Brain stem atrophy is a prominent feature that often results in death secondary to central apnea. Polysomnography, as well as overnight oximetry test, can be used as screening studies. Central apnea should be managed by a pulmonologist. Some patients may require tracheostomy.
Wolfram syndrome is characterized by progressive neurodegeneration. The most common problem is ataxia. Cerebellar ataxia should be assessed yearly or twice a year by neurologists. Dysarthria and swallowing disorders (dysphagia) are commonly seen. Swallowing treatment by a speech-language pathologist is beneficial for patients to prevent aspiration pneumonia. Surgical procedures, including esophageal dilation and esophagomyotomy, have been shown to be effective in some patients. Oral hygiene and dental care are important because dysphagia may lead to the impaired clearance of organisms and pathogenic colonization.
Sensorineural hearing loss is one of the common symptoms of Wolfram syndrome and observed in around 70 % of patients. The hearing loss affects the high frequencies first and progresses relatively slowly. Routine audiometry is recommended every year or every 2 years. Auditory brainstem response (ABR) audiometry should be performed at diagnosis to confirm the pathophysiology and examine the efficacy of any treatments. Management includes hearing aids and cochlear implant. Hearing manifestations in Wolfram syndrome should be carefully examined because dominant mutations in the WFS1 gene are a
common cause of low-frequency sensorineural hearing loss, which is different from Wolfram syndrome. These patients develop low-frequency sensorineural hearing loss but do not develop other symptoms seen in patients with Wolfram syndrome, such as diabetes mellitus and ataxia.
Structural and functional urinary tract abnormalities are commonly seen in patients with Wolfram syndrome and significantly affect quality of life. Yearly assessment of renal function, measurement of postvoid residual urine volume by ultrasound, a renal ultrasound, and urodynamic testing are recommended. A large atonic bladder, a low-capacity, high-pressure bladder with sphincteric dyssynergia, and hydroureteronephrosis are common manifestations. Both bladder dysfunction and upper urinary tract dilatation are primary manifestations although these symptoms may be partially affected by diabetes mellitus and diabetes insipidus. The treatment options for bladder dysfunction include anticholinergic drugs and clean intermittent catheterization. Electrical stimulation and physiotherapy have been effective in some patients.
Recurrent urinary tract infection (UTI) is one of the most common clinical challenges in patients with Wolfram syndrome. The bladder dysfunction caused by the central and peripheral neurologic dysfunction is thought to be the underlying cause of UTI. Urine culture is recommended for Wolfram patients with fever or other symptoms, such as headache. Inflammatory conditions associated with UTI may cause headache and other symptoms.
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