Case of Hallervorden-Spatz Syndrome: A Tale of Twin Sisters.

Hallervorden-Spatz syndrome, now known as pantothenate kinase-associated neurodegeneration (PKAN), is a rare autosomal recessive disorder that is characterized by cerebral iron deposition and leads to progressive extrapyramidal dysfunction and dementia. Most commonly seen in the first two decades of a person's life, it is a differential for patients presenting with atypical progressive extrapyramidal disorder and cognitive impairment. It is characterized by progressive degeneration of the basal ganglia, globus pallidus, and the reticular part of the substantia nigra due to iron accumulation. The characteristic MRI brain pattern of the disease shows the eye-of-the-tiger sign. We report cases of early onset PKAN in two sisters of the same family, in which diagnosis was based on clinical features, lab parameters, and MRI imaging findings. This report aims to differentiate PKAN from other static and progressive neurological illnesses.

Deep brain stimulation for pediatric pantothenate kinase-associated neurodegeneration with status dystonicus: A case report and literature review.

BACKGROUND: Pantothenate kinase-associated neurodegeneration (PKAN) is a type of inherited metabolic disorder caused by mutation in the PANK2 gene. The metabolic disorder mainly affects the basal ganglia region and eventually manifests as dystonia. For patients of dystonia, their dystonic symptom may progress to life-threatening emergency--status dystonicus. OBJECTIVE: We described a case of a child with PKAN who had developed status dystonicus and was successfully treated with deep brain stimulation (DBS). Based on this rare condition, we analysed the clinical features of PKAN with status dystonicus and reviewed the reasonable management process of this condition. CONCLUSION: This case confirmed the rationality of choosing DBS for the treatment of status dystonicus. Meanwhile, we found that children with classic PKAN have a cluster of risk factors for developing status dystonicus. Once children diagnosed with similar neurodegenerative diseases are under status dystonicus, DBS can be active considered because it has showed high control rate of this emergent condition.

De la microbiota como “cisne negro”: El extraño caso de los amiloides bacterianos y la neurodegeneración / Microbiota as a ‘black swan’: The extrange case of bacterial amyloids and neurodegeneration

La microbiota humana es la compleja comunidad de microorganismos que colonizan nuestros epitelios, con especial presencia en el intestino grueso. Investigaciones recientes vinculan a la microbiota con diversas patologías, entre las cuales aquí me ocuparé de las enfermedades neurodegenerativas. Metabolitos generados por las bacterias de nuestra microbiota tienen propiedades moduladoras de la inflamación, interaccionado con receptores específicos en el epitelio intestinal, permeando el tejido subyacente y abriéndose paso hacia los vasos sanguíneos, alcanzando así el sistema nervioso central (SNC). Por otra parte, proteínas con el potencial de agregar ordenadamente en forma de amiloides, secretadas por las bacterias para construir la matriz que entreteje las biopelículas que les permiten persistir en el intestino, pueden utilizar para llegar al SNC una vía alternativa: las terminaciones parasimpáticas del nervio vago, propagándose como priones (amiloides infectivos), lo que constituye el denominado “eje intestino-cerebro”. Una vez en el SNC, los amiloides bacterianos pueden promover la agregación de proteínas amiloidogénicas implicadas en neurodegeneración (α-sinucleína, Tau, Ab, Sod1). En este artículo se revisan y ponderan algunas de las recientes evidencias experimentales que, principalmente en sistemas modelo animales, asignan un papel central para la microbiota en la etiología de las enfermedades neurodegenerativas, así como los estudios realizados en el laboratorio del autor que han conducido al desarrollo de un sistema modelo mínimo, exclusivamente bacteriano, que recapitula aspectos moleculares esenciales de una enfermedad neurodegenerativa.(AU)

