Refsum Disease

Refsum Disease

National Organization for Rare Disorders, Inc.

Important

It is possible that the main title of the report Refsum Disease is not the name you expected. Please check the synonyms listing to find the alternate name(s) and disorder subdivision(s) covered by this report.

Synonyms

  • Refsum Disease
  • Phytanic Acid Storage Disease
  • Hypertrophic Neuropathy of Refsum
  • Heredopathia Atactica Polyneuritiformis
  • DOC 11 (Phytanic Acid Type)
  • Disorder of Cornification 11 (Phytanic Acid Type)

Disorder Subdivisions

  • None

General Discussion

Refsum disease is one of a family of genetic disorders known as the leukodystrophies in which, as a consequence of the disruption of lipid metabolism, the myelin sheath that insulates and protects the nerves of the brain fails to grow. It is inherited as an autosomal recessive trait. It is characterized by progressive loss of vision (retinitis pigmentosa); degenerative nerve disease (peripheral neuropathy); failure of muscle coordination (ataxia); and dry, rough, scaly skin (ichthyosis).



The disorder is caused by the accumulation of a particular fatty acid (phytanic acid) in blood plasma and tissues. This occurs because of a malfunction of the gene that makes the enzyme that breaks down (metabolizes) this acid. The essential enzyme is absent.



Treatment with a diet low in foods that contain phytanic acid can be beneficial. Our bodies cannot make phytanic acid. Instead, it is introduced to the body in certain foods, including dairy products, beef, lamb and some seafood.

Symptoms

Symptoms of Refsum disease may include vision impairment, degenerative nerve disease, failure of muscle coordination, and bone and skin changes. Symptoms may include night blindness, loss of peripheral vision, and numbness and weakness associated with failure of muscle coordination.



Affected individuals may experience an unusual burning or prickling sensation (paresthesia) of arms and legs. Neurological symptoms include unsteady walking with frequent falls (ataxia), and peripheral neuropathy (characterized by sensory, motor, and reflex changes). Skin changes may include dryness, itchiness, and scaliness.



An infantile form of Refsum disease exists that usually becomes apparent during the first year of life. In addition to early onset, it is characterized by developmental delay, vision and hearing impairment, enlargement of the liver and defective metabolism of bile acid.

Causes

Refsum disease is inherited as a recessive trait. The genes responsible for the failure in the metabolism of phytanic acid have been traced to the short arm of chromosome 10 (10pter-p11.2) and the long arm of chromosome 6 (6q22-q24).



Chromosomes, which are present in the nucleus of human cells, carry the genetic information for each individual. Human body cells normally have 46 chromosomes. Pairs of human chromosomes are numbered from 1 through 22 and the sex chromosomes are designated X and Y. Males have one X and one Y chromosome and females have two X chromosomes. Each chromosome has a short arm designated "p" and a long arm designated "q". Chromosomes are further sub-divided into many bands that are numbered. For example, "chromosome 6q22" refers to band 22 on the long arm of chromosome 6. The notation "10pter" refers to the end or terminus of the short arm of chromosome 10. The numbered bands specify the location of the thousands of genes that are present on each chromosome.



Genetic diseases are determined by the combination of genes for a particular trait that are on the chromosomes received from the father and the mother.



Recessive genetic disorders occur when an individual inherits the same abnormal gene for the same trait from each parent. If an individual receives one normal gene and one gene for the disease, the person will be a carrier for the disease, but usually will not show symptoms. The risk for two carrier parents to both pass the defective gene and, therefore, have an affected child is 25% with each pregnancy. The risk to have a child who is a carrier like the parents is 50% with each pregnancy. The chance for a child to receive normal genes from both parents and be genetically normal for that particular trait is 25%. The risk is the same for males and females.



All individuals carry 4-5 abnormal genes. Parents who are close relatives (consanguineous) have a higher chance than unrelated parents to both carry the same abnormal gene, which increases the risk to have children with a recessive genetic disorder.

Affected Populations

The age of onset of Refsum disease varies greatly. It may occur at any time from early childhood until around 50 years of age, but in most symptoms will have appeared by age 20. Males and females are affected in equal numbers.

Standard Therapies

Diagnosis

The presence of phytanic acid in blood or urine samples is diagnostic.



Treatment

Treatment of Refsum disease involves following a strict diet low in phytanic acid (found in dairy products, beef, lamb and some seafoods) and high in calories. The removal and reinfusion of blood plasma (plasmapheresis) may also be required. Other treatment is symptomatic and supportive.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.



