Gangliosides are complex sphingolipids present in the brain. There are 2 major forms, GM1 and GM2, both of which may be involved in lysosomal storage disorders. There are 2 main types of GM2 gangliosidosis, each of which can be caused by numerous different mutations.
For more information, see table Some Sphingolipidoses.
Tay-Sachs disease
Deficiency of hexosaminidase A results in accumulation of GM2 in the brain. Inheritance is autosomal recessive; the most common mutations are carried by 1/27 normal adults of Eastern European (Ashkenazi) Jewish origin, although other mutations cluster in some French-Canadian and Cajun populations.
Children with Tay-Sachs disease start missing developmental milestones after age 6 months and develop progressive cognitive and motor deterioration resulting in seizures, intellectual disability, paralysis, and death by age 5 years. A cherry-red macular spot is common.
Diagnosis of Tay-Sachs disease is clinical and can be confirmed by DNA analysis and/or enzyme assay. (Also see testing for suspected inherited disorders of metabolism.)
In the absence of effective treatment, management is focused on screening adults of childbearing age in high-risk populations to identify carriers (by way of enzyme activity and mutation testing) combined with genetic counseling.
Sandhoff disease
There is a combined hexosaminidase A and B deficiency. Clinical manifestations include progressive cerebral degeneration beginning at 6 months, accompanied by blindness, cherry-red macular spot, and hyperacusis. It is almost indistinguishable from Tay-Sachs disease in course, diagnosis, and management, except that there is visceral involvement (hepatomegaly and bone change) and no ethnic association.
