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Sabharwal P, Devinsky O, M Shepherd T. Novel bandlike signal abnormality suggestive of heterotopia in patient with a KCNQ1 frameshift mutation. Epilepsia Open 2018; 2:481-484. [PMID: 29588980 PMCID: PMC5862117 DOI: 10.1002/epi4.12072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2017] [Indexed: 11/11/2022] Open
Abstract
Malformations of cortical development are associated with epilepsy and cognitive dysfunction, and can occur in patients with SCN1A ion channel mutations. We report a novel and subtle bandlike subcortical heterotopia on integrated positron emission tomography–magnetic resonance imaging ( PET‐MRI) in a patient with treatment‐resistant epilepsy due to a de novo KCNQ1 frameshift mutation. Our case highlights the potential for other channel mutations to cause both epilepsy and cortical malformations. Further scrutiny of high contrast resolution MRI studies is warranted for patients with KCNQ1 and other epilepsy genes to further define their extended phenotype.
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Affiliation(s)
- Priyanka Sabharwal
- Department of Neurology NYU Langone Medical Center New York New York U.S.A
| | - Orrin Devinsky
- Department of Neurology NYU Langone Medical Center New York New York U.S.A
| | - Timothy M Shepherd
- Department of Radiology NYU Langone Medical Center New York New York U.S.A.,Center for Advanced Imaging Innovation and Research New York New York U.S.A
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Mahdieh N, Mikaeeli S, Badv RS, Shirazi AG, Maleki M, Rabbani B. Pathogenic significance of SCN1A splicing variants causing Dravet syndrome: Improving diagnosis with targeted sequencing for variants by in silico analysis. Clin Neurol Neurosurg 2018; 166:80-90. [PMID: 29408779 DOI: 10.1016/j.clineuro.2018.01.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/21/2018] [Accepted: 01/27/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Genetic heterogeneity of epileptic encephalopathy (IEE) mandates the use of gene-panels for diagnosis. PATIENTS AND METHODS A 36-gene-panel next-generation sequencing was applied for IEE in two Iranian families. A literature search was performed using keywords to identify reported splicing mutations in SCN1A and perform genotype-phenotype correlation. RESULTS An update of splicing mutations revealed 147 variants with 65.75% of them de novo mutations. Most of the familial variants were of parental origin. The structure of the protein was often affected in the linker and transmembrane segments. 92% of intronic variants were pathogenic. A de novo heterozygous mutation was found in the first patient, but not in her sibling and parents. In the second family, a novel de novo heterozygous mutation was found at position c.1210insT leading to a truncated protein. CONCLUSION Gene-panel sequencing is helpful for reducing the time and cost, guiding early treatment, and estimating the recurrence risks. The importance of characterization of intronic variants was noticed; though bioinformatics analysis of novel intronic variants should be of concern for rapid reporting the pathogenic effect of variants.
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Affiliation(s)
- Nejat Mahdieh
- Genetic Research Laboratory, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Sepideh Mikaeeli
- Genetic Research Laboratory, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Shervin Badv
- Children's Hospital Center, Pediatric Center of Excellence, Tehran University of Medical Center, Tehran, Iran
| | - Azadeh Gharehzadeh Shirazi
- Children's Hospital Center, Pediatric Center of Excellence, Tehran University of Medical Center, Tehran, Iran
| | - Majid Maleki
- Genetic Research Laboratory, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Bahareh Rabbani
- Genetic Research Laboratory, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
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53
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Kurian M, Korff CM, Ranza E, Bernasconi A, Lübbig A, Nangia S, Ramelli GP, Wohlrab G, Nordli DR, Bast T. Focal cortical malformations in children with early infantile epilepsy and PCDH19 mutations: case report. Dev Med Child Neurol 2018; 60:100-105. [PMID: 29064093 DOI: 10.1111/dmcn.13595] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED In this case report we assess the occurrence of cortical malformations in children with early infantile epilepsy associated with variants of the gene protocadherin 19 (PCDH19). We describe the clinical course, and electrographic, imaging, genetic, and neuropathological features in a cohort of female children with pharmacoresistant epilepsy. All five children (mean age 10y) had an early onset of epilepsy during infancy and a predominance of fever sensitive seizures occurring in clusters. Cognitive impairment was noted in four out of five patients. Radiological evidence of cortical malformations was present in all cases and, in two patients, validated by histology. Sanger sequencing and Multiplex Ligation-dependent Probe Amplification analysis of PCDH19 revealed pathogenic variants in four patients. In one patient, array comparative genomic hybridization showed a microdeletion encompassing PCDH19. We propose molecular testing and analysis of PCDH19 in patients with pharmacoresistant epilepsy, with onset in early infancy, seizures in clusters, and fever sensitivity. Structural lesions are to be searched in patients with PCDH19 pathogenic variants. Further, PCDH19 analysis should be considered in epilepsy surgery evaluation even in the presence of cerebral structural lesions. WHAT THIS PAPER ADDS Focal cortical malformations and monogenic epilepsy syndromes may coexist. Structural lesions are to be searched for in patients with protocadherin 19 (PCDH19) pathogenic variants with refractory focal seizures.
