U.S. flag

An official website of the United States government

Format

Send to:

Choose Destination

Neuronal ceroid lipofuscinosis 9(CLN9)

MedGen UID:
332304
Concept ID:
C1836841
Disease or Syndrome
Synonym: CLN9
Modes of inheritance:
Autosomal recessive inheritance
MedGen UID:
141025
Concept ID:
C0441748
Intellectual Product
Source: 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 individuals with two pathogenic alleles, either homozygotes (two copies of the same mutant allele) or compound heterozygotes (whereby each copy of a gene has a distinct mutant allele).
 
Monarch Initiative: MONDO:0012188
OMIM®: 609055
Orphanet: ORPHA228357

Definition

The neuronal ceroid lipofuscinoses (NCL; CLN) are a clinically and genetically heterogeneous group of neurodegenerative disorders characterized by the intracellular accumulation of autofluorescent lipopigment storage material in different patterns ultrastructurally. The clinical course includes progressive dementia, seizures, and progressive visual failure (Mole et al., 2005). For a discussion of genetic heterogeneity of neuronal ceroid lipofuscinosis, see CLN1 (256730). [from OMIM]

Clinical features

From HPO
Cerebellar ataxia
MedGen UID:
849
Concept ID:
C0007758
Disease or Syndrome
Cerebellar ataxia refers to ataxia due to dysfunction of the cerebellum. This causes a variety of elementary neurological deficits including asynergy (lack of coordination between muscles, limbs and joints), dysmetria (lack of ability to judge distances that can lead to under- or overshoot in grasping movements), and dysdiadochokinesia (inability to perform rapid movements requiring antagonizing muscle groups to be switched on and off repeatedly).
Dysarthria
MedGen UID:
8510
Concept ID:
C0013362
Mental or Behavioral Dysfunction
Dysarthric speech is a general description referring to a neurological speech disorder characterized by poor articulation. Depending on the involved neurological structures, dysarthria may be further classified as spastic, flaccid, ataxic, hyperkinetic and hypokinetic, or mixed.
Mutism
MedGen UID:
6476
Concept ID:
C0026884
Disease or Syndrome
Complete lack of speech or verbal communication in a person despite attempts to engage in conversation. Mutism as a phenomena assumes the individual has previous capacity for speech and in the pediatric population it assumes that the person is past the age of typical language development.
Seizure
MedGen UID:
20693
Concept ID:
C0036572
Sign or Symptom
A seizure is an intermittent abnormality of nervous system physiology characterized by a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain.
Cerebral atrophy
MedGen UID:
116012
Concept ID:
C0235946
Disease or Syndrome
Atrophy (wasting, decrease in size of cells or tissue) affecting the cerebrum.
Scanning speech
MedGen UID:
116113
Concept ID:
C0240952
Mental or Behavioral Dysfunction
An abnormal pattern of speech in which the words are as if measured or scanned; there is a pause after every syllable, and the syllables themselves are pronounced slowly.
Psychomotor deterioration
MedGen UID:
373191
Concept ID:
C1836842
Finding
Loss of previously present mental and motor abilities.
Loss of ambulation
MedGen UID:
332305
Concept ID:
C1836843
Finding
Inability to walk in a person who previous had the ability to walk.
Intellectual disability
MedGen UID:
811461
Concept ID:
C3714756
Mental or Behavioral Dysfunction
Intellectual disability, previously referred to as mental retardation, is characterized by subnormal intellectual functioning that occurs during the developmental period. It is defined by an IQ score below 70.
Rigidity
MedGen UID:
7752
Concept ID:
C0026837
Sign or Symptom
Continuous involuntary sustained muscle contraction. When an affected muscle is passively stretched, the degree of resistance remains constant regardless of the rate at which the muscle is stretched. This feature helps to distinguish rigidity from muscle spasticity.
Vacuolated lymphocytes
MedGen UID:
332307
Concept ID:
C1836855
Finding
The presence of clear, sharply defined vacuoles in the lymphocyte cytoplasm.
Optic atrophy
MedGen UID:
18180
Concept ID:
C0029124
Disease or Syndrome
Atrophy of the optic nerve. Optic atrophy results from the death of the retinal ganglion cell axons that comprise the optic nerve and manifesting as a pale optic nerve on fundoscopy.
Decreased light- and dark-adapted electroretinogram amplitude
MedGen UID:
326793
Concept ID:
C1839025
Finding
Decreased amplitude of eletrical response upon electroretinography.
Progressive visual loss
MedGen UID:
326867
Concept ID:
C1839364
Finding
A reduction of previously attained ability to see.
Rod-cone dystrophy
MedGen UID:
1632921
Concept ID:
C4551714
Disease or Syndrome
An inherited retinal disease subtype in which the rod photoreceptors appear to be more severely affected than the cone photoreceptors. Typical presentation is with nyctalopia (due to rod dysfunction) followed by loss of mid-peripheral field of vision, which gradually extends and leaves many patients with a small central island of vision due to the preservation of macular cones.
Fingerprint intracellular accumulation of autofluorescent lipopigment storage material
MedGen UID:
324619
Concept ID:
C1836851
Finding
An intracellular accumulation of autofluorescent lipopigment storage material in a trabecular or fingerprint-like pattern.
Curvilinear intracellular accumulation of autofluorescent lipopigment storage material
MedGen UID:
323011
Concept ID:
C1836852
Finding
An intracellular accumulation of autofluorescent lipopigment storage material in a curved pattern.

