What are the symptoms, presentation, management, and prognosis of Mitochondrial Neurogastrointestinal Encephalomyopathy (MNGIE) syndrome, also known as SANDO (Sideroblastic Anemia, Neutropenia, Exocrine Pancreatic Dysfunction, and variable degree of skeletal abnormalities, with or without sugar intolerance, and mitochondrial DNA depletion) or Pearson Syndrome (PS) or PEO (Progressive External Ophthalmoplegia)-like mitochondrial syndromes, including life expectancy, ideal habits, pregnancy complications, and miscarriage risk in individuals over 32 years old?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Article Review Status
Submitted
Under Review
Approved

Last updated: May 17, 2025 • View editorial policy

From the Research

Mitochondrial syndromes like SANDO and PEO typically present with neurological symptoms including muscle weakness, coordination problems, and eye movement abnormalities, and management focuses on supportive care to maintain function and quality of life. In childhood, these conditions may manifest as developmental delays, exercise intolerance, muscle weakness, seizures, and vision problems. The symptoms of SANDO or PEO-like mitochondrial syndrome can be broken down into:

  • Neurological symptoms: muscle weakness, coordination problems, and eye movement abnormalities
  • Developmental delays
  • Exercise intolerance
  • Muscle weakness
  • Seizures
  • Vision problems

Management of these conditions includes:

  • Supportive care rather than curative treatments
  • Physical therapy
  • Speech therapy
  • Occupational therapy to maintain function
  • Medications like CoQ10 (100-600mg daily), L-carnitine (1-3g daily), and vitamin supplements (particularly B vitamins, vitamin E, and vitamin C) may help support mitochondrial function, though evidence for their effectiveness varies 1.

Life expectancy depends on disease severity, with some patients living into adulthood while those with severe manifestations may have shortened lifespans. For optimal quality of life, patients should:

  • Maintain regular but moderate exercise
  • Follow a balanced diet rich in antioxidants
  • Avoid mitochondrial toxins (including certain medications, alcohol, and cigarettes)
  • Get adequate rest

Pregnancy can be challenging for women with mitochondrial disorders due to increased energy demands, with potentially higher risks of complications. For women over 32 with these conditions, miscarriage risk is elevated compared to the general population, though exact percentages vary based on individual factors and disease severity 2. Regular monitoring by a multidisciplinary team including neurologists, geneticists, and other specialists is essential for managing these complex disorders.

Ideal habits for someone with these illnesses to have the best life possible include:

  • Regular exercise
  • Balanced diet
  • Avoiding mitochondrial toxins
  • Getting adequate rest
  • Regular monitoring by a multidisciplinary team
  • Considering supplements like CoQ10, L-carnitine, and vitamin supplements under the guidance of a healthcare provider 3.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.