The hidden Niemann-Pick type C patient: clinical niches for a rare inherited metabolic disease

Research output: Contribution to journalArticle


title = "The hidden Niemann-Pick type C patient: clinical niches for a rare inherited metabolic disease",
abstract = "Background: Niemann-Pick disease type C (NP-C) is a rare, inherited neurodegenerative disease of impaired intracellular lipid trafficking. Clinical symptoms are highly heterogeneous, including neurological, visceral, or psychiatric manifestations. The incidence of NP-C is under-estimated due to under-recognition or misdiagnosis across a wide range of medical fields. New screening and diagnostic methods provide an opportunity to improve detection of unrecognized cases in clinical sub-populations associated with a higher risk of NP-C. Patients in these at-risk groups (“clinical niches”) have symptoms that are potentially related to NP-C, but go unrecognized due to other, more prevalent clinical features, and lack of awareness regarding underlying metabolic causes. Methods: Twelve potential clinical niches identified by clinical experts were evaluated based on a comprehensive, non-systematic review of literature published to date. Relevant publications were identified by targeted literature searches of EMBASE and PubMed using key search terms specific to each niche. Articles published in English or other European languages up to 2016 were included. Findings: Several niches were found to be relevant based on available data: movement disorders (early-onset ataxia and dystonia), organic psychosis, early-onset cholestasis/(hepato)splenomegaly, cases with relevant antenatal findings or fetal abnormalities, and patients affected by family history, consanguinity, and endogamy. Potentially relevant niches requiring further supportive data included: early-onset cognitive decline, frontotemporal dementia, parkinsonism, and chronic inflammatory CNS disease. There was relatively weak evidence to suggest amyotrophic lateral sclerosis or progressive supranuclear gaze palsy as potential niches. Conclusions: Several clinical niches have been identified that harbor patients at increased risk of NP-C.",
keywords = "Clinical niche, Diagnosis, Differential diagnosis, Epidemiology, Inborn errors of metabolism (IEM), Niemann-Pick disease type C (NP-C), Screening",
author = "Hendriksz, {Christian J.} and Mathieu Anheim and Peter Bauer and Olivier Bonnot and Anupam Chakrapani and Corvol, {Jean Christophe} and {de Koning}, {Tom J.} and Anna Degtyareva and Carlo Dionisi-Vici and Sarah Doss and Thomas Duning and Paola Giunti and Rosa Iodice and Tracy Johnston and Dierdre Kelly and Kl{\"u}nemann, {Hans Hermann} and Stefan Lorenzl and Alessandro Padovani and Miguel Pocovi and Matthis Synofzik and Alta Terblanche and {Then Bergh}, Florian and Meral Top{\c c}u and Christine Tranchant and Mark Walterfang and Christian Velten and Kolb, {Stefan A.}",
year = "2017",
month = may,
day = "4",
doi = "10.1080/03007995.2017.1294054",
language = "English",
volume = "33",
pages = "877--890",
journal = "Current Medical Research and Opinion",
issn = "1473-4877",
publisher = "LibraPharm",
number = "5",