The human microbiota is the complex community of microorganisms that colonize our epithelia, with a special presence in the large intestine. Recent research links the microbiota to various pathologies, among which I will focus here on neurodegenerative diseases. Metabolites generated by the bacteria of our microbiota have inflammation-modulating properties, interacting with specific receptors in the intestinal epithelium, permeating the underlying tissue and making their way into the blood vessels, thus reaching the central nervous system (CNS). On the other hand, proteins with the potential to aggregate in the form of amyloids, secreted by bacteria to build the matrix that interweaves the biofilms that allow them to persist in the intestine, can use an alternative route to reach the CNS: the parasympathetic endings of the vagus nerve, spreading as prions (infective amyloids), in what is known as the “gut-brain axis”. Once in the CNS, bacterial amyloids can promote aggregation of amyloidogenic proteins involved in neurodegeneration (α-synuclein, Tau, Ab, Sod1). This article reviews and discusses some of the recent experimental evidence that, mainly in animal model systems, assigns a central role for the microbiota in the aetiology of neurodegenerative diseases, as well as the studies performed in the laboratory of the author that have led to the development of a minimal, exclusively bacterial model system that recapitulates essential molecular aspects of a neurodegenerative disease.(AU)

Adicciones y enfermedades neurodegenerativas: Dianas comunes en la búsqueda de nuevas terapias / Addictions and neurodegenerative diseases: Common targets in the search for new therapies

La Pleiotrofina (PTN) es un factor neurotrófico para las neuronas dopaminérgicas cuya expresión se encuentra aumentada en el cerebro de pacientes alcohólicos, en roedores tras la administración de anfetamina y en pacientes con distintas enfermedades neurodegenerativas. La PTN limita los efectos neurotóxicos de las anfetaminas en el circuito nigroestriatal, que en el ser humano pueden llevar a causar la enfermedad de Parkinson. Además, la PTN limita los efectos reforzadores del alcohol.La PTN es un inhibidor endógeno del receptor de membrana Proteína Fosfatasa de Tirosinas Z1 (PTPRZ1, también conocido como RPTPβ/ζ o Fosfacano). Hemos demostrado que se pueden reproducir los efectos de la PTN con inhibidores selectivos del receptor RPTPβ/ζ que obtuvimos a través de un programa de diseño racional de fármacos. El compuesto líder inhibidor de RPTPβ/ζ, MY10, disminuye significativamente el consumo de alcohol en modelos animales y regula la respuesta neuroinmune a esta droga, logrando bloquear la disminución de la neurogénesis hipocampal producida por el alcohol, poniendo de manifiesto importantes diferencias entre sexos.Se ha demostrado que RPTPβ/ζ es un punto de anclaje clave para las redes perineuronales (PNNs) en la superficie celular, las cuales desempeñan un papel importante en la adicción al alcohol. En el hipocampo juegan un papel fundamental en la neurogénesis y el aprendizaje, lo que sugiere que los efectos de MY10 sobre el consumo de alcohol y la disminución de la neurogénesis hipocampal inducida por esta droga, podrían estar mediados por las acciones de la inhibición de RPTPβ/ζ sobre las PNNs.(AU)

Pleiotrophin (PTN) is a neurotrophic factor for dopaminergic neurons whose levels of expression are increased in the brain of alcoholic patients, in rodents after the administration of amphetamine and in patients with different neurodegenerative diseases. PTN limits the neurotoxic effects of amphetamines in the nigrostriatal pathway which, in humans, can lead to Parkinson’s disease. Additionally, PTN limits the rewarding effects of alcohol.PTN is an endogenous inhibitor of the Receptor Protein Tyrosine Phosphatase Z1 (PTPRZ1, also known as RPTPβ/ζ or Phosphacan). We have shown that the effects of PTN can be reproduced with selective inhibitors of RPTPβ/ζ that we obtained through a rational drug design program. The leading RPTPβ/ζ inhibitory compound, MY10, significantly reduces alcohol consumption in animal models and regulates the neuroimmune response to this drug, blocking as a result the decrease in hippocampal neurogenesis produced by alcohol, revealing important differences between sexes.RPTPβ/ζ has been shown to be a key anchor for cell surface perineuronal nets (PNNs), which play an important role in alcohol addiction. In the hippocampus PNNs play a fundamental role in neurogenesis and learning, suggesting that the effects of MY10 on alcohol consumption and the decrease in hippocampal neurogenesis induced by this drug could be mediated by the actions of RPTPβ/ζ inhibition on the PNNs.(AU)

Estimation of Ambulation and Survival in Neurodegeneration with Brain Iron Accumulation Disorders.

