X-linked adrenoleukodystrophy. The Saudi experience.
OBJECTIVE
To evaluate the clinical, biochemical, neuroradiological, and neurophysiological findings of patients with X-linked adrenoleukodystrophy.


METHODS
Retrospective study evaluating the data of 10 X-linked adrenoleukodystrophy patients diagnosed at King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.


RESULTS
The common presenting symptoms were deterioration in school performance, vision and hearing, behavioral changes, and seizures. Eight patients survived 1-4 years and one patient 12 years after the initial presentation, while one patient expired. Six patients had the childhood form, 3 had the adolescent form and one had the adrenomyeloneuropathy form. Six are in an advanced stage of the disease and 3 have mild to moderate spasticity. All except 2 manifested moderate to severe dementia with variable degrees of visual loss. Decreased hearing and features of adrenal insufficiency were seen in 7 patients. Very long chain fatty acids were significantly increased in seven and mildly elevated in 2 patients, however the C26 to C22 ratio was increased in all. The characteristic high-signal intensity of parieto-occipital white matter on brain magnetic resonance imaging T2-weighted images was observed in all patients. Two patients had functional study of the brain, which showed hypometabolic activity in gray and white matter of the occipital lobes. Various neurophysiological abnormalities were detected. The response to different treatment modalities was not promising.


CONCLUSIONS
The disease is more common than had been previously recognized due to phenotypic variability and a wide spectrum of presentations. This report describes various aspects of this disorder and emphasizes the importance of early identification and treatment of asymptomatic but biochemically affected individuals, since all current therapeutic approaches are disappointing if overt neurological abnormalities have been already developed.
Al-Essa
M A
MA
Department of Biological and Medical Research (MBC 03), King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh 11211, Kingdom of Saudi Arabia.
Sakati
N A
NA
Bakheet
S M
SM
Patay
Z J
ZJ
Dabbagh
O
O
Chaves-Carbello
E
E
Ozand
P T
PT
D000293:Adolescent; D000326:Adrenoleukodystrophy / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology* / Q000235:genetics; D002648:Child; D002653:Child Behavior Disorders / Q000235:genetics; D002675:Child, Preschool; D014644:Genetic Variation; D006311:Hearing Disorders / Q000235:genetics; D006801:Humans; D008607:Intellectual Disability / Q000235:genetics; D007859:Learning Disabilities / Q000235:genetics; D008279:Magnetic Resonance Imaging; D010375:Pedigree; D010641:Phenotype; D012189:Retrospective Studies; D012529:Saudi Arabia / Q000453:epidemiology; D012640:Seizures / Q000235:genetics; D016019:Survival Analysis; D014055:Tomography, Emission-Computed; D014786:Vision Disorders / Q000235:genetics