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Affiliation(s)
- Mary Kurian
- Pediatric Neurology Unit, Child and Adolescent Department, University Hospitals, Geneva, Switzerland
| | - Christian M Korff
- Pediatric Neurology Unit, Child and Adolescent Department, University Hospitals, Geneva, Switzerland
| | - Emmanuelle Ranza
- Service of Medical Genetics, University Hospitals, Geneva, Switzerland
| | - Andrea Bernasconi
- Neuroimaging of Epilepsy Laboratory, Department of Neurology and McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Anja Lübbig
- Neuropediatric Clinic and Clinic for Neurorehabilitation, Epilepsy Center for Children and Adolescents, Vogtareuth, Germany
| | - Srishti Nangia
- Department of Pediatrics, Division of Child Neurology, Weill Cornell Medical College, New York, NY, USA.,New York Presbyterian Hospital, New York, NY, USA
| | - Gian Paolo Ramelli
- Pediatric Department of Southern Switzerland, San Giovanni Hospital, Bellinzona, Switzerland
| | - Gabriele Wohlrab
- Pediatric Neurology Unit, University Children's Hospital, Zurich, Switzerland
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54
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Barba C, Specchio N, Guerrini R, Tassi L, De Masi S, Cardinale F, Pellacani S, De Palma L, Battaglia D, Tamburrini G, Didato G, Freri E, Consales A, Nozza P, Zamponi N, Cesaroni E, Di Gennaro G, Esposito V, Giulioni M, Tinuper P, Colicchio G, Rocchi R, Rubboli G, Giordano F, Lo Russo G, Marras CE, Cossu M. Increasing volume and complexity of pediatric epilepsy surgery with stable seizure outcome between 2008 and 2014: A nationwide multicenter study. Epilepsy Behav 2017; 75:151-157. [PMID: 28866334 DOI: 10.1016/j.yebeh.2017.08.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 08/02/2017] [Accepted: 08/03/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of the study was to assess common practice in pediatric epilepsy surgery in Italy between 2008 and 2014. METHODS A survey was conducted among nine Italian epilepsy surgery centers to collect information on presurgical and postsurgical evaluation protocols, volumes and types of surgical interventions, and etiologies and seizure outcomes in pediatric epilepsy surgery between 2008 and 2014. RESULTS Retrospective data on 527 surgical procedures were collected. The most frequent surgical approaches were temporal lobe resections and disconnections (133, 25.2%) and extratemporal lesionectomies (128, 24.3%); the most frequent etiologies were FCD II (107, 20.3%) and glioneuronal tumors (105, 19.9%). Volumes of surgeries increased over time independently from the age at surgery and the epilepsy surgery center. Engel class I was achieved in 73.6% of patients (range: 54.8 to 91.7%), with no significant changes between 2008 and 2014. Univariate analyses showed a decrease in the proportion of temporal resections and tumors and an increase in the proportion of FCDII, while multivariate analyses revealed an increase in the proportion of extratemporal surgeries over time. A higher proportion of temporal surgeries and tumors and a lower proportion of extratemporal and multilobar surgeries and of FCD were observed in low (<50surgeries/year) versus high-volume centers. There was a high variability across centers concerning pre- and postsurgical evaluation protocols, depending on local expertise and facilities. SIGNIFICANCE This survey reveals an increase in volume and complexity of pediatric epilepsy surgery in Italy between 2008 and 2014, associated with a stable seizure outcome.
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Affiliation(s)
- Carmen Barba
- Pediatric Neurology Unit, Neuroscience Department, Children's Hospital Anna Meyer-University of Florence, Florence, Italy.
| | - Nicola Specchio
- Pediatric Neurology Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Renzo Guerrini
- Pediatric Neurology Unit, Neuroscience Department, Children's Hospital Anna Meyer-University of Florence, Florence, Italy; IRCCS Stella Maris, Pisa, Italy
| | - Laura Tassi
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Salvatore De Masi
- Clinical Trial Office, Children's Hospital Anna Meyer, Florence, Italy
| | | | - Simona Pellacani
- Pediatric Neurology Unit, Neuroscience Department, Children's Hospital Anna Meyer-University of Florence, Florence, Italy
| | - Luca De Palma
- Pediatric Neurology Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | | | | | - Giuseppe Didato
- Clinical and Experimental Epileptology, Foundation IRCCS Neurological Institute "Carlo Besta", Milan, Italy
| | - Elena Freri
- Department of Pediatric Neuroscience, Foundation IRCCS Carlo Besta Neurological Institute, Milan, Italy
| | | | - Paolo Nozza
- Anatomical Pathology Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - Nelia Zamponi
- Child Neurology and Psychiatry Unit, Children's Hospital G. Salesi-University of Ancona, Ancona, Italy
| | - Elisabetta Cesaroni
- Child Neurology and Psychiatry Unit, Children's Hospital G. Salesi-University of Ancona, Ancona, Italy
| | | | - Vincenzo Esposito
- IRCCS Neuromed, Pozzilli, IS, Italy; Department of Neurology and Psychiatry, University of Rome "La Sapienza", Rome, Italy
| | - Marco Giulioni
- Division of Neurosurgery, IRCCS - Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
| | - Paolo Tinuper
- Division of Neurology, IRCCS - Institute of Neurological Sciences of Bologna, Bellaria Hospital, Bologna, Italy
| | | | - Raffaele Rocchi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Guido Rubboli
- Danish Epilepsy Centre, Filadelfia/University of Copenhagen, Dianalund, Denmark; IRCCS Institute of Neurological Sciences, Neurology Unit, Bellaria Hospital, Bologna, Italy
| | - Flavio Giordano
- Neurosurgery Department, Children's Hospital Anna Meyer-University of Florence, Florence, Italy
| | - Giorgio Lo Russo
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Carlo Efisio Marras
- Pediatric Neurosurgery Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Massimo Cossu
- "Claudio Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
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55
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Platzer K, Yuan H, Schütz H, Winschel A, Chen W, Hu C, Kusumoto H, Heyne HO, Helbig KL, Tang S, Willing MC, Tinkle BT, Adams DJ, Depienne C, Keren B, Mignot C, Frengen E, Strømme P, Biskup S, Döcker D, Strom TM, Mefford HC, Myers CT, Muir AM, LaCroix A, Sadleir L, Scheffer IE, Brilstra E, van Haelst MM, van der Smagt JJ, Bok LA, Møller RS, Jensen UB, Millichap JJ, Berg AT, Goldberg EM, De Bie I, Fox S, Major P, Jones JR, Zackai EH, Jamra RA, Rolfs A, Leventer RJ, Lawson JA, Roscioli T, Jansen FE, Ranza E, Korff CM, Lehesjoki AE, Courage C, Linnankivi T, Smith DR, Stanley C, Mintz M, McKnight D, Decker A, Tan WH, Tarnopolsky MA, Brady LI, Wolff M, Dondit L, Pedro HF, Parisotto SE, Jones KL, Patel AD, Franz DN, Vanzo R, Marco E, Ranells JD, Di Donato N, Dobyns WB, Laube B, Traynelis SF, Lemke JR. GRIN2B encephalopathy: novel findings on phenotype, variant clustering, functional consequences and treatment aspects. J Med Genet 2017; 54:460-470. [PMID: 28377535 PMCID: PMC5656050 DOI: 10.1136/jmedgenet-2016-104509] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 02/14/2017] [Accepted: 02/16/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND We aimed for a comprehensive delineation of genetic, functional and phenotypic aspects of GRIN2B encephalopathy and explored potential prospects of personalised medicine. METHODS Data of 48 individuals with de novo GRIN2B variants were collected from several diagnostic and research cohorts, as well as from 43 patients from the literature. Functional consequences and response to memantine treatment were investigated in vitro and eventually translated into patient care. RESULTS Overall, de novo variants in 86 patients were classified as pathogenic/likely pathogenic. Patients presented with neurodevelopmental disorders and a spectrum of hypotonia, movement disorder, cortical visual impairment, cerebral volume loss and epilepsy. Six patients presented with a consistent malformation of cortical development (MCD) intermediate between tubulinopathies and polymicrogyria. Missense variants cluster in transmembrane segments and ligand-binding sites. Functional consequences of variants were diverse, revealing various potential gain-of-function and loss-of-function mechanisms and a retained sensitivity to the use-dependent blocker memantine. However, an objectifiable beneficial treatment response in the respective patients still remains to be demonstrated. CONCLUSIONS In addition to previously known features of intellectual disability, epilepsy and autism, we found evidence that GRIN2B encephalopathy is also frequently associated with movement disorder, cortical visual impairment and MCD revealing novel phenotypic consequences of channelopathies.
