A syndrome is a collection of signs that are often seen together. Sturge-Weber syndrome (SWS) is a condition affecting the skin, brain and eyes. It is named after the doctors who described it in the late 19th century and early 20th century.
What are the signs and symptoms of SWS?
They affect the skin and brain as follows:
- A port wine stain is a vascular birthmark caused by abnormal development of blood vessels in the skin. It can occur anywhere on the body, but in SWS it affects the skin around the forehead and/or scalp.
- As well as the port wine stain affecting the skin, it will also involve an extra layer of blood vessels over the surface of the brain (angioma).
- The angioma may be associated with seizures (fits or convulsions) and developmental problems.
How is it diagnosed?
If a child’s port wine stain is on the forehead or scalp, he or she will need to be checked by a paediatrician (specialist children’s doctor). The child will have an MRI scan with gadolinium to confirm the diagnosis. This is basically the same as a regular MRI scan, but the child will have an injection of dye (gadolinium) beforehand.
This makes the child's blood vessels show up better on the scan. Once the diagnosis has been confirmed the child’s care will be shared between the paediatrician and a paediatric neurologist (brain and nervous system doctor).
What causes SWS?
SWS occurs sporadically. It is not a genetic condition and so is not passed from parent to child. The condition starts very early in pregnancy when the baby is developing in the womb. At six to nine weeks of pregnancy, the tissues that will eventually form the skin and brain are closely related.
We think that a network of blood vessels continues to develop instead of separating, causing an extra layer of blood vessels over the surface of the brain. We do not know exactly why this happens, but it is very unlikely that it is due to anything the child's mother did or did not do during pregnancy.
How common is it?
We do not know how many people are diagnosed with SWS but we know it is a rare disorder. It can affect all ethnic groups and is equally common in boys and girls. Children with a port wine stain on both sides of their scalp or forehead are more likely to have SWS.
What problems can the symptoms cause?
Port wine stain
Port wine stains, particularly if they are on the face, can affect children psychologically, emotionally and socially.
Developmental problems and learning disability
About 60 per cent of children with SWS have delayed developmental milestones and learning problems. That is, they do not develop and acquire key skills at the same age as children without SWS. This is more likely to happen in children who have SWS and epilepsy.
However, children vary enormously and so children with SWS can have abilities within the normal range or have more delayed development. It seems that children with abnormal blood vessels on both sides of the brain have more severe learning disabilities than others.
Visual field deficit
Some children with SWS have a visual field deficit. This means that they have trouble seeing objects out of the corner of their eye. In infants, this can be diagnosed by clinical examination, but proper diagnostic tests are more difficult until children are of primary school age and are more cooperative.
Once parents know which side is affected, they can make sure that toys, games or work are put within the child’s field of vision. Children with a visual field deficit may seem to use the affected side less than the other, so ways of improving this might be suggested.
Children with SWS might have a weakness in the opposite side of the body to the port wine stain due to abnormal blood vessels in the brain. They may also have difficulty using the affected side because they are less aware of it.
The degree of weakness varies from child to child and may be barely noticeable or more obvious. There seem to be three ways weakness can affect children with SWS: in one group, the weakness is noticeable during infancy, in the second the weakness develops with the seizures and in the final group the weakness may develop in association with headaches, and may improve.
Around 80 per cent of children with SWS have epilepsy (fits or convulsions) if the SWS is on both sides of the face. In most of these children it starts before the age of two, and by the time a child is five years old the majority of children who are going to develop epilepsy have done so. The onset of these seizures is often triggered by an illness causing a high temperature.
Various types of seizures might occur, most commonly jerky movements affecting one side of the body, although other types have been reported. If the seizures last for more than 30 minutes or happen very frequently, they may affect a child’s development. Treatment is usually adjusted to reduce the frequency or severity of the seizures.
About one third of children with SWS have headaches and migraine-like episodes. It is likely that these are caused by the blood flowing through the extra layer of blood vessels. Headaches seem to be linked to periods of seizures and weakness in many children.
Another feature of SWS is glaucoma. Glaucoma is raised pressure within the eye, which can lead to blindness if it is not treated. Glaucoma is diagnosed using a test that measures the pressure in the eye by blowing a puff of air.
The majority of children develop glaucoma in infancy, but some do not develop it until later childhood. The specialist eye doctor (ophthalmologist) should examine the child’s eyes to check for glaucoma regularly: every year for the first five years, and then every two years. If a child develops glaucoma, he or she will need more frequent appointments.
SWS itself cannot be treated, but there are various options for treating the symptoms. As SWS involves different parts of the body, a multidisciplinary team often provides the best care. Regular reviews with the local paediatrician and child development centre alongside doctors from a specialist hospital will be needed.
The specialists will usually involve dermatologists (skin doctors), neurologists (brain and nervous system doctors) and ophthalmologists (eye doctors).
SWS is a lifelong condition, needing ongoing care and treatment, so a child will need to transfer to adult services when he or she reaches 16 years old or so. We will work with parents and children to make sure that this transfer happens as smoothly as possible.
The symptoms of SWS can be treated as follows:
Port wine stain
Laser treatment, with a pulsed dye laser, is currently the treatment of choice for fading a port wine stain. When laser treatment is carried out at a specialist centre experienced in dealing with vascular birthmarks in children, the results can be excellent and the side effects minimal. With newer, up-to-date lasers these children (about 10per cent) who have not responded to the previous lasers have shown very promising results.
Developmental problems and learning disability
Support from therapists based at a child development centre or special needs school can be invaluable. Children with developmental problems and learning disability may also need support in school. An individual education plan (IEP) and statement of special educational need (Statementing) may be needed, as they set out the support the child needs and guarantees the extra resources for it. Some children develop thyroid problems after the age of seven or eight years, so they may require a blood test and possibly life long thyroid medicines.
Visual field deficit
The specialist eye doctor in the multidisciplinary team may be able to suggest ways of dealing with any visual field deficit. As a child grows older, certain games and sports might prove problematic, but there are plenty of alternatives or ways to get around the visual field deficit. The child may benefit from support from a specialist teacher of children with visual impairment.
Input from a physiotherapist and occupational therapist can improve the way a child copes with the weakness. They may suggest exercise programmes to strengthen the weaker limbs or aids to make everyday tasks easier.
There is some evidence that taking a low dose of aspirin every day can reduce how ‘sticky’ the blood is, and therefore reduce the number of episodes of severe weakness. Aspirin has been linked with a severe liver illness (Reye’s syndrome) in the past, although this is very rare. Parents should discuss whether or not to use aspirin with the child's doctor.
There are many anti-epilepsy medicines suitable for infants and children. It can take time to find the best combination and the ideal dosage for each child, so it is possible that a child’s epilepsy treatment plan could change quite frequently.
If the seizures are still severe after trying various combinations and dosages of medicines, epilepsy surgery might be considered. The child will need an appointment at a specialist hospital carrying out children’s epilepsy surgery. The assessment process for epilepsy surgery is complex, and is explained in more detail on our Surgery for epilepsy page.
The child will have his or her eyes checked regularly so that any glaucoma can be diagnosed and treated quickly. Treatment is usually with eye drops and occasionally an operation.
By filling in this Questionnaire (356.75 KB), parents are helping us decide which team members will be necessary to assess the child, and giving us information which will be useful during our assessment.
What is the outlook for children with SWS?
Children with SWS have a range of disability, from mildly affected to severe. The outlook varies greatly from child to child, depending on the severity of the symptoms and how well they are controlled.
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