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Alternative namesFamilial dysautonomia; Hereditary sensory and autonomic neuropathy - type III
DefinitionRiley-Day syndrome is an inherited disorder that affects the function of nerves throughout the body.
Causes, incidence, and risk factors
Riley-Day syndrome is inherited as an autosomal recessive trait, which means that a person must inherit the defective gene from both parents in order to develop the condition.
It is found predominantly in people of European Jewish descent (Ashkenazi Jews). The disease is caused by mutation of the IKBKAP gene on chromosome 9. It is rare in the general population, but not amongst Ashkenazi Jews, where the incidence is estimated to be 1 in 3,700 people.
Infants with this condition have feeding problems and develop pneumonia caused by breathing their formula and food into their airways. Vomiting and sweating spells begin as the infant matures. Young children may also have breath-holding spells that produce unconsciousness , since they can hold their breath for long enough to pass out without feeling the discomfort that normal children would.
A hallmark of Riley-Day syndrome is insensitivity to pain. This leads to unnoticed injuries or injuries that might not have occurred had the child sensed discomfort. Children do not feel the normal sensations that generally warn of impending injury, such as drying of the eyes, pressure over pressure points, and chronic rubbing and chaffing. Bone and skin pain, including burns, are also poorly perceived. However, they can feel visceral pain, like menstrual cramps.
Signs and tests
DNA testing can be done by linkage analysis or direct mutation testing. However, the formal diagnosis of Riley-Day is based on observations, not genetic testing. The signs are:
Protection from injury is critical. Problems are treated as they occur, including treatment of aspiration pneumonia , anticonvulsant therapy if seizures are present, and liquid tears and bethanechol to prevent drying of eyes.
Anti-emetics may be used to control vomiting . Postural hypotension can be managed with increased fluid and salt intake, caffeine, and waist-high elastic stockings.
An annual spine exam is needed to monitor for scoliosis, which can be treated with braces or surgery.
Support GroupsAdditional resources are available from Familial Dysautonomia Hope. Call 847-913-9377.
Expectations (prognosis)Life expectancy is shortened. A person who lives into their 40's is old for a Riley-Day syndrome patient. Half of these patients do not survive past 20 years of age.
Calling your health care providerCall your health care provider if you have a family history of Riley-Day syndrome and are planning to have a child or expecting a child. If you are unsure of your family history but belong to a high-risk population, it may be helpful to consult a genetic counselor.
PreventionGenetic counseling is recommended for prospective parents if there is a family history of Riley-Day syndrome.
Update Date: 1/30/2003Douglas R. Stewart, M.D., Division of Medical Genetics, Hospital of the University of Pennsylvania, Philadelphia, PA. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT