SMA is an autosomal recessive, with a frequency of 1 in 10,000 (carrier frequency of approximately 1 in 38). Clinical features include: proximal muscle weakness, floppy baby, poor feeding, absent reflexes, arthrogyphosis, and fasciculation of tongue. SMA results from the degeneration of the anterior horn cells of the spinal cord. Approximately 95% of SMA patients have homozygous absence of exons 7 and 8 (or exon 7 only) of the Survival Motor Neuron 1 (SMN1) gene (i.e. they have no functional copies of the SMN1 gene). The remainder of patients are compound heterozygotes for SMN1 mutations, with a subtle mutation on one chromosome and a deletion or gene conversion on the other. The copy number of the adjacent SMN2 gene has been shown to correlate with disease severity, however prediction of disease severity on this basis may not be accurate. SMA is clinically heterogeneous, classified into 4 types based on clinical severity:
SMA Types | Age of Onset | Prognosis |
---|---|---|
Type I (Werdnig-Hoffmann) | 0 - 6 months | most severe, never sit, death in early infancy |
Type II | < 2 years | never stand, death in early twenties |
Type III (Kugelberg-Welander) | > 2 years | muscle wasting, survive into adulthood |
Type IV | 30-50 years | Least severe |
In addition to supplying standard patient identification and referral information, the following should be clearly indicated:
It is the responsibility of the referring clinician to ensure consent has been obtained for testing and storage.
3 - 5mL of whole blood in an EDTA tube. Blood specimens must be appropriately packaged, and preferably sent by courier to arrive as soon as possible. Do not freeze prior or during postage.
Please note that extracted DNA from patients' samples is kept for at least 12 months, unless a written request for its disposal is received from the patient or their parent/guardian.
Prenatal or presymptomatic diagnosis is offered for families. Family testing for direct members will be performed prior to prenatal testing.
The SMA MLPA assay is a quantitative test for SMN1 & SMN2 genes copy number, kit used is from MRC-Holland
The SMA MLPA assay is a quantitative test for SMN1 gene copy number, and will not pick up subtle deletions, inversions or point mutations in SMN1- screening for such mutations can be arranged via external laboratories, where relevant. Diagnostic sensitivity of the MLPA assay is additionally influenced by the fact that approximately 4% of the SMN1 alleles in the general population have two SMN1 copies on a single chromosome.
Results are given in the form of a written interpretative report to the referring clinician.
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