1
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Ribeiro-Constante J, Tristán-Noguero A, Martínez Calvo FF, Ibañez-Mico S, Peña Segura JL, Ramos-Fernández JM, Moyano Chicano MDC, Camino León R, Soto Insuga V, González Alguacil E, Valera Dávila C, Fernández-Jaén A, Plans L, Camacho A, Visa-Reñé N, Martin-Tamayo Blázquez MDP, Paredes-Carmona F, Marti-Carrera I, Hernández-Fabián A, Tomas Davi M, Sanchez MC, Herraiz LC, Pita PF, Gonzalez TB, O'Callaghan M, Iglesias Santa Polonia FF, Cazorla MR, Ferrando Lucas MT, González-Meneses A, Sala-Coromina J, Macaya A, Lasa-Aranzasti A, Cueto-González AM, Valera Párraga F, Campistol Plana J, Serrano M, Alonso X, Del Castillo-Berges D, Schwartz-Palleja M, Illescas S, Ramírez Camacho A, Sans Capdevila O, García-Cazorla A, Bayés À, Alonso-Colmenero I. Developmental outcome of electroencephalographic findings in SYNGAP1 encephalopathy. Front Cell Dev Biol 2024; 12:1321282. [PMID: 38505260 PMCID: PMC10948473 DOI: 10.3389/fcell.2024.1321282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/22/2024] [Indexed: 03/21/2024] Open
Abstract
SYNGAP1 haploinsufficiency results in a developmental and epileptic encephalopathy (DEE) causing generalized epilepsies accompanied by a spectrum of neurodevelopmental symptoms. Concerning interictal epileptiform discharges (IEDs) in electroencephalograms (EEG), potential biomarkers have been postulated, including changes in background activity, fixation-off sensitivity (FOS) or eye closure sensitivity (ECS). In this study we clinically evaluate a new cohort of 36 SYNGAP1-DEE individuals. Standardized questionnaires were employed to collect clinical, electroencephalographic and genetic data. We investigated electroencephalographic findings, focusing on the cortical distribution of interictal abnormalities and their changes with age. Among the 36 SYNGAP1-DEE cases 18 presented variants in the SYNGAP1 gene that had never been previously reported. The mean age of diagnosis was 8 years and 8 months, ranging from 2 to 17 years, with 55.9% being male. All subjects had global neurodevelopmental/language delay and behavioral abnormalities; 83.3% had moderate to profound intellectual disability (ID), 91.7% displayed autistic traits, 73% experienced sleep disorders and 86.1% suffered from epileptic seizures, mainly eyelid myoclonia with absences (55.3%). A total of 63 VEEGs were revised, observing a worsening of certain EEG findings with increasing age. A disorganized background was observed in all age ranges, yet this was more common among older cases. The main IEDs were bilateral synchronous and asynchronous posterior discharges, accounting for ≥50% in all age ranges. Generalized alterations with maximum amplitude in the anterior region showed as the second most frequent IED (≥15% in all age ranges) and were also more common with increasing age. Finally, diffuse fast activity was much more prevalent in cases with 6 years or older. To the best of our knowledge, this is the first study to analyze EEG features across different age groups, revealing an increase in interictal abnormalities over infancy and adolescence. Our findings suggest that SYNGAP1 haploinsufficiency has complex effects in human brain development, some of which might unravel at different developmental stages. Furthermore, they highlight the potential of baseline EEG to identify candidate biomarkers and the importance of natural history studies to develop specialized therapies and clinical trials.
