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Objectives: To identify and characterise the paediatric cases of Auditory Neuropathy Spectrum Disorder (ANSD) and to analyse its rehabilitation. Study Design: Descriptive observational study. Material e Methods: Analysis of clinical processes from 671 patients evaluated in a first auditory rehabilitation appointment between 2012 and 2019. From 467 cases with sensorineural hearing loss, those with absent or profoundly altered brainstem auditory evoked responses and present otoacoustic emissions and/or pure tone thresholds disproportional to electrophysiological results were included. Twelve cases of ANSD were obtained. Results: The prevalence of ANSD was 2.6%. Most cases had risk factors for hearing loss. Audiometric results were heterogeneous and fluctuating. Four children were rehabilitated with hearing aids and three with cochlear implants. Conclusion: ANSD is an infrequent condition. It is associated with several risk factors and its diagnosis and management are challenging. Customised and guided by the child’s functional development auditory rehabilitation is mandatory. Objectivos: Identificar e caracterizar os casos pediátricos de Distúrbio do Espectro da Neuropatia Auditiva (DENA) e analisar a sua reabilitação. Desenho do Estudo: Estudo observacional descritivo. Material e Métodos: Análise dos processos clínicos de 671 doentes avaliados em primeira consulta de reabilitação auditiva pediátrica entre 2012 e 2019. Dos 467 casos de hipoacusia sensorioneural, incluíram-se aqueles que apresentavam PEATC sem resposta ou com resposta marcadamente anormal e OEAs presentes e/ou limiares tonais desproporcionais aos resultados electrofisiológicos. Obtiveram-se 12 casos de DENA. Resultados: A prevalência de DENA foi 2,6%. A maioria dos casos apresentou factores de risco para hipoacusia. Os resultados audiométricos foram heterogéneos e flutuantes. Quatro crianças foram reabilitadas com prótese auditiva e três com implante coclear. Conclusões: O DENA é uma condição rara, associada a vários factores de risco e de diagnóstico e abordagem desafiantes. A reabilitação auditiva tem de ser personalizada e guiada pelo desempenho funcional da criança.

Objetivos: Caracterizar a população com surdez de etiologia genética, a relação genótipo-fenótipo e fatores prognósticos na decisão de tratamento de reabilitação. Material e Métodos: Análise retrospetiva da população pediátrica referenciada da consulta de Reabilitação Auditiva à consulta de Genética Médica entre janeiro-2012 e dezembro-2017. Resultados: Foram encaminhadas 128 crianças e o estudo genético foi positivo em 47%. Os resultados foram sugestivos de haver correlação genótipo-fenótipo nas mutações do gene GJB2 (p=0,30), tendo este grupo etiológico sido o que obteve os melhores ganhos auditivos (p=0,57) e linguísticos (p=0,19) com a reabilitação. O estudo genético revelou alterações associadas a hipoacusia progressiva em seis doentes e identificou variantes que afetam o órgão de Corti, prevendo o desempenho com implante coclear (IC). Conclusões: A confirmação etiológica permite prever a evolução da hipoacusia, como observado no gene GJB2. Doentes com mutações nos genes expressos no labirinto membranoso, com preservação do gânglio espiral, apresentam bom prognóstico com IC., Revista Portuguesa de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, v. 59 n. 2 (2021): Junho

