This is my friend Clifford. When he was diagnosed with Batten Disease 20 years ago, doctors told his parents to take him home and enjoy the time he has left. Batten Disease is fatal 100% of the time. There are no exceptions. There’s no such thing as a ‘mild form’ of the disease.

Rare Disease Day is observed this year on February 29th. The objective of the day is to raise awareness with the general public and lawmakers about rare diseases, and how they impact the lives of patients and their families. Rare diseases touch the lives of about one in every 20 people.

Batten Disease is just one of over 6,000 rare diseases that have been documented. There are only about two to four cases in every 100,000 births.

Clifford is the son of one of my oldest and dearest friends, Dave. Prior to Clifford’s diagnosis, we led similar lives. We became friends in our 20s while we struggled to establish our respective careers. He was my best man and I his, as we married and started families within months of each other. 

Blindness is the most-obvious symptom to people. If that were his only problem, this would be something we could easily deal with.

Clifford’s life started out normally. We visited them in Illinois just months after he was born, right after finding out my wife was expecting twins. Holding him as a baby, I had no idea what would eventually unfold. None of us did. He walked, talked, sassed, played, and hit the usual childhood benchmarks at more or less the right times. He developed an insatiable love for sports. At a young age, Clifford set his sights on being a baseball announcer for the St. Louis Cardinals.

Life changed forever in November of 2003. As he began 1st grade, he was having difficulty seeing. He had begun wearing glasses in kindergarten, but his visual acuity had deteriorated further. After numerous tests, a specialist in Chicago confirmed that Clifford had Neuronal Ceroid Lipofuscinosis (NCL), or Batten Disease.

More information on the disease is available here, but Batten Disease is essentially a buildup of substances called lipopigments (or fatty tissues) in the cells of the brain, eyes, and other tissues. The disease causes the death of neurons in the brain, retinas, and central nervous system.

Its progression is slow. Kids with the juvenile form of Batten Disease (which Clifford has) are usually diagnosed when they are 5 to 7 years old. Usually the first symptom is vision loss. Clifford was completely blind just months after his diagnosis. “Blindness is the most-obvious symptom to people,” Dave once told me. “If that were his only problem, this would be something we could easily deal with.” As the fatty tissues slowly kill cells in the brain and central nervous system, cognitive ability and motor skills deteriorate. “Emotionally and socially he is much like a preschooler,” his mother Corrina said. “Physically, his speech has really gone downhill. We are constantly asking him to repeat stuff. His walking has gotten more difficult, he can be really unsteady on his feet, falling easily. He uses a wheelchair much more often than he used to.”

A “sentence” is usually how I characterize what Dave and his wife have been handed. Their son will inevitably die, and they have been sentenced to spend 25 years or so watching it happen, ever so gradually.

The backward steps he takes seem more pronounced to me. Since we live 450 miles apart, our visits are infrequent. Each time I see them, Clifford’s speech is more unintelligible than it was previously. But judging his regression on a mental, emotional, and social level is more difficult. Although he exhibits the naiveté of a toddler, his cognitive dexterity can be unpredictable. He was fascinated to learn that one of my stepsons is a vegetarian. Years later, he remembers that fact, but struggles to understand the concept of a blended family. (The picture above is from 2012 when our families met in Chicago for a Tigers/White Sox game. I only recall that Detroit lost. Clifford could probably tell you the score, who pitched, and plenty of other details.)

A boy who is the size of a typical teenager, but has the state of mind of a much younger child can be unbelievably frustrating to those close to him. But his big heart, and bigger-than-life personality make him truly endearing.

Younger brother Isaac was an infant when Clifford was diagnosed, and because Batten Disease is a genetic recessive disorder, there was a 25% chance he would have it as well. The Dahls agonized for three years, waiting until he was old enough to be tested, and were finally given the news in 2007 that he does not have the disease. “I think the hardest part for Isaac is that he has taken over the role of the big brother,” Corrina said, noting that he does not remember a time when his brother was healthy.

“For the most part, we go on with our lives like everyone else, going to school and work and other activities. But as the years go by, and we see the physical changes, and as the gap between him and his peers widens, we are hit by the sadness of knowing the he will continue to decline both mentally and physically, and we can’t change that.” the gap between him and his peers widens, we are hit by the sadness of knowing the he will continue to decline both mentally and physically, and we can’t change that.

At 26, the future is bleak. Batten Disease is fatal 100% of the time. The Dahls were told Clifford would probably live into his late teens or early 20s. Only a handful of Batten kids see their 30th birthday. In recent years, the disease has slowly gained more ground and Clifford has become bedridden.

“It certainly has changed my perspective about what to complain about,” Dave told me. My advice to him has always been, “Make the most of the time you have left with him,” and “Remember, it’s better to have loved and lost…” It’s sage advice, but it’s also a load of crap, because I truly don’t understand what it’s like to walk a mile in his shoes.

Since Batten Disease it is classified as a rare disease, funding for research is extremely limited. The Dahls were invited to participate in a drug trial that took place at the University of Rochester in New York. “Clifford was excited to take part, even though he did understand that the medicine would not help him at this time,” Corrina said, explaining that it was only a safety study to test patients’ tolerance for certain medications. “It probably won’t be a treatment option in time to help him, but it may help someone else [in the future] so another parent doesn’t have to hear the words, ‘No treatment, no cure.’”


For more information about Batten Disease, visit the Batten Disease Support and Research Association.
For more on rare diseases, visit the Rare Disease Day homepage.

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