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Affiliation(s)
| | - Alba Tristán-Noguero
- Department of Genetics, Microbiology and Statistics, University of Barcelona, Barcelona, Spain
- Molecular Physiology of the Synapse Laboratory, Institut de Recerca Sant Pau (IR Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - José Luis Peña Segura
- Pediatric Neurology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | - Rafael Camino León
- Pediatric Neurology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Víctor Soto Insuga
- Pediatric Neurology Department, Hospital Universitario Infantil del Niño Jesús, Madrid, Spain
| | - Elena González Alguacil
- Pediatric Neurology Department, Hospital Universitario Infantil del Niño Jesús, Madrid, Spain
| | - Carlos Valera Dávila
- Pediatric Neurology Department Sant Joan de Déu (SJD) Children’s Hospital, Barcelona, Spain
| | - Alberto Fernández-Jaén
- Pediatric Neurology Department, Neurogenetics Section, Hospital Universitario Quironsalud, Madrid, Spain
| | - Laura Plans
- Mental Health in Intellectual Disability Specialized Service Althaia, Xarxa Assistencial, Manresa, Spain
| | - Ana Camacho
- Pediatric Neurology Department, Hospital 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - Nuria Visa-Reñé
- Paediatric Department, Arnau de Vilanova University Hospital, Lleida, Spain
| | | | | | - Itxaso Marti-Carrera
- Pediatric Neurology Department, Hospital Universitario Donostia, San Sebastian, Spain
| | | | - Meritxell Tomas Davi
- Mental Health in Intellectual Disability Specialized Service Althaia, Xarxa Assistencial, Manresa, Spain
| | - Merce Casadesus Sanchez
- Mental Health in Intellectual Disability Specialized Service Althaia, Xarxa Assistencial, Manresa, Spain
| | | | - Patricia Fuentes Pita
- Pediatric Neurology Department, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Mar O'Callaghan
- Pediatric Neurology Department Sant Joan de Déu (SJD) Children’s Hospital, Barcelona, Spain
| | | | - María Rosario Cazorla
- Pediatric Neurology Department, Puerta de Hierro Majadahonda Universitary Hospital, Madrid, Spain
| | | | | | - Júlia Sala-Coromina
- Pediatric Neurology Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Bercelona, Spain
| | - Alfons Macaya
- Pediatric Neurology Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Bercelona, Spain
| | - Amaia Lasa-Aranzasti
- Department of Clinical and Molecular Genetic Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Bercelona, Spain
| | - Anna Ma Cueto-González
- Department of Clinical and Molecular Genetic Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Bercelona, Spain
| | | | - Jaume Campistol Plana
- Pediatric Neurology Department Sant Joan de Déu (SJD) Children’s Hospital, Barcelona, Spain
| | - Mercedes Serrano
- Pediatric Neurology Department Sant Joan de Déu (SJD) Children’s Hospital, Barcelona, Spain
| | - Xenia Alonso
- Pediatric Neurology Department Sant Joan de Déu (SJD) Children’s Hospital, Barcelona, Spain
| | - Diego Del Castillo-Berges
- Molecular Physiology of the Synapse Laboratory, Institut de Recerca Sant Pau (IR Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marc Schwartz-Palleja
- Eurecat, Technology Center of Catalonia, Multimedia Technologies, Barcelona, Spain
- Center for Brain and Cognition (CBC), Department of Information Technologies and Communications (DTIC), Pompeu Fabra University, Barcelona, Catalonia, Spain
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Sofía Illescas
- Pediatric Neurometabolism: Neural Communication Mechanisms and Personalized Therapies Pediatric Neurology Department: Neural Communication Mechanisms and Personalized Therapies Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Alia Ramírez Camacho
- Department of Child Neurology, Epilepsy and Neurophysiology Unit, Member of the ERN EpiCARE, Hospital Sant Joan de Dèu, Barcelona, Spain
| | - Oscar Sans Capdevila
- Pediatric Neurology Department Sant Joan de Déu (SJD) Children’s Hospital, Barcelona, Spain
| | - Angeles García-Cazorla
- Pediatric Neurology Department Sant Joan de Déu (SJD) Children’s Hospital, Barcelona, Spain
| | - Àlex Bayés
- Molecular Physiology of the Synapse Laboratory, Institut de Recerca Sant Pau (IR Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
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2