A maioria dos doentes com hiperplasia suprarrenal congénita (HSC) apresenta alterações moleculares no gene CYP21A2, o qual codifica a enzima 21-hidroxilase (21-OH). Os doentes com a forma clássica de deficiência em 21-OH (21-OHD) apresentam a síntese de cortisol diminuída no córtex adrenal e, os casos mais graves, também apresentam deficiência de aldosterona. As mulheres com 21-OHD grave apresentam excesso de andrógenos desde a sua vida fetal conduzindo à virilização dos órgãos genitais externos. Tanto homens como mulheres com 21-OHD completa não sintetizam a aldosterona e, consequentemente, logo após o nascimento, podem desenvolver crises de perda de sal se não forem corretamente diagnosticados e tratados. A 21- OHD não clássica é devida à deficiência parcial em 21-OH, os fenótipos clínicos são menos graves, as mulheres não apresentam virilização dos genitais externos ao nascimento, e geralmente os sinais relativos a excesso de androgénios podem surgir durante a infância ou até mais tarde (durante ou após a puberdade). Neste trabalho descrevem-se as alterações e os genótipos mais frequentes encontrados em doentes portugueses não adultos com 21-OHD. As alterações mais frequentes encontradas na forma clássica da HSC são c.293-13C> G, diferentes deleções/quimeras/conversões génicas do gene CYP21A2 e c.518T> A, enquanto na 21-OHD não-clássica a variante c.844G> T é a mais frequente. Estes resultados contribuem para um diagnóstico correto e uma melhor gestão clínica dos doentes, para o seu aconselhamento genético e para oferecer o diagnóstico pré-natal a casais com risco de ter filhos afetados com a forma clássica de 21-OHD. Most of the patients with congenital adrenal hyperplasia (CAH) have molecular alterations in the CYP21A2 gene, which encodes the enzyme 21-hydroxylase (21-OH). Patients with the classic form of 21-OH deficiency (21-OHD) have the synthesis of cor tisol impaired in the adrenal cor tex and, the most severe cases also have aldosterone deficiency. Females with severe 21-OHD, star ting their fetal life have excess of androgens leading to external genitalia virilization at bir th. Both males and females with complete 21-OHD are not able to synthesize aldosterone, consequently soon af ter bir th may develop salt wasting crises if not correctly diagnosed and treated. Non-classic 21-OHD is due to par tial deficiency of 21-OH, the clinical phenotypes are less severe, females don’t present ambiguity of the external genitalia at bir th, usually signs of androgen excess may be present during childhood or even later in life (during or af ter puber ty). We present here the most frequent alterations and genotypes found in non adult Por tuguese patients with 21-OHD. The most frequent alterations found in the classic form of CAH are c.293-13C>G, dif ferent CYP21A2 deletions/quimeras/gene conversions and c.518T>A, while in non-classic 21-OHD the variant c.844G>T is the most frequent. These results contribute to a correct patient diagnosis, to a better clinical care, genetic counseling and to of fer pre-natal diagnosis to couples at risk of having af fected babies with the classic form of 21-OHD. info:eu-repo/semantics/publishedVersion

Introduction: Congenital adrenal hyperplasia(CAH) is due to 21-hidroxilase deficiency(21-OHD) in about 95% of the cases. 21-OH is encoded by CYP21A2 gene, and most frequent mutations occurring in CYP21A2 are due to gene conversions originated from its pseudogene(CYP21A1P). The clinical severity of CAH is associated with the impairment of 21-OH activity, which is directly related with the molecular defect. CAH is classified as classic salt-wasting(SW) and simple virilising(SV) forms, and nonclassic(NC) form of the disease. SW and SV are usually diagnosed after birth or during the first years of life, respectively, while most cases of NC-CAH are diagnosed during infancy, puberty or until adult age. Here we present the molecular results performed in paediatric patients with CAH. Project: UID/BIM/0009/2016 from Fundação para a Ciência e a Tecnologia N/A

publicado em: Eur J Hum Gen.2016;24(S1):228. P11.027 Background: Most approaches are insensitive to the full mutational spectrum of chromosome rearrangements associated with human developmental abnormalities. Therefore, our aim is to introduce next-generation sequencing (NGS) into clinical cytogenetics, creating a sequence-based NextGen Cytogenetics to catalyze a dramatic advancement in clinical diagnostics. Methods: Twenty families with chromosome rearrangement-associated diseases, including two prenatal (PN) cases, have been enrolled. Fourteen of these were also analyzed by NGS using large-insert paired-end libraries. Results: The majority of these cases were confirmed to be balanced reciprocal rearrangements, whereas 4 were complex chromosomal rearrangements including 1 of chromothripsis. Thus far, over 50 breakpoints were identified disrupting protein coding genes, lncRNAs, or intergenic regions, thus revealing candidate genes or genomic loci. These cases are further assessed for pathogenicity from positional effects on genes located within topological domains (TADs) containing the breakpoints using DECIPHER predictions of haploinsufficiency. In one PN case, the 16q24 breakpoint disrupts ANKRD11, etiologic in the autosomal dominant KBG syndrome (OMIM #148050), predicting an abnormal phenotype. The chromothripsis case, submitted as 46,XY,t(7;14)(q22;q32.1),inv(15)(q21.2q26.1), proved by NGS to carry two further deletions, at 3p12 (5.3 Mb) and 15q14 (488 kb), as well as an insertion of 644.4 kb from 15q14 into 3p14. The inv(15) is in fact a complex rearrangement of 15q with eight breakpoints. Conclusions: We demonstrate that NGS-based chromosomal rearrangement characterization leads to major improvements in identification of chromosomal aberrations and in prediction of clinical outcomes of postnatally and prenatally detected genomic rearrangements, and to contributions to human genome annotation. FCT HMSP-ICT/0016/2013 info:eu-repo/semantics/publishedVersion

