Smith–Magenis syndrome

Smith–Magenis syndrome
Classification and external resources
Specialty medical genetics
ICD-10 Q93.5
ICD-9-CM 758.33
OMIM 182290
DiseasesDB 31737

Smith–Magenis Syndrome (SMS) is a developmental disorder affecting the body and brain. Features include intellectual disability, facial features such as a broad face, difficulty sleeping, and numerous behavioral problems. Smith–Magenis syndrome affects an estimated 1 in 25,000 individuals. [1]

It is a microdeletion syndrome characterized by an abnormality in the short (p) arm of chromosome 17 and is sometimes called the 17p- syndrome.[2]


The eponym Smith–Magenis refers to two scientists who described the condition in 1986, namely, Ann C. M. Smith, a genetic counselor at the National Institutes of Health, and R. Ellen Magenis, a pediatrician, medical geneticist and cytogeneticist at the Oregon Health Sciences University.[3][4]


Facial features of children with Smith-Magenis syndrome include a broad face, deep-set eyes, large cheeks, and a prominent jaw, as well as a flat nose bridge. The mouth curves downwards and the upper lip curves outwards. These facial features become more noticeable as the individual ages.

Disrupted sleep patterns are characteristic of Smith–Magenis syndrome, typically beginning early in life. Affected people may be very sleepy during the day, but have trouble falling asleep and awaken several times each night, due to an inverted circadian rhythm of melatonin.[5]

People with Smith–Magenis syndrome have engaging personalities, but all also have a lot behavioral problems. These behavioral problems include frequent temper tantrums, meltdowns and outbursts, aggression, anger, fidgeting, compulsive behavior, anxiety, impulsiveness, and difficulty paying attention. Self-injury, including biting, hitting, head banging, and skin picking, is very common. Repetitive self-hugging is a behavioral trait that may be unique to Smith–Magenis syndrome. People with this condition may also compulsively lick their fingers and flip pages of books and magazines (a behavior known as "lick and flip"), as well as possessing an impressive ability to recall a wide range of small details about people or subject-specific trivia.

Other symptoms can include short stature, abnormal curvature of the spine (scoliosis), reduced sensitivity to pain and temperature, and a hoarse voice. Some people with this disorder have ear abnormalities that lead to hearing loss. Affected individuals may have eye abnormalities that cause nearsightedness (myopia), strabismus, and other problems with vision. Heart and kidney defects also have been reported in people with Smith–Magenis syndrome, though they are less common.


Smith–Magenis syndrome is a chromosomal condition related to low copy repeats of specific segments of chromosome 17.[6] Most people with SMS have a deletion of genetic material from a specific region of chromosome 17 (17p11.2). Although this region contains multiple genes, recently researchers discovered that the loss of one particular gene the retinoic acid induced 1 or RAI1 is responsible for most of the characteristic features of this condition.[7][8] Also, other genes within the chromosome 17 contribute to the variability and severity of the clinical features. The loss of other genes in the deleted region may help explain why the features of Smith–Magenis syndrome vary among affected individuals. A small percentage of people with Smith–Magenis syndrome have a mutation in the RAI1 gene instead of a chromosomal deletion.

These deletions and mutations lead to the production of an abnormal or nonfunctional version of the RAI1 protein. RAI1 is a transcription factor that regulates the expression of multiple genes, including several that are involved in controlling circadian rhythm, such as CLOCK.[9] The groups led by James Lupski (Baylor College of Medicine) and Sarah Elsea (Virginia Commonwealth University) are in the process of studying the exact function of this gene in relation to Smith Magenis Syndrome.

SMS is typically not inherited. This condition usually results from a genetic change that occurs during the formation of reproductive cells (eggs or sperm) or in early fetal development. People with Smith–Magenis syndrome most often have no history of the condition in their family.


SMS is usually confirmed by blood tests called chromosome (cytogenetic) analysis and utilize a technique called FISH (fluorescent in situ hybridization). The characteristic micro-deletion was sometimes overlooked in a standard FISH test, leading to a number of people with the symptoms of SMS with negative results.

The recent development of the FISH for 17p11.2 deletion test has allowed more accurate detection of this deletion.[10] However, further testing is required for variations of Smith–Magenis syndrome that are caused by a mutation of the RAI1 gene as opposed to a deletion.

Children with SMS are often given psychiatric diagnoses such as autism, attention deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), attention deficit disorder (ADD) and/or mood disorders.


Treatment for Smith–Magenis syndrome relies on managing its symptoms. Children with SMS often require several forms of support, including physical therapy, occupational therapy and speech therapy. Support is often required throughout an affected person's lifetime.