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Affiliation(s)
- Konrad Platzer
- Institute of Human Genetics, University of Leipzig Hospitals and Clinics, Leipzig, Germany
| | - Hongjie Yuan
- Department of Pharmacology, Emory University School of Medicine, Rollins Research Center, Atlanta, Georgia, USA
- Center for Functional Evaluation of Rare Variants (CFERV), Emory University School of Medicine, Atlanta, Georgia, USA
| | - Hannah Schütz
- Department of Neurophysiology and Neurosensory Systems, Technical University Darmstadt, Darmstadt, Hessen, Germany
| | - Alexander Winschel
- Department of Neurophysiology and Neurosensory Systems, Technical University Darmstadt, Darmstadt, Hessen, Germany
| | - Wenjuan Chen
- Department of Pharmacology, Emory University School of Medicine, Rollins Research Center, Atlanta, Georgia, USA
| | - Chun Hu
- Department of Pharmacology, Emory University School of Medicine, Rollins Research Center, Atlanta, Georgia, USA
| | - Hirofumi Kusumoto
- Department of Pharmacology, Emory University School of Medicine, Rollins Research Center, Atlanta, Georgia, USA
| | - Henrike O Heyne
- Institute of Human Genetics, University of Leipzig Hospitals and Clinics, Leipzig, Germany
| | - Katherine L Helbig
- Division of Clinical Genomics, Ambry Genetics, Aliso Viejo, California, USA
| | - Sha Tang
- Division of Clinical Genomics, Ambry Genetics, Aliso Viejo, California, USA
| | - Marcia C Willing
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Brad T Tinkle
- Advocate Children’s Hospital, Park Ridge, Illinois, USA
| | - Darius J Adams
- Genetics and Metabolism, Goryeb Children’s Hospital, Atlantic Health System, Morristown, New Jersey, USA
| | - Christel Depienne
- INSERM, U 1127, Sorbonne Universités, UPMC Université Paris 06, CNRS, UMR 7225, Institut du cerveau et de la moelle épinière (ICM), Paris, France
- Département de Génétique, Centre de Référence des Déficiences Intellectuelles de Causes Rares, GRC UPMC “Déficiences Intellectuelles et Autisme”, Hôpital de la Pitié-Salpêtrière, Paris, France
- UMR 7104/INSERM U964/Université de Strasbourg, Illkirch, France
- Laboratoire de cytogénétique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Boris Keren
- INSERM, U 1127, Sorbonne Universités, UPMC Université Paris 06, CNRS, UMR 7225, Institut du cerveau et de la moelle épinière (ICM), Paris, France
- Département de Génétique, Centre de Référence des Déficiences Intellectuelles de Causes Rares, GRC UPMC “Déficiences Intellectuelles et Autisme”, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Cyril Mignot
- Département de Génétique, Centre de Référence des Déficiences Intellectuelles de Causes Rares, GRC UPMC “Déficiences Intellectuelles et Autisme”, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Eirik Frengen
- Department of Medical Genetics, Oslo University Hospitals and University of Oslo, Oslo, Norway
| | - Petter Strømme
- Department of Pediatrics, Oslo University Hospitals and University of Oslo, Oslo, Norway
| | - Saskia Biskup
- Practice for Human Genetics and CeGaT GmbH, Tübingen, Germany
| | - Dennis Döcker
- Practice for Human Genetics and CeGaT GmbH, Tübingen, Germany
| | - Tim M Strom
- Institute of Human Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Heather C Mefford
- Department of Pediatrics, Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
| | - Candace T Myers
- Department of Pediatrics, Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
| | - Alison M Muir
- Department of Pediatrics, Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
| | - Amy LaCroix
- Department of Pediatrics, Division of Genetic Medicine, University of Washington, Seattle, Washington, USA
| | - Lynette Sadleir
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Ingrid E Scheffer
- Department of Medicine, University of Melbourne, Austin Health and Royal Children’s Hospital, Melbourne, Victoria, Australia
| | - Eva Brilstra
- Department of Genetics, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Mieke M van Haelst
- Department of Genetics, Utrecht University Medical Center, Utrecht, The Netherlands
| | | | - Levinus A Bok
- Department of Paediatrics, Màxima Medical Centre, Veldhoven, The Netherlands
| | - Rikke S Møller
- The Danish Epilepsy Centre Filadelfia, Dianalund, Denmark
- Institute for Regional Health Services, University of Southern Denmark, Odense, Denmark
| | - Uffe B Jensen
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - John J Millichap
- Departments of Pediatrics, Epilepsy Center and Division of Neurology Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anne T Berg
- Departments of Pediatrics, Epilepsy Center and Division of Neurology Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ethan M Goldberg
- Division of Neurology, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Isabelle De Bie
- Department of Medical Genetics, Montreal Children’s Hospital, McGill University Health Center, Montreal, Canada
| | - Stephanie Fox
- Department of Medical Genetics, Montreal Children’s Hospital, McGill University Health Center, Montreal, Canada
| | - Philippe Major
- Department of Neurological Sciences, Université de Montréal, CHU Ste-Justine, Montreal, Canada
| | - Julie R Jones
- Greenwood Genetic Center, Greenwood, South Carolina, USA
| | - Elaine H Zackai
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Rami Abou Jamra
- Institute of Human Genetics, University of Leipzig Hospitals and Clinics, Leipzig, Germany
- Centogene AG, Rostock, Germany
| | | | - Richard J Leventer
- Department of Neurology, Royal Children’s Hospital, Melbourne, Victoria, Australia
- Murdoch Childrens Research Institute and Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - John A Lawson
- Department of Neurology, Sydney Children’s Hospital, Sydney, New South Wales, Australia
| | | | - Floor E Jansen