Introduction: Congenital adrenal hyperplasia (CAH) due to 21-Hydroxylase deficiency occurs in 90-95% of cases, being a common autosomal recessive condition that can present with a wide range of hyperandrogenemic signs in childhood or adulthood. Severity of this disease is correlated with the enzymatic blockade of 21-Hydroxylase which depends of the mutation in gene CYP21A2. Two clinical forms are possible: classic, subdivided in salt-wasting and simple virilizing form (severe) and nonclassic or late onset (less severe). Aims: We studied two portuguese families with NCCAH due to 21-Hidroxilase deficiency in order to improve clinical management and genetic counseling of their members. Methods: Clinical presentation and hormonal assays (including test of tetracosactide) were performed in index cases (IC) . Genomic DNA of each family member was sequenced for the 9 most frequent mutations in CYP21A2. Total deletion of CYP21A , conversion in non functioning CYP21A1P or CYP21A1P_ CYP21A2 quimeras were also analyzed by enzymatic restriction. Results: Family 1- IC: Female, 31 years old with NCCAH diagnosed at age 6 , after investigation of precocious pubarche and with test of tetracosactide positive (17-alpha hydroxyprogesterone levels > 10-15 ng/ml) . Molecular study of CYP21A2 showed a mutation g.1683G> T , homozygous , in CYP21A2 and a non functioning allele of CYP21A2 , heterozygous (non severe 21-Hidroxilase deficiency). Mother was carrying a non functioning allele of CYP21A2 , heterozygous (severe); Father, Brother and Partner were heterozygous for mutation g.1683G> T (non severe). Family 2- IC: Female, 45 years old presenting hirsutism and oligoamenorrhea at age 35 and with test of tetracosactide positive confirming NCCAH Genetic study identified mutation g.1683G> T (less severe) in a copy and g.655A/C>G in another copy (splicing mutation severe). Familial genetic study identified two sisters (age 36 and age 40), asymptomatic but with pathologic genotype confirming NCCAH. info:eu-repo/semantics/publishedVersion

publicado em: Nascer e Crescer. 2016 fev 26; Supl1:S29.Especial XLV conferências de genética Doutor Jacinto Magalhães. Disponível em: http://revistas.rcaap.pt/nascercrescer/article/view/10542/7563 Introdução: As alterações cromossómicas estruturais provocam doenças de severidade variável que acarretam sofrimento individual e familiar signifi cativo. Para compreensão da sua etiologia e estabelecimento de um possível prognóstico, uma adequada correlação fenótipo-genótipo é fundamental. O presente estudo faz parte do projeto intitulado àCitogenética de Próxima Geração Irrompe nos Cuidados de Saúde e Contribui para Anotação do Genoma Humanoà, que visa a introdu- ção da sequenciação de próxima geração (NGS) na citogené- tica clínica, tirando partido dessa inovação única na deteção de variantes estruturais, com uma resolução de um nucleótido para a criação de uma citogenética de alto rendimento, catalisadora de notáveis avanços no diagnóstico clínico e resulta da colaboração entre seis Instituições nacionais e a Harvard Medical School. Estima-se que exista um número considerável de indivíduos portadores de diversas patologias, incluindo algumas de início tardio associadas a rearranjos genómicos por identifi car. Assim, é fundamental a identifi cação e a referência destes indivíduos com possíveis rearranjos cromossómicos associados a doenças. FCT HMSP-ICT/0016/2013 info:eu-repo/semantics/publishedVersion