BACKGROUND: Neurodegeneration with Brain Iron Accumulation (NBIA) disorder is a group of ultra-orphan hereditary diseases with very limited data on its course. OBJECTIVES: To estimate the probability of preserving ambulatory ability and survival in NBIA. METHODS: In this study, the electronic records of the demographic data and clinical assessments of NBIA patients from 2012 to 2023 were reviewed. The objectives of the study and factors impacting them were investigated by Kaplan-Meier and Cox regression methods. RESULTS: One hundred and twenty-two genetically-confirmed NBIA patients consisting of nine subtypes were enrolled. Twenty-four and twenty-five cases were deceased and wheelchair-bound, with a mean disease duration of 11 ± 6.65 and 9.32 ± 5 years. The probability of preserving ambulation and survival was 42.9% in 9 years and 28.2% in 15 years for classical Pantothenate Kinase-Associated Neurodegeneration (PKAN, n = 18), 89.4% in 7 years and 84.7% in 9 years for atypical PKAN (n = 39), 23% in 18 years and 67.8% in 14 years for Mitochondrial Membrane Protein-Associated Neurodegeneration (MPAN, n = 23), 75% in 20 years and 36.5% in 33 years for Kufor Rakeb Syndrome (KRS, n = 17), respectively. The frequencies of rigidity, spasticity, and female gender were significantly higher in deceased cases compared to surviving patients. Spasticity was the only factor associated with death (P value = 0.03). CONCLUSIONS: KRS had the best survival with the most extended ambulation period. The classical PKAN and MPAN cases had similar progression patterns to loss of ambulation ability, while MPAN patients had a slower progression to death. Spasticity was revealed to be the most determining factor for death.

Femur Fractures in 5 Individuals With Pantothenate Kinase-associated Neurodegeneration: The Role of Dystonia and Suggested Management.

BACKGROUND: Pantothenate kinase-associated neurodegeneration (PKAN) is a rare, neurodegenerative disorder that manifests with progressive loss of ambulation and refractory dystonia, especially in the early-onset classic form. This leads to osteopenia and stress on long bones, which pose an increased risk of atraumatic femur fractures. The purpose of this study is to describe the unique challenges in managing femur fractures in PKAN and the effect of disease manifestations on surgical outcomes. METHODS: A retrospective case review was conducted on 5 patients (ages 10 to 20 y) with PKAN with a femur fracture requiring surgical intervention. Data regarding initial presentation, surgical treatment, complications, and outcomes were obtained. RESULTS: All patients were non-ambulatory, with 4 of 5 patients sustaining an atraumatic femur fracture in the setting of dystonia episode. One patient had an additional contralateral acetabular fracture. Postoperatively, 4 of the 5 patients sustained orthopaedic complications requiring surgical revision, with 3 of these secondary to dystonia. Overall, 4 required prolonged hospitalization in the setting of refractory dystonia. CONCLUSION: Femur fractures in PKAN present distinct challenges for successful outcomes. A rigid intramedullary rod with proximal and distal interlocking screws is most protective against surgical complications associated with refractory dystonia occurring during the postoperative period. Multidisciplinary planning for postoperative care is essential and may include aggressive sedation and pain management to decrease the risk of subsequent injuries or complications. LEVEL OF EVIDENCE: Level IV.

