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Published on: September 26, 2012
[Aicardi-Goutieres syndrome: an oft unrecognised familial early-onset encephalopathy]
V San Antonio1, P Sachs, A Monier
1Service de Neurologie Pédiatrique et des Maladies Métaboliques, Hôpital Robert-Debré, Paris, France.
Insights
Aicardi-Goutieres syndrome is a rare infantile encephalopathy characterized by brain calcifications and inflammation. Understanding its immune dysregulation offers insights into CNS calcification and chronic encephalopathies.
Area of Science:
- Neurology
- Genetics
- Immunology
Background:
- Aicardi-Goutieres syndrome (AGS) is a progressive, familial encephalopathy affecting infants.
- Key features include cerebral calcifications, white matter abnormalities, and cerebrospinal fluid (CSF) lymphocytosis.
- Elevated CSF interferon-alpha is a hallmark, especially early in the disease.
Observation:
- This report details two new French cases of AGS.
- The study discusses diagnostic challenges, particularly differentiating AGS from intrauterine infections.
- Unanswered questions remain regarding diagnostic criteria at different ages and the etiology of vasculitis.
Findings:
- AGS is linked to a locus on chromosome 3p21 in some families.
- Vasculitis lesions appear related to dysregulated interferon production.
- Approximately 75 AGS cases have been reported, with more likely undiagnosed.
Implications:
- Studying AGS enhances understanding of central nervous system (CNS) calcification mechanisms.
- It provides broader insights into chronic encephalopathies involving immune dysregulation.
- Accurate diagnosis is crucial due to genetic and therapeutic implications.
Introduction:
Aicardi-Goutieres syndrome, first described in 1984, is a progressive infantile familial encephalopathy featuring cerebral calcifications, mainly of the basal ganglia, cerebral white matter abnormalities and cerebrospinal fluid lymphocytosis. Most of the patients present with severe developmental retardation, microcephaly, abnormal eye movements, pyramidal tract signs, and prominent dystonic movements. An elevated level of interferon-alpha in the CSF is a constant feature, particularly during the first stages of the disease course. One locus has been mapped on chromosome 3p21 in about half of the families so far studied.
Patients:
and results. We report two new French cases and discuss the limits of the clinical syndrome, the differential diagnosis and issues raised by the pathophysiological mechanisms involved. The major concern is to separate this condition from intrauterine infections because of the genetic and therapeutic consequences. A number of other questions remain unanswered. For example, we still do not know today at what age the absence of features like CSF lymphocytosis, and possibly absence of calcifications, rules out the diagnosis of the condition. The origin of the vasculitis lesions is not known, but seems to be related to dysregulation of interferon production and secretion.
Conclusion:
Currently about 75 patients have been reported, even though many more probably exist. The study of this syndrome can contribute to the understanding of some mechanisms of CNS calcification and in a broader perspective to that of chronic encephalopathies with dysregulation of immune mechanisms.
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