MLD is usually caused by the lack of an important enzyme called arylsulfatase A. Because this enzyme is missing, chemicals called sulfatides accumulate in the nervous system, kidneys, gallbladder, and other organs. The sulfatides damage the nerves and organs where buildup occurs. In particular, it damages the myelin sheaths that surround nerve cells. The disease is inherited as an autosomal recessive genetic disorder. This means you must get a copy of the defective gene from both your parents. Those who only get a defective gene from only one parent, the child usually does not develop MLD. Parents can each have the defective gene, but not have MLD. A person with one defective gene is called a "carrier." When two carriers have a child, there is a 25% chance that the child will get both genes and have MLD. MLD occurs in about 1 per 40,000 people. There are three forms of the disease. They are based on when the symptoms begin. - Late infantile MLD symptoms usually begin by age 4 and include walking problems and loss of muscle control and mental functions.
- Juvenile MLD symptoms usually between age 4 and 6. The child has trouble walking and loses developmental milestones. The first sign may be problems with school performance.
- Adult and late-stage juvenile MLD symptoms usually occur slowly. They may occur between age 6-16 and adult (over age 16). Early symptoms include behavior problems, loss of mental functions and muscle control, poor school or work performance, and seizures.
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Neurogenetics, General Pediatrics