Manejo dental de paciente con Síndrome de Hallervorden-Spatz: reporte de caso / Manejo odontológico de paciente com síndrome de Hallervorden-Spatz: relato de caso / Dental management of a patient with Hallervorden-Spatz syndrome: case report

El Síndrome de Hallervorden-Spatz es una afección neurodegenerativa rara, autosómica recesiva, caracterizada por depósitos en gran cantidad de hierro en los ganglios de base, lo que ocasiona gran pérdida motora y mental. Presenta dos formas de manifestación: la clásica, que aparece en la infancia a lo largo de la primera década de vida, y la atípica, cuyas manifestaciones clínicas aparecen de forma tardía, entre la segunda y tercera décadas de vida. El objetivo del presente estudio es describir un caso clínico de tratamiento endodóntico, en ambulatorio, de una paciente del sexo femenino, de 28 años, con manifestaciones clásicas de dicho síndrome, con cambio de color en el elemento 11 y lesión periapical, que justifica la indicación de endodoncia. La atención odontológica de una enfermedad neurodegenerativa rara, realizada en forma ambulatoria, requiere el conocimiento del dentista para que se conduzca de forma eficiente y segura

A síndrome de Hallervorden-Spatz é uma afecção neurodegenerativa rara, autossômica recessiva, caracterizada por depósitos em grande quantidade de ferro nos gânglios de base, o que ocasiona grande perda motora e mental. Apresenta duas formas de manifestações: a clássica, que surge na infância na primeira década de vida; e a atípica, cujas manifestações clínicas surgem mais tardiamente, entre a segunda e terceira décadas de vida. O objetivo desse estudo foi descrever um caso clínico de tratamento endodôntico, ambulatorial, de uma paciente do sexo feminino, 28 anos, com manifestações clássicas da síndrome, apresentando mudança de cor no elemento 11 com lesão periapical, justificando a indicação para endodontia. O atendimento odontológico de uma doença neurodegenerativa rara; realizado em ambiente ambulatorial, requer o conhecimento do dentista para que seja conduzido de forma eficiente e segura.

Hallervorden-Spatz syndrome is a rare, autosomal recessive neurodegenerative disorder characterized by large deposits of iron in the basal ganglia, which causes great motor and mental loss. It presents two forms of manifestations: the classic, which arises in childhood in the first decade of life; and the atypical, whose clinical manifestations appear later, between the second and third decades of life. The objective of this study was to describe a clinical case of endodontic outpatient treatment of a female patient, 28 years old, with classic manifestations of the syndrome, showing color change in element 11 with periapical lesion, justifying the indication for endodontics. The dental care of a rare neurodegenerative disease in an outpatient setting requires the dental surgeon's knowledge so that it is conducted efficiently and safely.

Biomarcadores de enfermedad de Alzheimer en deterioro cognitivo leve: experiencia en una clínica de memoria de Latinoamérica / Biomarkers of Alzheimer's disease in mild cognitive impairment: Experience in a memory clinic from Latin America

Objetivo: El objetivo de este estudio fue investigar el rol y pronóstico de los biomarcadores de enfermedad de Alzheimer en pacientes con diagnóstico clínico de deterioro cognitivo leve (DCL) en una clínica de memoria de Latinoamérica.MétodoOchenta y nueve pacientes con DCL, 43 con demencia tipo Alzheimer y 18 controles normales apareados por edad, sexo y escolaridad fueron estudiados con un extenso protocolo demográfico, neurológico y neuropsicológico en la clínica de memoria del Instituto FLENI de Buenos Aires. Todos completaron una RM cerebral, una PET con FDG, una PET con estudios amiloideo (PIB), genotipificación de APOE y estudio de Aβ1-42, tau and f-tau de líquido cefalorraquídeo. Basado en la presencia/ausencia de patología amiloidea y neurodegeneración los pacientes fueron categorizados como A+/A− y N+/N− respectivamente.ResultadosEn el estudio de líquido cefalorraquídeo el 18% de los controles, el 64% de los DCL y el 92% de las demencia tipo Alzheimer tenían patología amiloidea; y un 11% de los controles, el 6% de los DCL y el 8% de las DTA eran sospechosos de fisiopatología no Alzheimer. En el seguimiento a los 30 meses el 45% de los DCL con amiloide positivo y el 20% de los que presentaron amiloide negativo progresaron a demencia.ConclusionesEste estudio muestra el pronóstico de los DCL basado en los biomarcadores, y respalda su importancia en la toma de decisiones en la práctica diaria. (AU)

