Melas Syndrome: pediatric case report

Authors

DOI:

https://doi.org/10.53358/lauinvestiga.v9i2.774

Keywords:

Síndrome MELAS, Infarto cerebral, Acidosis láctica, Epilepsia, Paciente pediátrico.

Abstract

Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like syndrome, also called MELAS, is a relatively unknown medical condition; however, it is the most common mitochondrial disease. This condition is hereditary, multisystemic, and progressive. We present the case of a 14-year-old adolescent diagnosed with MELAS at HSVP (San Vicente de Paúl Hospital) based on the clinical criteria of the MELAS Study Group Committee in Japan - 2012. The patient has been experiencing headaches, vomiting, and generalized tonic-clonic seizures since the age of 10. At the age of 13, she developed bilateral sensorineural hearing loss, and at 14, she experienced focal clonic seizures, hyperlactatemia, and an image of a left temporo-parietal infarction on cerebral magnetic resonance imaging. From our perspective, MELAS syndrome is still poorly understood, and the diagnosis is often delayed. This syndrome primarily affects the neurological system, leading to disability and high mortality rates. This article presents a clinical case that invites to know and learn more about this pathology.

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Author Biographies

Ángel Israel Guerrero Sarchi, Clínica de Especialidades Médicas Atuntaqui

Médico Residente Clínica de Especialidades Médicas Atuntaqui, Ibarra, Código postal 100101, Ecuador,
https://orcid.org/0000-0002-5153-3232, dr.israelguerrero@gmail.com

Nathaly Stephany Lapo Córdova, Hospital San Vicente de Paúl

Neuróloga Pediatra, servicio de pediatría del Hospital San Vicente de Paúl, Ibarra, Código postal 100102,
Ecuador, https://orcid.org/0000-0002-4863-7399, mdnathalylapoc@gmail.com

Adela Arasely Quirola Ruiz, Hospital San Vicente de Paúl

Médico residente de pediatría del Hospital San Vicente de Paúl, Ibarra, Código postal 100102, Ecuador,
https://orcid.org/0009-0009-4611-1199, arita_7710@hotmail.com

References

Pavlakis S, Phillips P, DiMauro S, De Vivo D, Rowland L. Mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes: A distinctive clinical syndrome. Annals Neurology [Internet]. 1984;16(4):481–8.

Disponible en: http://dx.doi.org/10.1002/ana.410160409.

Sharma S, Goldstein A, Falk M. Mitochondrial Disease. Conn's Current Therapy. United States of America. Elsevier; 2022. p. 1299-1307.

Disponible en: https://www linicalkey2443/service/content/pdf/watermarked/3-s2.0

Seed L, Dean A, Krishnakumar D, Phyu P, Horvath R, Harijan P. Molecular and neurological features of MELAS syndrome in pediatric patients: A case series and review of the literature. Mol Genet Genomic Med [Internet]. 2022;10(7):12-6.

Disponible en: http://dx.doi.org/10.1002/mgg3.1955.

Pia S, Lui F. Melas Syndrome. [Updated 2022 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.

Disponible en: https://www.ncbi.nlm.nih.gov/books/NBK532959/

El-Hattab A, Almannai M, Scaglia F. MELAS. 2001 Feb 27 [Updated 2018 Nov 29]. In: Adam MP, Everman DB, Mirzaa GM, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2022.

Disponible: https://www.ncbi.nlm.nih.gov/books/NBK1233/

Uusimaa J, Moilanen J, Vainionpää L, Tapanainen P, Lindholm P, Nuutinen M, et al. Prevalence, segregation, and phenotype of the mitochondrial DNA 3243ANG mutation in children. Ann Neurol [Internet]. 2007;62(3):278–87.

Disponible en: http://dx.doi.org/10.1002/ana.21196

Aguirre W, Valdez M, Urbina L, Rivera A, Sarapura E, Montoya J, et al. Enfermedad de MELAS en Latinoamérica: revisión temática. Rev Neuropsiquiatr [Internet]. 2022;84(4):316–32. Disponible en: http://www.scielo.org.pe/pdf/rnp/v84n4/0034-8597-rnp-84-04-316.pdf

Thomas A. Mitochondrial encephalomyopathy, lactic Acidosis, strokelike episodes overview of MELAS. Medscape [Internet] 2021.