Introdução: A hiperplasia congénita da supra renal surge por deficiência de 21-hidroxilase em 90-95% dos casos. É uma das doenças hereditárias de transmissão autossómica recessiva mais frequente. A gravidade da doença resulta do grau de deficiência enzimática da 21-hidroxilase, que depende da mutação que ocorre no gene CYP21A2. Pode ter duas apresentações clínicas: a forma clássica (perdedora de sal ou simplesmente virilizante) mais grave e a forma não clássica (ou expressão tardia) com bloqueio enzimático menos grave. Objetivos: Estudo de duas famílias portuguesas com HCSR-NC para melhor avaliação clínica e aconselhamento genético dessas famílias. N/A

Human developmental abnormalities are devastating conditions that account for almost half of all full-term neonatal deaths in developed countries. For individuals who survive, congenital anomalies often confer lifelong disability and their impact on public health is profound. However, the genetic etiology and genomic architecture contributing to the vast majority of these conditions remain unknown. Separately, and in addition, the genetic etiologies of recurrent infertility remain to be elucidated. The current low resolution diagnostic techniques are insensitive to the full mutational spectrum contributing to human developmental abnormalities and infertility, the poor understanding of the molecular alterations introduced by genomic rearrangements, and the lack of a fully annotated human genome hinders predictive diagnostics. This study results from collaboration between a Portuguese Consortium including clinical geneticists and the Developmental Genome Anatomy Project (DGAP) from Harvard Medical School. First, a group of cases were comparatively analyzed using genomic array and Next-Generation Sequencing (NGS). Subsequently, NGS of whole-genome large-insert libraries was applied for the identification of genomic or chromosomal rearrangements at nucleotide resolution in a series of cases, including two prenatal samples. Presently, this high-throughput technology is the only approach able to identify the full spectrum of structural variants, in a time frame that allows its application even for prenatal samples.The introduction of NGS into clinical cytogenetics surely will create a high-throughput, sequence-based Next-Gen Cytogenetics that will catalyze a dramatic advancement in clinical diagnostics. Therefore the understanding of the molecular pathology of these chromosome rearrangement-associated developmental disorders and infertilities will contribute to an improved prediction of the phenotypic consequences of these rearrangements.

RESUMO:O conceito de doenças raras como entidade própria começou a ser divulgado na comunidade médica no início deste século. A perspectiva de congregar múltiplas patologias, com características diferentes, valorizando a baixa frequência com que ocorrem na população interessou a comunidade científica, famílias, indústria e serviços de saúde. Esperava-se encontrar estratégias para melhorar a qualidade dos cuidados de saúde prestados a estes doentes. Uma vez que a informação científica sobre doenças raras está dispersa por diversas fontes o primeiro grande desafio foi sistematizar de forma a obter o “estado da arte”. A investigação que decorreu entre 2001 e 2010 teve como objectivo principal a caracterização dos doentes e das doenças raras numa população com características restritas mas não fechada como é o caso da ilha de S. Miguel nos Açores. Foram identificados 467 doentes a partir de várias fontes e monitorizado o nascimento de recém-nascidos com doença rara durante 10 anos. A prevalência das doenças raras encontrada na ilha de S. Miguel foi de 0,34% e a inerente à definição de doença rara foi de 6 % a 8 % da população na União Europeia. A diferença encontrada poderá decorrer de se ter sobrestimado o verdadeiro valor da prevalência das doenças raras na União Europeia. A incidência de doenças raras determinada na amostra foi de 0,1% e a taxa de mortalidade por causa específica foi de 0,14‰. O diagnóstico foi confirmado por técnicas laboratoriais de citogenética ou genética molecular em 43% dos doentes da amostra. Não foi identificado nenhum agregado populacional com doença rara para além do já conhecido para a DMJ. A criação de uma metodologia de estudo implicou a construção de um registo de doentes. Para tal foi utilizado o conhecimento adquirido anteriormente sobre uma doença rara que serviu de paradigma: a doença de Machado-Joseph. Na sequência dos resultados obtidos foi considerado útil a introdução de variáveis como a figura do cuidador, o cônjuge, o número de filhos do casal, a data da primeira consulta de Genética, o tempo decorrido entre o início dos sintomas e o acesso à consulta de Genética e entre esta actividade e dispor do diagnóstico para melhor compreender o contexto de vida destes doentes na perspectiva de poderem vir a ser incorporadas como indicadores. ----------- ABSTRACT: The concept of rare diseases as a condition began to be disclosed in the medical community at the beginning of this century.The prospect of bringing together multiple pathologies, with different features, enhancing the low frequency with which they occur in the population interested the scientific community, families, industry and health care services. The aim was to find strategies to improve the quality of care provided to these patients. Given that the scientific information on rare diseases is spread out across several sources the first major challenge was to systematize in order to get the "state of the art". The research took place between 2001 and 2010 and had as its main objective the characterization of patients and rare diseases in a population with specific features, but not confined, like in the case of the São Miguel Island in Azores. During 10 years were identified 467 patients from multiple sources and were observed the newborns with rare diseases. Prevalence of rare diseases found in the São Miguel Island was 0,34% compared to the 6% to 8% by definition of rare disease in the population in European Union. This discrepancy may be explained by a likely frequency of overrated rare diseases in European Union. The incidence of rare diseases in the sample was 0,1% and the specific mortality rate was 0,14 ‰. This diagnosis was confirmed by cytogenetic or molecular genetics analysis in 43% of patients in the sample. No population cluster was identified with rare disease besides the already known for Machado-Joseph Disease. The methodology for the study involved the construction of a database of patients. For such purpose it was used previously acquired knowledge on a rare disease paradigm: the Machado-Joseph disease. It was useful to introduce the following variables to properly establish the results: caregiver, spouse, number of children, date of first Genetics appointment, elapsed time between onset of symptoms and access to first appointment as well as this and the final diagnosis to better understand the context of life of these patients in order to incorporate them as rates.