- Department of Child Neurology, Brain Center Rudolf Magnus, University Medical Center, Utrecht, The Netherlands
| | - Emmanuelle Ranza
- Service of Genetic Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Christian M Korff
- Department of Child and Adolescent, Neurology Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Anna-Elina Lehesjoki
- The Folkhälsan Institute of Genetics, University of Helsinki, Helsinki, Finland
- Research Programs Unit, Molecular Neurology and Neuroscience Center, University of Helsinki, Helsinki, Finland
| | - Carolina Courage
- The Folkhälsan Institute of Genetics, University of Helsinki, Helsinki, Finland
- Research Programs Unit, Molecular Neurology and Neuroscience Center, University of Helsinki, Helsinki, Finland
| | - Tarja Linnankivi
- Department of Pediatric Neurology, Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | | | - Mark Mintz
- The Center for Neurological and Neurodevelopmental Health and the Clinical Research Center of New Jersey, Voorhees, New Jersey, USA
| | | | | | - Wen-Hann Tan
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Mark A Tarnopolsky
- Department of Pediatrics, McMaster University Children’s Hospital, Hamilton, Ontario, Canada
| | - Lauren I Brady
- Department of Pediatrics, McMaster University Children’s Hospital, Hamilton, Ontario, Canada
| | - Markus Wolff
- Department of Pediatric Neurology and Developmental Medicine, University Children’s Hospital, Tubingen, Germany
| | - Lutz Dondit
- Department of Pediatric Neurology and Center for Developmental Medicine, Olgahospital Stuttgart, Stuttgart, Germany
| | - Helio F Pedro
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | | | - Kelly L Jones
- Department of Pediatrics, Division of Medical Genetics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Anup D Patel
- Nationwide Children’s Hospital, Columbus, Ohio, USA
- The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - David N Franz
- Department of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Rena Vanzo
- Lineagen, Inc., Salt Lake City, Utah, USA
| | - Elysa Marco
- Department of Neurology, University of San Francisco School of Medicine, San Francisco, California, USA
| | - Judith D Ranells
- Department of Pediatrics, University of South Florida, Tampa, Florida, USA
| | - Nataliya Di Donato
- Institute for Clinical Genetics, Carl Gustav Carus Faculty of Medicine, TU Dresden, Dresden, Germany
| | - William B Dobyns
- Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Bodo Laube
- Department of Neurophysiology and Neurosensory Systems, Technical University Darmstadt, Darmstadt, Hessen, Germany
| | - Stephen F Traynelis
- Department of Pharmacology, Emory University School of Medicine, Rollins Research Center, Atlanta, Georgia, USA
- Center for Functional Evaluation of Rare Variants (CFERV), Emory University School of Medicine, Atlanta, Georgia, USA
| | - Johannes R Lemke
- Institute of Human Genetics, University of Leipzig Hospitals and Clinics, Leipzig, Germany
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Bernardo S, Marchionni E, Prudente S, De Liso P, Spalice A, Giancotti A, Manganaro L, Pizzuti A. Unusual association of SCN2A epileptic encephalopathy with severe cortical dysplasia detected by prenatal MRI. Eur J Paediatr Neurol 2017; 21:587-590. [PMID: 28254201 DOI: 10.1016/j.ejpn.2017.01.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 01/23/2017] [Accepted: 01/29/2017] [Indexed: 12/16/2022]
Abstract
We present an atypical association of SCN2A epileptic encephalopathy with severe cortical dysplasia. SCN2A mutations are associated with epileptic syndromes from benign to extremely severe in absence of such macroscopic brain findings. Prenatal MRI (Magnetic Resonance Imaging) in a 32 weeks fetus, with US (Ultrasonography) diagnosis of isolated ventriculomegaly showed CNS (Central Nervous System) dysplasia characterized by lack of differentiation between cortical and subcortical layers, pachygyria and corpus callosum dysgenesis. Postnatal MRI confirmed the prenatal findings. On day 6 the baby presented a focal status epilepticus, partially controlled by phenobarbital, phenytoin, and levetiracetam. After three weeks a moderate improvement in seizure control has been achieved with carbamazepine. Exome sequencing detected a de novo heterozygous mutation in the SCN2A gene, encoding the αII-subunit of a sodium channel. The patient findings expand the phenotype spectrum of SCN2A mutations to epileptic encephalopathies with macroscopic brain developmental features.
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Affiliation(s)
- Silvia Bernardo
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, Italy; Department of Experimental Medicine, Sapienza University of Rome, Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, Italy.
| | - Enrica Marchionni
- Department of Experimental Medicine, Sapienza University of Rome, Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, Italy; IRCCS Casa Sollievo della Sofferenza, Mendel-laboratory, San Giovanni Rotondo, Italy.
| | - Sabrina Prudente
- IRCCS Casa Sollievo della Sofferenza, Mendel-laboratory, San Giovanni Rotondo, Italy.
| | - Paola De Liso
- Department of Pediatrics, Child Neurology and Psychiatry, Sapienza University of Rome, Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, Italy.
| | - Alberto Spalice
- Department of Pediatrics, Child Neurology and Psychiatry, Sapienza University of Rome, Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, Italy.
| | - Antonella Giancotti
- Department of Obstetrics, Gynecology and Urologic Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, Italy.
| | - Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, Italy.
| | - Antonio Pizzuti
- Department of Experimental Medicine, Sapienza University of Rome, Policlinico Umberto I Hospital, Viale Regina Elena 324, Rome, Italy; IRCCS Casa Sollievo della Sofferenza, Mendel-laboratory, San Giovanni Rotondo, Italy.
