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Clinical and biochemical study of 29 Brazilian patients with metachromatic leukodystrophy

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Journal of Inherited Metabolic Disease


Metachromatic leukodystrophy (MLD) is a lysosomal disorder caused by arylsulfatase A (ARSA) deficiency. It is classified into three forms according to the age of onset of symptoms (late infantile, juvenile, and adult). We carried out a cross-sectional and retrospective study, which aimed to determine the epidemiological, clinical, and biochemical profile of MLD patients from a national reference center for Inborn Errors of Metabolism in Brazil. Twenty-nine patients (male,  17) agreed to participate in the study (late infantile form: 22; juvenile form: 4; adult form: 1; asymptomatic: 2). Mean ages at onset of symptoms and at biochemical diagnosis were, respectively, 19 and 39 months for late infantile form and 84.7 and 161.2 months for juvenile form. The most frequently reported first clinical symptom/sign of the disease was gait disturbance and other motor abnormalities (72.7%) for late infantile form and behavioral and cognitive alterations (50%) for juvenile form. Leukocyte ARSA activity level did not present significant correlation with the age of onset of symptoms (r = −0.09, p = 0.67). Occipital white matter and basal nuclei abnormalities were not found in patients with the late infantile MLD. Our results suggest that there is a considerable delay between the age of onset of signs and symptoms and the diagnosis of MLD in Brazil. Correlation between ARSA activity and MLD clinical form was not found. Further studies on the epidemiology and natural history of this disease with larger samples are needed, especially now when specific treatments should be available in the near future.

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The authors thank Dr. Louise Christini Seabra de Melo, Dr. Marta Regina Clivati, Dr. Emerson Santana Santos, Dr. Fernando Norio Arita, Dr. Júlio Amaro de Saconeski, and Mrs. Cristiane Spolador Pátaro Domingos for their collaboration in this work. This study was conducted with the support of the FIPE/HCPA, CNPq/Brazil, Post Graduation Program in Genetics and Molecular Biology (Department of Genetics, Universidade Federal do Rio Grande do Sul), and the “Pela Vida” Organization. The authors declare that they have no conflicting financial interests.

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Correspondence to Ida Vanessa Schwartz.

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Communicated by: Ed Wraith

Competing interest: None declared.

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Artigalás, O., Lagranha, V.L., Saraiva-Pereira, M.L. et al. Clinical and biochemical study of 29 Brazilian patients with metachromatic leukodystrophy. J Inherit Metab Dis 33 (Suppl 3), 257–262 (2010).

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