Causes and Risks: Lesch-Nyhan syndrome is inherited as an X-linked trait, therefore the disease is seen only in males. The disease is characterized by increased blood and urine uric acid levels and by the absence of the enzyme hypoxanthine guanine phosphoribosyltransferase (HGP).

Affected males have delayed motor development followed by bizarre sinuous movements and increased deep tendon reflexes. A striking feature of Lesch-Nyhan syndrome is self-destructive behavior characterized by chewing off fingertips and lips if not restrained. Children may also develop gout-like swelling in some of their joints.

Prevention: Genetic counseling for prospective parents with a family history of Lesch-Nyhan syndrome is recommended. The carrier state of the mother may be determined by culture of skin fibroblasts. Half the fibroblasts will have normal levels of the HGP enzyme and the remaining half will have deficient or absent HGP.

Symptoms:

• family history of Lesch-Nyhan syndrome
• male infant with delayed motor development
• movement disorder
• destructive chewing of fingers or lips (self-destructive behavior)

Signs and Tests: Physical examination and testing may show:

• hyperreflexia
• spasticity
• choreoathetoid movements
• compulsive self-destructive behavior
• increased serum uric acid
• increase excretion of uric acid, urine
• decreased HGP levels in cultured fibroblasts

• serum chemistry, uric acid
• urine chemistry, uric acid
• skin biopsy tissue culture (fibroblasts)

Treatment: No specific treatment exists for Lesch-Nyhan syndrome. Allopurinol has been tried and although it decreases the uric acid concentrations, it does not improve the neurological outcome. Recent advances in recombinant DNA techniques have allowed the gene responsible for the production of HGP to be cloned. Attempts will be made in the future to insert this gene into a patient’s genetic material to determine if it will correct the metabolic defect.

Prognosis: The outcome is likely to be poor even with attempts to treat the condition.

Complications: Severe progressive debility is likely.

Call your health care provider if signs of this illness appear in your child or if there is a history of Lesch-Nyhan syndrome in your family.