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57
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Perucca P, Scheffer IE, Harvey AS, James PA, Lunke S, Thorne N, Gaff C, Regan BM, Damiano JA, Hildebrand MS, Berkovic SF, O’Brien TJ, Kwan P. Real-world utility of whole exome sequencing with targeted gene analysis for focal epilepsy. Epilepsy Res 2017; 131:1-8. [DOI: 10.1016/j.eplepsyres.2017.02.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 12/30/2016] [Accepted: 02/04/2017] [Indexed: 01/05/2023]
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Optimizing the Diagnosis and Management of Dravet Syndrome: Recommendations From a North American Consensus Panel. Pediatr Neurol 2017; 68:18-34.e3. [PMID: 28284397 DOI: 10.1016/j.pediatrneurol.2017.01.025] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 01/24/2017] [Accepted: 01/28/2017] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To establish standards for early, cost-effective, and accurate diagnosis; optimal therapies for seizures; and recommendations for evaluation and management of comorbidities for children and adults with Dravet syndrome, using a modified Delphi process. METHODS An expert panel was convened comprising epileptologists with nationally recognized expertise in Dravet syndrome and parents of children with Dravet syndrome, whose experience and understanding was enhanced by their active roles in Dravet syndrome associations. Panelists were asked to base their responses to questions both on their clinical expertise and results of a literature review that was forwarded to each panelist. Three rounds of online questionnaires were conducted to identify areas of consensus and strength of that consensus, as well as areas of contention. RESULTS The panel consisted of 13 physicians and five family members. Strong consensus was reached regarding typical clinical presentation of Dravet syndrome, range of electroencephalography and magnetic resonance imaging findings, need for genetic testing, critical information that should be conveyed to families at diagnosis, priorities for seizure control and typical degree of control, seizure triggers and recommendations for avoidance, first- and second-line therapies for seizures, requirement and indications for rescue therapy, specific recommendations for comorbidity screening, and need for family support. Consensus was not as strong regarding later therapies, including vagus nerve stimulation and callosotomy, and for specific therapies of associated comorbidities. Beyond the initial treatment with benzodiazepines and use of valproate, there was no consensus on the optimal in-hospital management of convulsive status epilepticus. CONCLUSIONS We were able to identify areas where there was strong consensus that we hope will (1) inform health care providers on optimal diagnosis and management of patients with Dravet syndrome, (2) support reimbursement from insurance companies for genetic testing and Dravet syndrome-specific therapies, and (3) improve quality of life for patients with Dravet syndrome and their families by avoidance of unnecessary testing and provision of an early accurate diagnosis allowing optimal selection of therapeutic strategies.
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Abstract
Dravet syndrome is one of the most severe epilepsy syndromes of early childhood, and it comes with very high morbidity and mortality. The typical presentation is characterized by hemiclonic or generalized clonic seizures triggered by fever during the first year of life, followed by myoclonic, absence, focal and generalized tonic-clonic seizures. Non-convulsive status epilepticus and epileptic encephalopathy are common. Development is normal in the first year of life, but most individuals eventually suffer from intellectual impairment. Dravet syndrome is associated with mutations in the sodium channel alpha1 subunit gene (SCN1A) in 70-80% of individuals. SCN1A mutation results in inhibition of the GABAergic inhibitory interneurons, leading to excessive neuronal excitation. The "interneuron hypothesis" is the current most accepted pathophysiological mechanism of Dravet syndrome. The mortality rate is increased significantly in Dravet syndrome. Ataxia, a characteristic crouched gait and Parkinson's symptoms may develop in some individuals. It is likely that Dravet syndrome is underdiagnosed in adults with treatment-resistant epilepsy. Early diagnosis is important to avoid anti-seizure medications that exacerbate seizures.
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Kokoszka MA, McGoldrick PE, La Vega-Talbott M, Raynes H, Palmese CA, Wolf SM, Harden CL, Ghatan S. Epilepsy surgery in patients with autism. J Neurosurg Pediatr 2017; 19:196-207. [PMID: 27885946 DOI: 10.3171/2016.7.peds1651] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this study was to report outcomes of epilepsy surgery in 56 consecutive patients with autism spectrum disorder. METHODS Medical records of 56 consecutive patients with autism who underwent epilepsy surgery were reviewed with regard to clinical characteristics, surgical management, postoperative seizure control, and behavioral changes. RESULTS Of the 56 patients with autism, 39 were male, 45 were severely autistic, 27 had a history of clinically significant levels of aggression and other disruptive behaviors, and 30 were considered nonverbal at baseline. Etiology of the epilepsy was known in 32 cases, and included structural lesions, medical history, and developmental and genetic factors. Twenty-nine patients underwent resective treatments (in 8 cases combined with palliative procedures), 24 patients had only palliative treatments, and 3 patients had only subdural electroencephalography. Eighteen of the 56 patients had more than one operation. The mean age at surgery was 11 ± 6.5 years (range 1.5-35 years). At a mean follow-up of 47 ± 30 months (range 2-117 months), seizure outcomes included 20 Engel Class I, 12 Engel Class II, 18 Engel Class III, and 3 Engel Class IV cases. The age and follow-up times are stated as the mean ± SD. Three patients were able to discontinue all antiepileptic drugs (AEDs). Aggression and other aberrant behaviors observed in the clinical setting improved in 24 patients. According to caregivers, most patients also experienced some degree of improvement in daily social and cognitive function. Three patients had no functional or behavioral changes associated with seizure reduction, and 2 patients experienced worsening of seizures and behavioral symptoms. CONCLUSIONS Epilepsy surgery in patients with autism is feasible, with no indication that the comorbidity of autism should preclude a good outcome. Resective and palliative treatments brought seizure freedom or seizure reduction to the majority of patients, although one-third of the patients in this study required more than one procedure to achieve worthwhile improvement in the long term, and few patients were able to discontinue all AEDs. The number of palliative procedures performed, the need for multiple interventions, and continued use of AEDs highlight the complex etiology of epilepsy in patients with autism spectrum disorder. These considerations underscore the need for continued analysis, review, and reporting of surgical outcomes in patients with autism, which may aid in better identification and management of surgical candidates. The reduction in aberrant behaviors observed in this series suggests that some behaviors previously attributed to autism may be associated with intractable epilepsy, and further highlights the need for systematic evaluation of the relationship between the symptoms of autism and refractory seizures.
