DI 23022.127: CACH- Vanishing White Matter Disease- Congenital, Infantile and Early Childhood Onset Forms
Effective Dates: 09/15/2017 - Present
- TN 15 (09-17)
DI 23022.127 CACH- Vanishing White Matter Disease- Child CACH – VANISHING WHITE MATTER DISEASE- INFANITILE AND CHILDHOOD ONSET FORMS
- ALTERNATE NAMES
Childhood Ataxia with Central Hypomyelination; Childhood ataxia with diffuse central nervous system hypomyelination; CACH Syndrome; Leukoencephalopathy with Vanishing White Matter Disease; Leukoencephalopathy with Vanishing White MatterMyelinosis Centralis Diffusa; Cree Leukoencephalopathy; Cree Leukodystrophy
- Childhood Ataxia with Central Nervous System Hypomyelination/Vanishing White Matter Disease (CACH-VWM) is a progressive disorder that mainly affects the brain and spinal cord (central nervous system). This leukodystrophy disorder causes deterioration of the CNS white matter, which consists of nerve fibers covered by myelin. Myelin is the fatty substance that insulates and protects nerves. In most cases, children with CACH show no signs or symptoms of the disorder at birth. Affected children may have slightly delayed development of motor skills such as crawling or walking. During early childhood, previously healthy children begin to develop motor impairments, including abnormal muscle stiffness (spasticity) and difficulty with coordinating movements (ataxia). There may also be some deterioration of mental functioning, but this is not usually as pronounced as the motor impairments. Specific changes in the brain are seen using magnetic resonance imaging (MRI) are characteristic of CACH-VWM and may be visible before the onset of symptoms.
- DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM CODING
- Diagnostic testing: The diagnosis of CACH-VWM is made by physical examination; MRI demonstrating bilateral cerebral destruction of white matter; Genetic testing documenting mutations in one of the five causative gene mutations (EIF2B1, EIF2B2, EIF2B3, EIF2B4, and EIF2B5).
- Physical findings: Children with CACH-VWM have cerebellar ataxia, hypotonia or spasticity, difficulty swallowing (bulbar symptoms), optic atrophy, and lethargy.
- ICD-9: 330.0
- ONSET AND PROGRESSION
With CACH-VWM, generally the earlier onset of symptoms and signs correlates with faster progression and worse prognosis. The congenital and infantile onset forms result in death by age 2 years. The childhood onset form is the most common with onset between 1 and 5 years, with less spasticity and usually no cognitive decline. Most children with the childhood form die within a few years of onset.
- Currently there is no cure for CACH-VWM disease. Treatment is symptom specific and supportive. Physical therapy and rehabilitation may be prescribed for motor dysfunction (e.g. spasticity and ataxia); antiepileptic drugs for seizures. Referral to age-appropriate early childhood intervention program or special education.
- SUGGESTED PROGRAMMATIC ASSESSMENT*
- Suggested MER for evaluation:
- * Clinical history and examination that describes the diagnostic features of the impairment.
- * Imaging studies.
- * Genetic testing revealing a mutation in the EIF2B gene is definitive.
- Suggested Listings for Evaluation:
- Meets Listing
- Listing-level severity must be documented.
- Medical Equals
- * 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.
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