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Santarone ME, Zambrano S, Zanotta N, Mani E, Minghetti S, Pozzi M, Villa L, Molteni M, Zucca C. EEG Features in Autism Spectrum Disorder: A Retrospective Analysis in a Cohort of Preschool Children. Brain Sci 2023; 13:345. [PMID: 36831889 PMCID: PMC9954463 DOI: 10.3390/brainsci13020345] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder that can be associated with intellectual disability (ID) and epilepsy (E). The etiology and the pathogenesis of this disorder is in most cases still to be clarified. Several studies have underlined that the EEG recordings in children with these clinical pictures are abnormal, however the precise frequency of these abnormalities and their relationship with the pathogenic mechanisms and in particular with epileptic seizures are still unknown. We retrospectively reviewed 292 routine polysomnographic EEG tracings of preschool children (age < 6 years) who had received a first multidisciplinary diagnosis of ASD according to DSM-5 clinical criteria. Children (mean age: 34.6 months) were diagnosed at IRCCS E. Medea (Bosisio Parini, Italy). We evaluated: the background activity during wakefulness and sleep, the presence and the characteristics (focal or diffuse) of the slow-waves abnormalities and the interictal epileptiform discharges. In 78.0% of cases the EEG recordings were found to be abnormal, particularly during sleep. Paroxysmal slowing and epileptiform abnormalities were found in the 28.4% of the subjects, confirming the high percentage of abnormal polysomnographic EEG recordings in children with ASD. These alterations seem to be more correlated with the characteristics of the underlying pathology than with intellectual disability and epilepsy. In particular, we underline the possible significance of the prevalence of EEG abnormalities during sleep. Moreover, we analyzed the possibility that EEG data reduces the ASD clinical heterogeneity and suggests the exams to be carried out to clarify the etiology of the disorder.
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Affiliation(s)
| | - Stefania Zambrano
- Clinical Neurophysiology Unit, IRCCS E. Medea, 23842 Bosisio Parini, Italy
| | - Nicoletta Zanotta
- Clinical Neurophysiology Unit, IRCCS E. Medea, 23842 Bosisio Parini, Italy
| | - Elisa Mani
- Psychopathology Department, IRCCS E. Medea, 23842 Bosisio Parini, Italy
| | - Sara Minghetti
- Clinical Neurophysiology Unit, IRCCS E. Medea, 23842 Bosisio Parini, Italy
| | - Marco Pozzi
- Scientific Institute IRCCS E. Medea, 23842 Bosisio Parini, Italy
| | - Laura Villa
- Psychopathology Department, IRCCS E. Medea, 23842 Bosisio Parini, Italy
| | - Massimo Molteni
- Psychopathology Department, IRCCS E. Medea, 23842 Bosisio Parini, Italy
| | - Claudio Zucca
- Clinical Neurophysiology Unit, IRCCS E. Medea, 23842 Bosisio Parini, Italy
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3
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Cooper MS, Mackay MT, Dagia C, Fahey MC, Howell KB, Reddihough D, Reid S, Harvey AS. Epilepsy syndromes in cerebral palsy: varied, evolving and mostly self-limited. Brain 2023; 146:587-599. [PMID: 35871494 DOI: 10.1093/brain/awac274] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/25/2022] [Accepted: 07/08/2022] [Indexed: 11/12/2022] Open
Abstract
Seizures occur in approximately one-third of children with cerebral palsy. This study aimed to determine epilepsy syndromes in children with seizures and cerebral palsy due to vascular injury, anticipating that this would inform treatment and prognosis. We studied a population-based cohort of children with cerebral palsy due to prenatal or perinatal vascular injuries, born 1999-2006. Each child's MRI was reviewed to characterize patterns of grey and white matter injury. Children with syndromic or likely genetic causes of cerebral palsy were excluded, given their inherent association with epilepsy and our aim to study a homogeneous cohort of classical cerebral palsy. Chart review, parent interview and EEGs were used to determine epilepsy syndromes and seizure outcomes. Of 256 children, 93 (36%) had one or more febrile or afebrile seizures beyond the neonatal period and 87 (34%) had epilepsy. Children with seizures were more likely to have had neonatal seizures, have spastic quadriplegic cerebral palsy and function within Gross Motor Function Classification System level IV or V. Fifty-six (60%) children with seizures had electroclinical features of a self-limited focal epilepsy of childhood; we diagnosed these children with a self-limited focal epilepsy-variant given the current International League Against Epilepsy classification precludes a diagnosis of self-limited focal epilepsy in children with a brain lesion. Other epilepsy syndromes were focal epilepsy-not otherwise specified in 28, infantile spasms