Professional guidelines

PubMed

Leal-Pardinas F, Truty R, McKnight DA, Johnson B, Morales A, Bristow SL, Yar Pang T, Cohen-Pfeffer J, Izzo E, Sankar R, Koh S, Wirrell EC, Millichap JJ, Aradhya S
Epilepsia 2022 Jul;63(7):e68-e73. Epub 2022 May 10 doi: 10.1111/epi.17269. PMID: 35474188Free PMC Article
Sands MS
J Child Neurol 2013 Sep;28(9):1151-8. doi: 10.1177/0883073813495960. PMID: 24014510Free PMC Article
MacLeod PM, Dolman CL, Nickel RE, Chang E, Zonana J, Silvey K
N Engl J Med 1984 Mar 1;310(9):595. doi: 10.1056/NEJM198403013100914. PMID: 6694714

Recent clinical studies

Etiology

Schulz A, Specchio N, de Los Reyes E, Gissen P, Nickel M, Trivisano M, Aylward SC, Chakrapani A, Schwering C, Wibbeler E, Westermann LM, Ballon DJ, Dyke JP, Cherukuri A, Bondade S, Slasor P, Cohen Pfeffer J
Lancet Neurol 2024 Jan;23(1):60-70. doi: 10.1016/S1474-4422(23)00384-8. PMID: 38101904
Liu W, Kleine-Holthaus SM, Herranz-Martin S, Aristorena M, Mole SE, Smith AJ, Ali RR, Rahim AA
Biochim Biophys Acta Mol Basis Dis 2020 Sep 1;1866(9):165772. Epub 2020 Mar 24 doi: 10.1016/j.bbadis.2020.165772. PMID: 32220628
Ashrafi MR, Amanat M, Garshasbi M, Kameli R, Nilipour Y, Heidari M, Rezaei Z, Tavasoli AR
Expert Rev Neurother 2020 Jan;20(1):65-84. Epub 2019 Dec 12 doi: 10.1080/14737175.2020.1699060. PMID: 31829048
Kline RA, Wishart TM, Mills K, Heywood WE
Biochim Biophys Acta Mol Basis Dis 2020 Sep 1;1866(9):165498. Epub 2019 Jun 15 doi: 10.1016/j.bbadis.2019.06.012. PMID: 31207290
Tanner AJ, Dice JF
Biochem Mol Med 1996 Feb;57(1):1-9. doi: 10.1006/bmme.1996.0001. PMID: 8812718