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Affiliation(s)
| | | | | | - Hillary Raynes
- Neurology, Mount Sinai Health System, New York, New York
| | | | - Steven M Wolf
- Neurology, Mount Sinai Health System, New York, New York
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Hanaya R, Niantiarno FH, Kashida Y, Hosoyama H, Maruyama S, Otsubo T, Tanaka K, Ishii A, Hirose S, Arita K. Vagus nerve stimulation for genetic epilepsy with febrile seizures plus (GEFS +) accompanying seizures with impaired consciousness. EPILEPSY & BEHAVIOR CASE REPORTS 2016; 7:16-19. [PMID: 28070485 PMCID: PMC5219608 DOI: 10.1016/j.ebcr.2016.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/22/2016] [Accepted: 11/06/2016] [Indexed: 02/04/2023]
Abstract
Genetic epilepsy with febrile seizures plus (GEFS+) is characterized by childhood-onset epilepsy syndrome. It involves febrile seizures and a variety of afebrile epileptic seizure types within the same pedigree with autosomal-dominant inheritance. Approximately 10% of individuals with GEFS+ harbor SCN1A, a gene mutation in one of the voltage-gated sodium channel subunits. Considerably less common are focal epilepsies including complex partial seizures. We report vagus nerve stimulation (VNS) in a 6-year-old girl with GEFS+ who exhibited refractory generalized tonic-clonic seizures and complex partial seizures.
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Affiliation(s)
- Ryosuke Hanaya
- Department of Neurosurgery, Graduate School of Medical and Dental Science, Kagoshima University, Kagoshima, Japan
| | - Fajar H Niantiarno
- Department of Neurosurgery, Medical Faculty of Diponegoro University, Semarang, Indonesia
| | - Yumi Kashida
- Department of Neurosurgery, Graduate School of Medical and Dental Science, Kagoshima University, Kagoshima, Japan
| | - Hiroshi Hosoyama
- Department of Neurosurgery, Graduate School of Medical and Dental Science, Kagoshima University, Kagoshima, Japan
| | - Shinsuke Maruyama
- Department of Pediatrics, Graduate School of Medical and Dental Science, Kagoshima University, Kagoshima, Japan
| | | | - Kazumi Tanaka
- Department of Pediatrics, Saiseikai Sendai Hospital, Satsuma-Sendai, Japan
| | - Atsushi Ishii
- Department of Pediatrics, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shinichi Hirose
- Department of Pediatrics, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Kazunori Arita
- Department of Neurosurgery, Graduate School of Medical and Dental Science, Kagoshima University, Kagoshima, Japan
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Abstract
While genetic causes of epilepsy have been hypothesized from the time of Hippocrates, the advent of new genetic technologies has played a tremendous role in elucidating a growing number of specific genetic causes for the epilepsies. This progress has contributed vastly to our recognition of the epilepsies as a diverse group of disorders, the genetic mechanisms of which are heterogeneous. Genotype-phenotype correlation, however, is not always clear. Nonetheless, the developments in genetic diagnosis raise the promise of a future of personalized medicine. Multiple genetic tests are now available, but there is no one test for all possible genetic mutations, and the balance between cost and benefit must be weighed. A genetic diagnosis, however, can provide valuable information regarding comorbidities, prognosis, and even treatment, as well as allow for genetic counseling. In this review, we will discuss the genetic mechanisms of the epilepsies as well as the specifics of particular genetic epilepsy syndromes. We will include an overview of the available genetic testing methods, the application of clinical knowledge into the selection of genetic testing, genotype-phenotype correlations of epileptic disorders, and therapeutic advances as well as a discussion of the importance of genetic counseling.
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Affiliation(s)
- Christelle M El Achkar
- Division of Epilepsy, Department of Neurology, Boston Children's Hospital, and Harvard Medical School, Fegan 9, 300 Longwood Ave, Boston, MA, 02115, USA,
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Skjei KL, Church EW, Harding BN, Santi M, Holland-Bouley KD, Clancy RR, Porter BE, Heuer GG, Marsh ED. Clinical and histopathological outcomes in patients with SCN1A mutations undergoing surgery for epilepsy. J Neurosurg Pediatr 2015; 16:668-74. [PMID: 26339958 DOI: 10.3171/2015.5.peds14551] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Mutations in the sodium channel alpha 1 subunit gene (SCN1A) have been associated with a wide range of epilepsy phenotypes including Dravet syndrome. There currently exist few histopathological and surgical outcome reports in patients with this disease. In this case series, the authors describe the clinical features, surgical pathology, and outcomes in 6 patients with SCN1A mutations and refractory epilepsy who underwent focal cortical resection prior to uncovering the genetic basis of their epilepsy. METHODS Medical records of SCN1A mutation-positive children with treatment-resistant epilepsy who had undergone resective epilepsy surgery were reviewed retrospectively. Surgical pathology specimens were reviewed. RESULTS All 6 patients identified carried diagnoses of intractable epilepsy with mixed seizure types. Age at surgery ranged from 18 months to 20 years. Seizures were refractory to surgery in every case. Surgical histopathology showed evidence of subtle cortical dysplasia in 4 of 6 patients, with more neurons in the molecular layer of the cortex and white matter. CONCLUSIONS Cortical resection is unlikely to be beneficial in these children due to the genetic defect and the unexpected neuropathological finding of mild diffuse malformations of cortical development. Together, these findings suggest a diffuse pathophysiological mechanism of the patients' epilepsy which will not respond to focal resective surgery.
