Myoclonic Epilepsy with Ragged Red Fibers (MERRF)

Myoclonic epilepsy with ragged red fibers (MERRF) is a multisystem disorder characterized by myoclonus, which is often the first symptom, followed by generalized epilepsy, ataxia, weakness, and dementia. Symptoms usually first appear in childhood or adolescence after normal early development. The features of MERRF vary widely from individual to individual, even within families. Other common findings include hearing loss, short stature, optic atrophy, and cardiomyopathy with Wolff-Parkinson-White (WPW) syndrome. The diagnosis is based on clinical features and a muscle biopsy finding of ragged red fibers (RRF). In over 80% of cases, MERRF is caused by genetic changes in the mitochondrial gene called MT-TK. Several other mitochondrial genes have also been reported to cause MERRF, but many of the individuals with genetic changes in these other genes have additional signs and symptoms. Coenzyme Q10 and L-carnitine are often used with the hope of improving mitochondrial function.

Genetic Mutations: MERRF is caused by genetic mutations, also known as pathogenic variants. Genetic mutations can be hereditary, when parents pass them down to their children, or they may occur randomly when cells are dividing. Genetic mutations may also result from contracted viruses, environmental factors, such as UV radiation from sunlight exposure, or a combination of any of these.

If you suspect you may have this disease, you may want to start collecting your family health history. Information such as other family members who have had similar symptoms, when their/your symptoms first appeared, or exposures to any potential disease-causing environmental factors should be discussed with your medical team.

Known Genetic Mutations: MERRF is caused by genetic mutations in the following known gene(s):

TRNL1, TRNS1, MT-TF, TRNH, TRNP, ND5, TRNK

Given these known genetic mutation(s), you may want to ask your health care team if genetic testing is right for you. Genetic tests are laboratory tests that use samples of blood, saliva, or other tissues to help identify changes in genes, chromosomes, or proteins. Genetic testing can help confirm or rule out a suspected genetic disease, or can provide other useful information to your health care team.

Disruption in Metabolism: MERRF is caused by a disruption in a person’s metabolism. Metabolism is the series of chemical reactions in our body that turns the food we eat into energy and removes toxins. Hormones and specific proteins, called enzymes, help make the right chemical reactions happen in the right order. However, genetic changes can prevent hormones or enzymes from working properly, which can lead to a disruption in metabolism such as energy not being created for the body or toxins not being removed from the body.

Impaired Mitochondrial Function: MERRF is caused by an impairment, or issue, in mitochondrial function. Mitochondria make the energy needed for cells to work properly. When mitochondria are unable to produce enough energy for a cell, the cell can become damaged or can die. Depending on the location and number of damaged cells, different organs and body systems can be affected.

Yes. It is possible for a biological parent to pass down genetic mutations that cause or increase the chances of getting this disease to their child. This is known as inheritance. Knowing whether other family members have previously had this disease, also known as family health history, can be very important information for your medical team.

There are multiple ways, or patterns, a disease can be inherited depending on the gene(s) involved. Based on GARD’s current data, this disease can be inherited in the following pattern(s):

Mitochondrial Inheritance: Mitochondrial inheritance means the genetic mutation is located in a specific type of DNA, called mtDNA. mtDNA is found within the cell’s mitochondria. Mitochondria are tiny structures that produce energy for the body. Genetic mutations within mtDNA can prevent the mitochondria from working properly.

During human conception, egg cells, or the cells that come from the female parent, provide mitochondria. If a female parent is affected by a mitochondrial genetic mutation, there is a 100% chance their child inherits the mutated gene. However, the child may or may not be affected by the disease. A male parent cannot pass mitochondrial genetic mutations to their children.