|Classification and external resources|
First report of the GSS syndrome
Gerstmann–Sträussler–Scheinker syndrome (GSS) is a very rare, usually familial, fatal neurodegenerative disease that affects patients from 20 to 60 years in age. This extremely rare disease is classified as a transmissible spongiform encephalopathy (TSE).
Familial cases are associated with autosomal dominant inheritance. Gerstmann-Straussler-Scheinker Disease (GSS) is an extremely rare neurogenetic brain disorder. It is always inherited and is found in only a few families all over the world (NINDS ¶ 1). The trait is an autosomal dominant trait, caused by a gene mutation. It is also in a group of heredity prion protein diseases or also known as TSE’s. Many symptoms are associated with GSS like progressive ataxia, pyramidal signs, and even adult-onset dementia; they progress more as the disease progresses (Farlow, et al., Nov. 1989).
A change in codon 102 from proline to leucine on chromosome 20, has been found in the prion protein gene (PRNP) of most affected individuals. Therefore, it appears this genetic change is usually required for the development of the disease.
GSS is a disease that is very rare, making its history hard to track exactly where it descended from. Gerstmann-Straussler-Scheinker syndrome (GSS) were first described as neurodegenerative diseases in the 1920s (Elsevier Science, 2002). Gerstmann-Straussler-Scheinker (GSS) is called this because it was first reported in 1936 by Josef Gerstmann, Ernst Straussler and Ilya Scheinker. They were all German doctors who were specialized in prion protein diseases. In 1989, the first mutation of the prion protein gene was identified in a GSS family (Elsevier Science, 2002). Prion diseases (transmissible spongiform encephalopathies) are rare degenerative diseases of the brain thought to be caused by a protein that converts to an abnormal form called a prion (Gambetti Pierluigi, 2013). GSS was later realized to have many different gene mutation types some showing different symptoms first or having other symptoms be worse than others. Doctors in different parts of the world are recovering more generations and families that have the mutation. It is hard to discover GSS for two main reasons: (1) the disease has been reported in only a few countries; and (2) the disease may be underreported due to its clinical similarity to other diseases (Ghetti B, et al., 2003). The Indiana Kindred is the largest spanning over 8 generations, and includes over 3,000 people with 57 individuals known to be affected (B. Ghetti, et al., 1996).
Symptoms start with slowly developing dysarthria (difficulty speaking) and cerebellar ataxia (unsteadiness) and then the progressive dementia becomes more evident. Loss of memory can be the first symptom of GSS. Extrapyramidal and pyramidal symptoms and signs may occur and the disease may mimic spinocerebellar ataxias at the beginning. Myoclonus, spasmodic muscle contraction, is less frequently seen than in CJD. Many patients also exhibit nystagmus (involuntary movement of the eyes), visual disturbances, and even blindness or deafness. The neuropathological findings of GSS include widespread deposition of amyloid plaques composed of abnormally folded prion protein.
GSS can include some or many of these symptoms; progressive ataxia (lack of muscle coordination), pyramidal signs, adult-onset dementia, dysarthria (slurred speech), nystagmus (involuntary movements of the eyes), spasticfty (rigid muscle tone), some may even experience parkinsonian features. After the disease is diagnosed many patients will experience psychosis or severe depression with rapid weight loss (Farlow, et al., 1996).
Treatment and testing
There is no cure for GSS, nor any known treatments to slow the progression of the disease (NINDS ¶ 2). However, therapies and medication are aimed at treating or slowing down the effects of the symptoms. Their goal is to try and improve the patient's quality of life as much as possible. Despite there being no cure for GSS, it is possible to undergo testing for the presence of the underlying genetic mutation. Testing for GSS involves a blood and DNA examination in order to attempt to detect the mutated gene at certain codons. If the genetic mutation is present, the patient will eventually be afflicted by GSS, and due to the genetic nature of the disease, the offspring of the patient are predisposed to a higher risk of inheriting the mutation.
There is no cure or treatment for GSS. It can, however, be identified through genetic testing. GSS is the slowest to progress among human prion diseases. Duration of illness can range from 3 months to 13 years, with an average duration of 5 or 6 years.
- De Michele G, Pocchiari M, Petraroli R, et al. (August 2003). "Variable phenotype in a P102L Gerstmann–Sträussler–Scheinker Italian family". Can J Neurol Sci 30 (3): 233–6. PMID 12945948.
- synd/2269 at Who Named It?
- Gerstmann, J.; Sträussler, E.; Scheinker, I. (1936). "Über eine eigenartige hereditär-familiäre Erkrankung des Zentralnervensystems. Zugleich ein Beitrag zur Frage des vorzeitigen lokalen Alterns". Zeitschrift für die gesamte Neurologie und Psychiatrie 154: 736–762.
- Arata H, Takashima H, Hirano R, et al. (June 2006). "Early clinical signs and imaging findings in Gerstmann–Sträussler–Scheinker syndrome (Pro102Leu)". Neurology 66 (11): 1672–8. doi:10.1212/01.wnl.0000218211.85675.18. PMID 16769939.
- Collins S, McLean CA, Masters CL (September 2001). "Gerstmann–Sträussler–Scheinker syndrome,fatal familial insomnia, and kuru: a review of these less common human transmissible spongiform encephalopathies". J Clin Neurosci 8 (5): 387–97. doi:10.1054/jocn.2001.0919. PMID 11535002.
- Gambetti, Pierluigi. "Gerstmann-Sträussler-Scheinker Disease". The Merck Manuals: Online Medical Library. Retrieved 4/6/11.
- Gerstmann–Sträussler–Scheinker syndrome, MedicineNet.com
- UK CJD Surveillance Unit Monitors UK GSS cases and gives a comprehensive list of relevant links.
- Italian Spongiform Encephalopathies Association—AIEnP onlus
- A.I.En.P. Association Cause