Familial Amyotrophic Dystonic Paraplegia

Very rare syndrome characterized by progressive amyotrophy, mental retardation, nystagmus, and incontinence of bowel and bladder in association with spastic paraplegia.

Twelve patients have been described in the literature. Autosomal dominant.

Because the disease has a variable expression, the degree of symptoms ranges from an asymptomatic condition to a severe disease. Features include dystonia, spastic paraplegia, amyotrophy, mental retardation, bowel incontinence, bladder incontinence, and nystagmus.

Assess airway reflexes and history of gastroesophageal reflux (recurrent pulmonary aspiration). Because patient may be prone to frequent chest infections, assess respiratory function, including chest radiography, arterial blood gas analysis, and pulmonary function tests, if possible. In presence of severe pulmonary dysfunction, postoperative mechanical ventilatory support may be necessary and should be planned accordingly. Mental retardation may complicate communication and preoperative assessment. May suffer from gastroesophageal reflux (regurgitation) and poor swallowing (rapid-sequence induction). Care with positioning of patient with spastic paraplegia. Use of neuromuscular blocking agents should be done with titration considering muscle atrophy and under control of nerve stimulator.