Disponible en https://emedicine.medscape.com/article/1162238-overview

El-Hattab A, Adesina AM, Jones J, Scaglia F. MELAS syndrome: Clinical manifestations, pathogenesis, and treatment options. Mol Genet Metab [Internet]. 2015;116(1–2):4–12. Disponible en: http://dx.doi.org/10.1016/j.ymgme.2015.06.004

Kirby D, McFarland R, Ohtake A, Dunning C, Ryan MT, Wilson C, et al. Mutations of the mitochondrial ND1 gene as a cause of MELAS. J Med Genet [Internet]. 2004;41(10):784–9. Disponible en: http://dx.doi.org/10.1136/jmg.2004.020537

Patiño M, Palacios Sánchez E. Melas: Aproximación diagnóstica y experiencia terapéutica reporte de dos casos. Hospital de San José, Bogotá DC. Rev repert med cir [Internet]. 2012 [citado el 6 de diciembre de 2022];21(4):269–79.

Disponible en: https://revistas.fucsalud.edu.co/index.php/repertorio/article/view/830

Hirano M, Pavlakis SG. Mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes (MELAS): current concepts. J Child Neurol [Internet]. 1994;9(1):4–13.

Disponible en: http://dx.doi.org/10.1177/088307389400900102

Seed L, Dean A, Krishnakumar D, Phyu P, Horvath R, Harijan PD. Molecular and neurological features of MELAS syndrome in paediatric patients: A case series and review of the literature. Mol Genet Genomic Med [Internet]. 2022;10(7):1422-55.

Disponible en: http://dx.doi.org/10.1002/mgg3.1955

Ng Y, Bindoff L, Gorman G, Horvath R, Klopstock T, Mancuso M, et al. Consensus-based statements for the management of mitochondrial stroke-like episodes. Wellcome Open Res. 2019; 13(4):201-3. Disponible en: https://wellcomeopenresearch.org/articles/4-201

Kraya T, Neumann L, Paelecke-Habermann Y, Deschauer M, Stoevesandt D, Zierz S, et al. Cognitive impairment, clinical severity and MRI changes in MELAS syndrome. Mitochondrion [Internet]. 2019;44:53–7. Disponible en: http://dx.doi.org/10.1016/j.mito.2017.12.012

Sue C, Lipsett L, Crimmins D, Tsang C, Boyages S, Presgrave C, et al. Cochlear origin of hearing loss in MELAS syndrome. Ann Neurol [Internet]. 1998;43(3):350–9.

Disponible en: http://dx.doi.org/10.1002/ana.410430313

Sproule D, Kaufmann P. Mitochondrial encephalopathy, lactic acidosis, and strokelike episodes: basic concepts, clinical phenotype, and therapeutic management of MELAS syndrome. Ann N Y Acad Sci [Internet]. 2008;1142(1):133–58.

Disponible en: http://dx.doi.org/10.1196/annals.1444.011

Van den Ouweland J, Lemkes H, Ruitenbeek W, Sandkuijl L, de Vijlder M, Struyvenberg P, et al. Mutation in mitochondrial tRNA(Leu)(UUR) gene in a large pedigree with maternally transmitted type II diabetes mellitus and deafness. Nat Genet [Internet]. 1992;1(5):368–71.

Disponible en: http://dx.doi.org/10.1038/ng0892-368

Ali A, Ekinci E, Pyrlis F. Maternally inherited diabetes and deafness (MIDD): An uncommon but important cause of diabetes. Endocrine and Metabolic Science [Internet]. 2021;2(100074):100074. Disponible en: http://dx.doi.org/10.1016/j.endmts.2020.100074

Alcubilla-Prats P, Solé M, Botey A, Grau J, Garrabou G, Poch E. Kidney involvement in MELAS syndrome: Description of 2 cases. Med Clín (Engl Ed) [Internet]. 2017;148(8):357–61. Disponible en: https://www.elsevier.es/es-revista-medicina-clinica-english-edition--462-articulo-kidney-involvement-in-melas-syndrome-S238702061730253X

Gonçalves F, Alves C, Heuer B, Peterson J, Viaene A, Reis Teixeira S, et al. Primary mitochondrial disorders of the pediatric central nervous system: Neuroimaging findings. Radiographics [Internet]. 2020;40(7):2042–67. Disponible en: https://pubs.rsna.org/doi/full/10.1148/rg.2020200052#:~:text=Primary%20mitochondrial%20disorders%20(PMDs)%20constitute,to%20florid%20and%20highly%20suggestive