Introduction: The Kallmann Syndrome is a clinically and genetically heterogeneous disease, frequently characterized by an association between hypogonadotropic hypogonodism and anosmia or hyposmia. The X-linked form of this syndrome is caused by mutations affecting the KAL1 gene that encodes the extracellular glycoprotein anosmin-1 responsible for the migration of GnRH neurons and olfactory nerves to the hypothalamus. Methods: Molecular diagnosis was performed in a patient with a phenotype of micropenis and strabismus, diagnosed as Kallmann Syndrome. Molecular analysis was performed by PCR and DNA sequencing of the amplified KAL1 exons. Absence of amplification of specific exons was validated by MLPA(Multiplex Ligation-dependent Probe Amplification) in order to confirm a gross gene deletion. Results: The propositus and his mother are carriers of a deletion that comprises exons 4 to 14 detected by PCR and MLPA. Discussion/Conclusion: The patient has a normal male karyotype. Molecular analysis allowed the identification of a large deletion covering exons 4 to 14 of the KAL1 gene. In turn, is mother is heterozygous for this deletion, allowing us to conclude that the patient’s KAL1 gene deletion was inherited, and as expected, is of maternal origin. The patient has a gross deletion of KAL1 that, up to date, is not reported in the scientific literature. Several other KAL1 whole or partial gene deletions have been identified as the cause of this syndrome. In this specific case, the absence of almost the whole KAL1 gene is the molecular basis of the patient phenotype. The identified molecular defect, allowed a better genetic counselling to the nuclear family as well as to other family members.

Objective: To present the clinical, cytogenetic and molecular findings of a prenatal study of a familial partial monosomy 10q. Distal 10q deletions are rare and the majority are terminal deletions involving bands 10q25 and 10q26. Patients typically present with facial dysmorphism, postnatal growth retardation, developmental and mental retardation, genitourinary anomalies and digital anomalies. Methods: Conventional cytogenetic analysis in metaphases obtained by chorionic villi long term cultures, multiplex ligation dependent probe amplification (MLPA), fluorescent in situ hybridization (FISH), microarray analysis. Results: A 24-year-old gravida was referred for chorionic villus sampling at 12+6 weeks of gestation due to a previous child with facial dysmorphism, bilateral inguinal hernia, short stature and mild to moderate psychomotor delay of whom a microarray analysis was underway. His karyotype was normal but array-CGH analysis disclosed a 10q24.33-q25.1 interstitial deletion. The deletion encompasses 987Kb to 1,14Mb and includes 20 genes, in particular the COL17A gene. Fetal and parental karyotypes were normal. FISH analysis with a BAC clone located within the 10q region deleted in the phenotypically abnormal sibling showed normal results for both the mother and the fetus and a deletion in the apparently normal father. Conclusion: In this case chorionic villi analysis as well as the application of FISH with a specific and targeted BAC clone allowed a shorter turnaround time for the prenatal investigation of the chromosomal abnormality. The authors discuss the challenges of microarray analysis application in the prenatal setting namely in cases like the one presented here where there seems to be phenotypic variability.

