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What is Pediatric & Juvenile ALS?

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.

Signs & Symptoms

  • ​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

Diagnosis & Genetic Testing

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

Fulgent Genetics Amyotrophic Lateral Sclerosis NGS Panel

Causes of Pediatric & Juvenile ALS

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

Click here for more information on ALS gene mutations

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