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==Overview==
==Overview==
Angelman syndrome, formerly known as "happy puppet syndrome", is a [[genetic disorder]] characterized by [[Cognitive delay|intelectual]] and [[development delay]], [[Seizure|seizures]], [[puppet-like movement]], unprovoked [[laughter]]/[[Smile|smiling]], and excessive [[socialization]] with strangers.<ref name=":0">{{Cite book|title=Deletion Syndromes/ Step up to USMLE step 2CK|last=Jenkins|first=Brian|publisher=Wolters Kluwer|year=2016|isbn=978-1496309747|location=Fort Worth, Texas|pages=291}}</ref>
Angelman syndrome, formerly known as "happy puppet syndrome", is a [[genetic disorder]] characterized by [[Cognitive delay|intelectual]] and [[development delay]], [[Seizure|seizures]], [[puppet-like movement]], unprovoked [[laughter]]/[[Smile|smiling]], and excessive [[socialization]] with strangers.


<br />
<br />
==Historical Perspective==
==Historical Perspective==


* Angelman syndrome was first [[discovered]] by [[Dr. Harry Angelman]], a British [[Pediatricians|pediatrician]], in 1965 during his seminar, where he described three children with the typical [[facies]] of the [[syndrome]].<ref name="doctor">{{WhoNamedIt|synd|225|Angelman's syndrome}}</ref><ref name="Angelman2008">{{cite journal|last1=Angelman|first1=Harry|title=‘Puppet’ Children A Report on Three Cases|journal=Developmental Medicine & Child Neurology|volume=7|issue=6|year=2008|pages=681–688|issn=00121622|doi=10.1111/j.1469-8749.1965.tb07844.x}}</ref>
*Angelman syndrome was first [[discovered]] by [[Dr. Harry Angelman]], a British [[Pediatricians|pediatrician]], in 1965 during his seminar, where he described three children with the typical [[facies]] of the [[syndrome]].<ref name="doctor">{{WhoNamedIt|synd|225|Angelman's syndrome}}</ref><ref name="Angelman2008">{{cite journal|last1=Angelman|first1=Harry|title=‘Puppet’ Children A Report on Three Cases|journal=Developmental Medicine & Child Neurology|volume=7|issue=6|year=2008|pages=681–688|issn=00121622|doi=10.1111/j.1469-8749.1965.tb07844.x}}</ref>
* In 1965,Dr. Angelman quoted in his seminal paper:
*In 1965,Dr. Angelman quoted in his seminal paper:


''"I happened to see an oil painting...called... "a Boy with a Puppet". The boy's laughing face and the fact that my patients exhibited jerky movements gave me the idea of writing an article about the three children with a title of Puppet Children."''<ref name="doctor" />
''"I happened to see an oil painting...called... "a Boy with a Puppet". The boy's laughing face and the fact that my patients exhibited jerky movements gave me the idea of writing an article about the three children with a title of Puppet Children."''<ref name="doctor" />


* In 1987, maternal [[allele]] [[Deletion (genetics)|deletion]] in [[chromosome 15]] was first identified in the [[pathogenesis]] of Angelman syndrome.<ref name="pmid22830052">{{cite journal |vauthors=Jana NR |title=Understanding the pathogenesis of Angelman syndrome through animal models |journal=Neural Plast. |volume=2012 |issue= |pages=710943 |date=2012 |pmid=22830052 |pmc=3399338 |doi=10.1155/2012/710943 |url=}}</ref>
*In 1987, maternal [[allele]] [[Deletion (genetics)|deletion]] in [[chromosome 15]] was first identified in the [[pathogenesis]] of Angelman syndrome.<ref name="pmid22830052">{{cite journal |vauthors=Jana NR |title=Understanding the pathogenesis of Angelman syndrome through animal models |journal=Neural Plast. |volume=2012 |issue= |pages=710943 |date=2012 |pmid=22830052 |pmc=3399338 |doi=10.1155/2012/710943 |url=}}</ref>
* In 1994 [[Point mutation|point mutations]] in ''UBE3A'' [[gene]] was known to be the [[gene]] responsible for Angelman syndrome.<ref name="pmid22830052" /><ref name="pmid9585605">{{cite journal |vauthors=Malzac P, Webber H, Moncla A, Graham JM, Kukolich M, Williams C, Pagon RA, Ramsdell LA, Kishino T, Wagstaff J |title=Mutation analysis of UBE3A in Angelman syndrome patients |journal=Am. J. Hum. Genet. |volume=62 |issue=6 |pages=1353–60 |date=June 1998 |pmid=9585605 |pmc=1377156 |doi=10.1086/301877 |url=}}</ref>
*In 1994 [[Point mutation|point mutations]] in ''UBE3A'' [[gene]] was known to be the [[gene]] responsible for Angelman syndrome.<ref name="pmid22830052" /><ref name="pmid9585605">{{cite journal |vauthors=Malzac P, Webber H, Moncla A, Graham JM, Kukolich M, Williams C, Pagon RA, Ramsdell LA, Kishino T, Wagstaff J |title=Mutation analysis of UBE3A in Angelman syndrome patients |journal=Am. J. Hum. Genet. |volume=62 |issue=6 |pages=1353–60 |date=June 1998 |pmid=9585605 |pmc=1377156 |doi=10.1086/301877 |url=}}</ref>


<br />
==Pathophysiology==
==Pathophysiology==


=== Modes of Inheritance ===
===Modes of Inheritance===


* In 70% of the cases, Angelman syndrome is caused by a sporadic (de novo) maternal [[Deletion (genetics)|deletion]] in [[Chromosome abnormality|chromosomal]] region [[:File:Angelman.PNG|15q11-13]] causing an absence of [[UBE3A gene|''UBE3A'' gene]], involving the [[Ubiquitin-protein ligase|ubiquitin pathway]].<ref name="Clayton-SmithPembrey1992">{{cite journal|last1=Clayton-Smith|first1=J|last2=Pembrey|first2=M E|title=Angelman syndrome.|journal=Journal of Medical Genetics|volume=29|issue=6|year=1992|pages=412–415|issn=1468-6244|doi=10.1136/jmg.29.6.412}}</ref>
*In 70% of the cases, Angelman syndrome is caused by a sporadic (''de novo'') maternal [[Deletion (genetics)|deletion]] in [[Chromosome abnormality|chromosomal]] region [[:File:Angelman.PNG|15q11-13]] causing an absence of [[UBE3A|''UBE3A'' gene]], involving the [[Ubiquitin-protein ligase|ubiquitin pathway]].<ref name="Clayton-SmithPembrey1992">{{cite journal|last1=Clayton-Smith|first1=J|last2=Pembrey|first2=M E|title=Angelman syndrome.|journal=Journal of Medical Genetics|volume=29|issue=6|year=1992|pages=412–415|issn=1468-6244|doi=10.1136/jmg.29.6.412}}</ref><ref name="pmid194551853">{{cite journal |vauthors=Van Buggenhout G, Fryns JP |title=Angelman syndrome (AS, MIM 105830) |journal=Eur. J. Hum. Genet. |volume=17 |issue=11 |pages=1367–73 |date=November 2009 |pmid=19455185 |pmc=2986680 |doi=10.1038/ejhg.2009.67 |url=}}</ref><ref name="pmid22670133" />  There is a lack of [[Gene expression|expression]] of the [[maternally-inherited]] [[UBE3A|UBE3A gene]] in the brain, while the [[Paternally|paternally-inherited]] copy of [[UBE3A]] is [[Silencer (DNA)|silenced]].<ref name="pmid27860204">{{cite journal |vauthors=Tan WH, Bird LM |title=Angelman syndrome: Current and emerging therapies in 2016 |journal=Am J Med Genet C Semin Med Genet |volume=172 |issue=4 |pages=384–401 |date=December 2016 |pmid=27860204 |doi=10.1002/ajmg.c.31536 |url=}}</ref>
* Other causes include paternal [[uniparental disomy]], [[impringting]] error, [[Chromosomal translocation|translocation]], or single [[Mutation|gene mutation]] in ''UBE3A''.<ref>{{cite journal | author = Weeber E, Levenson J, Sweatt J | title = Molecular genetics of human cognition. | journal = Mol Interv | volume = 2 | issue = 6 | pages = 376-91, 339 | year = 2002 | id = PMID 14993414}}</ref>
*Other causes include paternal [[uniparental disomy]], [[impringting]] error, [[Chromosomal translocation|translocation]], or single [[Mutation|gene mutation]] in ''UBE3A''.<ref>{{cite journal | author = Weeber E, Levenson J, Sweatt J | title = Molecular genetics of human cognition. | journal = Mol Interv | volume = 2 | issue = 6 | pages = 376-91, 339 | year = 2002 | id = PMID 14993414}}</ref><ref name="pmid22670133" />
* 3-5% of cases of Angelman syndrome can be [[inherited]].<ref name=":1">{{Cite web|url=https://rarediseases.org/rare-diseases/angelman-syndrome/|title=Angelman Syndrome|last=Williams|first=Charles|date=|website=National Organization of Rare Diseases|archive-url=|archive-date=|dead-url=|access-date=06/02/2020}}</ref>
*3-5% of cases of Angelman syndrome can be [[inherited]].<ref name=":1">{{Cite web|url=https://rarediseases.org/rare-diseases/angelman-syndrome/|title=Angelman Syndrome|last=Williams|first=Charles|date=|website=National Organization of Rare Diseases|archive-url=|archive-date=|dead-url=|access-date=06/02/2020}}</ref><ref name="pmid194551854">{{cite journal |vauthors=Van Buggenhout G, Fryns JP |title=Angelman syndrome (AS, MIM 105830) |journal=Eur. J. Hum. Genet. |volume=17 |issue=11 |pages=1367–73 |date=November 2009 |pmid=19455185 |pmc=2986680 |doi=10.1038/ejhg.2009.67 |url=}}</ref>
* In approximately 10% of cases, no cause can be identified.<ref name=":1" />
*[[Recurrence quantification analysis|Recurrence]] of Angelman syndrome in subsequent children when having a child with a ''[[De novo mutation|de novo]]'' [[Deletion (genetics)|deletion]] is estimated around 1%.<ref name="pmid194551855">{{cite journal |vauthors=Van Buggenhout G, Fryns JP |title=Angelman syndrome (AS, MIM 105830) |journal=Eur. J. Hum. Genet. |volume=17 |issue=11 |pages=1367–73 |date=November 2009 |pmid=19455185 |pmc=2986680 |doi=10.1038/ejhg.2009.67 |url=}}</ref>
*In approximately 10% of cases, no cause can be identified.<ref name=":1" />


