eMedicine Specialties > Pediatrics: Genetics and Metabolic Disease > Metabolic Diseases

Mucopolysaccharidosis Type III: Treatment & Medication

Author: Germaine L Defendi, MD, MS, FAAP, Associate Clinical Professor, Department of Pediatrics, Olive View-UCLA Medical Center
Coauthor(s): Surendra Varma, MD, Vice-Chairman and Program Director, University Distinguished Professor, Department of Pediatrics, Texas Tech University School of Medicine
Contributor Information and Disclosures

Updated: May 14, 2009

Treatment

Medical Care

No treatment for the underlying cause is available. Medical treatment is supportive and is directed toward improving the patient's quality of life. Because of the varied symptoms seen in mucopolysaccharidosis type III (MPS III), a multidisciplinary approach is indicated (see Consultations). Currently, specific therapies such as bone marrow transplantation (BMT) and enzyme replacement therapy (ERT) are not options for patients with Sanfilippo syndrome.
  • BMT has been shown to improve the clinical outcomes of patients with mucopolysaccharidosis disorders; however this therapy has been most successful in patients with mucopolysaccharidosis I, mucopolysaccharidosis II and mucopolysaccharidosis VI. To date, patients with mucopolysaccharidosis III have not shown positive clinical benefit from BMT.
  • ERT has been approved in the United States for patients with mucopolysaccharidosis I, mucopolysaccharidosis II, and mucopolysaccharidosis VI. Recombinant enzymes for the deficiencies seen in mucopolysaccharidosis IIIA and mucopolysaccharidosis IIIB are available; however medical trials in ERT have not been favorable in improving prognosis because the enzymes are not able to cross the blood brain barrier to enter the CNS. Presently, enzyme injections directly into the CNS are being investigated.
  • Gene therapy to treat mucopolysaccharidosis IIIB is being researched in the United States and France using animal models.

Consultations

  • The treatment of individual patients requires consultation and ongoing care with pediatric neurologists, ophthalmologists, audiologists, cardiologists, gastroenterologists, and orthopedists.
  • Pediatric surgical consultation is indicated for those patients in need of hernia repair.
  • Neurosurgical evaluation is indicated for those patients who show clinical signs of cervical cord compression or other nerve compression disorders (ie, claw hand deformity).
  • Refer patients and their families to a developmental pediatrician to help with behavioral concerns and to establish routines for nighttime sleep.
  • Patients and their families need evaluation by a medical genetics team for diagnosis, counseling, and referrals to support groups and organizations (see Patient Education).

Medication

  • Currently, drug therapy is not part of the standard of care for mucopolysaccharidosis type III (MPS III). Medications are used for symptomatic treatment, such as anticonvulsants for seizure activity.
  • Sedative medications and melatonin have been used in these patients to help improve quality of sleep in conjunction with establishing a strict bedtime regimen in a quiet, dark room. See Medical Care.

More on Mucopolysaccharidosis Type III

Overview: Mucopolysaccharidosis Type III
Differential Diagnoses & Workup: Mucopolysaccharidosis Type III
Treatment & Medication: Mucopolysaccharidosis Type III
Follow-up: Mucopolysaccharidosis Type III
Multimedia: Mucopolysaccharidosis Type III
References
Further Reading

References

  1. Zhang WM, Shi HP, Meng Y, Li BT, Qiu ZQ, Liu JT. [Postnatal and prenatal diagnosis of mucopolysaccharidosis type III (Sanfilippo syndrome)]. Zhonghua Er Ke Za Zhi. Jun 2008;46(6):407-10. [Medline].

  2. Vitry S, Ausseil J, Hocquemiller M, Bigou S, Dos Santos Coura R, Heard JM. Enhanced degradation of synaptophysin by the proteasome in mucopolysaccharidosis type IIIB. Mol Cell Neurosci. May 2009;41(1):8-18. [Medline].