Medication is often used to address some symptoms. Melatonin supplements and trazodone are commonly used to regulate sleep disturbances. In combination with exogenous melatonin, blockade of endogenous melatonin production during the day by the adrenergic antagonist acebutolol can increase concentration, improve sleep and sleep timing and aid in improvement of behaviour.[11] Other medications (such as risperdal) are sometimes used to regulate violent behavior.

Australian respite camps

Since 2003 there have been seven bi-annual SMS camps held in Australia, attended by families with SMS children from all around the country. The camps have been organised and hosted by Camp Breakaway at San Remo on the New South Wales central coast. Professor Ann Smith has been in attendance and has run clinics at each camp. The most recent camp was held in April 2016.[12]

See also


  1. "Smith-Magenis syndrome". December 2013. Retrieved 2016-03-27.
  2. Bi, W; Yan, J; Stankiewicz, P; Park, SS; Walz, K; Boerkoel, CF; Potocki, L; Shaffer, LG; Devriendt, K; Nowaczyk, MJ; Inoue, K; Lupski, JR (May 2002). "Genes in a refined Smith-Magenis syndrome critical deletion interval on chromosome 17p11.2 and the syntenic region of the mouse.". Genome Research. 12 (5): 713–28. doi:10.1101/gr.73702. PMC 186594Freely accessible. PMID 11997338.
  3. synd/3884 at Who Named It?
  4. Smith AC, McGavran L, Robinson J, et al. (1986). "Interstitial deletion of (17)(p11.2p11.2) in nine patients". Am. J. Med. Genet. 24 (3): 393–414. doi:10.1002/ajmg.1320240303. PMID 2425619.
  5. De Leersnyder H, De Blois MC, Claustrat B, et al. (2001). "Inversion of the circadian rhythm of melatonin in the Smith-Magenis syndrome". J Pediatr. 139 (1): 111–116. doi:10.1067/mpd.2001.115018. PMID 11445803.
  6. Shaw, CJ; Withers, MA; Lupski, JR (July 2004). "Uncommon deletions of the Smith-Magenis syndrome region can be recurrent when alternate low-copy repeats act as homologous recombination substrates.". American Journal of Human Genetics. 75 (1): 75–81. doi:10.1086/422016. PMID 15148657.
  7. Girirajan S, Vlangos CN, Szomju BB, et al. (2006). "Genotype-phenotype correlation in Smith–Magenis syndrome: evidence that multiple genes in 17p11.2 contribute to the clinical spectrum". Genet. Med. 8 (7): 417–27. doi:10.1097/01.gim.0000228215.32110.89. PMID 16845274.
  8. Elsea, SH; Girirajan, S (April 2008). "Smith-Magenis syndrome.". European Journal of Human Genetics. 16 (4): 412–21. doi:10.1038/sj.ejhg.5202009. PMID 18231123.
  9. Williams SR, Zies D, Mullegama SV, et al. (2012). "Smith-Magenis syndrome results in disruption of CLOCK gene transcription and reveals an integral role for RAI1 in the maintenance of circadian rhythmicity". Am. J. Hum. Genet. 90 (6): 941–949. doi:10.1016/j.ajhg.2012.04.013. PMID 22578325.
  10. Lupski, James R.; Potocki, Lorraine; Chen, Ken-Shiung; Park, Sung-Sup; Osterholm, Doreen E.; Withers, Marjorie A.; Kimonis, Virginia; Summers, Anne M.; Meschino, Wendy S.; Anyane-Yeboa, Kwame; Kashork, Catherine D.; Shaffer, Lisa G. (1 January 2000). "Molecular mechanism for duplication 17p11.2— the homologous recombination reciprocal of the Smith-Magenis microdeletion". Nature Genetics. 24 (1): 84–87. doi:10.1038/71743. PMID 10615134.
  11. De Leersnyder, H. (September 2006). "Inverted rhythm of melatonin secretion in Smith–Magenis syndrome: from symptoms to treatment". Trends Endocrinol Metab. (Abstract). 17 (7): 291–8. doi:10.1016/j.tem.2006.07.007. PMID 16890450.
    De-Leersnyder H, de-Blois MC, Vekemans M, Sidi D, Villain E, Kindermans C, Munnich A (September 2001). 1-adrenergic antagonists improve sleep and behavioural disturbances in a circadian disorder, Smith–Magenis syndrome" (Full text). Journal of Medical Genetics. BMJ Publishing Group Ltd. 38 (9): 586–590. doi:10.1136/jmg.38.9.586. Retrieved 2009-05-21.

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