syndrome in 11, Lennox-Gastaut syndrome in three, genetic generalized epilepsies in two and febrile seizures in nine. No epilepsy syndrome could be assigned in seven children with no EEG. Twenty-one changed syndrome classification during childhood. Self-limited focal epilepsy-variant usually manifested with a mix of autonomic and brachio-facial motor features, and occipital and/or centro-temporal spikes on EEG. Of those with self-limited focal epilepsy-variant, 42/56 (75%) had not had a seizure for >2 years. Favourable seizure outcomes were also seen in some children with infantile spasms syndrome and focal epilepsy-not otherwise specified. Of the 93 children with seizures, at last follow-up (mean age 15 years), 61/91 (67%) had not had a seizure in >2 years. Children with cerebral palsy and seizures can be assigned specific epilepsy syndrome diagnoses typically reserved for normally developing children, those syndromes commonly being age-dependent and self-limited. Compared to typically developing children with epilepsy, self-limited focal epilepsy-variant occurs much more commonly in children with cerebral palsy and epilepsy. These findings have important implications for treatment and prognosis of epilepsy in cerebral palsy, and research into pathogenesis of self-limited focal epilepsy.
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Affiliation(s)
- Monica S Cooper
- The Royal Children's Hospital, Melbourne, Victoria 3052, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria 3052, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria 3052, Australia
| | - Mark T Mackay
- The Royal Children's Hospital, Melbourne, Victoria 3052, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria 3052, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria 3052, Australia
| | - Charuta Dagia
- The Royal Children's Hospital, Melbourne, Victoria 3052, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria 3052, Australia
| | - Michael C Fahey
- Department of Paediatrics, Monash University, Melbourne, Victoria 3168, Australia
| | - Katherine B Howell
- The Royal Children's Hospital, Melbourne, Victoria 3052, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria 3052, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria 3052, Australia
| | - Dinah Reddihough
- The Royal Children's Hospital, Melbourne, Victoria 3052, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria 3052, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria 3052, Australia
| | - Susan Reid
- The Royal Children's Hospital, Melbourne, Victoria 3052, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria 3052, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria 3052, Australia
| | - A Simon Harvey
- The Royal Children's Hospital, Melbourne, Victoria 3052, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria 3052, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria 3052, Australia
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4
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SCN2A Pathogenic Variants and Epilepsy: Heterogeneous Clinical, Genetic and Diagnostic Features. Brain Sci 2021; 12:brainsci12010018. [PMID: 35053762 PMCID: PMC8773615 DOI: 10.3390/brainsci12010018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 12/19/2022] Open
Abstract
Pathogenic variants of the SCN2A gene (MIM 182390) are associated with several epileptic syndromes ranging from benign familial neonatal-infantile seizures (BFNIS) to early infantile epileptic encephalopathy. The aim of this work was to describe clinical features among five patients with concomitant SCN2A gene variants and cryptogenic epileptic syndromes, thus expanding the SCN2A spectrum of phenotypic heterogeneity. De novo variants were identified in four patients, while one inherited variant was identified in a patient with an unaffected carrier biological father with somatic mosaicism. Two of five patients were diagnosed with a neonatal epileptic encephalopathy. The remaining three patients manifested a focal epileptic syndrome associated with autistic spectrum disorders (ASD) or with a variable degree of intellectual disability (ID), one of them displaying a hitherto unreported atypical late onset epilepsy. Overall, the pattern of clinical manifestations among these patients suggest that any observed neurological impairment may not be directly related to the severity of the electroclinical pattern, but instead likely associated with the mutation itself. Moreover, our results highlight the importance of SCN2A mutational screening in cases of ID/ASD with or without epilepsy.
