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Smith Magenis syndrome

What are the symptoms?

Most children with SMS have developmental delay and moderate to severe learning difficulties. In infancy low muscle tone, feeding difficulties, failure to thrive and frequent ear infections are common. Speech delay tends to be more pronounced than motor delay, and language comprehension is more impaired than expression.

The most distinctive features of SMS are the behavioural problems. These include self-injurious behaviours such as hand biting, self-pinching or scratching, picking at sores, hitting the head or body, and tearing or picking fingernails or the skin around the nails. Some affected patients also demonstrate 'self-hugging' and 'lick and flip' (licking their fingers and rapidly flicking the pages of a book) behaviours. Other behavioural problems include aggression, frequent temper tantrums, hyperactivity, restlessness and distractibility, and severe sleep disturbance, including difficulties falling asleep, shortened sleep cycles, frequent and prolonged night waking and early morning waking. These abnormalities and a phase shift of the circadian rhythm of melatonin are suggestive of an underlying biological clock problem in the syndrome. Autistic-type behaviours such as resistance to change, repetitive questioning, and preoccupations with particular topics are also common.

In many cases the severe behaviour difficulties in children with the syndrome persist into adulthood. Some individuals show improved behaviour with age, but others show a worsening of the aggression and self injury or no change. At the same time, people with SMS are often described as loving and caring, eager to please and with a good sense of humour. They love adult attention and enjoy interacting with adults.

Facial features of SMS are fairly distinctive and include a flat, broad head and prominent forehead, heavy brows, up-slanting eyes, depressed nasal bridge, and a wide mouth with fleshy and inverted central portion of the upper lip. Other features include a relatively hoarse, deep voice, short stature, eye problems (squint and iris abnormalities), hearing loss and scoliosis (spinal curvature). Congenital heart disease, epilepsy and kidney abnormalities are less consistent features. Clinical signs of peripheral neuropathy are found in seventy-five per cent of individuals, and include decreased sensitivity to pain and temperature, gait disturbances and muscle weakness.

View Background Background  |  What are the causes? View What are the causes?

Medical text written July 2003 by Contact a Family. Approved July 2003 by Dr J Tolmie, Consultant Clinical Geneticist, Duncan Guthrie Institute of Medical Genetics, Glasgow, UK. Last reviewed January 2004 by Dr M Suri, Consultant Clinical Geneticist, City Hospital, Nottingham, UK. Additional material provided by Dr O Udwin, Consultant Clinical Child Psychologist, West London Mental Health NHS Trust, London, UK.

 

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