Ondine's curse
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| ICD-10 | G47.3 |
|---|---|
| ICD-9 | 348.8 |
| OMIM | 209880 |
| DiseasesDB | 32976 |
| MedlinePlus | 000078 |
| eMedicine | ped/1645 |
| MeSH | D020182 |
Ondine's Curse, Congenital Central Hypoventilation Syndrome or primary alveolar hypoventilation, is a respiratory disorder that is fatal if untreated. Persons afflicted with Ondine's Curse classically suffer from respiratory arrest during sleep.
This very rare and serious form of Central Sleep Apnea involves an inborn failure of autonomic control of breathing. About 1 in 200,000 live born children have the condition. In 2006, there were only about 200 known cases worldwide. In all cases, episodes of apnea occur in sleep, but in a few patients, at the most severe end of the spectrum, apnea also occurs while awake. Patients generally require tracheotomies and lifetime mechanical ventilation on a respirator in order to survive.
As in many disorders that are very rare, an infant with this unusual form of sleep apnea suffers from the probability that their physician has most likely never seen another case and will not recognize the diagnosis. In some locations, such as France, optimal management of patients, once identified, has been aided by the creation of a national registry and the formation of a network of centers.
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[edit] Etymology
Its name is a reference to the myth of Ondine, a water nymph who had an unfaithful mortal lover. He swore to her that his "every waking breath would be a testimony of [his] love", and upon witnessing his adultery, she cursed that if he should fall asleep, he would forget to breathe. Eventually, he fell asleep from sheer exhaustion, and his respiration stopped.
[edit] Symptoms
This disorder associates respiratory arrests during sleep and, with incomplete penetrance, neuroblastoma (tumors of the sympathetic ganglia), Hirschprung disease (partial agenesis of the enteric nervous system), dysphagia, anomalies of the pupilla, etc.
[edit] Causes
Ondine's Curse is exhibited typically as a congenital disorder, but in rare circumstances, can also result from severe brain or spinal trauma (such as after an automobile accident, or an error made during neurosurgery).
Medical investigation of patients with this syndrome has led to a deeper understanding of how the body and brain regulate breathing on a molecular level. PHOX2B is the main disease-causing gene for congenital central hypoventilation syndrome. This homeobox gene is important for the normal development of the autonomic nervous system.
NB: the disease used to be classified as a "neurocristopathy", or disease of the neural crest because part of the autonomic nervous system (such as sympathetic ganglia) derives from the neural crest. However, this denomination should be dropped because essential neurons of the autonomic nervous system, including those that underlie the defining symptom of the disease (respiratory arrests), are derived from the neural tube (the medulla), not from the neural crest.
[edit] Diagnosis
Children with Congenital Central Hypoventilaion Syndrome develop life-threatening episodes of apnea with cyanosis, usually in the first months of life. Medical evaluation excludes lesions of the brain, heart, and lungs but demonstrate impaired responses to build-up of carbon dioxide (hypercapnia) and decreases of oxygen in the circulation (hypoxia), the two strongest stimuli to increase breathing rate.
Polysomnography shows that hypoventilation is most marked during slow-wave sleep. In the most severe cases, hypoventilation is present during other nonrapid eye movement sleep stages and even wakefulness. A subset of CCHS patients are at very high risk for developing malignant neural crest derived tumors, such as neuroblastoma.
The sequence of PHOX2B reveals mutations in more than 96% of the cases.
[edit] Prognosis
Most people with congenital Ondine's curse do not survive infancy, though they can be kept alive with a ventilator. An alternative to a mechanical ventilator is phrenic nerve pacing.
[edit] History
It was first described in 1962 by Severinghaus and Mitchell in three patients following surgery to the upper cervical spinal cord and brainstem.
[edit] References
- Severinghaus JW, Mitchell RA. Ondine's curse - failure of respiratory center automaticity while awake. Clin Res 1962;10:122.
- Ondine's Curse was mentioned in the 1987 film "Black Widow" starring Debra Winger, Theresa Russell, Terry O'Quinn and DW Moffett. Ondine's Curse was given as a reason for the death of a mafia connected man who suddenly died in his sleep for no reason.
- Gaultier C. Amiel J. Dauger S. Trang H. Lyonnet S. Gallego J. Simonneau M. Genetics and early disturbances of breathing control. [Review] [50 refs] [Journal Article. Review] Pediatric Research. 55(5):729-33, 2004 May.
UI: 14739359
- Gaultier C. Trang H. Dauger S. Gallego J. Pediatric disorders with autonomic dysfunction: what role for PHOX2B?. [Review] [55 refs] [Journal Article. Review] Pediatric Research. 58(1):1-6, 2005 Jul.
- Todd ES. Weinberg SM. Berry-Kravis EM. Silvestri JM. Kenny AS. Rand CM. Zhou L. Maher BS. Marazita ML. Weese-Mayer DE. Facial phenotype in children and young adults with PHOX2B-determined congenital central hypoventilation syndrome: quantitative pattern of dysmorphology. [Journal Article] Pediatric Research. 59(1):39-45, 2006 Jan.
- Trang H. Dehan M. Beaufils F. Zaccaria I. Amiel J. Gaultier C. French CCHS Working Group. The French Congenital Central Hypoventilation Syndrome Registry: general data, phenotype, and genotype. [Journal Article] Chest. 127(1):72-9, 2005 Jan.
UI: 15653965
- Takeda S. Fujii Y. Kawahara H. Nakahara K. Matsuda H. Central alveolar hypoventilation syndrome (Ondine's curse) with gastroesophageal reflux. [Case Reports. Journal Article] Chest. 110(3):850-2, 1996 Sep.
[edit] External links
- "Gene secret of 'mythical curse'" at BBC News, 5 May 2003 (The article misspells PHOX2B as "Thox2b".)
- Nannapaneni R, Behari S, Todd N, Mendelow A (2005). "Retracing "Ondine's curse".". Neurosurgery 57 (2): 354-63; discussion 354-63. PMID 16094167.
- Windisch W, Hennings E, Storre J, Matthys H, Sorichter S. "Long-term survival of a patient with congenital central hypoventilation syndrome despite the lack of continuous ventilatory support.". Respiration 71 (2): 195-8. PMID 15031579.
