EduPort 2025, 9(1) | DOI: 10.21062/edp.2025.001

LIFE WITH GLYCOGENOSIS IXa: DELAYED DEVELOPMENT AND THE PATH TO THERAPY IN A CASE STUDY

Barbora Lanková1, Michal Vostrý1,2, Veronika Kvochová2, Ilona Pešatová1, Radka Beranová2, Ivana Štolová2
1 Faculty od Education, J. E. Purkyně Unviersity in Ústí nad Labem (Czech Republic)
2 Faculty of Health Studies, J. E. Purkyně Unviersity in Ústí nad Labem (Czech Republic)

This article presents a case study of a child diagnosed with glycogenosis IXa, a rare metabolic disorder caused by a deficiency of phosphorylase b kinase, which disrupts glycogen metabolism and leads to its accumulation in the liver. This condition results in a range of clinical manifestations, including hepatomegaly, hypoglycemia, muscle hypotonia, delayed psychomotor development, and other neurological impairments. The study focuses on a detailed description of the patient's clinical symptoms, which include difficulties with gross and fine motor skills, delayed speech and cognitive development, reduced physical activity, and problems maintaining balance. As part of the proposed therapy, the article highlights the importance of a multidisciplinary approach encompassing medical, rehabilitative, psychological, and educational care. Various rehabilitation methods are discussed, including proprioceptive neuromuscular facilitation (PNF), acral coactivation therapy (ACT), and sensorimotor stimulation, all aimed at increasing muscle tone, improving motor functions, and enhancing coordination. Speech therapy focuses on the development of speech and communication skills, with interventions tailored to the child's individual needs. Pharmacological treatment includes the administration of nootropics to support the development of the central nervous system, and dietary therapy also plays a crucial role, aiming to prevent hypoglycemia and promote growth through a diet rich in proteins and complex carbohydrates. The presented case underscores the significance of multidisciplinary team collaboration and individually tailored therapeutic approaches to ensure optimal care for patients with glycogenosis IXa. The study also opens avenues for further research into the long-term effectiveness of various therapeutic methods, with the goal of improving patients' quality of life and minimizing complications associated with this chronic metabolic disorder.

Keywords: glycogenosis, metabolic disorders, psychomotor retardation, multidisciplinary collaboration, helping professions, delayed development

Published: January 1, 2025  Show citation

ACS AIP APA ASA Harvard Chicago IEEE ISO690 MLA NLM Turabian Vancouver
Lanková B, Vostrý M, Kvochová V, Pešatová I, Beranová R, Štolová I. LIFE WITH GLYCOGENOSIS IXa: DELAYED DEVELOPMENT AND THE PATH TO THERAPY IN A CASE STUDY. EduPort. 2025;9(1):. doi: 10.21062/edp.2025.001.
Download citation

