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PEHO syndrome(PEHO)

MedGen UID:
342404
Concept ID:
C1850055
Disease or Syndrome
Synonyms: Infantile cerebellooptic atrophy; PEHO; Progressive Encephalopathy with edema, Hypsarrhythmia, and Optic atrophy
Modes of inheritance:
Autosomal recessive inheritance
MedGen UID:
141025
Concept ID:
C0441748
Intellectual Product
Sources: HPO, OMIM, Orphanet
A mode of inheritance that is observed for traits related to a gene encoded on one of the autosomes (i.e., the human chromosomes 1-22) in which a trait manifests in homozygotes. In the context of medical genetics, autosomal recessive disorders manifest in homozygotes (with two copies of the mutant allele) or compound heterozygotes (whereby each copy of a gene has a distinct mutant allele). [HPO:curators]
Autosomal dominant inheritance
MedGen UID:
141047
Concept ID:
C0443147
Intellectual Product
Sources: HPO, OMIM, Orphanet
A mode of inheritance that is observed for traits related to a gene encoded on one of the autosomes (i.e., the human chromosomes 1-22) in which a trait manifests in heterozygotes. In the context of medical genetics, an autosomal dominant disorder is caused when a single copy of the mutant allele is present. Males and females are affected equally, and can both transmit the disorder with a risk of 50% for each child of inheriting the mutant allele.
Autosomal recessive inheritance (HPO, OMIM, Orphanet)
Autosomal dominant inheritance (HPO, OMIM, Orphanet)
 
Gene (location): ZNHIT3 (17q12)
OMIM®: 260565
Orphanet: ORPHA2836

Definition

PEHO is a severe autosomal recessive neurodevelopmental disorder characterized by extreme cerebellar atrophy due to almost total loss of granule neurons. Affected individuals present in early infancy with hypotonia, profoundly delayed psychomotor development, optic atrophy, progressive atrophy of the cerebellum and brainstem, and dysmyelination. Most patients also develop infantile seizures that are often associated with hypsarrhythmia on EEG, and many have peripheral edema (summary by Anttonen et al., 2017). [from OMIM]

