Study on Moebius Syndrome and Congenital Facial Weakness Disorders
Study on Moebius Syndrome and Congenital Facial Weakness Disorders
Background:

 - Moebius syndrome limits the ability to make facial expressions like smile, frown or blink -
 and move the eyes laterally. It can also cause speech, swallowing or breathing difficulties
 and affect parts of the body, such as the limbs, jaw, muscles, or the heart. Some individuals
 with Moebius can have intellectual impairment or behavior problems. Researchers want to study
 the clinical features of individuals with Moebius or related disorders and explore the
 genetic and/or environmental causes of these conditions.

 Objective:

 - To learn more about the genetics and clinical characteristics of Moebius syndrome and other
 Congenital Facial Weakness disorders.

 Eligibility:

 - People ages 2 to 80 years with congenital facial weakness, isolated or combined with other
 congenital anomalies, and their family members.

 Design:

 -  Participants with Moebius syndrome or other congenital facial weakness disorder will be
 evaluated at the NIH Clinical Research Center over 3 to 5 days and undergo the following
 procedures:

 -  Medical and family history and physical examination, including body measurements and
 vital signs.

 -  Blood or saliva will be collected for genetic tests and to evaluate liver, kidney, heart
 and hormonal

 functions.

 -  Eye examination, including having a video taken of their eyes moving.

 -  Hearing evaluation.

 -  Speech and language assessment, including swallowing studies.

 -  Dental exam.

 -  Detailed neurological evaluation, including electromyogram/nerve conduction and blink
 reflex study.

 -  Rehabilitation medicine evaluation, including muscle and tongue strength testing and
 assessment of balance.

 -  Neurocognitive and behavioral testing and questionnaires to assess quality of life and
 copying mechanisms.

 -  Imaging studies of their head, by magnetic resonance and diffusion tensor imaging
 -MRI/DTI. Participants

 will lie on a table that slides into a metal cylinder that takes images of internal body
 structures using

 magnets. Child participants may be sedated.

 -  Some adults may have additional X-rays of their head or limbs, if there are abnormal
 findings.

 -  Medical photographs of the face and affected body parts may be taken.

 -  Other specialized tests or consultations, as indicated.

 -  Participants can choose to have a skin biopsy taken.

 -  A follow-up visit will be offered to participants for review of genetic test findings
 and possibly additional clinical tests, as indicated.

 Family members of the patients will have a medical and family history and physical
 examination. Blood or saliva will be obtained for genetic studies.

 ...
This is a natural history study with a cross-sectional design of Moebius syndrome (MIM
 157900), a heterogeneous developmental disorder defined as a congenital, non-progressive
 facial weakness with limited abduction of one or both eyes, often associated with additional
 features such as other cranial nerve dysfunction, craniofacial, skeletal and limb
 deformities, as well as intellectual or behavioral impairments. In this study we will attempt
 to characterize the clinical phenotype of Moebius and associated congenital facial weakness
 syndromes, collect thorough information on possible prenatal environmental exposures and use
 genetic studies, including whole exome sequencing, on DNA from patients and family members of
 patients to identify disease-causing genes. We will also conduct brain magnetic resonance-
 and diffusion tensor imaging- studies in these patients in order to explore brainstem and
 cranial nerve structure and associated white matter tract anomalies. Through this combined
 clinical, molecular and imaging approach, we anticipate that phenotype-genotype correlations
 will be revealed. These results will lead to new insights into the clinical definition of
 these conditions, molecular pathways, and potential networks involved in the pathogenesis of
 facial weakness and associated multisystem dysmorphogenesis. Our population will consist of
 patients, ages 2 to 80 years, inclusive of any gender, race, or ethnic group, with congenital
 facial palsy, isolated or combined with other congenital anomalies, and their families. We
 will continue to recruit approximately 24 probands each year, ages 2 to 80 years, inclusive
 of any gender, race, or ethnic group, and their parents and unaffected family members for a
 total of 72 patients/families. In most cases, patients will be referred through the Moebius
 Syndrome Foundation, a patient organization with a current membership of 2000 people in its
 database, 1400 of whom have been diagnosed with Moebius syndrome. Outcome measures will
 include the results from a battery of clinical evaluations, including ophthalmology,
 audiology, neurology, psychiatry, and rehabilitative medicine. Patients will also undergo
 neurocognitive and autism screening assessments, electromyography/nerve conduction, and blink
 reflex studies. Imaging and genetic studies will provide the most robust data for analysis in
 this study. A skin biopsy may be performed on some patients in order to culture fibroblasts
 for additional biochemical, cell biological, and molecular analyses.
-  INCLUSION CRITERIA:

 1. Subject is 2-80 years, any gender, race or ethnic group, inclusive.

 2. Subject has a diagnosis of congenital facial palsy, isolated or combined with
 other congenital anomalies, based on MPIs review of prior medical records and
 interview with patient and/or patient physicians.

 3. Subject is a family member of a patient with a diagnosis of congenital facial
 palsy, isolated or combined with other congenital anomalies.

 4. Subject has the ability to travel to the NIH Clinical Center for admissions.

 5. Subject or subject s legal guardian is able to provide written informed consent.

 EXCLUSION CRITERIA:

 1. Subject has severe respiratory difficulties (i.e., requiring a tracheostomy or other
 assistive device to maintain respiration) or other disease manifestation that would
 interfere with the ability to comply with the requirements of this protocol and/or
 pose a severe anesthesia risk.

 2. Subject has a psychiatric illness or neurological disease that would interfere with
 the ability to comply with the requirements of this protocol. This includes, but is
 not limited to, uncontrolled/untreated psychotic depression, bipolar disorder,
 schizophrenia, substance abuse or dependence, antisocial personality disorder, or
 panic disorder.

 3. Subject shows evidence of clinically significant cardiovascular, pulmonary, hepatic,
 renal, hematological, metabolic, or gastrointestinal disease, or has a condition that
 requires immediate surgical intervention.

 4. Subject is pregnant during the study.

 5. Subject or subject s legal guardian is unable or unwilling to provide consent or
 assent.

 6. The principal investigator may decline to enroll a patient for other reasons.