  3. Ohmi K, Kudo LC, Ryazantsev S, Zhao HZ, Karsten SL, Neufeld EF. Sanfilippo syndrome type B, a lysosomal storage disease, is also a tauopathy. Proc Natl Acad Sci U S A. May 5 2009;[Medline].

  4. Nelson J. Incidence of the mucopolysaccharidoses in Northern Ireland. Hum Genet. Dec 1997;101(3):355-8. [Medline].

  5. Poorthuis BJ, Wevers RA, Kleijer WJ, et al. The frequency of lysosomal storage diseases in The Netherlands. Hum Genet. Jul-Aug 1999;105(1-2):151-6. [Medline].

  6. Meikle PJ, Hopwood JJ, Clague AE, Carey WF. Prevalence of lysosomal storage disorders. JAMA. Jan 20 1999;281(3):249-54. [Medline].

  7. Blanch L, Weber B, Guo XH, et al. Molecular defects in Sanfilippo syndrome type A. Hum Mol Genet. May 1997;6(5):787-91. [Medline].

  8. Kleijer WJ, Karpova EA, Geilen GC, et al. Prenatal diagnosis of Sanfilippo A syndrome: experience in 35 pregnancies at risk and the use of a new fluorogenic substrate for the heparin sulphamidase assay. Prenat Diagn. Sep 1996;16(9):829-35. [Medline].

  9. Man TT, Tsai PS, Rau RH, et al. Children with mucopolysaccharidoses--three cases report. Acta Anaesthesiol Sin. Jun 1999;37(2):93-6. [Medline].

  10. Connor JM, Emery AE, Rimoin DL, Pyeritz RE, eds. Emery and Rimoin's Principle and Practice of Medical Genetics. 3rd ed. New York, NY: Churchill Livingstone; 1996.

  11. Fensom AH, Benson PF. Recent advances in the prenatal diagnosis of the mucopolysaccharidoses. Prenat Diagn. Jan 1994;14(1):1-12. [Medline].

  12. Jablonski S. Jablonski's Dictionary of Syndromes and Eponymic Diseases. 2nd ed. Melbourne, FL: Krieger Publishing Co; 1991.

  13. Jones KL. Storage disorders. In: Smith's Recognizable Patterns of Human Malformation. 5th ed. Philadelphia, Pennsylvania: WB Saunders Company; 1997:464-5.

  14. Kakkis E, Wraith E. Clinical features and diagnosis of the mucopolysaccharidoses. UpToDate. Available at http://www.utdol.com. Accessed November 6, 2007.

  15. Lindor NM, Hoffman A, O'Brien JF, Hanson NP, Thompson JN. Sanfilippo syndrome type A in two adult sibs. Am J Med Genet. Nov 15 1994;53(3):241-4. [Medline].

  16. Mucopolysaccharidosis III (MPS III) Disease (Sanfilippo Syndrome). Genzyme Corporation. Available at www.lysosomallearning.com/healthcare/about/lsd_hc_abt_mps3. Accessed 04/01/2009.

  17. Mucopolysaccharidosis Type III. National Organization for Rare Disorders, Inc. Available at http://www.rarediseases.org. Accessed 03/31/2009.

  18. National Center for Biotechnology Information. Mucopolysaccharidosis Type IIIA, IIIB, IIIC, and IIID. Online Mendelian Inheritance in Man. Available at http://www.ncbi.nlm.nih.gov. Accessed April 1, 2009.

  19. National Institutes of Health. Mucopolysaccharidosis Type III (Sanfilippo Syndrome). GeneTests. Available at http://www.geneclinics.org. Accessed 03/31/2009.

  20. Scriver CR, Beaudet AL, Sly WL, et al. The Metabolic Basis of Inherited Disease. 7th ed. New York, NY: McGraw-Hill; 1995.

  21. Spitz JL. Genodermatoses. In: A Full Color Clinical Guide to Genetic Skin Disorders. Baltimore, Md: Williams and Wilkins; 1995.