=== Phenotype-Gene Relationships ===
===Phenotype-Gene Relationships===
{| class="wikitable"
{| class="wikitable"
!Phenotype
!Phenotype
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|15q11-15q13
|15q11-15q13
|}<br />
|}<br />
== Clinical Features ==
==Clinical Features==
Angelman syndrome is characterized by:
Angelman syndrome is characterized by:


* [[Puppet-like movement]]<ref name=":0" />
*[[Puppet-like movement]]<ref name=":0">{{Cite book|title=Deletion Syndromes/ Step up to USMLE step 2CK|last=Jenkins|first=Brian|publisher=Wolters Kluwer|year=2016|isbn=978-1496309747|location=Fort Worth, Texas|pages=291}}</ref><ref name="pmid145106232" /><ref name="pmid22670133" /><ref name="pmid20445456" />
* [[Cognitive delay|Intelectual]] and [[development delay]]<ref name=":0" />
*[[Cognitive delay|Intelectual]] and [[development delay]]<ref name=":0" /><ref name="pmid194551852">{{cite journal |vauthors=Van Buggenhout G, Fryns JP |title=Angelman syndrome (AS, MIM 105830) |journal=Eur. J. Hum. Genet. |volume=17 |issue=11 |pages=1367–73 |date=November 2009 |pmid=19455185 |pmc=2986680 |doi=10.1038/ejhg.2009.67 |url=}}</ref><ref name="pmid22670133" /><ref name="pmid20445456" />
* [[Seizure|Seizures]]<ref name=":0" />
*[[Seizure|Seizures]]<ref name=":0" /><ref name="pmid22670133" /><ref name="pmid20445456" />
* Unprovoked [[laughter]]/[[Smile|smiling]]<ref name=":0" />
*Unprovoked [[laughter]]/[[Smile|smiling]]<ref name=":0" /><ref name="pmid145106232">{{cite journal |vauthors=Guerrini R, Carrozzo R, Rinaldi R, Bonanni P |title=Angelman syndrome: etiology, clinical features, diagnosis, and management of symptoms |journal=Paediatr Drugs |volume=5 |issue=10 |pages=647–61 |date=2003 |pmid=14510623 |doi=10.2165/00148581-200305100-00001 |url=}}</ref>
* Excessive [[socialization]] with strangers<ref name=":0" />
*Excessive [[socialization]] with strangers<ref name=":0" />
*[[Speech and language pathology|Speech impairment]]
*[[Speech and language pathology|Speech impairment]]<ref name="pmid145106232" /><ref name="pmid22670133" /><ref name="pmid20445456" />


Other less common features are:
Other less common features are:


* Delayed [[Head circumference growth|head circumference]] growth<ref name="SidorovDeck20172" />  
*Delayed [[Head circumference growth|head circumference]] growth<ref name="SidorovDeck20172" />


* [[Suction|Suck]]/[[swallowing]] disorders<ref name="SidorovDeck20172" />  
*[[Suction|Suck]]/[[swallowing]] disorders<ref name="SidorovDeck20172" /><ref name="pmid20445456" />
* [[Feeding]] problems<ref name="SidorovDeck20172" />  
*[[Feeding]] problems<ref name="SidorovDeck20172" />
* Frequent [[drooling]]<ref name="SidorovDeck20172" />
*Frequent [[drooling]]<ref name="SidorovDeck20172" />
* Excessive [[Mastication|chewing]]<ref name="SidorovDeck20172" />  
*Excessive [[Mastication|chewing]]<ref name="SidorovDeck20172" />
* [[Gait abnormality|Wide based gait]]<ref name="SidorovDeck20172" />  
*[[Gait abnormality|Wide based gait]]<ref name="SidorovDeck20172" /><ref name="pmid145106232" />
* Increased [[Hyperesthesia|sensitivity to heat]]<ref name="SidorovDeck20172" />
*Increased [[Hyperesthesia|sensitivity to heat]]<ref name="SidorovDeck20172" />
* [[Insomnia|Diminished need for sleep]]<ref name="SidorovDeck20172" />  
*[[Insomnia|Diminished need for sleep]]<ref name="SidorovDeck20172" />
* Hydrophilia<ref name="SidorovDeck20172" />  
*Hydrophilia<ref name="SidorovDeck20172" />
* Fascination with crinkly things<ref name="SidorovDeck20172" />  
*Fascination with crinkly things<ref name="SidorovDeck20172" />
* Abnormal [[feeding]] conducts<ref name="SidorovDeck20172" />  
*Abnormal [[feeding]] conducts<ref name="SidorovDeck20172" />
* [[Constipation]]<ref name="SidorovDeck20172" />  
*[[Constipation]]<ref name="SidorovDeck20172" />


<br />
==Differentiating {{PAGENAME}} from Other Diseases==
==Differentiating {{PAGENAME}} from Other Diseases==
Angelman syndrome must be differentiated from other diseases that cause intelectual and development delay, dismorfic facies, seizures and/or deletion in chromosome 15, such as:
Angelman syndrome must be differentiated from other [[Genetic diseases|diseases]] that cause intelectual and [[development]] delay, [[Dysmorphic feature|dysmorphic facies]], and [[Seizure|seizures]], such as:
{|
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
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|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Leigh syndrome]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Leigh syndrome]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Progressive [[psychomotor]] regression
*Progressive [[psychomotor]] regression
*[[Seizures]]
*[[Seizures]]
* External [[ophthalmoplegia]]
*External [[ophthalmoplegia]]
*[[Lactic acidosis]]
*[[Lactic acidosis]]
*[[Vomiting]]
*[[Vomiting]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Increased [[lactate]] levels in [[blood]] and [[CSF]]
*Increased [[lactate]] levels in [[blood]] and [[CSF]]
* Genetic testing
*Genetic testing
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* MRI: abnormal [[white matter]] signal in the [[putamen]], [[basal ganglia]], and [[brainstem]] on T2 images
*MRI: abnormal [[white matter]] signal in the [[putamen]], [[basal ganglia]], and [[brainstem]] on T2 images
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Niemann-Pick]] disease type C
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Niemann-Pick]] disease type C
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Progressive [[neurodegeneration]]
*Progressive [[neurodegeneration]]
*[[Hepatosplenomegaly]]
*[[Hepatosplenomegaly]]
* Systemic involvement of [[liver]], [[spleen]], or [[lung]] preceedes [[neurologic]] symptoms
*Systemic involvement of [[liver]], [[spleen]], or [[lung]] preceedes [[neurologic]] symptoms
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Abnormal [[liver]] function tests
*Abnormal [[liver]] function tests
*[[Fibroblast]] cell culture with filipin staining
*[[Fibroblast]] cell culture with filipin staining
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* MRI:
*MRI:
**[[Cerebral]] and [[cerebellar]] [[atrophy]]
**[[Cerebral]] and [[cerebellar]] [[atrophy]]
**Thinning of the [[corpus callosum]]
**Thinning of the [[corpus callosum]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Infantile Refsum disease
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Infantile Refsum disease
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Abnormalities of the [[optic nerve]] and disc
*Abnormalities of the [[optic nerve]] and disc
*[[Retinitis pigmentosa]]
*[[Retinitis pigmentosa]]
*[[Sensorineural]] hearing loss
*[[Sensorineural]] hearing loss
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|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Adrenoleukodystrophy]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Adrenoleukodystrophy]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*[[Cognitive]] and behavioral abnormalities
*[[Cognitive]] and behavioral abnormalities
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*[[Neurologic]] deterioration progresses at a variable rate
*[[Neurologic]] deterioration progresses at a variable rate
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Elevated plasma VLCFA levels
*Elevated plasma VLCFA levels
* Molecular [[genetic testing]] for mutations in the ABCD1 gene
*Molecular [[genetic testing]] for mutations in the ABCD1 gene
| style="background: #F5F5F5; padding: 5px; text-align: center;" | --
| style="background: #F5F5F5; padding: 5px; text-align: center;" | --
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Zellweger syndrome]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Zellweger syndrome]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*[[Craniofacial]] dysmorphism
*[[Craniofacial]] dysmorphism
*[[Hepatomegaly]]
*[[Hepatomegaly]]
* Neonatal [[seizures]]
*Neonatal [[seizures]]
* Profound developmental delay
*Profound developmental delay
*[[MRI]] findings include [[cortical]] and [[white matter]] abnormalities
*[[MRI]] findings include [[cortical]] and [[white matter]] abnormalities
*[[Neurologic deterioration]] is rapid and infants rarely survive beyond six months of age
*[[Neurologic deterioration]] is rapid and infants rarely survive beyond six months of age
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Elevated plasma VLCFA levels
*Elevated plasma VLCFA levels
* Elevated levels of [[phytanic acid]], pristanic acid, and pipecolic acid in plasma and [[fibroblasts]]
*Elevated levels of [[phytanic acid]], pristanic acid, and pipecolic acid in plasma and [[fibroblasts]]
* Reduced plasmalogen in [[erythrocytes]]
*Reduced plasmalogen in [[erythrocytes]]
* Molecular [[genetic]] testing for [[mutations]] in the PEX1 or PEX6 genes
*Molecular [[genetic]] testing for [[mutations]] in the PEX1 or PEX6 genes
| style="background: #F5F5F5; padding: 5px; text-align: center;" | --
| style="background: #F5F5F5; padding: 5px; text-align: center;" | --
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pyruvate dehydrogenase deficiency]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pyruvate dehydrogenase deficiency]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
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| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*[[Lactic acidosis]]
*[[Lactic acidosis]]
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*[[Intellectual disability]]
*[[Intellectual disability]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Elevated [[lactate]] and pyruvate levels in [[blood]] and CSF
*Elevated [[lactate]] and pyruvate levels in [[blood]] and CSF
* Abnormal PDH enzymatic activity in cultured fibroblasts
*Abnormal PDH enzymatic activity in cultured fibroblasts
| style="background: #F5F5F5; padding: 5px; text-align: center;" | --
| style="background: #F5F5F5; padding: 5px; text-align: center;" | --
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Arginase deficiency]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Arginase deficiency]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
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| style="background: #F5F5F5; padding: 5px;" |
*[[Hyperammonemia]]
*[[Hyperammonemia]]
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*[[Respiratory alkalosis]]
*[[Respiratory alkalosis]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Elevated [[ammonia]] level
*Elevated [[ammonia]] level
* Elevated [[arginine]] level
*Elevated [[arginine]] level
| style="background: #F5F5F5; padding: 5px; text-align: center;" | --
| style="background: #F5F5F5; padding: 5px; text-align: center;" | --
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Holocarboxylase synthetase deficiency
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Holocarboxylase synthetase deficiency
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*[[Ketoacidosis]]
*[[Ketoacidosis]]
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| style="background: #F5F5F5; padding: 5px;" |Elevated levels of:
| style="background: #F5F5F5; padding: 5px;" |Elevated levels of:


