TN 3 (02-10)
DI 23022.435 Late Infantile Neuronal Ceroid-Lipofuscinoses
LATE INFANTILE NEURONAL CEROID LIPOFUSCINOSES
Jansky-Bielchowsky disease; CNL2; LINCL
Late Infantile Neuronal Ceroid Lipofuscinoses (LINCL) is a rare, inherited disorder of the nerve cells that are caused by a mutation of the CLN2 gene. It is one form of a family of at least eight genetically separate neurodegenerative disorders. The condition causes excessive accumulation of lipfuscin in the body’s tissues. The lipofuscins are made up of fats and proteins. The lipofuscins build up in neuronal cells and many organs, including the liver, spleen, myocardium, and kidneys. The late infantile form of this disease begins between the ages of 2 and 4, usually starting with partial and generalized seizures. Children with this disorder show signs of loss of muscle coordination (ataxia), regression of developmental milestones, followed by decline in intellectual and cognitive functioning, and rapidly progressing visual impairments. Some children may show mild-severe delays in speech development well before other symptoms appear.
TESTING, PHYSICAL FINDINGS, AND ICD-9-CM CODING
Definitive diagnostic lab testing: Eye exams to detect a loss of vision; neurological exam; EEG (electroencephalogram) to record the electrical activity in the brain for seizures; electrical studies of the eyes (VER and ERG) to detect eye problems; CT scan to detect any decaying brain areas or MRI to create a picture of the brain; tissue sampling to spot INCL deposits and enzyme assay that looks for specific lysosomal enzymes.
ICD-9: 330.1 Cerebral lipidoses
ONSET AND PROGRESSION
Children with LINCL usually develop severe disabilities and have considerable nursing care needs by mid-childhood. LINCL progresses rapidly with survival depending on the degree of supportive care provided.
There are no current treatments for this disorder. However, seizures may be controlled or reduced with the use of anti-epileptic drugs. Additionally, physical, speech, and occupational therapies may help affected individuals retain functioning for as long as possible.
SUGGESTED PROGRAMMATIC ASSESSMENT*
Suggested MER for Evaluation: Laboratory reports showing enzyme activity of the PPT1 enzyme; complete neurological, ophthalmological, and mental examinations (including intellectual and psychological functioning) may be needed if one of these examinations alone is insufficient to meet a listing.
Suggested Listings for Evaluation:
111.06 A & B
Clinical descriptions of examinations and neurological findings, as well as documentation of lab test findings, are needed for this listing.
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* Adjudicators may, at their discretion, use the Medical Evidence of Record or Listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.