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Affiliation(s)
- Karen L Skjei
- Perelman School of Medicine, University of Pennsylvania, Philadelphia;,Pediatric Regional Epilepsy Program, Children's Hospital of Philadelphia
| | - Ephraim W Church
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, Pennsylvania; and
| | - Brian N Harding
- Perelman School of Medicine, University of Pennsylvania, Philadelphia;,Pediatric Regional Epilepsy Program, Children's Hospital of Philadelphia
| | - Mariarita Santi
- Perelman School of Medicine, University of Pennsylvania, Philadelphia;,Pediatric Regional Epilepsy Program, Children's Hospital of Philadelphia
| | | | - Robert R Clancy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia;,Pediatric Regional Epilepsy Program, Children's Hospital of Philadelphia
| | - Brenda E Porter
- Perelman School of Medicine, University of Pennsylvania, Philadelphia;,Pediatric Regional Epilepsy Program, Children's Hospital of Philadelphia
| | - Gregory G Heuer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia;,Pediatric Regional Epilepsy Program, Children's Hospital of Philadelphia
| | - Eric D Marsh
- Perelman School of Medicine, University of Pennsylvania, Philadelphia;,Pediatric Regional Epilepsy Program, Children's Hospital of Philadelphia
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Gonsales MC, Montenegro MA, Soler CV, Coan AC, Guerreiro MM, Lopes-Cendes I. Recent developments in the genetics of childhood epileptic encephalopathies: impact in clinical practice. ARQUIVOS DE NEURO-PSIQUIATRIA 2015; 73:946-58. [PMID: 26517219 DOI: 10.1590/0004-282x20150122] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 07/20/2015] [Indexed: 01/03/2023]
Abstract
Recent advances in molecular genetics led to the discovery of several genes for childhood epileptic encephalopathies (CEEs). As the knowledge about the genes associated with this group of disorders develops, it becomes evident that CEEs present a number of specific genetic characteristics, which will influence the use of molecular testing for clinical purposes. Among these, there are the presence of marked genetic heterogeneity and the high frequency of de novo mutations. Therefore, the main objectives of this review paper are to present and discuss current knowledge regarding i) new genetic findings in CEEs, ii) phenotype-genotype correlations in different forms of CEEs; and, most importantly, iii) the impact of these new findings in clinical practice. Accompanying this text we have included a comprehensive table, containing the list of genes currently known to be involved in the etiology of CEEs.
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Affiliation(s)
- Marina C Gonsales
- Instituto Brasileiro de Neurociências e Neurotecnologia, Faculdade de Ciências Médicas, Universidade de Campinas, Campinas, SP, Brazil
| | - Maria Augusta Montenegro
- Instituto Brasileiro de Neurociências e Neurotecnologia, Faculdade de Ciências Médicas, Universidade de Campinas, Campinas, SP, Brazil
| | - Camila V Soler
- Instituto Brasileiro de Neurociências e Neurotecnologia, Faculdade de Ciências Médicas, Universidade de Campinas, Campinas, SP, Brazil
| | - Ana Carolina Coan
- Instituto Brasileiro de Neurociências e Neurotecnologia, Faculdade de Ciências Médicas, Universidade de Campinas, Campinas, SP, Brazil
| | - Marilisa M Guerreiro
- Instituto Brasileiro de Neurociências e Neurotecnologia, Faculdade de Ciências Médicas, Universidade de Campinas, Campinas, SP, Brazil
| | - Iscia Lopes-Cendes
- Instituto Brasileiro de Neurociências e Neurotecnologia, Faculdade de Ciências Médicas, Universidade de Campinas, Campinas, SP, Brazil
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Guerrini R, Duchowny M, Jayakar P, Krsek P, Kahane P, Tassi L, Melani F, Polster T, Andre VM, Cepeda C, Krueger DA, Cross JH, Spreafico R, Cosottini M, Gotman J, Chassoux F, Ryvlin P, Bartolomei F, Bernasconi A, Stefan H, Miller I, Devaux B, Najm I, Giordano F, Vonck K, Barba C, Blumcke I. Diagnostic methods and treatment options for focal cortical dysplasia. Epilepsia 2015; 56:1669-86. [DOI: 10.1111/epi.13200] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Renzo Guerrini
- Pediatric Neurology and Neurogenetics Unit and Laboratories; Children's Hospital Meyer-University of Florence; Florence Italy
- IRCCS Stella Maris Foundation; Pisa Italy
| | - Michael Duchowny
- Neuroscience Program and the Comprehensive Epilepsy Center; Miami Children's Hospital; Miami Florida U.S.A
| | - Prasanna Jayakar
- Department of Neurology; Miami Children's Hospital; Miami Florida U.S.A
| | - Pavel Krsek
- Department of Pediatric Neurology; 2nd Faculty of Medicine; Motol University Hospital; Charles University; Prague Czech Republic
| | - Philippe Kahane
- INSERM U836; University of Grenoble Alpes, GIN; Grenoble; France
- Epilepsy Unit; Michallon Hospital; Grenoble France
| | - Laura Tassi
- Epilepsy Surgery Center; Niguarda Hospital; Milan Italy
| | - Federico Melani
- Pediatric Neurology and Neurogenetics Unit and Laboratories; Children's Hospital Meyer-University of Florence; Florence Italy
| | - Tilman Polster
- Department of Child Neurology; Bethel Epilepsy Center; Bielefeld Germany
| | | | - Carlos Cepeda
- Intellectual and Developmental Disabilities Research Center; David Geffen School of Medicine; University of California at Los Angeles; Los Angeles California U.S.A
| | - Darcy A. Krueger
- Division of Neurology; Department of Pediatrics; Cincinnati Children's Hospital Medical Center; University of Cincinnati College of Medicine; Cincinnati Ohio U.S.A
| | - J. Helen Cross
- UCL-Institute of Child Health; Great Ormond Street Hospital for Children NHS Foundation Trust; London United Kingdom
- Young Epilepsy; Lingfield United Kingdom
| | - Roberto Spreafico
- Clinical Epileptology and Experimental Neurophysiology Unit; Neurological InstituteC. Besta”; Milan Italy
| | - Mirco Cosottini
- Department of Translational Research and New Technologies in Medicine and Surgery; University of Pisa; Pisa Italy
| | - Jean Gotman
- Montreal Neurological Institute and Hospital; McGill University; Montreal Quebec Canada
| | | | - Philippe Ryvlin
- Department of Clinical Neurosciences; CHUV; Lausanne Switzerland