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Reviewing Evidence for the Relationship of EEG Abnormalities and RTT Phenotype Paralleled by Insights from Animal Studies. Int J Mol Sci 2021; 22:ijms22105308. [PMID: 34069993 PMCID: PMC8157853 DOI: 10.3390/ijms22105308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/09/2021] [Accepted: 05/12/2021] [Indexed: 12/29/2022] Open
Abstract
Rett syndrome (RTT) is a rare neurodevelopmental disorder that is usually caused by mutations of the MECP2 gene. Patients with RTT suffer from severe deficits in motor, perceptual and cognitive domains. Electroencephalogram (EEG) has provided useful information to clinicians and scientists, from the very first descriptions of RTT, and yet no reliable neurophysiological biomarkers related to the pathophysiology of the disorder or symptom severity have been identified to date. To identify consistently observed and potentially informative EEG characteristics of RTT pathophysiology, and ascertain areas most worthy of further systematic investigation, here we review the literature for EEG abnormalities reported in patients with RTT and in its disease models. While pointing to some promising potential EEG biomarkers of RTT, our review identify areas of need to realize the potential of EEG including (1) quantitative investigation of promising clinical-EEG observations in RTT, e.g., shift of mu rhythm frequency and EEG during sleep; (2) closer alignment of approaches between patients with RTT and its animal models to strengthen the translational significance of the work (e.g., EEG measurements and behavioral states); (3) establishment of large-scale consortium research, to provide adequate Ns to investigate age and genotype effects.
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Shimogawa T, Mukae N, Morioka T, Sakata A, Sakai Y, Matsumoto N, Mizoguchi M. Corpus callosotomy for drug-resistant epilepsy in a pediatric patient with Waardenburg syndrome Type I. Surg Neurol Int 2021; 12:217. [PMID: 34084644 PMCID: PMC8168647 DOI: 10.25259/sni_228_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Waardenburg syndrome (WS) is caused by autosomal dominant mutations. Since the coexistence of epilepsy and WS type I is rare, the detailed clinical features and treatment of epilepsy, including surgery, have not been fully reported for these patients. We report the first case of an individual with WS type I, who underwent corpus callosotomy (CC) for drug-resistant epilepsy and obtained good seizure outcomes. Case Description: A boy was diagnosed as having WS type I and developmental delay based on characteristic symptoms and a family history of hearing loss. He underwent cochlear implantation at 18 months of age. At 4 years of age, he developed epileptic seizures with a semiology of drop attack. Electroencephalography (EEG) showed bilateral synchronous high-amplitude spikes and wave bursts, dominant in the right hemisphere. Based on the multimodality examinations, we considered that ictal discharges propagated from the entire right hemisphere to the left, resulting in synchronous discharge and a clinical drop attack; therefore, CC was indicated. At 9 years of age, he underwent a front 2/3rd CC. At 1 year, the patient became seizure free, and interictal EEG showed less frequent and lower amplitude spike and wave bursts than before. Conclusion: When patients with WS Type I and cognitive impairment show drug-resistant epilepsy, clinicians should consider a presurgical evaluation.
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Affiliation(s)
| | | | | | - Ayumi Sakata
- Clinical Chemistry and Laboratory Medicine, Kyushu University Hospital
| | | | - Nozomu Matsumoto
- Department of Department of Otorhinolaryngology, Kyushu University
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7
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De Giorgis V, Varesio C, Viri M, Giordano L, La Piana R, Tonduti D, Roncarolo F, Masnada S, Pichiecchio A, Veggiotti P, Fazzi E, Orcesi S. The epileptology of Aicardi-Goutières syndrome: electro-clinical-radiological findings. Seizure 2021; 86:197-209. [PMID: 33589296 DOI: 10.1016/j.seizure.2020.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Although epileptic seizures occur in approximately a quarter of patients with Aicardi-Goutières syndrome (AGS), their phenotypic and electrophysiological characterization remains elusive. The aim of our study was to characterize epilepsy phenotypes and electroencephalographic (EEG) patterns in AGS and look for possible correlations with clinical, genetic and neuroradiological features. METHODS We selected patients with an established AGS diagnosis followed at three Italian reference centers. Medical records, EEGs and MRI/CT findings were reviewed. EEGs were independently and blindly reviewed by three board-certified pediatric epileptologists. Chi square and Fisher's exact tests were used to test associations between epilepsy and EEG feature categories and clinical, radiological and genetic variables. RESULTS Twenty-seven patients were enrolled. We reviewed 63 EEGs and