Objective: This study aimed to investigate the role and prognosis of Alzheimer disease biomarkers in patients with mild cognitive impairment (MCI) at a memory clinic in Latin America.MethodsWe studied 89 patients with MCI, 43 with Alzheimer-type dementia, and 18 healthy controls (matched for age, sex, and educational level) at our memory clinic (Instituto FLENI) in Buenos Aires, Argentina. Patients and controls underwent an extensive demographic, neurological, and neuropsychological assessment. All subjects underwent a brain MRI scan; FDG-PET scan; amyloid PET scan; apolipoprotein E genotyping; and cerebrospinal fluid concentrations of Aβ1-42, tau, and phosphorylated tau. Patients were categorised as positive or negative for the presence of amyloid pathology and neurodegeneration.ResultsAmyloid pathology was observed in cerebrospinal fluid results in 18% of controls, 64% of patients with MCI, and 92% of patients with Alzheimer-type dementia. Suspected non–Alzheimer disease pathophysiology was found in 11% of controls, 6% of patients with MCI, and 8% of patients with Alzheimer-type dementia. At 30 months of follow-up, 45% of amyloid-positive patients with MCI and 20% of amyloid-negative patients with MCI showed progression to dementia.ConclusionsThis study demonstrates biomarker-based MCI prognosis and supports its role in clinical decision-making in daily practice. (AU)

Evolução clínica e nutricional de uma paciente com a síndrome de hallervorden spatz: relato de caso clínico / Clinical and nutritional evolution of a patient with hallervorden spatz syndrome: clinical case report

Relatou-se o caso de um paciente com a Síndrome de Hallervorden Spatz, acolhida no programa domiciliar do Hospital Regional da Asa Norte (HRAN), Brasília, DF e discutir a terapia nutricional instituída para melhoria de qualidade de vida da mesma. Trata-se de um estudo de caso clínico compreendido entre o período de 01/09/2017 a 30/10/2017 onde se averiguou toda a evolução clínica e nutricional do paciente durante o período de internação. Após a introdução adequada de uma conduta dietoterápica para a situação da paciente, ocorreram mudanças em seu diagnóstico nutricional, levando-a a sair do nível de desnutrição com consequente ganho ponderal, além de aliviar a constipação intestinal crônica e promover a cicatrização da lesão por pressão. A partir de uma elaboração dietoterápica, pode-se notar que a terapia nutricional instituída demonstrou benefícios para a qualidade de vida da paciente com a Síndrome de Hallervorden Spatz

Botulinum Toxin-A Injection in the Treatment of Spasticity in a Infantile-Onset Neurodegeneration With Brain Iron Accumulation: A Case Report

Pantothenate kinase-associated neurodegeneration (PKAN) is a neurodegenerative disorder characterized by iron accumulation in the globus pallidus (GP) of the brain (neurodegeneration with brain iron accumulation [NBIA]), which is characterized by dystonia and spasticity resulting in postural difficulties. A 33-month-old boy was admitted with a pronounced gait disturbance. Marked hypertonicity in the patient's both calf muscles was noted, resulting in waddling with repeated slip-falls. NBIA was suspected by high T2 intensity in the GP on brain MRI, then it was confirmed by detecting PANK2 mutation. Botulinum toxin-A injection was administered to both calf muscles. After 2 weeks, a decrease in spasticity and an increase in range of motion were observed, and consequently, an increase in the patient's gait stability with both heels touching the ground, enabling him to walk straight independently. A definitive treatment for NBIA has not been established, and a symptomatic therapy is currently the mainstay of treatment in this case. This is the first case report of botulinum toxin injection for treatment of gait disturbance caused by spasticity in an infantile-onset PKAN.