References

  1. Beauchamp, N. J., Dalton, A., Ramaswami, U., Niinikoski, H., Mention, K., Kenny, P., Kolho, K.-L., Raiman, J., Walter, J., Treacy, E., Tanner, S., & Sharrard, M. (2007). Glycogen storage disease type IX: High variability in clinical phenotype. Molecular Genetics and Metabolism, 92(1), 88-99. https://doi.org/10.1016/j.ymgme.2007.06.007 Go to original source...
  2. Brown, L. M., Corrado, M. M., van der Ende, R. M., Derks, T. G. J., Chen, M. A., Siegel, S., Hoyt, K., Correia, C. E., Lumpkin, C., Flanagan, T. B., Carreras, C. T., & Weinstein, D. A. (2015). Evaluation of glycogen storage disease as a cause of ketotic hypoglycemia in children. Journal of Inherited Metabolic Disease, 38(3), 489-493. https://doi.org/10.1007/s10545-014-9744-1 Go to original source...
  3. Burwinkel, B., Amat, L., Gray, R. G., Matsuo, N., Muroya, K., Narisawa, K., Sokol, R. J., Vilaseca, M. A., & Kilimann, M. W. (1998). Variability of biochemical and clinical phenotype in X-linked liver glycogenosis with mutations in the phosphorylase kinase PHKA2 gene. Human Genetics, 102(4), 423-429. https://doi.org/10.1007/s004390050715 Go to original source...
  4. Davidson, J. J., Ozçelik, T., Hamacher, C., Willems, P. J., Francke, U., & Kilimann, M. W. (1992). cDNA cloning of a liver isoform of the phosphorylase kinase alpha subunit and mapping of the gene to Xp22.2-p22.1, the region of human X-linked liver glycogenosis. Proceedings of the National Academy of Sciences of the United States of America, 89(6), 2096-2100. https://doi.org/10.1073/pnas.89.6.2096 Go to original source...
  5. Derks, T. G. J., Peeks, F., de Boer, F., Fokkert-Wilts, M., van der Doef, H. P. J., van den Heuvel, M. C., Szymańska, E., Rokicki, D., Ryan, P. T., & Weinstein, D. A. (2021). The potential of dietary treatment in patients with glycogen storage disease type IV. Journal of Inherited Metabolic Disease, 44(3), 693-704. https://doi.org/10.1002/jimd.12339 Go to original source...
  6. Fu, J., Wang, T., & Xiao, X. (2019). A novel PHKA2 mutation in a Chinese child with glycogen storage disease type IXa: A case report and literature review. BMC Medical Genetics, 20(1), 56. https://doi.org/10.1186/s12881-019-0789-8 Go to original source...
  7. Goldstein, J., Austin, S., Kishnani, P., & Bali, D. (1993). Phosphorylase kinase deficiency. In R. A. Pagon, M. P. Adam, H. H. Ardinger, & et al. (Eds.), GeneReviews®. University of Washington.
  8. Hendrickx, J., Dams, E., Coucke, P., Lee, P., Fernandes, J., & Willems, P. J. (1996). X-linked liver glycogenosis type II (XLG II) is caused by mutations in PHKA2, the gene encoding the liver alpha subunit of phosphorylase kinase. Human Molecular Genetics, 5(5), 649-652. https://doi.org/10.1093/hmg/5.5.649 Go to original source...
  9. Hermens, H. J., Freriks, B., Disselhorst-Klug, C., & Rau, G. (2006). Development of recommendations for SEMG sensors and sensor placement procedures. Journal of Electromyography and Kinesiology, 10(5), 361-374. https://doi.org/10.1016/S1050-6411(00)00027-4 Go to original source...
  10. Hug, G., Schubert, W. K., & Chuck, G. (1966). Phosphorylase kinase of the liver: Deficiency in a girl with increased hepatic glycogen. Science, 153(3743), 1534-1535. https://doi.org/10.1126/science.153.3743.1534 Go to original source...
  11. Johnson, A. O., Goldstein, J. L., & Bali, D. (2012). Glycogen storage disease type IX: Novel PHKA2 missense mutation and cirrhosis. Journal of Pediatric Gastroenterology & Nutrition, 55(1), 90-92. https://doi.org/10.1097/MPG.0b013e31823276ea Go to original source...
  12. Kanungo, S., Wells, K., Tribett, T., & El-Gharbawy, A. (2018). Glycogen metabolism and glycogen storage disorders. Annals of Translational Medicine, 6(24), 474. https://doi.org/10.21037/atm.2018.10.59 Go to original source...
  13. Karande, I. S., Boulter, E., Queit, L., & Balasubramaniam, S. (2016). Structured dietary management dramatically improves marked transaminitis, metabolic and clinical profiles in glycogen storage disease type IXa. Journal of Inborn Errors of Metabolism and Screening, 4, 2326409816682766. https://doi.org/10.1177/2326409816682766 Go to original source...
  14. Kim, J. A., Kim, J. H., Lee, B. H., Kim, G. H., Shin, Y. S., Yoo, H. W., & Kim, K. M. (2015). Clinical, biochemical, and genetic characterization of glycogen storage type IX in a child with asymptomatic hepatomegaly. Pediatric Gastroenterology, Hepatology & Nutrition, 18(2), 138-142. https://doi.org/10.5223/pghn.2015.18.2.138 Go to original source...
  15. Kishnani, P. S., Goldstein, J. L., Austin, S. L., Arn, P., Bachrach, B., Bali, D. S., Chung, W. K., El-Gharbawy, A., Brown, L. M., Kahler, S., Pendyal, S., Ross, K. M., Tsilianidis, L., Weinstein, D. A., Watson, M. S., & ACMG Work Group on Diagnosis and Management of Glycogen Storage Diseases Type VI and IX. (2019). Diagnosis and management of glycogen storage diseases type VI and IX: A clinical practice resource of the American College of Medical Genetics and Genomics (ACMG). Genetics in Medicine, 21(4), 772-789. https://doi.org/10.1038/s41436-018-0364-2 Go to original source...
  16. Lau, C.-K., Hui, J., Fong, F. N. Y., To, K.-F., Fok, T.-F., Tang, N. L. S., & Tsui, S. K. W. (2011). Novel mutations in PHKA2 gene in glycogen storage disease type IX patients from Hong Kong, China. Molecular Genetics and Metabolism, 102(2), 222-225. https://doi.org/10.1016/j.ymgme.2010.11.004 Go to original source...