  22. Sutton VR. Presenting features of inborn errors of metabolism. UpToDate. Available at www.utdol.com. Accessed November 6, 2007.

  23. Therapeutic Approaches. Alliance Sanfilippo. Available at http://www.alliancesanfilippo.com/us/approaches.php. Accessed 04/01/2009.

  24. Thoene JG, ed. Physician's Guide to Rare Diseases. 2nd ed. Montvale, NJ: Dowden Publishing Co; 1995.

  25. Toone JR, Applegarth DA. Carrier detection in Sanfilippo A syndrome. Clin Genet. Jun 1988;33(6):401-3. [Medline].

  26. van de Kamp JJ, Niermeijer MF, von Figura K, Giesberts MA. Genetic heterogeneity and clinical variability in the Sanfilippo syndrome (types A, B, and C). Clin Genet. Aug 1981;20(2):152-60. [Medline].

Further Reading

The American Academy of Pediatrics have established the following relevant clinical guidelines: Hearing assessment in infants and children: recommendations beyond neonatal screening.

Keywords

mucopolysaccharidosis, MPS, MPS III, mucopolysaccharide storage disease type III, Sanfilippo syndrome, Sanfilippo disease, MPS IIIA, Sanfilippo A, MPS IIIB, Sanfilippo B, MPS IIIC, Sanfilippo C, MPS IIID, Sanfilippo D, lysosomal storage disorders, heparan sulfate, clear corneas, dysostosis multiplex, mucopolysaccharides, glycosaminoglycans, GAGs, lysosomal storage disorder, cardiovascular functional impairments, hepatosplenomegaly, dysostosis multiplex, mental retardation, Hurler syndrome, Hunter syndrome, Sanfilippo syndrome, organomegaly, diarrhea, respiratory compromise, airway obstruction, upper respiratory tract infections, synophrys, clear corneas, splenomegaly, inguinal hernia, umbilical hernia, enzyme replacement therapy, ERT, treatment, diagnosis

Contributor Information and Disclosures

Author

Germaine L Defendi, MD, MS, FAAP, Associate Clinical Professor, Department of Pediatrics, Olive View-UCLA Medical Center
Germaine L Defendi, MD, MS, FAAP is a member of the following medical societies: Ambulatory Pediatric Association and American Academy of Pediatrics
Disclosure: Nothing to disclose.

Coauthor(s)

Surendra Varma, MD, Vice-Chairman and Program Director, University Distinguished Professor, Department of Pediatrics, Texas Tech University School of Medicine
Surendra Varma, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Diabetes Association, American Medical Association, American Thyroid Association, Endocrine Society, Medical Group Management Association, New York Academy of Sciences, Sigma Xi, Society for Pediatric Radiology, Southern Society for Pediatric Research, and Texas Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Karl S Roth, MD, Professor and Chair, Department of Pediatrics, Creighton University School of Medicine
Karl S Roth, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Nutrition, American Pediatric Society, American Society for Clinical Nutrition, American Society of Nephrology, Association of American Medical Colleges, Medical Society of Virginia, New York Academy of Sciences, Sigma Xi, Society for Pediatric Research, and Southern Society for Pediatric Research
Disclosure: MDS Pharma Salary Employment

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Margaret M McGovern, MD, PhD, Professor and Chair of Pediatrics, Stony Brook University, New York
Margaret M McGovern, MD, PhD is a member of the following medical societies: American Academy of Pediatrics and American Society of Human Genetics
Disclosure: Genzyme Grant/research funds PI

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting

Chief Editor

Bruce Buehler, MD, Professor, Department of Pediatrics, Pathology and Microbiology, Executive Director, Hattie B Munroe Center for Human Genetics and Rehabilitation, University of Nebraska Medical Center
Bruce Buehler, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, American Academy of Pediatrics, American Association on Mental Retardation, American College of Medical Genetics, American College of Physician Executives, American Medical Association, and Nebraska Medical Association
Disclosure: Nothing to disclose.

 
 
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