Diagnosis

Saleh MM, Hamhom AM, Al-Otaibi A, AlGhamdi M, Housawi Y, Aljadhai YI, Alameer S, Almannai M, Jad LA, Alwadei AH, Tabassum S, Alsaman A, AlAsmari A, Al Mutairi F, Althiyab H, Bashiri FA, AlHumaidi S, Alfadhel M, Mink JW, AlHashim A, Faqeih EA; Saudi NCL Study Consortium
Pediatr Neurol 2024 Jun;155:149-155. Epub 2024 Mar 7 doi: 10.1016/j.pediatrneurol.2024.03.004. PMID: 38653183
Tripathi S, Jain S, Kumar M
Indian Pediatr 2022 Sep 15;59(9):726-727. PMID: 36101955
Band H, Stehr F, Murphy N
Biochim Biophys Acta Mol Basis Dis 2020 Sep 1;1866(9):165773. Epub 2020 Mar 26 doi: 10.1016/j.bbadis.2020.165773. PMID: 32224155
Rietdorf K, Coode EE, Schulz A, Wibbeler E, Bootman MD, Ostergaard JR
Biochim Biophys Acta Mol Basis Dis 2020 Sep 1;1866(9):165643. Epub 2019 Dec 19 doi: 10.1016/j.bbadis.2019.165643. PMID: 31863828
Ashrafi MR, Amanat M, Garshasbi M, Kameli R, Nilipour Y, Heidari M, Rezaei Z, Tavasoli AR
Expert Rev Neurother 2020 Jan;20(1):65-84. Epub 2019 Dec 12 doi: 10.1080/14737175.2020.1699060. PMID: 31829048

Therapy

Schulz A, Specchio N, de Los Reyes E, Gissen P, Nickel M, Trivisano M, Aylward SC, Chakrapani A, Schwering C, Wibbeler E, Westermann LM, Ballon DJ, Dyke JP, Cherukuri A, Bondade S, Slasor P, Cohen Pfeffer J
Lancet Neurol 2024 Jan;23(1):60-70. doi: 10.1016/S1474-4422(23)00384-8. PMID: 38101904
Wawrzynski J, Martinez AR, Thompson DA, Ram D, Bowman R, Whiteley R, Gan C, Harding L, Mortensen A, Mills P, Gissen P, Henderson RH
Eye (Lond) 2024 Apr;38(6):1176-1182. Epub 2023 Dec 4 doi: 10.1038/s41433-023-02859-4. PMID: 38049626Free PMC Article
Centa JL, Jodelka FM, Hinrich AJ, Johnson TB, Ochaba J, Jackson M, Duelli DM, Weimer JM, Rigo F, Hastings ML
Nat Med 2020 Sep;26(9):1444-1451. Epub 2020 Jul 27 doi: 10.1038/s41591-020-0986-1. PMID: 32719489Free PMC Article
Kauss V, Dambrova M, Medina DL
Biochim Biophys Acta Mol Basis Dis 2020 Sep 1;1866(9):165553. Epub 2019 Sep 12 doi: 10.1016/j.bbadis.2019.165553. PMID: 31521819
Ghezzi P, Mennini T
Neuroimmunomodulation 2001;9(4):178-82. doi: 10.1159/000049024. PMID: 11847479

Prognosis

Wawrzynski J, Martinez AR, Thompson DA, Ram D, Bowman R, Whiteley R, Gan C, Harding L, Mortensen A, Mills P, Gissen P, Henderson RH
Eye (Lond) 2024 Apr;38(6):1176-1182. Epub 2023 Dec 4 doi: 10.1038/s41433-023-02859-4. PMID: 38049626Free PMC Article
Cooper JD, Mole SE
Biochim Biophys Acta Mol Basis Dis 2020 Sep 1;1866(9):165681. Epub 2020 Jan 8 doi: 10.1016/j.bbadis.2020.165681. PMID: 31926264
Adams HR, Mink JW; University of Rochester Batten Center Study Group
J Child Neurol 2013 Sep;28(9):1128-36. doi: 10.1177/0883073813494813. PMID: 24014508Free PMC Article
Vashishta A, Ohri SS, Vetvicka V
Endocr Metab Immune Disord Drug Targets 2009 Dec;9(4):385-91. doi: 10.2174/187153009789839174. PMID: 19807669
Gulati S, Maheshwari R, Kabra M, Verma IC, Kalra V
Indian J Pediatr 2000 Sep;67(9):689-91. doi: 10.1007/BF02762187. PMID: 11028125