Clinical features

Edema
MedGen UID:
4451
Concept ID:
C0013604
Sign or Symptom
Abnormal fluid accumulation in TISSUES or body cavities. Most cases of edema are present under the SKIN in SUBCUTANEOUS TISSUE.
Abnormality of the hand
MedGen UID:
6715
Concept ID:
C0018564
Anatomical Abnormality
Alterations or deviations from normal shape or size which result in a disfigurement of the hand.
Intellectual disability, profound
MedGen UID:
43816
Concept ID:
C0020796
Mental or Behavioral Dysfunction
Profound mental retardation is defined as an intelligence quotient (IQ) below 20.
Myoclonus
MedGen UID:
10234
Concept ID:
C0027066
Sign or Symptom
A rapid, involuntary jerk of a muscle or group of muscles.
Optic atrophy
MedGen UID:
18180
Concept ID:
C0029124
Disease or Syndrome
A disorder characterized by loss of optic nerve fibers. It may be inherited or acquired. Acquired causes include ischemia, optic nerve neuropathy, glaucoma, trauma, radiation, brain tumors, and multiple sclerosis. It leads to vision disturbances.
Seizures
MedGen UID:
20693
Concept ID:
C0036572
Sign or Symptom
Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as EPILEPSY or "seizure disorder."
Hyperreflexia
MedGen UID:
57738
Concept ID:
C0151889
Finding
Autonomic nervous system overreaction to stimuli, most commonly after spinal cord injury at a T-5 level and above.
Open mouth
MedGen UID:
116104
Concept ID:
C0240379
Finding
A facial appearance characterized by a permanently or nearly permanently opened mouth.
Polymicrogyria
MedGen UID:
78605
Concept ID:
C0266464
Congenital Abnormality
A congenital abnormality of the cerebral hemisphere characterized by an excessive number of small gyri (convolutions) on the surface of the brain.
Macrogyria
MedGen UID:
120579
Concept ID:
C0266483
Congenital Abnormality
A congenital abnormality of the cerebral hemisphere chacterized by unusually thick gyrations (convolutions) of the cerebral cortex.
Hypoplasia of the corpus callosum
MedGen UID:
138005
Concept ID:
C0344482
Congenital Abnormality
Underdevelopment of the corpus callosum.
Epicanthus
MedGen UID:
151862
Concept ID:
C0678230
Congenital Abnormality
Epicanthus is a condition in which a fold of skin stretches from the upper to the lower eyelid, partially covering the inner canthus. Usher (1935) noted that epicanthus is a normal finding in the fetus of all races. Epicanthus also occurs in association with hereditary ptosis (110100).
Hypsarrhythmia
MedGen UID:
195766
Concept ID:
C0684276
Finding
Hypsarrhythmia is abnormal interictal high amplitude waves and a background of irregular spikes. There is continuous (during wakefulness), high-amplitude (>200 Hz), generalized polymorphic slowing with no organized background and multifocal spikes demonstrated by electroencephalography (EEG).
Severe muscular hypotonia
MedGen UID:
326544
Concept ID:
C1839630
Finding
A severe degree of muscular hypotonia characterized by markedly reduced muscle tone.
Narrow forehead
MedGen UID:
326956
Concept ID:
C1839758
Finding
Width of the forehead or distance between the frontotemporales is more than two standard deviations below the mean (objective); or apparently narrow intertemporal region (subjective).
Developmental stagnation
MedGen UID:
341348
Concept ID:
C1848980
Finding
A cessation of the development of a child in the areas of motor skills, speech and language, cognitive skills, and social and/or emotional skills.
Undetectable visual evoked potentials
MedGen UID:
376697
Concept ID:
C1850069
Finding
Tented upper lip vermilion
MedGen UID:
342408
Concept ID:
C1850072
Finding
Triangular appearance of the oral aperture with the apex in the midpoint of the upper vermilion and the lower vermilion forming the base.
Progressive microcephaly
MedGen UID:
340542
Concept ID:
C1850456
Finding
Progressive microcephaly is diagnosed when the head circumference falls progressively behind age- and gender-dependent norms.
Neuronal loss in central nervous system
MedGen UID:
342515
Concept ID:
C1850496
Finding
Short nose
MedGen UID:
343052
Concept ID:
C1854114
Finding
Distance from nasion to subnasale more than two standard deviations below the mean, or alternatively, an apparently decreased length from the nasal root to the nasal tip.
Infantile encephalopathy
MedGen UID:
343542
Concept ID:
C1856408
Finding
Encephalopathy with onset in the infantile period.
Full cheeks
MedGen UID:
355661
Concept ID:
C1866231
Finding
Increased prominence or roundness of soft tissues between zygomata and mandible.
Feeding difficulties in infancy
MedGen UID:
436211
Concept ID:
C2674608
Finding
Impaired feeding performance of an infant as manifested by difficulties such as weak and ineffective sucking, brief bursts of sucking, and falling asleep during sucking. There may be difficulties with chewing or maintaining attention.
Retrognathia
MedGen UID:
488375
Concept ID:
C3494422
Finding
A physical misalignment of the upper (maxilla) and lower (mandibular) jaw bones in which either or both recede relative to the frontal plane of the forehead.
Cerebellar atrophy
MedGen UID:
892891
Concept ID:
C4020873
Disease or Syndrome
Atrophy (wasting) of the cerebellum.
Global developmental delay
MedGen UID:
892935
Concept ID:
C4020875
Pathologic Function
A delay in the achievement of motor or mental milestones in the domains of development of a child, including motor skills, speech and language, cognitive skills, and social and emotional skills. This term should only be used to describe children younger than five years of age.
Peripheral dysmyelination
MedGen UID:
871139
Concept ID:
C4025610
Finding
Defective structure and function of myelin sheaths. Dysmyelination is distinguished from demyleination where there is destruction or damage of previously normal myelination.

