of motor function accompanied by spasticity in the lower extremities. This condition is a manifestation of CENTRAL NERVOUS SYSTEM DISEASES that cause injury to the motor cortex or descending motor pathways.
Bradykinesia
MedGen UID:
115925
Concept ID:
C0233565
Sign or Symptom
Bradykinesia literally means slow movement, and is used clinically to denote a slowness in the execution of movement (in contrast to hypokinesia, which is used to refer to slowness in the initiation of movement).
Abnormal postural reflex
MedGen UID:
535828
Concept ID:
C0234155
Finding
Anomaly of the physiological response to maintain the body's posture when movement and position is altered.
Mental deterioration
MedGen UID:
66713
Concept ID:
C0234985
Mental or Behavioral Dysfunction
Loss of previously present mental abilities, generally in adults.
Delayed ability to walk
MedGen UID:
66034
Concept ID:
C0241726
Finding
A failure to achieve the ability to walk at an appropriate developmental stage. Most children learn to walk in a series of stages, and learn to walk short distances independently between 12 and 15 months.
Hypoplasia of the corpus callosum
MedGen UID:
138005
Concept ID:
C0344482
Congenital Abnormality
Underdevelopment of the corpus callosum.
Spastic tetraplegia
MedGen UID:
98433
Concept ID:
C0426970
Disease or Syndrome
Spastic paralysis affecting all four limbs.
Tip-toe gait
MedGen UID:
98104
Concept ID:
C0427144
Finding
An abnormal gait pattern characterized by the failure of the heel to contact the floor at the onset of stance during gait.
Global developmental delay
MedGen UID:
107838
Concept ID:
C0557874
Finding
A delay in the achievement of motor or mental milestones in the domains of development of a child, including motor skills, speech and language, cognitive skills, and social and emotional skills. This term should only be used to describe children younger than five years of age.
Gait disturbance
MedGen UID:
107895
Concept ID:
C0575081
Finding
The term gait disturbance can refer to any disruption of the ability to walk. In general, this can refer to neurological diseases but also fractures or other sources of pain that is triggered upon walking. However, in the current context gait disturbance refers to difficulty walking on the basis of a neurological or muscular disease.
Compulsive behaviors
MedGen UID:
109373
Concept ID:
C0600104
Mental or Behavioral Dysfunction
Behavior that consists of repetitive acts, characterized by the feeling that one "has to" perform them, while being aware that these acts are not in line with one's overall goal.
Hyporeflexia
MedGen UID:
195967
Concept ID:
C0700078
Finding
Reduction of neurologic reflexes such as the knee-jerk reaction.
Motor tics
MedGen UID:
199761
Concept ID:
C0751900
Sign or Symptom
Movement-based tics affecting discrete muscle groups.
Developmental regression
MedGen UID:
324613
Concept ID:
C1836830
Disease or Syndrome
Loss of developmental skills, as manifested by loss of developmental milestones.
Oromandibular dystonia
MedGen UID:
473560
Concept ID:
C2242577
Sign or Symptom
A kind of focal dystonia characterized by forceful contractions of the face, jaw, and/or tongue causing difficulty in opening and closing the mouth and often affecting chewing and speech.
Motor axonal neuropathy
MedGen UID:
413108
Concept ID:
C2749625
Disease or Syndrome
Progressive impairment of function of motor axons with muscle weakness, atrophy, and cramps. The deficits are length-dependent, meaning that muscles innervated by the longest nerves are affected first, so that for instance the arms are affected at a later age than the onset of deficits involving the lower leg.
Intellectual disability
MedGen UID:
811461
Concept ID:
C3714756
Mental or Behavioral Dysfunction
Intellectual disability, previously referred to as mental retardation, is characterized by subnormal intellectual functioning that occurs during the developmental period. It is defined by an IQ score below 70.
Rigidity
MedGen UID:
7752
Concept ID:
C0026837
Sign or Symptom
Continuous involuntary sustained muscle contraction. When an affected muscle is passively stretched, the degree of resistance remains constant regardless of the rate at which the muscle is stretched. This feature helps to distinguish rigidity from muscle spasticity.
Distal amyotrophy
MedGen UID:
338530
Concept ID:
C1848736
Disease or Syndrome
Muscular atrophy affecting muscles in the distal portions of the extremities.