For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:



Tollfree: (800) 411-1222

TTY: (866) 411-1010

Email: prpl@cc.nih.gov



For information about clinical trials sponsored by private sources, contact:

www.centerwatch.com



High doses of vitamin A are thought by some researchers to retard the rate of degradation of eyesight in retinitis pigmentosa associated with classical (adult-onset) Refsum disease.

References

TEXTBOOKS

Burns RS. Ataxia, Refsum Disease. In: NORD Guide to Rare Disorders. Lippincott Williams & Wilkins. Philadelphia, PA. 2003:604-05.



Beers MH, Berkow R, eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:215-16.



Steinberg D. Refsum Disease. In: Scriver CR, Beaudet AL, Sly WS, et al. Eds. The Metabolic Molecular Basis of Inherited Disease. 7th ed. McGraw-Hill Companies. New York, NY; 1995.



JOURNAL ARTICLES

Van den Brink DM, Brites P, Haasjes J, et al. Identification of PEX7 as the second gene involved in Refsum disease. Am J Hum Genet. 2003;72:471-77.



Pareyson D. Diagnosis of hereditary neuropathies in adult patients. J Neurol. 2003;250:148-60.



Bouillot S, Martin-Negrier Vital A, et al. Peripheral neuropathy associated with mitochondrial disorders: 8 cases and review of the literature. J Periph Nerv Syst. 2002;7:213-20.



Wierzbicki AS, Lloyd MD, Schofield CJ, et al. Refsum's disease: a peroxisomal disorder affecting phytanic acid alpha-oxidation. J Neurochem. 2002;80:727-35.



Gootjes J, Mooijer PA, Dekker C, et al. Biochemical markers predicting survival in peroxisome biogenesis disorders. Neurology. 2002;59:1746-49.



Wanders RJ, Jansen GA, Skjeldal OH. Refsum disease, peroxisomes, and phytanic acid oxidation: a review. J Neuropathol Exp Neurol. 2001;60:1021-31.



Wills AJ, Manning NJ, Reilly MM. Refsum's disease. QJM. 2001;94:403-06.



Grant CA, Berson EL. Treatable forms of retinitis pigmentosa associated with systemic neurological disorders. Int Ophthalmol Clin. 2001;41:103-10.



Barth PG, Gootjes J, Bode H, et al. Late onset white matter disease in peroxisome biogenesis disorder. Neurology. 2001;57:1949-55.



Oysu C, Aslan I, Basaran B, et al. The site of hearing loss in Refsum's disease. Int J Pediatr Otorhinolaryngol. 2001;61:129-34.



Walter C, Gootjes J, Mooijer PA, et al. Disorders of peroxisome biogenesis due to mutations in PEX1: phenotypes and PEX1 protein levels. Am J Hum Genet. 2001;69:35-48.



McGuinness MC, Wei H, Smith KD. Therapeutic developments in peroxisome biogenesis disorders. Expert Opin Exp Drugs. 2000;9:1985-92.



Moser HW. Molecular Genetics of peroxisomal disorders. Front Biosci. 2000;5:D298-306.

Korman SH, Mandel H, Gutman A. Characteristic urine organic acid profile in peroxisome biogenesis disorders. J Inherit Metab Dis. 2000;23:425-28.



Jansen GA, Hogenhout EM, Ferdinandusse S, et al. Human phytanoyl-CoA hydroxylase: resolution of gene structure and the molecular basis of Refsum's disease. Hum Mol Genet. 2000;9:1195-200.



Jansen GA, Ferdinandusse S, Hogenhout EM, et al. Phytanoyl-CoA hydroxylase deficiency. Enzymological and molecular basis of classical Refsum disease. Adv Edp Med. 1999;466:371-76.



FROM THE INTERNET

Disease of Refsum. Rev 12-01-2003. 7pp.

www.snof.org/maladies/refsum.html



McKusick VA, ed. Online Mendelian Inheritance In Man (OMIM). The Johns Hopkins University. Refsum Disease. Entry Number; 266500: Last Edit Date; 3/4/2003.