Recent clinical studies

Etiology

Huisman TA, Klein A, Werner B, Straube T, Boltshauser E
AJNR Am J Neuroradiol 2006 Aug;27(7):1555-8. PMID: 16908579
D'Arrigo S, Grazia BM, Faravelli F, Riva D, Pantaleoni C
J Child Neurol 2005 May;20(5):454-6. doi: 10.1177/08830738050200051801. PMID: 15968934
Riikonen R, Somer M, Turpeinen U
Epilepsia 1999 Nov;40(11):1642-8. PMID: 10565594
Shevell MI, Colangelo P, Treacy E, Polomeno RC, Rosenblatt B
Pediatr Neurol 1996 Nov;15(4):337-9. PMID: 8972535
Somer M, Salonen O, Pihko H, Norio R
AJNR Am J Neuroradiol 1993 Jul-Aug;14(4):861-7. PMID: 8352158

Diagnosis

Samanta D, Gokden M
J Clin Neurosci 2019 Mar;61:298-301. Epub 2018 Oct 29 doi: 10.1016/j.jocn.2018.10.091. PMID: 30385166
Gawlinski P, Posmyk R, Gambin T, Sielicka D, Chorazy M, Nowakowska B, Jhangiani SN, Muzny DM, Bekiesinska-Figatowska M, Bal J, Boerwinkle E, Gibbs RA, Lupski JR, Wiszniewski W
Pediatr Neurol 2016 Jul;60:83-7. Epub 2016 Apr 9 doi: 10.1016/j.pediatrneurol.2016.03.011. PMID: 27343026Free PMC Article
Langlois S, Tarailo-Graovac M, Sayson B, Drögemöller B, Swenerton A, Ross CJ, Wasserman WW, van Karnebeek CD
Eur J Hum Genet 2016 Jun;24(6):949-53. Epub 2015 Oct 21 doi: 10.1038/ejhg.2015.217. PMID: 26486474Free PMC Article
Alfadhel M, Yong SL, Lillquist Y, Langlois S
J Child Neurol 2011 Jul;26(7):851-7. Epub 2011 May 18 doi: 10.1177/0883073810396582. PMID: 21596701
Caraballo RH, Pozo AN, Gomez M, Semprino M
Pediatr Neurol 2011 Apr;44(4):259-64. doi: 10.1016/j.pediatrneurol.2010.11.007. PMID: 21397166

Therapy

Riikonen R
Int J Mol Sci 2017 Sep 26;18(10) doi: 10.3390/ijms18102056. PMID: 28954393Free PMC Article
Caraballo RH, Pozo AN, Gomez M, Semprino M
Pediatr Neurol 2011 Apr;44(4):259-64. doi: 10.1016/j.pediatrneurol.2010.11.007. PMID: 21397166

Prognosis

Huisman TA, Klein A, Werner B, Straube T, Boltshauser E
AJNR Am J Neuroradiol 2006 Aug;27(7):1555-8. PMID: 16908579
D'Arrigo S, Grazia BM, Faravelli F, Riva D, Pantaleoni C
J Child Neurol 2005 May;20(5):454-6. doi: 10.1177/08830738050200051801. PMID: 15968934
Klein A, Schmitt B, Boltshauser E
Eur J Paediatr Neurol 2004;8(6):317-21. doi: 10.1016/j.ejpn.2004.08.006. PMID: 15542387
de Vries BB, van'tHoff WG, Surtees RA, Winter RM
Clin Dysmorphol 2001 Apr;10(2):115-21. PMID: 11310991
Shevell MI, Colangelo P, Treacy E, Polomeno RC, Rosenblatt B
Pediatr Neurol 1996 Nov;15(4):337-9. PMID: 8972535

Clinical prediction guides

Caraballo RH, Pozo AN, Gomez M, Semprino M
Pediatr Neurol 2011 Apr;44(4):259-64. doi: 10.1016/j.pediatrneurol.2010.11.007. PMID: 21397166
Fujimoto S, Yokochi K, Nakano M, Wada Y
Neuropediatrics 1995 Oct;26(5):270-2. doi: 10.1055/s-2007-979771. PMID: 8552220
Haltia M, Somer M
Acta Neuropathol 1993;85(3):241-7. PMID: 8460530

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