Professional guidelines

PubMed

Cossu G, Abbruzzese G, Matta G, Murgia D, Melis M, Ricchi V, Galanello R, Barella S, Origa R, Balocco M, Pelosin E, Marchese R, Ruffinengo U, Forni GL
Parkinsonism Relat Disord 2014 Jun;20(6):651-4. Epub 2014 Mar 12 doi: 10.1016/j.parkreldis.2014.03.002. PMID: 24661465

Recent clinical studies

Etiology

Amini E, Rohani M, Jalessi M, Azad Z, Valzania F, Cavallieri F, Farhadi M, Gholibeigian Z
Neurol Sci 2024 Feb;45(2):647-654. Epub 2023 Aug 31 doi: 10.1007/s10072-023-07037-8. PMID: 37651040
Cavestro C, Diodato D, Tiranti V, Di Meo I
Int J Mol Sci 2023 Mar 21;24(6) doi: 10.3390/ijms24065951. PMID: 36983025Free PMC Article
Lange LM, Gonzalez-Latapi P, Rajalingam R, Tijssen MAJ, Ebrahimi-Fakhari D, Gabbert C, Ganos C, Ghosh R, Kumar KR, Lang AE, Rossi M, van der Veen S, van de Warrenburg B, Warner T, Lohmann K, Klein C, Marras C; on behalf of the Task Force on Genetic Nomenclature in Movement Disorders
Mov Disord 2022 May;37(5):905-935. Epub 2022 Apr 28 doi: 10.1002/mds.28982. PMID: 35481685
Nardocci N, Zorzi G
Handb Clin Neurol 2013;113:1919-24. doi: 10.1016/B978-0-444-59565-2.00062-9. PMID: 23622415
Kurian MA, McNeill A, Lin JP, Maher ER
Dev Med Child Neurol 2011 May;53(5):394-404. doi: 10.1111/j.1469-8749.2011.03955.x. PMID: 21480873

Diagnosis

Amini E, Rohani M, Jalessi M, Azad Z, Valzania F, Cavallieri F, Farhadi M, Gholibeigian Z
Neurol Sci 2024 Feb;45(2):647-654. Epub 2023 Aug 31 doi: 10.1007/s10072-023-07037-8. PMID: 37651040
Möller HE, Bossoni L, Connor JR, Crichton RR, Does MD, Ward RJ, Zecca L, Zucca FA, Ronen I
Trends Neurosci 2019 Jun;42(6):384-401. Epub 2019 Apr 29 doi: 10.1016/j.tins.2019.03.009. PMID: 31047721
Nardocci N, Zorzi G
Handb Clin Neurol 2013;113:1919-24. doi: 10.1016/B978-0-444-59565-2.00062-9. PMID: 23622415
Kurian MA, McNeill A, Lin JP, Maher ER
Dev Med Child Neurol 2011 May;53(5):394-404. doi: 10.1111/j.1469-8749.2011.03955.x. PMID: 21480873
Schneider SA, Bhatia KP
Curr Neurol Neurosci Rep 2010 Nov;10(6):431-9. doi: 10.1007/s11910-010-0136-0. PMID: 20694531

Therapy

Kulshreshtha D, Ganguly J, Jog M
Can J Neurol Sci 2021 Nov;48(6):752-759. Epub 2021 Jan 5 doi: 10.1017/cjn.2020.279. PMID: 33397531
Agrawal S, Berggren KL, Marks E, Fox JH
Nutr Rev 2017 Jun 1;75(6):456-470. doi: 10.1093/nutrit/nux015. PMID: 28505363Free PMC Article
Doll S, Conrad M
IUBMB Life 2017 Jun;69(6):423-434. Epub 2017 Mar 9 doi: 10.1002/iub.1616. PMID: 28276141
Weinreb O, Mandel S, Youdim MBH, Amit T
Free Radic Biol Med 2013 Sep;62:52-64. Epub 2013 Jan 30 doi: 10.1016/j.freeradbiomed.2013.01.017. PMID: 23376471
Kakhlon O, Breuer W, Munnich A, Cabantchik ZI
Can J Physiol Pharmacol 2010 Mar;88(3):187-96. doi: 10.1139/Y09-128. PMID: 20393584