* Beta-hydroxyisovalerate
*Beta-hydroxyisovalerate
* Beta-methylcrotonylglycine
*Beta-methylcrotonylglycine
* Beta-hydroxypropionate
*Beta-hydroxypropionate
* Methylcitrate
*Methylcitrate
* Tiglylglycine
*Tiglylglycine
| style="background: #F5F5F5; padding: 5px; text-align: center;" | --
| style="background: #F5F5F5; padding: 5px; text-align: center;" | --
|-
|-
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| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>+</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Episodes of [[metabolic decompensation]] and [[encephalopathy]] often precipitated by [[infection]] and [[fever]]
*Episodes of [[metabolic decompensation]] and [[encephalopathy]] often precipitated by [[infection]] and [[fever]]
* Rarely presents in the newborn period
*Rarely presents in the newborn period
* Microencephalic [[macrocephaly]]
*Microencephalic [[macrocephaly]]
*[[Seizures]] (approximately 20 percent)
*[[Seizures]] (approximately 20 percent)
*[[Cognitive function]] is preserved
*[[Cognitive function]] is preserved
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*[[glutaric acid]]
*[[glutaric acid]]
* 3-hydroxyglutaric acid
*3-hydroxyglutaric acid
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* MRI:
*MRI:
**[[Frontal]] and [[temporal]] [[atrophy]]
**[[Frontal]] and [[temporal]] [[atrophy]]
|-
|-
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| style="background: #F5F5F5; padding: 5px;" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px;" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Progressive [[cerebellar]] [[ataxia]]
*Progressive [[cerebellar]] [[ataxia]]
* Abnormal eye movements
*Abnormal eye movements
*[[Oculocutaneous]] [[telangiectasias]]
*[[Oculocutaneous]] [[telangiectasias]]
* Immune deficiency
*Immune deficiency
* Increased risk of [[malignancy]]
*Increased risk of [[malignancy]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Elevated serum alpha-fetoprotein level
*Elevated serum alpha-fetoprotein level
* Low [[IgA]] and [[IgG]] levels
*Low [[IgA]] and [[IgG]] levels
*[[Lymphopenia]]
*[[Lymphopenia]]
* Genetic testing for [[mutation]] in the ATM gene
*Genetic testing for [[mutation]] in the ATM gene
| style="background: #F5F5F5; padding: 5px; text-align: center;" | --
| style="background: #F5F5F5; padding: 5px; text-align: center;" | --
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pontocerebellar]] [[hypoplasias]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pontocerebellar]] [[hypoplasias]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Progressive muscle [[atrophy]]
*Progressive muscle [[atrophy]]
*[[Microcephaly]]
*[[Microcephaly]]
*[[Developmental delay]]
*[[Developmental delay]]
| style="background: #F5F5F5; padding: 5px;" |[[Genetic]] testing for PCH gene mutations
| style="background: #F5F5F5; padding: 5px;" |[[Genetic]] testing for PCH gene mutations
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* MRI :
*MRI :
**Small [[cerebellum]] and [[brainstem]] including the [[pons]]
**Small [[cerebellum]] and [[brainstem]] including the [[pons]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Metachromatic leukodystrophy]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Metachromatic leukodystrophy]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Regression of motor skills
*Regression of motor skills
*[[Seizures]]
*[[Seizures]]
*[[Optic atrophy]]
*[[Optic atrophy]]
* Reduced or absent [[deep tendon reflexes]]
*Reduced or absent [[deep tendon reflexes]]
*[[Intellectual disability]]
*[[Intellectual disability]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Deficient arylsulfatase A enzyme activity in [[leukocytes]] or cultured skin fibroblasts
*Deficient arylsulfatase A enzyme activity in [[leukocytes]] or cultured skin fibroblasts
| style="background: #F5F5F5; padding: 5px; text-align: center;" | --
| style="background: #F5F5F5; padding: 5px; text-align: center;" | --
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pelizaeus-Merzbacher]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pelizaeus-Merzbacher]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*[[Nystagmus]]
*[[Nystagmus]]
*[[Cognitive impairment]]
*[[Cognitive impairment]]
* Onset in infancy
*Onset in infancy
* Slowly progressive
*Slowly progressive
* Language development may be normal
*Language development may be normal
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*[[Genetic]] testing for [[mutations]] in PLP1 gene
*[[Genetic]] testing for [[mutations]] in PLP1 gene
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|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Angelman syndrome]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Angelman syndrome]]
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Profound [[intellectual disability]]
*Profound [[intellectual disability]]
* Postnatal [[microcephaly]]
*Postnatal [[microcephaly]]
* Typical abnormal behaviors (paroxysmal laughter, easily excitable)
*Typical abnormal behaviors (paroxysmal laughter, easily excitable)
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Methylation studies and [[chromosome]] microarray to detect chromosome 15 anomalies and UBE3A mutations
*Methylation studies and [[chromosome]] microarray to detect chromosome 15 anomalies and UBE3A mutations
| style="background: #F5F5F5; padding: 5px; text-align: center;" | --
| style="background: #F5F5F5; padding: 5px; text-align: center;" | --
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Rett syndrome]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Rett syndrome]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Occurs almost exclusively in females
*Occurs almost exclusively in females
* Normal development during first six months followed by regression and loss of milestones
*Normal development during first six months followed by regression and loss of milestones
* Loss of speech capability
*Loss of speech capability
* Stereotypic hand movements
*Stereotypic hand movements
*[[Seizures]]
*[[Seizures]]
*[[Autistic]] features
*[[Autistic]] features
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Clinical diagnosis
*Clinical diagnosis
*[[Genetic]] testing for MECP2 mutations
*[[Genetic]] testing for MECP2 mutations
| style="background: #F5F5F5; padding: 5px; text-align: center;" | --
| style="background: #F5F5F5; padding: 5px; text-align: center;" | --
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Lesch-Nyhan syndrome]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Lesch-Nyhan syndrome]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*[[Self-mutilating]] behavior
*[[Self-mutilating]] behavior
*[[Urinary]] stones due to [[hyperuricemia]]
*[[Urinary]] stones due to [[hyperuricemia]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Elevated [[uric acid]] level
*Elevated [[uric acid]] level
* Abnormal enzymatic activity of HPRT in cultured fibroblasts
*Abnormal enzymatic activity of HPRT in cultured fibroblasts
*[[Genetic]] testing for HPRT gene [[mutations]]
*[[Genetic]] testing for HPRT gene [[mutations]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | --
| style="background: #F5F5F5; padding: 5px; text-align: center;" | --
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Miller-Dieker lissencephaly
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Miller-Dieker lissencephaly
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
*[[Lissencephaly]]
*[[Lissencephaly]]
Line 357: Line 360:
*[[Dysmorphic]] features
*[[Dysmorphic]] features
*[[Seizures]]
*[[Seizures]]
* Failure to thrive
*Failure to thrive
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Cytogenetic testing for 17p13.3 microdeletion
*Cytogenetic testing for 17p13.3 microdeletion
| style="background: #F5F5F5; padding: 5px; text-align: center;" | --
| style="background: #F5F5F5; padding: 5px; text-align: center;" | --
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Dopa-responsive [[dystonia]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Dopa-responsive [[dystonia]]
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Onset in early childhood
*Onset in early childhood
* Symptoms worsen with [[fatigue]] and exercise
*Symptoms worsen with [[fatigue]] and exercise
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Positive response to a trial of [[levodopa]]
*Positive response to a trial of [[levodopa]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" | --
| style="background: #F5F5F5; padding: 5px; text-align: center;" | --
|}
|}
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==Epidemiology and Demographics==
==Epidemiology and Demographics==


* The [[prevalence]] of Angelman syndrome is approximately 5-7 per 100,000 individuals worldwide.<ref name="Clayton-SmithPembrey19925">{{cite journal|last1=Clayton-Smith|first1=J|last2=Pembrey|first2=M E|title=Angelman syndrome.|journal=Journal of Medical Genetics|volume=29|issue=6|year=1992|pages=412–415|issn=1468-6244|doi=10.1136/jmg.29.6.412}}</ref>
*The [[prevalence]] of Angelman syndrome is approximately 5-7 per 100,000 individuals worldwide.<ref name="Clayton-SmithPembrey19925">{{cite journal|last1=Clayton-Smith|first1=J|last2=Pembrey|first2=M E|title=Angelman syndrome.|journal=Journal of Medical Genetics|volume=29|issue=6|year=1992|pages=412–415|issn=1468-6244|doi=10.1136/jmg.29.6.412}}</ref>
* The exact [[Incidence (epidemiology)|incidence]] of Angelman syndrome is unknown, but its estimated to be between 6-7 per 100,000 births .<ref name="urlwww.angelman.org2">{{cite web |url=https://www.angelman.org/wp-content/uploads/2019/12/facts_about_as_2009_3-19-10.pdf |title=www.angelman.org |format= |work= |accessdate=}}</ref>
*The exact [[Incidence (epidemiology)|incidence]] of Angelman syndrome is unknown, but its estimated to be between 6-7 per 100,000 births .<ref name="urlwww.angelman.org2">{{cite web |url=https://www.angelman.org/wp-content/uploads/2019/12/facts_about_as_2009_3-19-10.pdf |title=www.angelman.org |format= |work= |accessdate=}}</ref>


=== Age ===
===Age===
Full spectrum of the disease appears usually before 3 years of age.<ref name="urlAngelman syndrome - Symptoms and causes - Mayo Clinic">{{cite web |url=https://www.mayoclinic.org/diseases-conditions/angelman-syndrome/symptoms-causes/syc-20355621#:~:text=Developmental%20delays%2C%20which%20begin%20between,2%20and%203%20years%20old. |title=Angelman syndrome - Symptoms and causes - Mayo Clinic |format= |work= |accessdate=}}</ref>
Full [[Spectrum disorder|spectrum]] of the disease appears usually before 3 years of age.<ref name="urlAngelman syndrome - Symptoms and causes - Mayo Clinic">{{cite web |url=https://www.mayoclinic.org/diseases-conditions/angelman-syndrome/symptoms-causes/syc-20355621#:~:text=Developmental%20delays%2C%20which%20begin%20between,2%20and%203%20years%20old. |title=Angelman syndrome - Symptoms and causes - Mayo Clinic |format= |work= |accessdate=}}</ref>


