

ansteffen
Aug 11, 20212 min read
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Pediatric (onset before age 18) and juvenile (onset before age 25) Amyotrophic Lateral Sclerosis (ALS) is a rare, life-threatening, progressive neurodegenerative disease occurring in children, teenagers and young adults. ALS attacks and destroys motor neurons which strips a person of their ability to move, walk, talk, eat and breathe eventually leading to death.
ALS knows no racial boundaries and cases of pediatric and juvenile ALS have been documented in medical literature around the globe in both males and females. Pediatric and juvenile ALS can follow a slow or aggressive disease progression dependent upon the person's specific gene mutation.
The majority of reported cases of pediatric and juvenile ALS are caused by a genetic mutation. Many of these mutations are found to be de novo meaning they are not inherited from either parent. The most prevalent mutated genes include SOD1 (superoxide dismutase one), SETX (senataxin), or FUS (fused in sarcoma). Several other genes have also recently been linked to this disease in children, teenagers and young adults. Current research has shown that over 50% of Pediatric ALS cases are due to FUS mutations. Genetic testing should be pursued in young people presenting with symptoms of ALS.
Research of pediatric and juvenile ALS causing genes is desperately needed in order to discover treatments and eventually lead to a cure for this fatal disease. Gene silencing therapies such as antisense oligonucleotide (ASO) and RNA interference (RNAi) along with gene-editing tools such as CRISPR/Cas-9 are showing potential as powerful and promising ALS treatments.
Facial spasticity or twitching and overactive reflexes
Slurred speech (dysarthria)
Trouble swallowing (dysphagia)
Spastic gait (manner of walking)
Frequent falls
Muscle weakness in hands, arms, legs or neck
Muscle atrophy
Emotional lability (uncontrolled laughter and/or weeping)
Respiratory insufficiency
Unintended weight loss
The high degree of clinical and genetic diversity in the various forms of pediatric and juvenile ALS makes a diagnosis difficult and lengthy. Medical tests and procedures during diagnosis include MRIs, EMGs, muscle biopsies, lumbar punctures and blood work. Below are some differential diagnosis (genetic and acquired disorders) that clinicians may consider and test for before a diagnosis of ALS can be made. Genetic testing should be pursued in children and young people displaying ALS symptoms.
GM2 gangliosidosis
Hereditary Spastic Paraplegia
Hereditary motor neuronopathies/motor forms of Charcot-Marie-Tooth disease.
Heavy metal intoxications (especially lead)
Infections (HTLV-II, HIV and poliomyelitis)
Kennedy's Disease (primarily affects males < 20 yrs of age)
Lambert-Eaton myasthenic syndrome
Lyme disease
Multifocal Motor Neuropathy
Myasthenia Gravis
Paraneoplastic syndromes
Pompe Disease
Riboflavin Transporter Deficiency (RTD)
SBMA
Spinal Muscular Atrophy (SMA)
Tay-Sachs disease
Vitamin deficiencies
Click on the link below for education material regarding genetic testing.
Comprehensive_Genomic_Testing_Information
Click on the links below for various ALS genes panel testing.
Invitae Amyotrophic Lateral Sclerosis Panel
Blueprint Genetics Amyotrophic Lateral Sclerosis Panel
GeneDx Juvenile Amyotrophic Lateral Sclerosis Panel
To-date mutations in the following genes have been linked to pediatric & juvenile ALS.
FUS
SOD1
SEXT
ALS2
SPG11
UBQLN2
SIGMAR1
VRK1
GNE
TDP-43
DDHD1
Click here for more information on FUS