at least one brain MRI scan per patient. Epilepsy, mainly in the form of epileptic spasms and focal seizures, was present in 37 % of the cohort; mean age at epilepsy onset was 9.5 months (range 1-36). The presence of epilepsy was associated with calcification severity (p = 0.016) and startle reactions (p = 0.05). Organization of EEG electrical activity appeared to be disrupted or markedly disrupted in 73 % of cases. Severe EEG disorganization correlated with microcephaly (p < 0.001) and highly abnormal MRI T2-weighted signal intensity in white matter (p = 0.022). Physiological organization of the EEG was found to be better preserved during sleep (87 %) than wakefulness (38 %). Focal slow activity was recorded in more than one third of cases. Fast activity, either diffuse or with frontal location, was more frequent in the awake state (78 %) than in sleep (50 %). Interictal epileptiform discharges (IEDs) were present in 33 % of awake and 45 % of sleep recordings. IEDs during sleep were associated with a higher risk of a epileptic seizures (p = 0.008). SIGNIFICANCE The hallmarks of EEG recordings in AGS were found to be: disruption of electrical organization, the presence of focal slow and fast activity, and the presence of IEDs, both in patients with and in those without epilepsy. The associations between epilepsy and calcification and between EEG pattern and the finding of a highly abnormal white matter T2 signal intensity suggest a common anatomical correlate. However, the complex anatomical-electroclinical basis of AGS-related epilepsy still requires further elucidation.
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Affiliation(s)
- Valentina De Giorgis
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy
| | - Costanza Varesio
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy.
| | - Maurizio Viri
- Department of Child Neurology and Psychiatry, AOU Maggiore della Carità Novara, Novara, Italy
| | - Lucio Giordano
- Child Neurology and Psychiatry Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Roberta La Piana
- Department of Neuroradiology and Laboratory of Neurogenetics of Motion, Neurological Institute and Hospital, McGill University, Montreal, QC H3A2B4, Canada
| | - Davide Tonduti
- Pediatric Neurology Unit - COALA (Center for Diagnosis and Treatment of Leukodystrophies) -V. Buzzi Children's Hospital, Milan, Italy
| | - Federico Roncarolo
- Institute of Public Health Research of University of Montreal (IRSPUM), University of Montreal, Montreal, QC, Canada
| | - Silvia Masnada
- Pediatric Neurology Unit - COALA (Center for Diagnosis and Treatment of Leukodystrophies) -V. Buzzi Children's Hospital, Milan, Italy
| | - Anna Pichiecchio
- Neuroradiology Unit, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Pierangelo Veggiotti
- Pediatric Neurology Unit - COALA (Center for Diagnosis and Treatment of Leukodystrophies) -V. Buzzi Children's Hospital, Milan, Italy; Biomedical and Clinical Sciences Department, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Elisa Fazzi
- Child Neurology and Psychiatry Unit, ASST Spedali Civili di Brescia, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Simona Orcesi
- Department of Child Neurology and Psychiatry, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
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8
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Ciaccio C, Pantaleoni C, Milani D, Alfei E, Sciacca FL, Canafoglia L, Erbetta A, D'Arrigo S. Neurological phenotype of Potocki-Lupski syndrome. Am J Med Genet A 2020; 182:2317-2324. [PMID: 33043631 DOI: 10.1002/ajmg.a.61789] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/19/2020] [Accepted: 06/25/2020] [Indexed: 12/20/2022]
Abstract
Potocki-Lupski syndrome is a condition mainly characterized by infantile hypotonia, developmental delay/intellectual disability (DD/ID), and congenital anomalies, caused by duplications of the 17p11.2 region, encompassing RAI1 gene. Its clinical presentation is extremely variable, especially for what concerns the cognitive level and the behavioral phenotype. Such aspects, as well as the dysmorphic/malformative ones, have been covered by previous studies; otherwise neurological features have never been systematically described. In order to delineate the neurological phenotype of Potocki-Lupski Syndrome, we collect an 8-patients cohort. Developmental milestones are delayed and a mild to moderate cognitive impairment is present in all patients, variably associated with features of autism spectrum disorder, behavioral disturb, and sleep disturb. Hypotonia appears a less frequent finding than what previously reported, while motor clumsiness/coordination impairment is frequent. EGG registration demonstrated a common pattern with excess of diffuse rhythmic activity in sleep phases or while the patient is falling asleep. Brain MRI did not reveal common anomalies, although unspecific white matter changes may be present. We discuss such findings and compare them to literature data, offering an overview on the neurological and cognitive-behavioral presentation of the syndrome.