=== Gender ===
===Gender===
Angelman syndrome affects men and women equally.<ref name="Clayton-SmithPembrey19925" /><ref name="pmid26942024">{{cite journal |vauthors=Luk HM |title=Angelman-Like Syndrome: A Genetic Approach to Diagnosis with Illustrative Cases |journal=Case Rep Genet |volume=2016 |issue= |pages=9790169 |date=2016 |pmid=26942024 |pmc=4749774 |doi=10.1155/2016/9790169 |url=}}</ref>
Angelman syndrome affects men and women equally.<ref name="Clayton-SmithPembrey19925" /><ref name="pmid26942024">{{cite journal |vauthors=Luk HM |title=Angelman-Like Syndrome: A Genetic Approach to Diagnosis with Illustrative Cases |journal=Case Rep Genet |volume=2016 |issue= |pages=9790169 |date=2016 |pmid=26942024 |pmc=4749774 |doi=10.1155/2016/9790169 |url=}}</ref>


=== Race ===
===Race===
There is no [[Race|racial predilection]] for Angelman syndrome.<ref name="urlAngelmans Syndrome - symptoms, average, Definition, Description, Demographics, Causes and symptoms, Diagnosis2" />
There is no [[Race|racial predilection]] for Angelman syndrome.<ref name="urlAngelmans Syndrome - symptoms, average, Definition, Description, Demographics, Causes and symptoms, Diagnosis2" />
<br />
<br />
==Risk Factors==
==Risk Factors==
Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
There are no [[Risk factor|risk factors]] for developing Angelman syndrome, since most of the cases occur due to a [[De novo mutation|''de novo'']] [[Deletion (genetics)|deletion]] and there is a very small chance for this condition to be [[Heredity|hereditary]] transmitted.<ref name="pmid14510623">{{cite journal |vauthors=Guerrini R, Carrozzo R, Rinaldi R, Bonanni P |title=Angelman syndrome: etiology, clinical features, diagnosis, and management of symptoms |journal=Paediatr Drugs |volume=5 |issue=10 |pages=647–61 |date=2003 |pmid=14510623 |doi=10.2165/00148581-200305100-00001 |url=}}</ref>


==Screening==
==Screening==
<br />
[[Prenatal]] [[Screening test|screening]] of [[15q11.2-q13]] region [[Mutation|mutations]] is possible through [[DNA]] and/or [[chromosomal]]/[[Fluorescence in situ hybridization|FISH analysis]] of [[fetal]] cells acquired by [[chorionic villus sampling]] or [[amniocentesis]].<ref name="pmid20445456" />
==Natural History==


* The majority of patients with [disease name] remain asymptomatic for [duration/years].
[[Screening test|Screening]] for Angelman syndrome-suspected patients can be made by the following tests:
* Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
* If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
* Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
* Prognosis is generally [excellent/good/poor], and the [1/5/10­year mortality/survival rate] of patients with [disease name] is approximately [#%].


<br />Natural history
*[[Karyotyping]]. Is warranted for any patient with suspected Angelman syndrome.<ref name="pmid145106233" />
*[[Fluorescence in situ hybridization|Fluorescent in situ hybridization (FISH)]]. May detect [[Deletion (genetics)|deletions]], but not [[Genomic imprinting|imprinting]] centers or [[uniparental disomy]].<ref name="pmid145106233" />
*[[Methylation]] test. May detect [[Deletion (genetics)|deletions]], [[Uniparental disomy|uniparental disomies]], and [[Genomic imprinting|imprinting mutations]], but not [[UBE3A|UBE3A gene]] [[mutation]].<ref name="pmid145106233" />
*[[Paternal mtDNA transmission|Paternal]] [[Uniparental disomy|uniparental disomy (UPD)]] studies. Usually done after a normal [[Fluorescence in situ hybridization|FISH]] and [[methylation]] test.<ref name="pmid145106233" />
*[[UBE3A|Ubiquitin-protein ligase E3A (UBE3A)]] [[mutations]]. Is performed in patients with clinical presentation of Angelman syndrome, but negative [[Methylation specific oligonucleotide microarray|methylation]] test.<ref name="pmid145106233" />
*[[Genomic imprinting|Imprinting]] center (IC) [[mutations]]. Detects small [[Deletion (genetics)|deletions]], but is only available in research centers.<ref name="pmid145106233">{{cite journal |vauthors=Guerrini R, Carrozzo R, Rinaldi R, Bonanni P |title=Angelman syndrome: etiology, clinical features, diagnosis, and management of symptoms |journal=Paediatr Drugs |volume=5 |issue=10 |pages=647–61 |date=2003 |pmid=14510623 |doi=10.2165/00148581-200305100-00001 |url=}}</ref>


Pregnancy and delivery are usually uneventful but the babies tend to weigh 200 to 300 g less than their sibs on average. They are often miserable babies and feeding problems are a common cause for concern. Jerky movements become apparent during the first few months and motor delay is obvious by 9 months of age. Seizures begin around 2 years and remain a problem until 7 or 8 years when they decrease in frequency and may cease altogether. Hyperactivity and sleep disturbance, which are common in childhood, improve with age. The facial features are not usually apparent in infancy but evolve over the first five years of life. Language does not develop, most patients having only one or two words, in spite of having reasonable comprehension of simple commands and sentences. Some patients can communicate using Makaton sign language or other gestures. Most patients remain ambulant into adulthood if kept mobile to prevent contractures developing in the hypertonic limbs. General health is good. Scoliosis occurs in 10% patients. This is an infantile type of scoliosis, apparent before the age of 5 years but progressive, particularly during the adolescent years. Cardiorespiratory difficulties may arise if it is left untreated. Patients with AS can acquire some simple skills, such as eating with a knife or spoon and fork, dressing and washing with help, and performing simple household tasks; 80% become toilet trained by day. None acquires sufficient skills to be able to live independently.
<br />
==Complications==
==Natural History, Complications & Prognosis==


==Prognosis==
*[[Newborns]] with Angelman syndrome usually [[weight]] less than [[averange]] when delivered.<ref name="urlwww.ncbi.nlm.nih.gov">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1015993/pdf/jmedgene00020-0054.pdf |title=www.ncbi.nlm.nih.gov |format= |work= |accessdate=}}</ref>
Note that the severity of the symptoms associated with AS varies significantly across the population of affected persons. Some speech and a greater degree of self-care are possible among the least profoundly affected. Unfortunately, walking and the use of simple sign language may be beyond the reach of the more profoundly affected. Early and continued participation in physical, occupational (related to the development of fine-motor control skills), and communication (speech) therapies are believed to improve significantly the prognosis (in the areas of cognition and communication) of individuals affected by AS. Further, the specific genetic mechanism underlying the condition is thought to correlate to the general prognosis of the affected person. On one end of the spectrum, a mutation to the [[UBE3A]] [[gene]] is thought to correlate to the least affected, whereas larger deletions on chromosome 15 are thought to correspond to the most affected.
*[[Motor delay]] and [[jerky movements]] usually appear before 1 year of age.<ref name="urlwww.ncbi.nlm.nih.gov" /><ref name="pmid22670133" />
*[[Seizure|Seizures]] could be present between 2 and 8 years of age.<ref name="urlwww.ncbi.nlm.nih.gov" /><ref name="pmid22670133" />
*[[Dysmorphic feature|Dysmorphic facies]] and scoliosis are aparent after 5 years of age.<ref name="urlwww.ncbi.nlm.nih.gov" /><ref name="pmid9072912">{{cite journal |author=Laan LA, den Boer AT, Hennekam RC, Renier WO, Brouwer OF |title=Angelman syndrome in adulthood |journal=Am. J. Med. Genet. |volume=66 |issue=3 |pages=356-60 |year=1996 |pmid=9072912 | doi=10.1002/(SICI)1096-8628(19961218)66:3%3C356::AID-AJMG21%3E3.0.CO;2-K}}</ref><ref name="pmid90729122">{{cite journal |vauthors=Laan LA, den Boer AT, Hennekam RC, Renier WO, Brouwer OF |title=Angelman syndrome in adulthood |journal=Am. J. Med. Genet. |volume=66 |issue=3 |pages=356–60 |date=December 1996 |pmid=9072912 |doi=10.1002/(SICI)1096-8628(19961218)66:3<356::AID-AJMG21>3.0.CO;2-K |url=}}</ref><ref name="pmid22670133" />
*[[Tanner staging|Sexual developement]] begins and progresses at a normal time.<ref>{{cite journal | author = Lossie A, Driscoll D | title = Transmission of Angelman syndrome by an affected mother. | journal = Genet Med | volume = 1 | issue = 6 | pages = 262-6 | year = | id = PMID 11258627}}</ref><ref name="pmid11258627">{{cite journal |vauthors=Lossie AC, Driscoll DJ |title=Transmission of Angelman syndrome by an affected mother |journal=Genet. Med. |volume=1 |issue=6 |pages=262–6 |date=1999 |pmid=11258627 |doi=10.1097/00125817-199909000-00004 |url=}}</ref>
*Dressing skills and use of certain utensils may happen.<ref name="pmid9072912" />
*Patients never develope proper [[Language acquisition|language]] (5-10 learned word) and usually comunicate with signs.<ref name="urlwww.ncbi.nlm.nih.gov" /><ref name="pmid22670133" /><ref name="pmid11432411" />
*At the end, patients do not acquire enough abilities to live by there own.<ref name="urlwww.ncbi.nlm.nih.gov" />
*[[Prognosis]] will vary depending on the severity of [[Symptoms and Signs|symptoms]] and earliness of management.<ref name="pmid28494826">{{cite journal |vauthors=Bonello D, Camilleri F, Calleja-Agius J |title=Angelman Syndrome: Identification and Management |journal=Neonatal Netw |volume=36 |issue=3 |pages=142–151 |date=May 2017 |pmid=28494826 |doi=10.1891/0730-0832.36.3.142 |url=}}</ref>
*Patients may have a normal [[life span]].<ref name="pmid28494826" />
*The [[Mortality rate|mortality]] rate of Angelman syndrome per 1000 patients/year was 15.84.<ref name="HerbstByard2012">{{cite journal|last1=Herbst|first1=Jonathon|last2=Byard|first2=Roger W.|title=Sudden Death and Angelman Syndrome|journal=Journal of Forensic Sciences|volume=57|issue=1|year=2012|pages=257–259|issn=00221198|doi=10.1111/j.1556-4029.2011.01901.x}}</ref>


The clinical features of Angelman syndrome alter with age. As adulthood approaches, hyperactivity and poor sleep patterns improve. The seizures decrease in frequency and often cease altogether and the EEG abnormalities are less obvious. Medication is typically advisable to those with seizure disorders. Often overlooked is the contribution of the poor sleep patterns to the frequency and/or severity of the seizures. Medication may be worthwhile in order to help deal with this issue and improve the prognosis with respect to seizures and sleep. Also noteworthy are the reports that the frequency and severity of seizures temporarily escalate in pubescent AS girls but do not seem to affect long-term health.
<br />
 
The facial features remain recognizable but many adults with AS look remarkably youthful for their age.
 
