From the Guidelines
Pompe disease can cause significant neurologic and developmental effects over time, particularly if not treated early, and enzyme replacement therapy (ERT) is the primary treatment to improve muscle function and survival. The long-term neurological effects of Pompe disease include progressive muscle weakness affecting mobility, respiratory function, and speech 1. Children with infantile-onset Pompe disease may experience developmental delays in motor skills, cognitive function, and speech development. ERT with alglucosidase alfa (Myozyme or Lumizyme) is typically administered intravenously every two weeks at 20 mg/kg, and while it can improve muscle function and survival, it cannot completely reverse existing neurological damage, making early diagnosis and treatment crucial 1.
Key Considerations
- Patients with Pompe disease require multidisciplinary care including physical therapy, occupational therapy, speech therapy, and respiratory support.
- Regular developmental assessments and early intervention services are essential for children with Pompe disease to maximize their developmental potential.
- The neurological effects of Pompe disease occur because glycogen accumulation in neurons and muscle cells disrupts normal function, with the central nervous system being particularly vulnerable in infantile-onset disease.
- Even with treatment, some patients may develop white matter abnormalities, hearing loss, and intellectual disabilities, requiring ongoing monitoring and supportive care throughout life.
Treatment and Management
- ERT is the primary treatment for Pompe disease, and its effectiveness has been demonstrated in several open-label clinical trials 1.
- Gene therapy and small molecule treatments are emerging therapeutic options, but more research is needed to establish their safety and efficacy.
- Patients with Pompe disease should be closely monitored for potential complications, including cardiac and respiratory problems, and receive supportive care as needed.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Neurologic Long Term Effects
- The long-term consequences of glycogen storage in the central nervous system (CNS) for classic infantile Pompe disease using enzyme replacement therapy have been examined, showing involvement of the periventricular white matter and centrum semiovale from approximately age 2 years onwards 2.
- After 8 years of age, additional white-matter abnormalities occurred in the corpus callosum, internal and external capsule, and subcortical areas, and from 11 years of age, white-matter abnormalities were also found in the brainstem 2.
- Cognitive development ranged from stable and normal to declines that lead to intellectual disabilities, with considerable variations between patients 2.
Developmental Concerns
- Enzyme replacement therapy (ERT) with alglucosidase alfa has improved overall survival, ventilator-free survival, cardiomyopathy, and motor development in infants with Pompe disease 3.
- In patients with late onset Pompe disease, ERT has resulted in disease course stabilization with motor and pulmonary improvements 3.
- However, the currently available treatments lose effectiveness over the long run and do not have penetration into neuronal tissues and inconsistent penetration in certain muscles 4.
- The development of adjunctive and alternative therapies, including immune modulation, upregulation of receptor expression, diet and exercise, second-generation recombinant ERT, chaperone therapy, substrate reduction therapy and gene therapy, is ongoing 3.