All that glitters is not gold: When motor and vocal tics in a child do not match Tourette syndrome: A case report / Nem tudo que reluz é ouro: quando tiques motores e vocais em uma criança não combinam com Síndrome de Tourette: relato de caso

ABSTRACT The atypical form of Pantothenate Kinase-Associated Neurodegeneration (PKAN) tends to present at around the age of 14 years, has a heterogeneous presentation with extrapyramidal symptoms, and approximately one third of patients exhibit psychiatric problems. This paper reports the case of a patient with apparent typical symptoms of Tourette syndrome. However, the severity and poor response to treatment led to further investigation and the diagnosis of PKAN as a secondary cause of Tourettism was reached.

RESUMO A forma atípica de PKAN costuma se apresentar por volta dos 14 anos de idade, possui uma sintomatologia heterogênea, com sintomas extrapiramidais e, em cerca de um terço dos pacientes, também com a manifestação de sintomas psiquiátricos. O presente artigo relata o caso de uma paciente com sintomatologia típica da Síndrome de Tourette à primeira vista. Entretanto, a gravidade do quadro e pouca resposta ao tratamento levaram a uma maior investigação e ao diagnóstico de PKAN como causa secundária do Tourettismo.

Neurodegeneration with brain iron accumulation: A case report / Neurodegeneração com acúmulo cerebral de ferro: relato de caso

ABSTRACT Pantothenate kinase-associated neurodegeneration (PKAN) is an autosomal recessive disorder caused by mutation in the PANK2 gene. It is characterized by abnormal brain iron accumulation, mainly in the globus pallidus. PKAN is included in a group of disorders known as neurodegeneration with brain iron accumulation (NBIA). We report a case of atypical PKAN with its most characteristic presentation, exhibiting marked psychiatric symptoms, speech disorder and focal dystonia. Brain MRI has great diagnostic importance in this group of disorders and, in this case, disclosed the eye-of-the-tiger sign. Genetic testing confirmed the diagnosis.

RESUMO Neurodegeneração associada à pantotenato-quinase (PKAN) é uma entidade autossômica recessiva causada pela mutação do gene PANK2. Caracteriza-se por depósito cerebral anormal de ferro, particularmente nos globos pálidos. PKAN faz parte de um grupo de desordens conhecidas como neurodegeneração com acúmulo cerebral de ferro (NBIA). Relatamos um caso de PKAN atípica com sua apresentação mais característica, sendo evidentes sintomas psiquiátricos marcados, distúrbio da fala e distonia focal. A ressonância magnética de crânio possui grande importância diagnóstica neste grupo de desordens, e neste caso, demonstrou o sinal do olho de tigre. O teste genético confirmou o diagnóstico.

Clinical Heterogeneity of Atypical Pantothenate Kinase-Associated Neurodegeneration in Koreans

OBJECTIVE: Neurodegeneration with brain iron accumulation (NBIA) represents a group of inherited movement disorders characterized by iron accumulation in the basal ganglia. Recent advances have included the identification of new causative genes and highlighted the wide phenotypic variation between and within the specific NBIA subtypes. This study aimed to investigate the current status of NBIA in Korea. METHODS: We collected genetically confirmed NBIA patients from twelve nationwide referral hospitals and from a review of the literature. We conducted a study to describe the phenotypic and genotypic characteristics of Korean adults with atypical pantothenate kinase-associated neurodegeneration (PKAN). RESULTS: Four subtypes of NBIA including PKAN (n = 30), PLA2G6-related neurodegeneration (n = 2), beta-propeller protein-associated neurodegeneration (n = 1), and aceruloplasminemia (n = 1) have been identified in the Korean population. The clinical features of fifteen adults with atypical PKAN included early focal limb dystonia, parkinsonism-predominant feature, oromandibular dystonia, and isolated freezing of gait (FOG). Patients with a higher age of onset tended to present with parkinsonism and FOG. The p.R440P and p.D378G mutations are two major mutations that represent approximately 50% of the mutated alleles. Although there were no specific genotype-phenotype correlations, most patients carrying the p.D378G mutation had a late-onset, atypical form of PKAN. CONCLUSIONS: We found considerable phenotypic heterogeneity in Korean adults with atypical PKAN. The age of onset may influence the presentation of extrapyramidal symptoms.