[[Puberty]] and [[menstruation]] begin at around the normal time. [[Sexual development]] is thought to be normal, as evidenced by a single reported case of a woman with Angelman syndrome conceiving a female child who also had Angelman syndrome. <ref>{{cite journal | author = Lossie A, Driscoll D | title = Transmission of Angelman syndrome by an affected mother. | journal = Genet Med | volume = 1 | issue = 6 | pages = 262-6 | year = | id = PMID 11258627}}</ref>
 
The majority of those with AS achieve [[continence]] by day and some by night.
 
Dressing skills are variable and usually limited to items of clothing without buttons or zippers. Most adults are able to eat with a knife or spoon and fork and can learn to perform simple household tasks. General health is fairly good and life-span near normal. Particular problems which have arisen in adults are a tendency to obesity (more in females), and worsening of [[scoliosis]]<ref name="pmid9072912">{{cite journal |author=Laan LA, den Boer AT, Hennekam RC, Renier WO, Brouwer OF |title=Angelman syndrome in adulthood |journal=Am. J. Med. Genet. |volume=66 |issue=3 |pages=356-60 |year=1996 |pmid=9072912 | doi=10.1002/(SICI)1096-8628(19961218)66:3%3C356::AID-AJMG21%3E3.0.CO;2-K}}</ref> if it is present. The affectionate nature which is also a positive aspect in the younger children may also persist into adult life where it can pose a problem socially, but this problem is not insurmountable.


==Diagnosis==
==Diagnosis==


=== Diagnostic Criteria ===
===Diagnostic Criteria===
The Angelman Syndrome Foundation defined criteria for diagnosis in 1995, and updated his criteria in 2006.<ref name="pmid7625452">{{cite journal |author=Williams CA, Angelman H, Clayton-Smith J, ''et al'' |title=Angelman syndrome: consensus for diagnostic criteria. Angelman Syndrome Foundation |journal=Am. J. Med. Genet. |volume=56 |issue=2 |pages=237-8 |year=1995 |pmid=7625452 |doi=10.1002/ajmg.1320560224}}</ref>


* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
The [[diagnosis]] of Angelman syndrome according to the Scientific Advisory Committee of the US Angelman syndrome Foundation (Williams ''et al'' 2006) is based on:<ref name="pmid164707472">{{cite journal |vauthors=Williams CA, Beaudet AL, Clayton-Smith J, Knoll JH, Kyllerman M, Laan LA, Magenis RE, Moncla A, Schinzel AA, Summers JA, Wagstaff J |title=Angelman syndrome 2005: updated consensus for diagnostic criteria |journal=Am. J. Med. Genet. A |volume=140 |issue=5 |pages=413–8 |date=March 2006 |pmid=16470747 |doi=10.1002/ajmg.a.31074 |url=}}</ref><ref name="pmid194551856" /><ref name="pmid16470747">{{cite journal |author=Williams CA, Beaudet AL, Clayton-Smith J, ''et al'' |title=Angelman syndrome 2005: updated consensus for diagnostic criteria |journal=Am. J. Med. Genet. A |volume=140 |issue=5 |pages=413-8 |year=2006 |pmid=16470747 |doi=10.1002/ajmg.a.31074}}</ref>


:* [criterion 1]
:*Developement history. Normal [[birth]], delayed motor [[milestones]], with no loss of [[skills]].<ref name="pmid194551856" /><ref name="pmid22670133" />
:* [criterion 2]
:*[[Clinical]] findings. Clinical features (puppet-like movements, [[Speech and language pathology|speech impairment]], [[feeding]] dificulties, unprovoked [[laughter]], etc.) previously described, [[Dysmorphic feature|dysmorphic facies]], and [[behavioural]] uniqueness.<ref name="pmid194551856" />
:* [criterion 3]
:*[[Genetic testing]]. [[Deletion (genetics)|Deletion]] in [[Chromosome abnormality|chromosomal]] region [[:File:Angelman.PNG|15q11-13]] with absence of [[UBE3A|''UBE3A'' gene]].<ref name="pmid194551856" />
:* [criterion 4]


=== Symptoms ===
===Symptoms===
Angelman syndrome is usually [[Asymptomatic condition|asymptomatic]].


* [Disease name] is usually asymptomatic.
===Physical Examination===
* Symptoms of [disease name] may include the following:
 
:* [symptom 1]
:* [symptom 2]
:* [symptom 3]
:* [symptom 4]
:* [symptom 5]
:* [symptom 6]
 
=== Physical Examination ===


* Patients with Angelman syndrome usually appear dysmorphic.
*Patients with Angelman syndrome usually appear [[Dysmorphic feature|dysmorphic.]]<ref name="pmid19455185">{{cite journal |vauthors=Van Buggenhout G, Fryns JP |title=Angelman syndrome (AS, MIM 105830) |journal=Eur. J. Hum. Genet. |volume=17 |issue=11 |pages=1367–73 |date=November 2009 |pmid=19455185 |pmc=2986680 |doi=10.1038/ejhg.2009.67 |url=}}</ref><ref name="pmid20445456" />
* The most common physical examination finding are:
*The most common [[physical examination]] findings are:<ref name="pmid194551856" />


:* Flat occiput <ref name="SidorovDeck20172">{{cite journal|last1=Sidorov|first1=Michael S.|last2=Deck|first2=Gina M.|last3=Dolatshahi|first3=Marjan|last4=Thibert|first4=Ronald L.|last5=Bird|first5=Lynne M.|last6=Chu|first6=Catherine J.|last7=Philpot|first7=Benjamin D.|title=Delta rhythmicity is a reliable EEG biomarker in Angelman syndrome: a parallel mouse and human analysis|journal=Journal of Neurodevelopmental Disorders|volume=9|issue=1|year=2017|issn=1866-1947|doi=10.1186/s11689-017-9195-8}}</ref>
:*Flat [[occiput]] <ref name="SidorovDeck20172">{{cite journal|last1=Sidorov|first1=Michael S.|last2=Deck|first2=Gina M.|last3=Dolatshahi|first3=Marjan|last4=Thibert|first4=Ronald L.|last5=Bird|first5=Lynne M.|last6=Chu|first6=Catherine J.|last7=Philpot|first7=Benjamin D.|title=Delta rhythmicity is a reliable EEG biomarker in Angelman syndrome: a parallel mouse and human analysis|journal=Journal of Neurodevelopmental Disorders|volume=9|issue=1|year=2017|issn=1866-1947|doi=10.1186/s11689-017-9195-8}}</ref>
:*Small head size<ref name="urlAngelman syndrome - Symptoms and causes - Mayo Clinic2">{{cite web |url=https://www.mayoclinic.org/diseases-conditions/angelman-syndrome/symptoms-causes/syc-20355621#:~:text=Developmental%20delays%2C%20which%20begin%20between,2%20and%203%20years%20old. |title=Angelman syndrome - Symptoms and causes - Mayo Clinic |format= |work= |accessdate=}}</ref>
:*[[Microcephaly|Below average head size]]<ref name="urlAngelman syndrome - Symptoms and causes - Mayo Clinic2">{{cite web |url=https://www.mayoclinic.org/diseases-conditions/angelman-syndrome/symptoms-causes/syc-20355621#:~:text=Developmental%20delays%2C%20which%20begin%20between,2%20and%203%20years%20old. |title=Angelman syndrome - Symptoms and causes - Mayo Clinic |format= |work= |accessdate=}}</ref><ref name="pmid20445456" />
:*Occipital groove<ref name="SidorovDeck20172" />  
:*[[Occipital groove]]<ref name="SidorovDeck20172" />
:*Protruding tongue<ref name="SidorovDeck20172" />
:*Protruding tongue<ref name="SidorovDeck20172" /><ref name="pmid20445456" />
:*Tongue thrusting<ref name="SidorovDeck20172" />
:*Tongue thrusting<ref name="SidorovDeck20172" />
:*Truncal hypotonia<ref name="SidorovDeck20172" />
:*Truncal hypotonia<ref name="SidorovDeck20172" />
:*Prognathia<ref name="SidorovDeck20172" />  
:*[[Prognathia]]<ref name="SidorovDeck20172" />
:*Wide mouth<ref name="SidorovDeck20172" />
:*Wide mouth<ref name="SidorovDeck20172" />
:*Wide spaced teeth<ref name="SidorovDeck20172" />  
:*Wide spaced teeth<ref name="SidorovDeck20172" />
:*Strabismus<ref name="SidorovDeck20172" />  
:*[[Strabismus]]<ref name="SidorovDeck20172" />
:*Light color of skin,hair, and eyes<ref name="SidorovDeck20172" />
:*Light color of skin,hair, and eyes<ref name="SidorovDeck20172" />
:*Uplifted, flexed arm position during ambulation<ref name="SidorovDeck20172" />  
:*Uplifted, flexed arm position during ambulation<ref name="SidorovDeck20172" />
:*Valgus positioned ankles<ref name="SidorovDeck20172" />  
:*[[Valgus]] positioned ankles<ref name="SidorovDeck20172" />
:*Obesity found in older child<ref name="SidorovDeck20172" />
:*[[Obesity]] found in older child<ref name="SidorovDeck20172" />
:*Scoliosis<ref name="SidorovDeck20172" />
:*[[Scoliosis]]<ref name="SidorovDeck20172" /><ref name="pmid20445456" />
 
=== Laboratory Findings ===
 
* There are no specific laboratory findings associated with [disease name].
 
* A [positive/negative] [test name] is diagnostic of [disease name].
* An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
* Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
 
=== Imaging Findings ===
 
* There are no [imaging study] findings associated with [disease name].
 
* [Imaging study 1] is the imaging modality of choice for [disease name].
* On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
* [Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].
 
