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Walker-Warburg Syndrome (WWS) is a rare form of congenital muscular dystrophy associated with brain and eye abnormalities.
- HARD syndrome
- Hydrocephalus-agyria-retinal dysplasia syndrome
- Prevalence: 1-9 / 1 000 000
- Inheritance: Autosomal recessive
- Age of onset: Infancy, Neonatal
- ICD-10: Q04.3
- OMIM: 236670 253280 253800 613150 613153 613154 614643 614830 615041 615181 615249 615287 616538
- UMLS: C0265221
- MeSH: D058494
- GARD: 2599
- MedDRA: -
The prevalence is estimated at 1/60,500. WWS has a worldwide distribution.
Patients present at birth with generalized severe hypotonia, muscle weakness, absent or very poor psychomotor development, eye involvement and seizures. Brain MRI shows type II cobblestone lissencephaly, hydrocephalus (see these terms), severe brainstem and cerebellar hypoplasia (Dandy-Walker malformation is possible, see this term). White matter abnormalities are also observed.
This disease is due to abnormal O-glycosylation of alpha-dystroglycan, which leads, in addition to the brain abnormalities, to congenital muscular dystrophy. WWS represents the most severe phenotype of the so called dystroglycanopathies (see this term). Several genes have been implicated in the etiology of WWS, and others are as yet unknown. Most mutations were found in the Protein O-Mannosyltransferase 1 and 2 (POMT1 and POMT) genes. Other genes in the alpha-dystroglycan glycosylation pathway were found mutated in WWS cases (FKTN, LARGE, FKRP and POMGNT1). A mutation in the COL4A1 gene not directly related to posttranslational modification of dystroglycan has been identified in WWS patients.
Laboratory investigations usually show elevated creatine kinase, myopathic/dystrophic muscle pathology with altered alpha-dystroglycan expression.
Differential diagnoses include other types of congenital muscular dystrophies and myopathies (see these terms).
Antenatal diagnosis is possible in families with known mutations. Prenatal ultrasound after 22-25 weeks of gestational age (WGA) and fetal MRI at 30 WGA may be helpful for diagnosis in families where the molecular defect is unknown.
Transmission is autosomal recessive.
Management and treatment
No specific treatment is available. Management is only supportive and preventive.
WWS is the most severe form of congenital muscular dystrophy with most children dying before the age of three years.
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