Cornelia de Lange Syndrome

Cornelia de Lange Syndrome (CdLS) is a genetic disorder that can lead to severe developmental anomalies. It affects the physical and intellectual development of a child. Exact incidence is unknown, but it is estimated at 1 in 10,000 to 30,000.

Causes
The vast majority of cases are due to spontaneous mutations.

It can be associated with mutations affecting the cohesin complex.

Multiple genes have been associated with the condition:

The latter two genes seem to correlate with a milder form of the syndrome.

Evidence of a linkage at chromosome 3q26.3 is mixed.

History
The first ever documented case was in 1916 by W. Brachmann followed up by Cornelia de Lange, a Dutch pediatrician, in 1933 after whom the disorder has been named.

Diagnosis
The diagnosis of CdLS is primarily a clinical one based on signs and symptoms (see below) observed through an evaluation by a physician, including a medical history, physical examination, and laboratory tests. Since 2006, testing for NIPBL and SMC1A has been available through the University of Chicago. This is best accomplished through a referral to a genetics specialist or clinic.

CdLS is thought to be underdiagnosed and frequently misdiagnosed.

Features and characteristics
Following are the features and characteristics that help in spotting this disorder:
 * Low birth weight (usually under 5 pounds/2.5 kilograms)
 * Delayed growth and small stature
 * Developmental delay
 * Limb differences (missing limbs or portions of limbs)
 * Small head size (microcephaly)
 * Thick eyebrows, which typically meet at midline (synophrys)
 * Long eyelashes
 * Short upturned nose and thin downturned lips
 * Long philtrum
 * Excessive body hair
 * Small hands and feet
 * Small widely spaced teeth
 * Low-set ears
 * Hearing impairments
 * Vision abnormalities (e.g., ptosis, nystagmus, high myopia, hypertropia)
 * Partial joining of the second and third toes
 * Incurved 5th fingers
 * Gastroesophageal reflux
 * Seizures
 * Heart defects
 * Cleft palate
 * Feeding problems

Children with this syndrome are often found to have long eyelashes, bushy eyebrows and synophrys (joined eyebrows). Body hair can be excessive and affected individuals are often shorter than their immediate family members.

CdLS can give rise to its own array of complexities. Children with CdLS often suffer from gastrointestinal tract difficulties, particularly gastroesophageal reflux. Vomiting, intermittent poor appetite, constipation, diarrhea or gaseous distention are known to be a regularity in cases where the GE tract problems are acute. Symptoms may range from mild to severe.

CdLS may include behavior problems, including self-stimulation, aggression, self-injury or strong preference to a structured routine. Many children with CdLS exhibit autistic-like behaviors.

Behavior problems in CdLS are not inevitable. Many behavior issues associated with CdLS are reactive (i.e., something happens within the person's body or environment to bring on the behavior) and cyclical (comes and goes). Often, an underlying medical issue causes a change in behavior. Once the medical issue is treated, the behavior diminishes.

Treatment
Often, an interdisciplinary approach to therapy and treatment of any medical issues that arise is recommended. A team for promotion of the child's well being often includes speech, occupational and physical therapists, teachers, physicians and, most importantly, the parent(s). Treatment protocols can be viewed at http://www.cdlsusa.org/treatment_protocols.shtml.

Support
The Cornelia de Lange Syndrome (CdLS) Foundation is a nonprofit, family support organization based in Connecticut which provides materials for public education and information. In addition to Reaching Out, a bi-monthly newsletter, the foundation produces and distributes other publications on the syndrome, as well as a free video.