Prognosis

Amini E, Rohani M, Lang AE, Azad Z, Habibi SAH, Alavi A, Shahidi G, Emamikhah M, Chitsaz A
Mov Disord Clin Pract 2024 Jan;11(1):53-62. Epub 2023 Dec 1 doi: 10.1002/mdc3.13933. PMID: 38291840Free PMC Article
Kim HW, Lee S, Yang JH, Moon Y, Lee J, Moon WJ
Korean J Radiol 2023 Nov;24(11):1131-1141. doi: 10.3348/kjr.2023.0490. PMID: 37899522Free PMC Article
Darling A, Aguilera-Albesa S, Tello CA, Serrano M, Tomás M, Camino-León R, Fernández-Ramos J, Jiménez-Escrig A, Poó P, O'Callaghan M, Ortez C, Nascimento A, Fernández Mesaque RC, Madruga M, Arrabal L, Roldan S, Gómez-Martín H, Garrido C, Temudo T, Jou-Muñoz C, Muchart J, Huisman TAGM, Poretti A, Lupo V, Espinós C, Pérez-Dueñas B
Parkinsonism Relat Disord 2019 Apr;61:179-186. Epub 2018 Oct 13 doi: 10.1016/j.parkreldis.2018.10.013. PMID: 30340910
Nardocci N, Zorzi G
Handb Clin Neurol 2013;113:1919-24. doi: 10.1016/B978-0-444-59565-2.00062-9. PMID: 23622415
Timmermann L, Pauls KA, Wieland K, Jech R, Kurlemann G, Sharma N, Gill SS, Haenggeli CA, Hayflick SJ, Hogarth P, Leenders KL, Limousin P, Malanga CJ, Moro E, Ostrem JL, Revilla FJ, Santens P, Schnitzler A, Tisch S, Valldeoriola F, Vesper J, Volkmann J, Woitalla D, Peker S
Brain 2010 Mar;133(Pt 3):701-12. Epub 2010 Mar 5 doi: 10.1093/brain/awq022. PMID: 20207700Free PMC Article

Clinical prediction guides

Amini E, Rohani M, Jalessi M, Azad Z, Valzania F, Cavallieri F, Farhadi M, Gholibeigian Z
Neurol Sci 2024 Feb;45(2):647-654. Epub 2023 Aug 31 doi: 10.1007/s10072-023-07037-8. PMID: 37651040
Sait H, Srivastava S, Pandey M, Ravichandran D, Shukla A, Mandal K, Saxena D, Shambhavi A, Majethia P, Rao LP, Sharma S, Phadke SR, Moirangthem A
Neurogenetics 2023 Apr;24(2):113-127. Epub 2023 Feb 15 doi: 10.1007/s10048-023-00712-0. PMID: 36790591
Martin-Bastida A, Tilley BS, Bansal S, Gentleman SM, Dexter DT, Ward RJ
J Neural Transm (Vienna) 2021 Jan;128(1):15-25. Epub 2020 Oct 20 doi: 10.1007/s00702-020-02271-2. PMID: 33079260
Darling A, Aguilera-Albesa S, Tello CA, Serrano M, Tomás M, Camino-León R, Fernández-Ramos J, Jiménez-Escrig A, Poó P, O'Callaghan M, Ortez C, Nascimento A, Fernández Mesaque RC, Madruga M, Arrabal L, Roldan S, Gómez-Martín H, Garrido C, Temudo T, Jou-Muñoz C, Muchart J, Huisman TAGM, Poretti A, Lupo V, Espinós C, Pérez-Dueñas B
Parkinsonism Relat Disord 2019 Apr;61:179-186. Epub 2018 Oct 13 doi: 10.1016/j.parkreldis.2018.10.013. PMID: 30340910
Weinreb O, Mandel S, Youdim MBH, Amit T
Free Radic Biol Med 2013 Sep;62:52-64. Epub 2013 Jan 30 doi: 10.1016/j.freeradbiomed.2013.01.017. PMID: 23376471

Recent systematic reviews

Agrawal S, Berggren KL, Marks E, Fox JH
Nutr Rev 2017 Jun 1;75(6):456-470. doi: 10.1093/nutrit/nux015. PMID: 28505363Free PMC Article

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