=== Other Diagnostic Studies ===
 
* [Disease name] may also be diagnosed using [diagnostic study name].
* Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
 
The diagnosis of Angelman syndrome is based on:
 
* A history of delayed motor milestones and then later a delay in general development, especially of speech
* Unusual movements including fine tremors, jerky limb movements, hand flapping and a wide-based, stiff-legged gait.
* Characteristic facial appearance (but not in all cases).
* A history of epilepsy and an abnormal [[EEG]] tracing.
* A happy disposition with frequent laughter
* A deletion on chromosome 15
 
The Angelman Syndrome Foundation defined criteria for diagnosis in 1995,<ref name="pmid7625452">{{cite journal |author=Williams CA, Angelman H, Clayton-Smith J, ''et al'' |title=Angelman syndrome: consensus for diagnostic criteria. Angelman Syndrome Foundation |journal=Am. J. Med. Genet. |volume=56 |issue=2 |pages=237-8 |year=1995 |pmid=7625452 |doi=10.1002/ajmg.1320560224}}</ref>, and updated these criteria in 2005.<ref name="pmid16470747">{{cite journal |author=Williams CA, Beaudet AL, Clayton-Smith J, ''et al'' |title=Angelman syndrome 2005: updated consensus for diagnostic criteria |journal=Am. J. Med. Genet. A |volume=140 |issue=5 |pages=413-8 |year=2006 |pmid=16470747 |doi=10.1002/ajmg.a.31074}}</ref>
===Diagnostic Criteria===
 
===Features===
* Feeding problems during infancy (poor suck and poor weight gain) in 75%
* Delay in sitting and walking
* Absent or little speech (not in all cases - some children have a vocabulary of up to 50 words)
* Receptive and non-verbal communication skills higher than verbal ones
* Poor attention span and [[hyperactivity]]
* Severe learning disabilities
* [[Epilepsy]] (80%) and an abnormal EEG
* Unusual movements (fine tremors, hand flapping, jerking movements)
* Affectionate nature and frequent laughter
* Wide-based stiff-legged gait, with tendency to hold arms up and flexed while walking.
* Below average head size, often with flattening at the back
* Subtle, but ''sometimes'' characteristic facial features (wide mouth, widely spaced teeth, prominent chin, tendency to tongue thrust)
* Poor sleeping pattern
* [[Strabismus]] (Squint - crossed eye/s) in 40%
* [[Scoliosis]] (abnormal curvature of the spine) in 10%
* Increased sensitivity to heat
* Attraction to/fascination with water
 
===History and Symptoms===
 
===Physical Examination===


===Laboratory Findings===
===Laboratory Findings===


=== EEG ===
* [[Hematologic]], [[metabolic]], and [[chemical]] laboratory findings in Angelman syndrome are usually normal.<ref name="pmid194551856">{{cite journal |vauthors=Van Buggenhout G, Fryns JP |title=Angelman syndrome (AS, MIM 105830) |journal=Eur. J. Hum. Genet. |volume=17 |issue=11 |pages=1367–73 |date=November 2009 |pmid=19455185 |pmc=2986680 |doi=10.1038/ejhg.2009.67 |url=}}</ref>
The most common patern observed in Angelman syndrome are signals of high amplitude rhythmic 2–3 Hz activity (delta rythmicity) primarly over the frontal regions with superimposed interictal epileptiform discharges.<ref name="LaanVein2005">{{cite journal|last1=Laan|first1=Laura A.E.M.|last2=Vein|first2=Alla A.|title=Angelman syndrome: is there a characteristic EEG?|journal=Brain and Development|volume=27|issue=2|year=2005|pages=80–87|issn=03877604|doi=10.1016/j.braindev.2003.09.013}}</ref> Other patern found are rhythmic theta, and epileptiform spike-wave discharges.<ref name="SidorovDeck2017">{{cite journal|last1=Sidorov|first1=Michael S.|last2=Deck|first2=Gina M.|last3=Dolatshahi|first3=Marjan|last4=Thibert|first4=Ronald L.|last5=Bird|first5=Lynne M.|last6=Chu|first6=Catherine J.|last7=Philpot|first7=Benjamin D.|title=Delta rhythmicity is a reliable EEG biomarker in Angelman syndrome: a parallel mouse and human analysis|journal=Journal of Neurodevelopmental Disorders|volume=9|issue=1|year=2017|issn=1866-1947|doi=10.1186/s11689-017-9195-8}}</ref>


===Imaging Findings===
===Imaging Findings===


===Other Diagnostic Studies===
* Usually, [[MRI]] and [[Computed tomography|CT scans]] demonstrate normal structural finidings; in some cases, there may be cortical [[atrophy]] or [[Demyelinating|demyelinating lesions]].<ref name="pmid194551856" />


==Treatment==
===EEG===
=== Medical Therapy ===


* There is no treatment for [disease name]; the mainstay of therapy is supportive care.
* The most common [[EEG]] patern observed in Angelman syndrome are signals of high amplitude rhythmic 2–3 Hz activity ([[delta rythmicity]]) primarly over the frontal regions with superimposed [[Interictal|interictal epileptiform]] discharges.<ref name="LaanVein2005">{{cite journal|last1=Laan|first1=Laura A.E.M.|last2=Vein|first2=Alla A.|title=Angelman syndrome: is there a characteristic EEG?|journal=Brain and Development|volume=27|issue=2|year=2005|pages=80–87|issn=03877604|doi=10.1016/j.braindev.2003.09.013}}</ref> Other patern found are rhythmic [[Theta rhythm|theta]], and epileptiform spike-wave discharges.<ref name="SidorovDeck2017">{{cite journal|last1=Sidorov|first1=Michael S.|last2=Deck|first2=Gina M.|last3=Dolatshahi|first3=Marjan|last4=Thibert|first4=Ronald L.|last5=Bird|first5=Lynne M.|last6=Chu|first6=Catherine J.|last7=Philpot|first7=Benjamin D.|title=Delta rhythmicity is a reliable EEG biomarker in Angelman syndrome: a parallel mouse and human analysis|journal=Journal of Neurodevelopmental Disorders|volume=9|issue=1|year=2017|issn=1866-1947|doi=10.1186/s11689-017-9195-8}}</ref>


* The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
==Treatment==
* [Medical therapy 1] acts by [mechanism of action 1].
===Medical Therapy===
* Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].


=== Surgery ===
*Currently, there is no specific treatment for Angelman syndrome.<ref name="pmid26040994">{{cite journal |vauthors=Margolis SS, Sell GL, Zbinden MA, Bird LM |title=Angelman Syndrome |journal=Neurotherapeutics |volume=12 |issue=3 |pages=641–50 |date=July 2015 |pmid=26040994 |pmc=4489961 |doi=10.1007/s13311-015-0361-y |url=}}</ref>
*Treatment is only supportive and is amied to:<ref name="pmid26040994" /><ref name="pmid24876791">{{cite journal |vauthors=Bird LM |title=Angelman syndrome: review of clinical and molecular aspects |journal=Appl Clin Genet |volume=7 |issue= |pages=93–104 |date=2014 |pmid=24876791 |pmc=4036146 |doi=10.2147/TACG.S57386 |url=}}</ref>
*#Mitigate gross and fine motor delays.<ref name="pmid26040994" /><ref name="pmid24876791" /><ref name="pmid22670133" /><ref name="pmid20445456" />
*#Improve [[Communication disorder|communication]] with non-verbal methods (eg. use of communication devices, implement a [[Sign language media|sign language]], exchange of image cards).<ref name="pmid26040994" /><ref name="pmid24876791" /><ref name="pmid22670133" /><ref name="pmid20445456" />
*#Intervention for [[autism spectrum disorder]], when present.<ref name="pmid26040994" /><ref name="pmid24876791" /><ref name="pmid22670133" /><ref name="pmid20445456" />


* Surgery is the mainstay of therapy for [disease name].
*[[Feeding]] in newborns may requiere special [[Nipple|nipples]] due to poor [[Suction|sucking]].<ref name="pmid20445456" /><ref name="pmid203013236" />
* [Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*[[Anticonvulsant|Antiepileptics]] are used for [[Seizure|seizures]], but there hasn't been a consensus on wich medication is the most appropiate.<ref name="pmid20445456" /><ref name="pmid19453717">{{cite journal |vauthors=Thibert RL, Conant KD, Braun EK, Bruno P, Said RR, Nespeca MP, Thiele EA |title=Epilepsy in Angelman syndrome: a questionnaire-based assessment of the natural history and current treatment options |journal=Epilepsia |volume=50 |issue=11 |pages=2369–76 |date=November 2009 |pmid=19453717 |doi=10.1111/j.1528-1167.2009.02108.x |url=}}</ref><ref name="pmid203013236" />
* [Surgical procedure] can only be performed for patients with [disease stage] [disease name].
*[[Stimulant|Stimulants]] ([[methylphenidate]]) have been used to control [[Attention-deficit hyperactivity disorder|hyperactivity behaviours]].<ref name="pmid20445456" /><ref name="pmid26040994" />
*[[Physiotherapy]] may improve [[range of movements]] and prevents [[joint stiffness]].
*[[Occupational therapy]] helps to ameliorate [[Fine motor skill|fine motor]] and [[oral-motor]] control.<ref name="pmid20445456" /><ref name="pmid203013236" />
*Use of low-potency [[Sedative|sedatives]] may help with disruptive [[nighttime wakefulness]].<ref name="pmid20445456" /><ref name="pmid10392349">{{cite journal |vauthors=Zhdanova IV, Wurtman RJ, Wagstaff J |title=Effects of a low dose of melatonin on sleep in children with Angelman syndrome |journal=J. Pediatr. Endocrinol. Metab. |volume=12 |issue=1 |pages=57–67 |date=1999 |pmid=10392349 |doi=10.1515/jpem.1999.12.1.57 |url=}}</ref><ref name="pmid26040994" />
*[[Orthopedic|Orthopedic postures]] may be corrected with [[Brace (orthopaedic)|bracing]].<ref name="pmid20445456" /><ref name="pmid203013236" />
*[[Dietary recomendations]] should be made in patients with [[constipation]] and/or [[obesity]].<ref name="pmid11748306">{{cite journal |vauthors=Lossie AC, Whitney MM, Amidon D, Dong HJ, Chen P, Theriaque D, Hutson A, Nicholls RD, Zori RT, Williams CA, Driscoll DJ |title=Distinct phenotypes distinguish the molecular classes of Angelman syndrome |journal=J. Med. Genet. |volume=38 |issue=12 |pages=834–45 |date=December 2001 |pmid=11748306 |pmc=1734773 |doi=10.1136/jmg.38.12.834 |url=}}</ref><ref name="pmid26040994" />


=== Prevention ===
===Surgery===


* There are no primary preventive measures available for [disease name].
*Sometimes [[fundoplication]] may be requiered for [[Reflux esophagitis|reflux symptoms]].<ref name="pmid20445456" />
*[[Orthopedic surgery|Surgery]] may be needed to correct certain orthopedic problems (eg. severe [[scoliosis]]).<ref name="pmid20445456" /><ref name="pmid203013236">{{cite journal |vauthors=Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean LJH, Stephens K, Amemiya A, Dagli AI, Mueller J, Williams CA |title= |journal= |volume= |issue= |pages= |date= |pmid=20301323 |doi= |url=}}</ref>
*Surgery for [[tongue protrusion]] has not found to be effective.<ref name="pmid20445456" />


* Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
===Prevention===
 
* Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].