Bhatia K, Krishnan P, Kortman H, Klostranec J, Krings T. Acute cortical lesions in MELAS syndrome: Anatomic distribution, symmetry, and evolution. AJNR Am J Neuroradiol [Internet]. 2020;41(1):167–73. Disponible en: http://dx.doi.org/10.3174/ajnr.A6325

Kolb S, Costello F, Lee A, White M, Wong S, Schwartz E, et al. Distinguishing ischemic stroke from the stroke-like lesions of MELAS using apparent diffusion coefficient mapping. J Neurol Sci [Internet]. 2003;216(1):11–5. Disponible en: http://dx.doi.org/10.1016/s0022-510x(03)00218-1

Liu Z, Zheng D, Wang X, Zhang J, Xie S, Xiao J, et al. Apparent diffusion coefficients of metabolites in patients with MELAS using diffusion-weighted MR spectroscopy. AJNR Am J Neuroradiol [Internet]. 2011;32(5):898–902. Disponible en: http://dx.doi.org/10.3174/ajnr.A2395

Kim I, Kim J, Kim W, Hwang Y, Yeon K, Han M. Mitochondrial myopathy-encephalopathy-lactic acidosis-and strokelike episodes (MELAS) syndrome: CT and MR findings in seven children. AJR Am J Roentgenol [Internet]. 1996;166(3):641–5.

Disponible en: http://dx.doi.org/10.2214/ajr.166.3.8623642

Yatsuga S, Povalko N, Nishioka J, Katayama K, Kakimoto N, Matsuishi T, et al. MELAS: a nationwide prospective cohort study of 96 patients in Japan. Biochim Biophys Acta [Internet]. 2012;1820(5):619–24. Disponible en: http://dx.doi.org/10.1016/j.bbagen.2011.03.015

Lee H, Eom S, Kim S, Kang H, Lee J, Kim H, et al. Epilepsy characteristics and clinical outcome in patients with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS). Pediatr Neurol [Internet]. 2016;64(2):59–65.

Disponible en: http://dx.doi.org/10.1016/j.pediatrneurol.2016.08.016

Koga Y, Ishibashi M, Ueki I, Yatsuga S, Fukiyama R, Akita Y, et al. Effects of L-arginine on the acute phase of strokes in three patients with MELAS. Neurology [Internet]. 2002;58(5):827–8. Disponible en: http://dx.doi.org/10.1212/wnl.58.5.827

Koga Y, Povalko N, Inoue E, Nakamura H, Ishii A, Suzuki Y, et al. Therapeutic regimen of L-arginine for MELAS: 9-year, prospective, multicenter, clinical research. J Neurol [Internet]. 2018;265(12):2861–74. Disponible en: http://dx.doi.org/10.1007/s00415-018-9057-7

Abe K, Matsuo Y, Kadekawa J, Inoue S, Yanagihara T. Effect of coenzyme Q10 in patients with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS): evaluation by noninvasive tissue oximetry. J Neurol Sci [Internet]. 1999;162(1):65–8. Disponible en: http://dx.doi.org/10.1016/s0022-510x(98)00296-2

Parikh S, Saneto R, Falk M, Anselm I, Cohen B, Haas R, et al. A modern approach to the treatment of mitochondrial disease. Curr Treat Options Neurol [Internet]. 2009;11(6):414–30. Disponible en: http://dx.doi.org/10.1007/s11940-009-0046-0

López J, Galán G, Luna M, Lancheros D. Síndrome MELAS en pediatría. Reporte de caso. Rev Fac Med Univ Nac Colomb [Internet]. 2020;68(2). Disponible en: http://dx.doi.org/10.15446/revfacmed.v68n2.71926

Fan H, Lee H, Yue C, Chi C. Clinical characteristics of mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes. Life (Basel) [Internet]. 2021;11(11):1111. Disponible en: http://dx.doi.org/10.3390/life11111111

Published

2023-11-23

How to Cite

1.
Guerrero Sarchi Ángel I, Lapo Córdova NS, Quirola Ruiz AA. Melas Syndrome: pediatric case report. lauinvestiga [Internet]. 2023 Nov. 23 [cited 2024 Nov. 22];9(2):47-66. Available from: http://revistasojs.utn.edu.ec/index.php/lauinvestiga/article/view/774

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Section

Clinical cases

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