Holoprosencephaly

This relatively common birth defect of the brain, often also affects facial features, causing closely spaced eyes, small head size, and sometimes clefts of the lip and roof of the mouth. Not all individuals with holoprosencephaly (HPE) are affected to the same degree, even in families where more than one individual has this predisposition. The risk of reoccurrence is small in most families. The best diagnostic procedure is a brain scan (CT or MRI). There are a number of causes of HPE, including genetic alterations and environmental effects. HPE’s cause in any individual family may be unknown.

Holoprosencephaly is characterized by the failure of the prosencephalon (the forebrain of the embryo) to develop. During normal development, the forebrain is formed and the face begins to develop in the fifth and sixth weeks of pregnancy. Holoprosencephaly is caused by a failure of the embryo’s forebrain to divide to form bilateral cerebral hemispheres (the left and right halves of the brain), causing developmental defects of the face and in brain structure.

Holoprosencephaly has three classifications. Alobar holoprosencephaly is the most serious form because the brain fails to separate and is usually associated with severe facial anomalies. Semilobar holoprosencephaly shows the brain’s hemispheres have a slight tendency to separate and is a more intermediate form. Lobar holoprosencephaly, in which there is considerable evidence of separate brain hemispheres, is the least severe form. In some cases of lobar holoprosencephaly, the patient’s brain may be nearly normal.

Holoprosencephaly, once called arhinencephaly, consists of a spectrum of defects or malformations of the brain and face. At the most severe end of this spectrum are cases involving serious brain malformations, some so severe that they are incompatible with life and often cause spontaneous intrauterine death. At the other end of the spectrum are individuals with facial defects – which may affect the eyes, nose, and upper lip – and normal or near-normal brain development. Seizures and mental retardation may occur.

The most severe of the facial defects (or anomalies) is cyclopia, an abnormality characterized by the development of a single eye, located in the area normally occupied by the root of the nose, and a missing nose or a nose in the form of a proboscis (a tubular appendage) located above the eye.

Ethmocephaly is the least common facial anomaly. It consists of a proboscis separating narrow-set eyes with an absent nose and microphthalmia (abnormal smallness of one or both eyes). Cebocephaly, another facial anomaly, is characterized by a small, flattened nose with a single nostril situated below incomplete or underdeveloped closely set eyes.

The least severe in the spectrum of facial anomalies is the median cleft lip, also called premaxillary agenesis.

Approximately one-half of all cases of holoprosencephaly have a chromosomal cause. Trisomy 13 (Patau) syndrome and trisomy 18 (Edwards) syndrome are associated with holoprosencephaly. There is an increased risk for holoprosencephaly in infants born to diabetic mothers.

There is no treatment for holoprosencephaly and the prognosis for individuals with the disorder is poor. Most of those who survive show no significant developmental gains. For children who survive, treatment is symptomatic.