Because Angelman syndrome is not an illness, but a genetic condition, there is no currently available cure for AS. The epilepsy can be controlled by the use of one or more types of anticonvulsant medications. However, there are difficulties in ascertaining the levels and types of anticonvulsant medications needed to establish control, because AS is usually associated with having multiple varieties of seizures, rather than just the one as is normal cases of epilepsy. Many families use melatonin to promote sleep in a condition which often affects sleep patterns. Many individuals with Angelman Syndrome sleep for a maximum of 5 hours at any one time. Mild laxatives are also used frequently to encourage regular bowel movements and early intervention with [[physiotherapy]] is important to encourage joint mobility and prevent stiffening of the joints. [[Occupational therapy]], [[speech therapy]], [[hydrotherapy]] and [[music therapy]] are also used in the management of this condition.
* There are no primary [[Preventive care|preventive]] measures available for Angelman syndrome.
===Medical Therapy===
 
===Surgery===
 
===Prevention===


==Living with Angelman syndrome==
==Living with Angelman syndrome==
Although a diagnosis of AS is life changing, it does not need to be life destroying. Individuals with Angelman Syndrome are generally happy and contented individuals, who like human contact and play. AS individuals exhibit a profound desire for personal interaction with others. Communication can be difficult at first, but as an AS child develops, there is a definite character and ability to make themselves understood. It is widely accepted that their understanding of communication directed to them is much larger than their ability to return conversation. Most afflicted individuals will not develop more than 5-10 words, if at all.<ref name="pmid11432411">{{cite journal |author=Andersen WH, Rasmussen RK, Strømme P |title=Levels of cognitive and linguistic development in Angelman syndrome: a study of 20 children |journal=Logopedics, phoniatrics, vocology |volume=26 |issue=1 |pages=2-9 |year=2001 |pmid=11432411 |doi=}}</ref>
Although a diagnosis of Angelman syndrome is life-changing, it does not need to be life-destroying. Individuals with Angelman Syndrome are generally happy and contented individuals, who like human contact and play. Angelman syndrome individuals exhibit a profound desire for personal interaction with others. [[Communication disorder|Communication]] can be difficult at first, but as an AS child develops, there is a definite character and ability to make themselves understood. It is widely accepted that their understanding of communication directed to them is much larger than their ability to return conversation.<ref name="pmid11432411">{{cite journal |author=Andersen WH, Rasmussen RK, Strømme P |title=Levels of cognitive and linguistic development in Angelman syndrome: a study of 20 children |journal=Logopedics, phoniatrics, vocology |volume=26 |issue=1 |pages=2-9 |year=2001 |pmid=11432411 |doi=}}</ref>


==See also==
==See also==
* [[Epigenetics]]
 
*[[Epigenetics]]


==External links==
==External links==
*{{dmoz|Health/Conditions_and_Diseases/Neurological_Disorders/Movement_Disorders/Angelman_Syndrome|Angelman syndrome}}  
 
*{{dmoz|Health/Conditions_and_Diseases/Neurological_Disorders/Movement_Disorders/Angelman_Syndrome|Angelman syndrome}}
*{{GeneTests|angelman|Angelman Syndrome}}
*{{GeneTests|angelman|Angelman Syndrome}}
*[http://www.angelman.org Angelman Syndrome Foundation USA]
*[http://www.angelman.org Angelman Syndrome Foundation USA]

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Moises Romo, M.D.

Angelman Syndrome
ICD-10 Q93.5
ICD-9 759.89
OMIM 105830
DiseasesDB 712
MeSH D017204

Overview

Angelman syndrome, formerly known as "happy puppet syndrome", is a genetic disorder characterized by intelectual and development delay, seizures, puppet-like movement, unprovoked laughter/smiling, and excessive socialization with strangers.


Historical Perspective

"I happened to see an oil painting...called... "a Boy with a Puppet". The boy's laughing face and the fact that my patients exhibited jerky movements gave me the idea of writing an article about the three children with a title of Puppet Children."[1]


Pathophysiology

Modes of Inheritance

Phenotype-Gene Relationships

Phenotype Gene Location
Angelman syndrome UBE3A 15q11-15q13


Clinical Features

Angelman syndrome is characterized by:

Other less common features are:


Differentiating Angelman syndrome from Other Diseases

Angelman syndrome must be differentiated from other diseases that cause intelectual and development delay, dysmorphic facies, and seizures, such as:

Diseases Type of motor abnormality Clinical findings Laboratory findings and diagnostic tests Radiographic findings
Spasticity Hypotonia Ataxia Dystonia
Leigh syndrome - - + +
Niemann-Pick disease type C - - + +
  • Abnormal liver function tests
  • Fibroblast cell culture with filipin staining
Infantile Refsum disease - + + - Elevated plasma VLCFA levels --
Adrenoleukodystrophy + - - -
  • Elevated plasma VLCFA levels
  • Molecular genetic testing for mutations in the ABCD1 gene
 --
Zellweger syndrome - + - - --
Pyruvate dehydrogenase deficiency + + + -
  • Elevated lactate and pyruvate levels in blood and CSF
  • Abnormal PDH enzymatic activity in cultured fibroblasts
 --
Arginase deficiency + - - - --
Holocarboxylase synthetase deficiency - + - - Elevated levels of:
  • Beta-hydroxyisovalerate
  • Beta-methylcrotonylglycine
  • Beta-hydroxypropionate
  • Methylcitrate
  • Tiglylglycine
 --
Glutaric aciduria type 1 - - - + Elevated levels of:
Ataxia telangiectasia - - + - --
Pontocerebellar hypoplasias - + - - Genetic testing for PCH gene mutations
Metachromatic leukodystrophy - + + -
  • Deficient arylsulfatase A enzyme activity in leukocytes or cultured skin fibroblasts
 --
Pelizaeus-Merzbacher + - + -
Angelman syndrome - - + -
  • Methylation studies and chromosome microarray to detect chromosome 15 anomalies and UBE3A mutations
 --
Rett syndrome + - - +
  • Occurs almost exclusively in females
  • Normal development during first six months followed by regression and loss of milestones
  • Loss of speech capability
  • Stereotypic hand movements
  • Seizures
  • Autistic features
  • Clinical diagnosis
  • Genetic testing for MECP2 mutations
 --
Lesch-Nyhan syndrome + - - + --
Miller-Dieker lissencephaly + + - -
  • Cytogenetic testing for 17p13.3 microdeletion
 --
Dopa-responsive dystonia + - - +
  • Onset in early childhood
  • Symptoms worsen with fatigue and exercise
  • Positive response to a trial of levodopa
 --


Epidemiology and Demographics

  • The prevalence of Angelman syndrome is approximately 5-7 per 100,000 individuals worldwide.[18]
  • The exact incidence of Angelman syndrome is unknown, but its estimated to be between 6-7 per 100,000 births .[19]

Age

Full spectrum of the disease appears usually before 3 years of age.[20]

Gender

Angelman syndrome affects men and women equally.[18][21]

Race

There is no racial predilection for Angelman syndrome.[22]

Risk Factors

There are no risk factors for developing Angelman syndrome, since most of the cases occur due to a de novo deletion and there is a very small chance for this condition to be hereditary transmitted.[23]

Screening

Prenatal screening of 15q11.2-q13 region mutations is possible through DNA and/or chromosomal/FISH analysis of fetal cells acquired by chorionic villus sampling or amniocentesis.[15]

Screening for Angelman syndrome-suspected patients can be made by the following tests:


Natural History, Complications & Prognosis


Diagnosis

Diagnostic Criteria

The Angelman Syndrome Foundation defined criteria for diagnosis in 1995, and updated his criteria in 2006.[33]

The diagnosis of Angelman syndrome according to the Scientific Advisory Committee of the US Angelman syndrome Foundation (Williams et al 2006) is based on:[34][35][36]

Symptoms

Angelman syndrome is usually asymptomatic.

Physical Examination

Laboratory Findings

Imaging Findings

EEG

  • The most common EEG patern observed in Angelman syndrome are signals of high amplitude rhythmic 2–3 Hz activity (delta rythmicity) primarly over the frontal regions with superimposed interictal epileptiform discharges.[39] Other patern found are rhythmic theta, and epileptiform spike-wave discharges.[40]

Treatment

Medical Therapy

Surgery

Prevention

  • There are no primary preventive measures available for Angelman syndrome.

Living with Angelman syndrome

Although a diagnosis of Angelman syndrome is life-changing, it does not need to be life-destroying. Individuals with Angelman Syndrome are generally happy and contented individuals, who like human contact and play. Angelman syndrome individuals exhibit a profound desire for personal interaction with others. Communication can be difficult at first, but as an AS child develops, there is a definite character and ability to make themselves understood. It is widely accepted that their understanding of communication directed to them is much larger than their ability to return conversation.[30]