Background. Machado-Joseph disease (MJD) is an autosomal dominant neurodegenerative disorder of late onset, caused by a (CAG)n expansion at the ATXN3 gene (14q32.1). Variation in age-at-onset is partially explained by the size of the (CAG)n tract in expanded alleles. The remaining variation should be the product of other factors, namely modifier genes. The genotype at the APOE locus has been described as a possible modifier in different neurological disorders, namely Parkinson (PD) and Huntington disease (HD). In the CNS, apolipoprotein E constitutes an important mediator of cholesterol transport/metabolism, which is essential for synaptic integrity and neuronal function. Objective. To investigate a modulating effect of the APOE polymorphism on age-at-onset of MJD. Design and Subjects. The APOE polymorphism was typed in a series of 192 MJD patients. Results. Cases with the ε2/ε3 genotype presented an earlier onset, when compared with those with ε3/ε3 or ε3/ε4. In this series of patients, the presence of an APOE ε2 allele implies a decrease of nearly 5 years in the age-at-onset. When combining, in a general linear model, several other predictors, namely the presence/absence of the APOE ε2 allele, with the size of the (CAG)n in expanded alleles, the model was significantly improved and the explanation of onset variance was raised from 59.8% to 66.5%. Furthermore, the presence of the ε2 allele was associated with an onset below 39 years (OR=5.00; 95% CI: 1.18-21.14). Conclusions. These findings indicate that the polymorphism at the APOE gene plays a role as a genetic modifier of MJD phenotype., Fundação para a Ciência e a Tecnologia (FCT) - SFRH/BPD/63121/2009, SFRH/BPD/38659/2007, M3.1.3/F/004/2009, “Secretaria Regional da Ciência, Tecnologia e Equipamentos”., Fundação para a Ciência e a Tecnologia (FCT) - “Transcriptional variation of the ATXN3 gene as modulator of the clinical heterogeneity in Machado-Joseph disease (MJD)” (PIC/IC/83074/2007), Institute of Biotechnology and Biomedicine (IBBA) - “High prevalence diseases in the Azores Islands” (M2.1.2/I/026/2008

A Síndrome de Alström (SA, MIM# 203800) é uma doença hereditária, de transmissão autossómica recessiva, descrita pela primeira vez em 1959, por Alström. O gene ALMS1, causador da doença, foi identificado em 2002 e localiza-se no cromossoma 2p13. É uma doença genética rara, com o envolvimento de múltiplos órgãos e de evolução progressiva. As principais características fenotípicas incluem: retinopatia pigmentar, surdez neurosensorial, miocardiopatia dilatada, obesidade, hiperinsulinismo e resistência à insulina. Recentemente, foram publicados critérios de diagnóstico, classificados em major e minor, contribuindo para um diagnóstico precoce da doença. Descrevem-se quatro casos, realçando-se as diferentes formas de apresentação clínica, a importância de um seguimento multidisciplinar e a possibilidade de se tratar provavelmente de uma doença sub-diagnosticada., Portuguese Journal of Pediatrics, Vol 40 No 3 (2009)

XII Expedição Científica do Departamento de Biologia - Pico 2005. A doença de Machado-Joseph (DMJ) é uma doença neurodegenerativa, de transmissão autossómica dominante e de início tardio (média de 40 anos) (Coutinho, 1992), causada pela expansão do tripleto CAG, num gene localizado em 14q32.1 (Kawaguchi et al., 1994). A DMJ constitui nos Açores, dada a sua elevada prevalência, um problema de Saúde Pública. As famílias afectadas dos Açores são originárias das ilhas das Flores, S. Miguel, Terceira e Graciosa, sendo nas ilhas das Flores (1 em cada 106 habitantes é doente) e em S. Miguel (1 em cada 3148 é doente) que se encontra a maior concentração de doentes (Lima et al., 1997). Existem, contudo elementos das referidas famílias em praticamente todas as ihas açorianas, nomeadamente na ilha do Pico. Um conhecimento detalhado da epidemiologia da DMJ nos Açores assume a maior importância, por permitir uma melhor intervenção assistencial, que inclui não só o apoio aos doentes, como se estende aos indivíduos em risco (filhos de um doente DMJ), através da disponibilização do Programa de Aconselhamento Genético e Teste Preditivo.