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Affiliation(s)
- Claudia Ciaccio
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Chiara Pantaleoni
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Donatella Milani
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pediatria Alta Intensità di Cura, Milan, Italy
| | - Enrico Alfei
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Pediatric Neurology Unit-Vittore Buzzi Children's Hospital-ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Francesca L Sciacca
- Laboratory of Cytogenetic, Neurological Biochemistry and Neuropharmacology Unit, Department of Diagnostic and Technology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Laura Canafoglia
- Neurophysiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alessandra Erbetta
- Department of Neuroradiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Stefano D'Arrigo
- Developmental Neurology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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9
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Lucena PH, Armani-Franceschi G, Bispo-Torres AC, Bandeira ID, Lucena MFG, Maldonado I, Veiga MF, Miguel D, Lucena R. KPTN gene homozygous variant-related syndrome in the northeast of Brazil: A case report. Am J Med Genet A 2020; 182:762-767. [PMID: 31999056 DOI: 10.1002/ajmg.a.61492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 12/22/2019] [Accepted: 01/03/2020] [Indexed: 11/11/2022]
Abstract
Alteration of the KPTN gene, responsible for the coding of kaptin (a protein involved in actin cytoskeletal dynamics), causes a syndrome characterized by macrocephaly, neurodevelopmental delay and epileptic seizures. We report the first Brazilian case of KPTN gene variation, previously described in nine subjects from four interlinked families from an Amish community in Ohio, two Estonian siblings and a 9-year-old boy from Kansas City. We report a case of KPTN-related syndrome in a 5-year-old child which presented macrocephaly, muscular hypotonia, and global development delay. The neurological examination revealed below-expected performance in coordination and balance tests, dyspraxia, and hand-mouth synkinesia. Expressive language was characterized by phono-articulatory imprecision, abundance of phonological processes and morphosyntactic immaturity. Neuropsychological assessment revealed intellectual disability with impairment of verbal and executive functions. Exome sequencing was performed. Analysis revealed a homozygous 2-nucleotide duplication c.597_598dup p.(Ser200Ilefs*55) in the KPTN gene, which is predicted to lead to a translational frameshift and formation of a premature stop codon. The phenotypic profile is similar to the cases described in the other families. Presence of macrocephaly and delayed development indicate the possibility of KPTN gene variation. Genetic testing should be carried out at an early stage in order to reach a timely diagnosis.