- Translational and Integrative Group in Epilepsy Research (TIGER) and Institute for Epilepsies (IDEE); Lyon's Neuroscience Center; INSERM U1028; CNRS 5292; UCBL; Le Vinatier Hospital; Bron; Lyon France
| | - Fabrice Bartolomei
- Faculty of Medicine; INSERM, U1106; Institute of Neurosciences of Systems; Marseille France
- Faculty of Medicine; Aix Marseille University; Marseille France
- Clinical Neurophysiology Unit; Department of Clinical Neurosciences; CHU Timone; Marseille France
- Henri-Gastaut Hospital; Saint-Paul Center; Marseille France
| | - Andrea Bernasconi
- Neuroimaging of Epilepsy Laboratory; McConnell Brain Imaging Center; Montreal Neurological Institute and Hospital; McGill University; Montreal Quebec Canada
| | - Hermann Stefan
- Epilepsy Center Erlangen (ZEE); University Erlangen-Nürnberg; Erlangen Germany
| | - Ian Miller
- Department of Neurology and Comprehensive Epilepsy Program; Brain Institute; Miami Children's Hospital; Miami Florida U.S.A
| | | | - Imad Najm
- Epilepsy Center; Neurological Institute; Cleveland Clinic; Cleveland OH U.S.A
| | - Flavio Giordano
- Pediatric Neurosurgery Unit; Children's Hospital Meyer-University of Florence; Florence Italy
| | - Kristl Vonck
- Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology; Department of Neurology; Ghent University; Ghent Belgium
| | - Carmen Barba
- Pediatric Neurology and Neurogenetics Unit and Laboratories; Children's Hospital Meyer-University of Florence; Florence Italy
| | - Ingmar Blumcke
- Department of Neuropathology; University Hospital Erlangen; Erlangen Germany
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Fabera P, Krijtova H, Tomasek M, Krysl D, Zamecnik J, Mohapl M, Jiruska P, Marusic P. Familial temporal lobe epilepsy due to focal cortical dysplasia type IIIa. Seizure 2015; 31:120-3. [PMID: 26362388 DOI: 10.1016/j.seizure.2015.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 07/17/2015] [Accepted: 07/19/2015] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Focal cortical dysplasia (FCD) represents a common cause of refractory epilepsy. It is considered a sporadic disorder, but its occasional familial occurrence suggests the involvement of genetic mechanisms. METHODS Siblings with intractable epilepsy were referred for epilepsy surgery evaluation. Both patients were examined using video-EEG monitoring, MRI examination and PET imaging. They underwent left anteromedial temporal lobe resection. RESULTS Electroclinical features pointed to left temporal lobe epilepsy and MRI examination revealed typical signs of left-sided hippocampal sclerosis and increased white matter signal intensity in the left temporal pole. PET examination confirmed interictal hypometabolism in the left temporal lobe. Histopathological examination of resected tissue demonstrated the presence FCD type IIIa, i.e. hippocampal sclerosis and focal cortical dysplasia in the left temporal pole. CONCLUSION We present a unique case of refractory mesial temporal lobe epilepsy in siblings, characterized by an identical clinical profile and histopathology of FCD type IIIa, who were successfully treated by epilepsy surgery. The presence of such a high concordance between the clinical and morphological data, together with the occurrence of epilepsy and febrile seizures in three generations of the family pedigree points towards a possible genetic nature of the observed FCD type IIIa.
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Affiliation(s)
- Petr Fabera
- Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague, Motol University Hospital, Prague, 150 06, Czech Republic; Department of Developmental Epileptology, Institute of Physiology, The Czech Academy of Sciences, Prague 142 20, Czech Republic
| | - Hana Krijtova
- Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague, Motol University Hospital, Prague, 150 06, Czech Republic
| | - Martin Tomasek
- Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague, Motol University Hospital, Prague, 150 06, Czech Republic
| | - David Krysl
- Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague, Motol University Hospital, Prague, 150 06, Czech Republic
| | - Josef Zamecnik
- Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University in Prague, Motol University Hospital, Prague 150 06, Czech Republic
| | - Milan Mohapl
- Department of Neurosurgery, 1st Faculty of Medicine, Charles University in Prague, Central Military Hospital, Prague, Czech Republic
| | - Premysl Jiruska
- Department of Developmental Epileptology, Institute of Physiology, The Czech Academy of Sciences, Prague 142 20, Czech Republic
| | - Petr Marusic
- Department of Neurology, 2nd Faculty of Medicine, Charles University in Prague, Motol University Hospital, Prague, 150 06, Czech Republic.
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Dravet C. Dravet syndrome in Sweden. Dev Med Child Neurol 2015; 57:593. [PMID: 25731594 DOI: 10.1111/dmcn.12731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Focal cortical dysplasias are common malformations of cerebral cortical development and are highly associated with medically intractable epilepsy. They have been classified into neuropathological subtypes (type Ia, Ib, IIa, IIb, and III) based on the severity of cytoarchitectural disruption--tangential or radial dispersion, or loss of laminar structure--and the presence of unique cells types such as cytomegalic neurons or balloon cells. Most focal cortical dysplasias can be identified on neuroimaging and many require resective epilepsy surgery to cure refractory seizures. The pathogenesis of focal cortical dysplasias remains to be defined, although there is recent evidence to suggest that focal cortical dysplasias arise from de novo somatic mutations occurring during brain development. Some focal cortical dysplasia subtypes show a link to the mammalian target of rapamycin signaling cascade; this has now extended to other cortical malformations, including hemimegalencephaly.
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Affiliation(s)
- Peter B Crino
- Department of Neurology, Shriners Hospital Pediatric Research Center and Temple University, Philadelphia, Pennsylvania
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