Clinical prediction guides

Saleh MM, Hamhom AM, Al-Otaibi A, AlGhamdi M, Housawi Y, Aljadhai YI, Alameer S, Almannai M, Jad LA, Alwadei AH, Tabassum S, Alsaman A, AlAsmari A, Al Mutairi F, Althiyab H, Bashiri FA, AlHumaidi S, Alfadhel M, Mink JW, AlHashim A, Faqeih EA; Saudi NCL Study Consortium
Pediatr Neurol 2024 Jun;155:149-155. Epub 2024 Mar 7 doi: 10.1016/j.pediatrneurol.2024.03.004. PMID: 38653183
Schulz A, Specchio N, de Los Reyes E, Gissen P, Nickel M, Trivisano M, Aylward SC, Chakrapani A, Schwering C, Wibbeler E, Westermann LM, Ballon DJ, Dyke JP, Cherukuri A, Bondade S, Slasor P, Cohen Pfeffer J
Lancet Neurol 2024 Jan;23(1):60-70. doi: 10.1016/S1474-4422(23)00384-8. PMID: 38101904
Beniczky S, Aurlien H, Franceschetti S, Martins da Silva A, Bisulli F, Bentes C, Canafoglia L, Ferri L, Krýsl D, Rita Peralta A, Rácz A, Cross JH, Arzimanoglou A
Epilepsia 2020 Sep;61(9):e124-e128. Epub 2020 Sep 19 doi: 10.1111/epi.16655. PMID: 32949474
Rietdorf K, Coode EE, Schulz A, Wibbeler E, Bootman MD, Ostergaard JR
Biochim Biophys Acta Mol Basis Dis 2020 Sep 1;1866(9):165643. Epub 2019 Dec 19 doi: 10.1016/j.bbadis.2019.165643. PMID: 31863828
Ghezzi P, Mennini T
Neuroimmunomodulation 2001;9(4):178-82. doi: 10.1159/000049024. PMID: 11847479

Recent systematic reviews

Yoganathan S, Whitney R, Thomas M, Danda S, Chettali AM, Prasad AN, Farhan SMK, AlSowat D, Abukhaled M, Aldhalaan H, Gowda VK, Kinhal UV, Bylappa AY, Konanki R, Lingappa L, Parchuri BM, Appendino JP, Scantlebury MH, Cunningham J, Hadjinicolaou A, El Achkar CM, Kamate M, Menon RN, Jose M, Riordan G, Kannan L, Jain V, Manokaran RK, Chau V, Donner EJ, Costain G, Minassian BA, Jain P
Epilepsia 2024 Mar;65(3):709-724. Epub 2024 Jan 17 doi: 10.1111/epi.17880. PMID: 38231304
Kuper WFE, van Alfen C, Rigterink RH, Fuchs SA, van Genderen MM, van Hasselt PM
J Inherit Metab Dis 2018 Mar;41(2):257-261. Epub 2018 Feb 1 doi: 10.1007/s10545-018-0143-x. PMID: 29392585Free PMC Article

Supplemental Content

Table of contents

    Clinical resources

    Practice guidelines

    • PubMed
      See practice and clinical guidelines in PubMed. The search results may include broader topics and may not capture all published guidelines. See the FAQ for details.

    Recent activity

    Your browsing activity is empty.

    Activity recording is turned off.

    Turn recording back on

    See more...