NINDS Refsum Disease Information Page. Reviewed 07-01-2001. 2pp.

www.ninds.nih.gov/health_and_medical/disorders/refsum_doc.htm



Refsum Disease. Genes and disease. nd. 2pp.

www.ncbi.nlm.nih.gov/books



Refsum Disease. nd. 2pp.

www.peroxisome.org/Scientist/Biochemistry/disorders/refsumtext.html



A Clinical Description of Refsum Syndrome

Refsum's Disease

www.srpf.a.se/forsk/refsum.html



Refsum Disease. Article Created: 1999-03-20. 1p.

http://healthlink.mcw.edu/article/921960794.html



Refusm Disease. United Leukodystrophy Foundation. nd. 21pp.

www.ulf.org/ulf/intro/index.htm

Resources

CLIMB (Children Living with Inherited Metabolic Diseases)

Climb Building

176 Nantwich Road

Crewe, CW2 6BG

United Kingdom

Tel: 4408452412173

Fax: 4408452412174

Email: enquiries@climb.org.uk

Internet: http://www.CLIMB.org.uk



Foundation Fighting Blindness

7168 Columbia Gateway Drive, Suite 100

Columbia, MD 21046

Tel: (410)423-0600

Fax: (410)872-0574

Tel: (800)683-5555

TDD: (800)683-5551

Email: info@FightBlindness.org

Internet: http://www.blindness.org/



Foundation for Ichthyosis & Related Skin Types

2616 N Broad Street

Colmar, PA 18915

Tel: (215)997-9400

Fax: (215)997-9403

Tel: (800)545-3286

Email: info@firstskinfoundation.org

Internet: http://www.firstskinfoundation.org



Lighthouse International

111 E 59th St

New York, NY 10022-1202

Tel: (800)829-0500

Email: info@lighthouse.org

Internet: http://www.lighthouse.org



Retinitis Pigmentosa International

P.O. Box 900

Woodland Hills, CA 91365

Tel: (818)992-0500

Fax: (818)992-3265

Tel: (800)344-4877

Email: info@rpinternational.org

Internet: http://www.rpinternational.org



United Leukodystrophy Foundation

224 N. 2nd St.

Suite 2

DeKalb, IL 60115

Tel: (815)748-3211

Tel: (800)728-5483

Email: office@ulf.org

Internet: http://www.ulf.org/



ELA - European Association Against Leukodystrophies

2, rue Mi-les-Vignes

54521

Laxou Cedex, 61024

France

Tel: 33383309334

Fax: 33383300068

Email: ela@ela-asso.com

Internet: http://www.ela-asso.com



NIH/National Institute of Neurological Disorders and Stroke

P.O. Box 5801

Bethesda, MD 20824

Tel: (301)496-5751

Fax: (301)402-2186

Tel: (800)352-9424

TDD: (301)468-5981

Internet: http://www.ninds.nih.gov/



National Registry for Ichthyosis and Related Disorders

University of Washington

Dermatology Dept. Box 356524

1959 N.E. Pacific Street

Seattle, WA 98195-6524

Tel: (800)595-1265

Email: info@skinregistry.org

Internet: http://www.skinregistry.org/



Hunter's Hope Foundation, Inc.

PO Box 643

6368 West Quaker Street

Orchard Park, NY 14127

Tel: (716)667-1200

Fax: (716)667-1212

Tel: (877)984-4673

Email: info@huntershope.org

Internet: http://www.huntershope.org



Genetic and Rare Diseases (GARD) Information Center

PO Box 8126

Gaithersburg, MD 20898-8126

Tel: (301)251-4925

Fax: (301)251-4911

Tel: (888)205-2311

TDD: (888)205-3223

Internet: http://rarediseases.info.nih.gov/GARD/



Madisons Foundation

PO Box 241956

Los Angeles, CA 90024

Tel: (310)264-0826

Fax: (310)264-4766

Email: getinfo@madisonsfoundation.org

Internet: http://www.madisonsfoundation.org



Let Them Hear Foundation

1900 University Avenue, Suite 101

East Palo Alto, CA 94303

Tel: (650)462-3174

Fax: (650)462-3144

Email: info@letthemhear.org

Internet: http://www.letthemhear.org



Zellweger Baby Support Network

9310 Groundhog Drive

Richmond, VA 23235

Tel: (605)642-2072

Fax: (605)642-7525

Email: pamfreeth@zbsn.org

Internet: http://www.zbsn.org



Retina International

Ausstellungsstrasse 36

CH-8005

Zürich,

Switzerland

Tel: 410444441077

Fax: 410444441070

Email: christina.fasser@retina-international.org

Internet: http://www.retina-international.org



Perkins School for the Blind

175 North Beacon Street

Watertown, MA 02472

Tel: (617)924-3434

Fax: (617)926-2027

Email: Info@Perkins.org

Internet: http://www.Perkins.org



National Consortium on Deaf-Blindness

The Teaching Research Institute

345 N. Monmouth Avenue

Monmouth, OR 97361

Tel: (800)438-9376

Fax: (503)838-8150

Tel: (800)438-9376

TDD: (800)854-7013

Email: info@nationaldb.org

Internet: http://www.nationaldb.org



For a Complete Report

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