See also

External links

References

  1. ↑ 1.0 1.1 Template:WhoNamedIt
  2. ↑ Angelman, Harry (2008). "'Puppet' Children A Report on Three Cases". Developmental Medicine & Child Neurology. 7 (6): 681–688. doi:10.1111/j.1469-8749.1965.tb07844.x. ISSN 0012-1622.
  3. ↑ 3.0 3.1 Jana NR (2012). "Understanding the pathogenesis of Angelman syndrome through animal models". Neural Plast. 2012: 710943. doi:10.1155/2012/710943. PMC 3399338. PMID 22830052.
  4. ↑ Malzac P, Webber H, Moncla A, Graham JM, Kukolich M, Williams C, Pagon RA, Ramsdell LA, Kishino T, Wagstaff J (June 1998). "Mutation analysis of UBE3A in Angelman syndrome patients". Am. J. Hum. Genet. 62 (6): 1353–60. doi:10.1086/301877. PMC 1377156. PMID 9585605.
  5. ↑ Clayton-Smith, J; Pembrey, M E (1992). "Angelman syndrome". Journal of Medical Genetics. 29 (6): 412–415. doi:10.1136/jmg.29.6.412. ISSN 1468-6244.
  6. ↑ Van Buggenhout G, Fryns JP (November 2009). "Angelman syndrome (AS, MIM 105830)". Eur. J. Hum. Genet. 17 (11): 1367–73. doi:10.1038/ejhg.2009.67. PMC 2986680. PMID 19455185.
  7. ↑ 7.00 7.01 7.02 7.03 7.04 7.05 7.06 7.07 7.08 7.09 7.10 7.11 7.12 7.13
  8. ↑ Tan WH, Bird LM (December 2016). "Angelman syndrome: Current and emerging therapies in 2016". Am J Med Genet C Semin Med Genet. 172 (4): 384–401. doi:10.1002/ajmg.c.31536. PMID 27860204.
  9. ↑ Weeber E, Levenson J, Sweatt J (2002). "Molecular genetics of human cognition". Mol Interv. 2 (6): 376–91, 339. PMID 14993414.
  10. ↑ 10.0 10.1 Williams, Charles. "Angelman Syndrome". National Organization of Rare Diseases. Retrieved 06/02/2020. Check date values in: |access-date= (help)
  11. ↑ Van Buggenhout G, Fryns JP (November 2009). "Angelman syndrome (AS, MIM 105830)". Eur. J. Hum. Genet. 17 (11): 1367–73. doi:10.1038/ejhg.2009.67. PMC 2986680. PMID 19455185.
  12. ↑ Van Buggenhout G, Fryns JP (November 2009). "Angelman syndrome (AS, MIM 105830)". Eur. J. Hum. Genet. 17 (11): 1367–73. doi:10.1038/ejhg.2009.67. PMC 2986680. PMID 19455185.
  13. ↑ 13.0 13.1 13.2 13.3 13.4 Jenkins, Brian (2016). Deletion Syndromes/ Step up to USMLE step 2CK. Fort Worth, Texas: Wolters Kluwer. p. 291. ISBN 978-1496309747.
  14. ↑ 14.0 14.1 14.2 14.3 Guerrini R, Carrozzo R, Rinaldi R, Bonanni P (2003). "Angelman syndrome: etiology, clinical features, diagnosis, and management of symptoms". Paediatr Drugs. 5 (10): 647–61. doi:10.2165/00148581-200305100-00001. PMID 14510623.
  15. ↑ 15.00 15.01 15.02 15.03 15.04 15.05 15.06 15.07 15.08 15.09 15.10 15.11 15.12 15.13 15.14 15.15 15.16 15.17 15.18 15.19 15.20 15.21
  16. ↑ Van Buggenhout G, Fryns JP (November 2009). "Angelman syndrome (AS, MIM 105830)". Eur. J. Hum. Genet. 17 (11): 1367–73. doi:10.1038/ejhg.2009.67. PMC 2986680. PMID 19455185.
  17. ↑ 17.00 17.01 17.02 17.03 17.04 17.05 17.06 17.07 17.08 17.09 17.10 17.11 17.12 17.13 17.14 17.15 17.16 17.17 17.18 17.19 17.20 17.21 17.22 17.23 17.24 17.25 Sidorov, Michael S.; Deck, Gina M.; Dolatshahi, Marjan; Thibert, Ronald L.; Bird, Lynne M.; Chu, Catherine J.; Philpot, Benjamin D. (2017). "Delta rhythmicity is a reliable EEG biomarker in Angelman syndrome: a parallel mouse and human analysis". Journal of Neurodevelopmental Disorders. 9 (1). doi:10.1186/s11689-017-9195-8. ISSN 1866-1947.
  18. ↑ 18.0 18.1 Clayton-Smith, J; Pembrey, M E (1992). "Angelman syndrome". Journal of Medical Genetics. 29 (6): 412–415. doi:10.1136/jmg.29.6.412. ISSN 1468-6244.
  19. ↑ "www.angelman.org" (PDF).
  20. ↑ "Angelman syndrome - Symptoms and causes - Mayo Clinic".
  21. ↑ Luk HM (2016). "Angelman-Like Syndrome: A Genetic Approach to Diagnosis with Illustrative Cases". Case Rep Genet. 2016: 9790169. doi:10.1155/2016/9790169. PMC 4749774. PMID 26942024.
  22. ↑
  23. ↑ Guerrini R, Carrozzo R, Rinaldi R, Bonanni P (2003). "Angelman syndrome: etiology, clinical features, diagnosis, and management of symptoms". Paediatr Drugs. 5 (10): 647–61. doi:10.2165/00148581-200305100-00001. PMID 14510623.
  24. ↑ 24.0 24.1 24.2 24.3 24.4 24.5 Guerrini R, Carrozzo R, Rinaldi R, Bonanni P (2003). "Angelman syndrome: etiology, clinical features, diagnosis, and management of symptoms". Paediatr Drugs. 5 (10): 647–61. doi:10.2165/00148581-200305100-00001. PMID 14510623.
  25. ↑ 25.0 25.1 25.2 25.3 25.4 25.5 "www.ncbi.nlm.nih.gov" (PDF).
  26. ↑ 26.0 26.1 Laan LA, den Boer AT, Hennekam RC, Renier WO, Brouwer OF (1996). "Angelman syndrome in adulthood". Am. J. Med. Genet. 66 (3): 356–60. doi:10.1002/(SICI)1096-8628(19961218)66:3%3C356::AID-AJMG21%3E3.0.CO;2-K. PMID 9072912.
  27. ↑ Laan LA, den Boer AT, Hennekam RC, Renier WO, Brouwer OF (December 1996). "Angelman syndrome in adulthood". Am. J. Med. Genet. 66 (3): 356–60. doi:10.1002/(SICI)1096-8628(19961218)66:3<356::AID-AJMG21>3.0.CO;2-K. PMID 9072912.
  28. ↑ Lossie A, Driscoll D. "Transmission of Angelman syndrome by an affected mother". Genet Med. 1 (6): 262–6. PMID 11258627.
  29. ↑ Lossie AC, Driscoll DJ (1999). "Transmission of Angelman syndrome by an affected mother". Genet. Med. 1 (6): 262–6. doi:10.1097/00125817-199909000-00004. PMID 11258627.
  30. ↑ 30.0 30.1 Andersen WH, Rasmussen RK, Strømme P (2001). "Levels of cognitive and linguistic development in Angelman syndrome: a study of 20 children". Logopedics, phoniatrics, vocology. 26 (1): 2–9. PMID 11432411.
  31. ↑ 31.0 31.1 Bonello D, Camilleri F, Calleja-Agius J (May 2017). "Angelman Syndrome: Identification and Management". Neonatal Netw. 36 (3): 142–151. doi:10.1891/0730-0832.36.3.142. PMID 28494826.
  32. ↑ Herbst, Jonathon; Byard, Roger W. (2012). "Sudden Death and Angelman Syndrome". Journal of Forensic Sciences. 57 (1): 257–259. doi:10.1111/j.1556-4029.2011.01901.x. ISSN 0022-1198.
  33. ↑ Williams CA, Angelman H, Clayton-Smith J; et al. (1995). "Angelman syndrome: consensus for diagnostic criteria. Angelman Syndrome Foundation". Am. J. Med. Genet. 56 (2): 237–8. doi:10.1002/ajmg.1320560224. PMID 7625452.
  34. ↑ Williams CA, Beaudet AL, Clayton-Smith J, Knoll JH, Kyllerman M, Laan LA, Magenis RE, Moncla A, Schinzel AA, Summers JA, Wagstaff J (March 2006). "Angelman syndrome 2005: updated consensus for diagnostic criteria". Am. J. Med. Genet. A. 140 (5): 413–8. doi:10.1002/ajmg.a.31074. PMID 16470747.
  35. ↑ 35.0 35.1 35.2 35.3 35.4 35.5 35.6 Van Buggenhout G, Fryns JP (November 2009). "Angelman syndrome (AS, MIM 105830)". Eur. J. Hum. Genet. 17 (11): 1367–73. doi:10.1038/ejhg.2009.67. PMC 2986680. PMID 19455185.
  36. ↑ Williams CA, Beaudet AL, Clayton-Smith J; et al. (2006). "Angelman syndrome 2005: updated consensus for diagnostic criteria". Am. J. Med. Genet. A. 140 (5): 413–8. doi:10.1002/ajmg.a.31074. PMID 16470747.
  37. ↑ Van Buggenhout G, Fryns JP (November 2009). "Angelman syndrome (AS, MIM 105830)". Eur. J. Hum. Genet. 17 (11): 1367–73. doi:10.1038/ejhg.2009.67. PMC 2986680. PMID 19455185.
  38. ↑ "Angelman syndrome - Symptoms and causes - Mayo Clinic".
  39. ↑ Laan, Laura A.E.M.; Vein, Alla A. (2005). "Angelman syndrome: is there a characteristic EEG?". Brain and Development. 27 (2): 80–87. doi:10.1016/j.braindev.2003.09.013. ISSN 0387-7604.
  40. ↑ Sidorov, Michael S.; Deck, Gina M.; Dolatshahi, Marjan; Thibert, Ronald L.; Bird, Lynne M.; Chu, Catherine J.; Philpot, Benjamin D. (2017). "Delta rhythmicity is a reliable EEG biomarker in Angelman syndrome: a parallel mouse and human analysis". Journal of Neurodevelopmental Disorders. 9 (1). doi:10.1186/s11689-017-9195-8. ISSN 1866-1947.
  41. ↑ 41.0 41.1 41.2 41.3 41.4 41.5 41.6 41.7 Margolis SS, Sell GL, Zbinden MA, Bird LM (July 2015). "Angelman Syndrome". Neurotherapeutics. 12 (3): 641–50. doi:10.1007/s13311-015-0361-y. PMC 4489961. PMID 26040994.
  42. ↑ 42.0 42.1 42.2 42.3 Bird LM (2014). "Angelman syndrome: review of clinical and molecular aspects". Appl Clin Genet. 7: 93–104. doi:10.2147/TACG.S57386. PMC 4036146. PMID 24876791.
  43. ↑ 43.0 43.1 43.2 43.3 43.4 Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean L, Stephens K, Amemiya A, Dagli AI, Mueller J, Williams CA. PMID 20301323. Vancouver style error: initials (help); Missing or empty |title= (help)
  44. ↑ Thibert RL, Conant KD, Braun EK, Bruno P, Said RR, Nespeca MP, Thiele EA (November 2009). "Epilepsy in Angelman syndrome: a questionnaire-based assessment of the natural history and current treatment options". Epilepsia. 50 (11): 2369–76. doi:10.1111/j.1528-1167.2009.02108.x. PMID 19453717.
  45. ↑ Zhdanova IV, Wurtman RJ, Wagstaff J (1999). "Effects of a low dose of melatonin on sleep in children with Angelman syndrome". J. Pediatr. Endocrinol. Metab. 12 (1): 57–67. doi:10.1515/jpem.1999.12.1.57. PMID 10392349.
  46. ↑ Lossie AC, Whitney MM, Amidon D, Dong HJ, Chen P, Theriaque D, Hutson A, Nicholls RD, Zori RT, Williams CA, Driscoll DJ (December 2001). "Distinct phenotypes distinguish the molecular classes of Angelman syndrome". J. Med. Genet. 38 (12): 834–45. doi:10.1136/jmg.38.12.834. PMC 1734773. PMID 11748306.

Template:Chromosomal abnormalities

ca:Síndrome d'Angelman de:Angelman-Syndrom zh-classical:天使人症候群 he:תסמונת אנגלמן hu:Angelman-szindróma nl:Syndroom van Angelman sr:Ангелманов синдром fi:Angelmanin oireyhtymä sv:Angelmans syndrom


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