Facial-muscle weakness, speech disorders and dysphagia are common in patients with classic infantile Pompe disease treated with enzyme therapy.
Classic infantile Pompe disease is an inherited generalized glycogen storage disorder caused by deficiency of lysosomal acid α-glucosidase. If left untreated, patients die before one year of age. Although enzyme-replacement therapy (ERT) has significantly prolonged lifespan, it has also revealed new aspects of the disease. For up to 11 years, we investigated the frequency and consequences of facial-muscle weakness, speech disorders and dysphagia in long-term survivors. Sequential photographs were used to determine the timing and severity of facial-muscle weakness. Using standardized articulation tests and fibreoptic endoscopic evaluation of swallowing, we investigated speech and swallowing function in a subset of patients. This study included 11 patients with classic infantile Pompe disease. Median age at the start of ERT was 2.4 months (range 0.1-8.3 months), and median age at the end of the study was 4.3 years (range 7.7 months -12.2 years). All patients developed facial-muscle weakness before the age of 15 months. Speech was studied in four patients. Articulation was disordered, with hypernasal resonance and reduced speech intelligibility in all four. Swallowing function was studied in six patients, the most important findings being ineffective swallowing with residues of food (5/6), penetration or aspiration (3/6), and reduced pharyngeal and/or laryngeal sensibility (2/6). We conclude that facial-muscle weakness, speech disorders and dysphagia are common in long-term survivors receiving ERT for classic infantile Pompe disease. To improve speech and reduce the risk for aspiration, early treatment by a speech therapist and regular swallowing assessments are recommended.
Department of Pediatrics, Division of Metabolic Diseases and Genetics, Center for Lysosomal and Metabolic Diseases, Erasmus MC University Medical Center, PO Box 2060, 3000 CB Rotterdam, the Netherlands.
C M
CM
van Gelder
C I
CI
van Capelle
B J
BJ
Ebbink
I
I
Moor-van Nugteren
J M P
JM
van den Hout
M M
MM
Hakkesteegt
P A
PA
van Doorn
I F M
IF
de Coo
A J J
AJ
Reuser
H H W
HH
de Gier
A T
AT
van der Ploeg
D002648:Child; D002675:Child, Preschool; D003679:Deglutition; D003680:Deglutition Disorders / Q000175:diagnosis / Q000473:pathology*; D057487:Enzyme Therapy / Q000379:methods*; D005152:Facial Muscles / Q000473:pathology*; D005260:Female; D006009:Glycogen Storage Disease Type II / Q000175:diagnosis / Q000473:pathology*; D006801:Humans; D007223:Infant; D007830:Larynx / Q000473:pathology; D008297:Male; D018908:Muscle Weakness / Q000175:diagnosis / Q000473:pathology*; D010614:Pharynx / Q000473:pathology; D013060:Speech; D013064:Speech Disorders / Q000473:pathology*; D013070:Speech Therapy / Q000379:methods