A Case of Retinal Pigmentary Degeneration in PKAN

PURPOSE: Pantothenate kinase-associated neurodegeneration (PKAN), also known as neurodegeneration with brain iron accumulation is an extremely rare degenerative disease. The present study reports a case of retinal pigmentary changes in PKAN. CASE SUMMARY: A 6-year-old girl presented with night blindness and developmental delay. Neurologic examination revealed toe gait and dystonia. Ocular examination showed retinal pigmentary change in the entire retina without optic atrophy. Brain magnetic resonance imaging showed iron deposits in the basal ganglia, the so-called "eye of the tiger" sign. Genetic tests confirmed a mutation in the gene encoding pantothenate kinase 2. Electroretinography demonstrated severe loss of rod and cone responses, prominently reduced in the rod response. The patient was diagnosed with PKAN and pharmacologic treatment started. CONCLUSIONS: In the case of systemic neurological abnormalities with pigmentary retinal change, PKAN should be considered as a differential diagnosis.

Probable neurodegeneración asociada a pantotenato Kinasa (PKAN). Estudio de cuatro casos en Perú / Likely degeneration associated with pantothenate kinase (PKAN). Study of four cases in Peru

Introducción: La PKAN (Neurodegeneración Asociada a Pantotenato Kinasa) es una enfermedad autosómica recesiva caracterizada clinicamente por presentarse en la primera infancia, regresión en el desarrollo psicomotor, compromiso extrapiramidal, piramidal y neuro-oftalmológico, de curso progresivo y fatal. La alteración genética se encuentra en el cromosoma 20p12.3-p13 que codifica la pantotenato kinasa, que regula el metabolismo del pantotenato, fundamental en la síntesis de ácidos grasos. Su alteración resulta en un aumento de la concentración de cisteína y el depósito de hierro en los ganglios basales. Casos Clínicos: Se presentan cuatro pacientes, dos de ellos con antecedente de consanguinidad, que iniciaron síntomas neurológicos entre los 3 a 6 años de edad, caracterizados por distonía, coreoatetosis, regresión psicomotora, compromiso visual y piramidalismo, de curso progresivo, que fallecieron antes de los 10 años de edad. La RM de encéfalo mostró las características imágenes de ôojos de tigreõ, correspondientes al depósito de hierro en los globos pallidus, concluyéndose en el diagnóstico de PKAN. Conclusión: Se presentan cuatro pacientes peruanos que por sus características hereditarias, clínicas y radiológicas corresponden al diagnóstico de PKAN.

Introduction: PKAN is an autosomal recessive disorder clinically characterized by delayed motor involvement, pyramidal and extrapyramidal symptoms, and neuro-ophthalmologic involvement with a progressive course and fatal outcome.The causal gene is localized to chromosome 20pI2.3-pI3 which encodes forpanthothenate kinase. Pantothenate kinase regulates panthothenate metabolism and is integral to fatty acids synthesis. Its alteration may result in an elevated concentration of cysteine and iron accumulation in the basal ganglia. Case Report: We report four patients between the ages of 3 and 6 with a history ofconsanguinity who presented with a specific constellation of neurological symptoms, characterized by dystonia, choreoatetosis, psychomotor regression, visual involvement, pyramidalism, and a progressive course culminating in death prior to the age of 10. MRI showed the "eye-of-the-tiger" sign related to iron deposits at the globus pallidus, consistent with the diagnosis of PKAN.Conclusion: We report four Peruvian cases that according to inheritance, clinical and imaging characteristics correspond with a diagnosis of PKAN.