  17. Maichele, A. J., Burwinkel, B., Maire, I., Søvik, O., & Kilimann, M. W. (1996). Mutations in the testis/liver isoform of the phosphorylase kinase gamma subunit (PHKG2) cause autosomal liver glycogenosis in the gsd rat and in humans. Nature Genetics, 14(3), 337-340. https://doi.org/10.1038/ng1196-337 Go to original source...
  18. Massese, M., Tagliaferri, F., Dionisi-Vici, C., & Maiorana, A. (2022). Glycogen storage diseases with liver involvement: A literature review of GSD type 0, IV, VI, IX and XI. Orphanet Journal of Rare Diseases, 17(1), 241. https://doi.org/10.1186/s13023-022-02387-6 Go to original source...
  19. Morava, E., Wortmann, S. B., van Essen, H. Z., Liebrand van Sambeek, R., Wevers, R., & van Diggelen, O. P. (2005). Biochemical characteristics and increased tetraglucoside excretion in patients with phosphorylase kinase deficiency. Journal of Inherited Metabolic Disease, 28(5), 703-706. https://doi.org/10.1007/s10545-005-0095-9 Go to original source...
  20. Nguyen, N.-L., Thi Bich Ngoc, C., Dung Vu, C., Van Tung, N., & Hoang Nguyen, H. (2020). A novel frameshift PHKA2 mutation in a family with glycogen storage disease type IXa: A first report in Vietnam and review of literature. Clinica Chimica Acta, 508, 9-15. https://doi.org/10.1016/j.cca.2020.05.010 Go to original source...
  21. Ozen, H. (2007). Glycogen storage diseases: New perspectives. World Journal of Gastroenterology, 13(18), 2541-2553. https://doi.org/10.3748/wjg.v13.i18.2541 Go to original source...
  22. Pennisi, A., Maranda, B., Benoist, J.-F., Baudouin, V., Rigal, O., Pichard, S., Santer, R., Romana Lepri, F., Novelli, A., Ogier de Baulny, H., Dionisi-Vici, C., & Schiff, M. (2020). Nocturnal enteral nutrition is therapeutic for growth failure in Fanconi-Bickel syndrome. Journal of Inherited Metabolic Disease, 43(3), 540-548. https://doi.org/10.1002/jimd.12203 Go to original source...
  23. Roscher, A., Patel, J., Hewson, S., Nagy, L., Feigenbaum, A., Kronick, J., Raiman, J., Schulze, A., Siriwardena, K., & Mercimek-Mahmutoglu, S. (2014). The natural history of glycogen storage disease types VI and IX: Long-term outcome from the largest metabolic center in Canada. Molecular Genetics and Metabolism, 113(3), 171-176. https://doi.org/10.1016/j.ymgme.2014.09.005 Go to original source...
  24. Ross, K. M., Ferrecchia, I. A., Dahlberg, K. R., Dambska, M., Ryan, P. T., & Weinstein, D. A. (2020). Dietary management of the glycogen storage diseases: Evolution of treatment and ongoing controversies. Advances in Nutrition, 11(2), 439-446. https://doi.org/10.1093/advances/nmz092 Go to original source...
  25. Schippers, H. M., Smit, G. P. A., Rake, J. P., & Visser, G. (2003). Characteristic growth pattern in male X-linked phosphorylase-b kinase deficiency (GSD IX). Journal of Inherited Metabolic Disease, 26(1), 43-47. https://doi.org/10.1023/A:1024071328772 Go to original source...
  26. Schönau, E. (1996). A longitudinal evaluation of bone mineral density in adult men with histories of delayed puberty. The Journal of Clinical Endocrinology and Metabolism, 81(10), 3812-3813. https://doi.org/10.1210/jcem.81.10.8855844 Go to original source...
  27. Smith, C., Care4Rare Canada Consortium, Dicaire, M.-J., Brais, B., & La Piana, R. (2020). Neurological involvement in glycogen storage disease type IXa due to PHKA2 mutation. Canadian Journal of Neurological Sciences, 47(3), 400-403. https://doi.org/10.1017/cjn.2020.18 Go to original source...
  28. Tsilianidis, L. A., Fiske, L. M., Siegel, S., Lumpkin, C., Hoyt, K., Wasserstein, M., & Weinstein, D. A. (2013). Aggressive therapy improves cirrhosis in glycogen storage disease type IX. Molecular Genetics and Metabolism, 109(2), 179-182. https://doi.org/10.1016/j.ymgme.2013.03.009 Go to original source...
  29. Waheed, N., Saeed, A., Ijaz, S., Fayyaz, Z., Anjum, M. N., Zahoor, Y., & Cheema, H. A. (2020). Variability of clinical and biochemical phenotype in liver phosphorylase kinase deficiency with variants in the phosphorylase kinase (PHKG2) gene. Journal of Pediatric Endocrinology & Metabolism, 33(9), 1117-1123. https://doi.org/10.1515/jpem-2019-0603 Go to original source...
  30. Walter, J., Labrune, P. A., & Laforet, P. (2016). The glycogen storage diseases and related disorders. In J.-M. Saudubray, M. R. Baumgartner, & J. Walter (Eds.), Inborn Metabolic Diseases (pp. 121-137). Springer. Go to original source...
  31. Willems, P. J., Gerver, W. J., Berger, R., & Fernandes, J. (1990). The natural history of liver glycogenosis due to phosphorylase kinase deficiency: A longitudinal study of 41 patients. European Journal of Pediatrics, 149(4), 268-271. https://doi.org/10.1007/bf02106291 Go to original source...
  32. Zhu, Y., Wang, S., Peng, Y., Chen, Y., Chen, R., Ke, G., & Li, J. (2023). Research and implementation of intelligent learning desk based on visio sensor in AI IoT environments for smart education. Sensors and Materials, 35(12), 4251. https://doi.org/10.18494/SAM4339 Go to original source...

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0), which permits non-comercial use, distribution, and reproduction in any medium, provided the original publication is properly cited. No use, distribution or reproduction is permitted which does not comply with these terms.