Table 10. [Supportive Treatment of Manifestations in Males and Females with Adrenomyeloneuropathy (AMN)]. - GeneReviews®

Manifestation/Concern	Treatment	Considerations/Other
Cognitive decline	By neuropsychologist
Behavioral issues	By mental health providers
Communication	By speech-language pathologist	Consider alternative means of communication.
Seizures	By neurologist	Appropriate ASMs
Motor impairment / ADL	Orthopedics / physical medicine & rehab / PT & OT incl stretching to help avoid contractures & falls	Consider need for positioning & mobility devices, disability parking placard.
Neurogenic bladder	By urologist
Bowel control	By gastroenterologist
Sexual dysfunction	By urologist	In males only
Emotional & vocational counseling	By mental health providers	If necessary
Adrenocortical insufficiency ¹	Corticosteroid replacement therapy ² (which can be lifesaving in males, & is rarely needed in females)	Per treating endocrinologist
Family/Community	Ensure appropriate social work involvement to connect families w/local resources, respite, & support. Coordinate care to manage multiple subspecialty appointments, equipment, medications, & supplies.	Ongoing assessment of need for palliative care involvement &/or home nursing

Manifestation/Concern

Treatment

Considerations/Other

Cognitive decline

By neuropsychologist

Behavioral issues

By mental health providers

Communication

By speech-language pathologist

Consider alternative means of communication.

Seizures

By neurologist

Appropriate ASMs

Motor impairment / ADL

Orthopedics / physical medicine & rehab / PT & OT incl stretching to help avoid contractures & falls

Consider need for positioning & mobility devices, disability parking placard.

Neurogenic bladder

By urologist

Bowel control

By gastroenterologist

Sexual dysfunction

By urologist

In males only

Emotional & vocational counseling

By mental health providers

If necessary

Adrenocortical insufficiency ¹

Corticosteroid replacement therapy ² (which can be lifesaving in males, & is rarely needed in females)

Per treating endocrinologist

Family/Community

Ensure appropriate social work involvement to connect families w/local resources, respite, & support.
Coordinate care to manage multiple subspecialty appointments, equipment, medications, & supplies.

Ongoing assessment of need for palliative care involvement &/or home nursing

From: X-Linked Adrenoleukodystrophy

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Adam MP, Feldman J, Mirzaa GM, et al., editors.

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