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Affiliation(s)
- Pedro H Lucena
- Departamento de Medicina, Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Giulia Armani-Franceschi
- Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Ana Cecília Bispo-Torres
- Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Igor D Bandeira
- Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil.,Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Mariana F G Lucena
- Departamento de Medicina, Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Igor Maldonado
- Le Studium Loire Valley Institute for Advanced Studies, Orleans, France.,UMR 1253, iBrain, Université de Tours, Inserm, Tours, France.,CHRU de Tours, Tours, France
| | - Marielza F Veiga
- Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | - Diego Miguel
- Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | - Rita Lucena
- Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
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Jimenez-Gomez A, Niu S, Andujar-Perez F, McQuade EA, Balasa A, Huss D, Coorg R, Quach M, Vinson S, Risen S, Holder JL. Phenotypic characterization of individuals with SYNGAP1 pathogenic variants reveals a potential correlation between posterior dominant rhythm and developmental progression. J Neurodev Disord 2019; 11:18. [PMID: 31395010 PMCID: PMC6688356 DOI: 10.1186/s11689-019-9276-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 07/11/2019] [Indexed: 01/24/2023] Open
Abstract
Background The SYNGAP1 gene encodes for a small GTPase-regulating protein critical to dendritic spine maturation and synaptic plasticity. Mutations have recently been identified to cause a breadth of neurodevelopmental disorders including autism, intellectual disability, and epilepsy. The purpose of this work is to define the phenotypic spectrum of SYNGAP1 gene mutations and identify potential biomarkers of clinical severity and developmental progression. Methods A retrospective clinical data analysis of individuals with SYNGAP1 mutations was conducted. Data included genetic diagnosis, clinical history and examinations, neurophysiologic data, neuroimaging, and serial neurodevelopmental/behavioral assessments. All patients were seen longitudinally within a 6-year period; data analysis was completed on June 30, 2018. Records for all individuals diagnosed with deleterious SYNGAP1 variants (by clinical sequencing or exome sequencing panels) were reviewed. Results Fifteen individuals (53% male) with seventeen unique SYNGAP1 mutations are reported. Mean age at genetic diagnosis was 65.9 months (28–174 months). All individuals had epilepsy, with atypical absence seizures being the most common semiology (60%). EEG abnormalities included intermittent rhythmic delta activity (60%), slow or absent posterior dominant rhythm (87%), and epileptiform activity (93%), with generalized discharges being more common than focal. Neuroimaging revealed nonspecific abnormalities (53%). Neurodevelopmental evaluation revealed impairment in all individuals, with gross motor function being the least affected. Autism spectrum disorder was diagnosed in 73% and aggression in 60% of cases. Analysis of biomarkers revealed a trend toward a moderate positive correlation between visual-perceptual/fine motor/adaptive skills and language development, with posterior dominant rhythm on electroencephalogram (EEG), independent of age. No other neurophysiology-development associations or correlations were identified. Conclusions A broad spectrum of neurologic and neurodevelopmental features are found with pathogenic variants of SYNGAP1. An abnormal posterior dominant rhythm on EEG correlated with abnormal developmental progression, providing a possible prognostic biomarker. Electronic supplementary material The online version of this article (10.1186/s11689-019-9276-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andres Jimenez-Gomez
- Department of Pediatrics, Division of Neurology and Developmental Neuroscience, Baylor College of Medicine, 6701 Fannin St, Suite 1250, Houston, TX, 77030, USA
| | - Sizhe Niu
- Department of Pediatrics, Division of Neurology and Developmental Neuroscience, Baylor College of Medicine, 6701 Fannin St, Suite 1250, Houston, TX, 77030, USA.,Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, 1250 Morsund Street, Suite 925, Houston, TX, 77030, USA
| | - Fabiola Andujar-Perez
- Department of Pediatrics, Division of Neurology and Developmental Neuroscience, Baylor College of Medicine, 6701 Fannin St, Suite 1250, Houston, TX, 77030, USA.,Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, 1250 Morsund Street, Suite 925, Houston, TX, 77030, USA
| | - Elizabeth A McQuade
- Department of Pediatrics, Division of Neurology and Developmental Neuroscience, Baylor College of Medicine, 6701 Fannin St, Suite 1250, Houston, TX, 77030, USA
| | - Alfred Balasa
- Department of Pediatrics, Division of Neurology and Developmental Neuroscience, Baylor College of Medicine, 6701 Fannin St, Suite 1250, Houston, TX, 77030, USA
| | - David Huss
- Department of Pediatrics, Division of Neurology and Developmental Neuroscience, Baylor College of Medicine, 6701 Fannin St, Suite 1250, Houston, TX, 77030, USA
| | - Rohini Coorg
- Department of Pediatrics, Division of Neurology and Developmental Neuroscience, Baylor College of Medicine, 6701 Fannin St, Suite 1250, Houston, TX, 77030, USA
| | - Michael Quach
- Department of Pediatrics, Division of Neurology and Developmental Neuroscience, Baylor College of Medicine, 6701 Fannin St, Suite 1250, Houston, TX, 77030, USA
| | - Sherry Vinson
- Department of Pediatrics, Division of Neurology and Developmental Neuroscience, Baylor College of Medicine, 6701 Fannin St, Suite 1250, Houston, TX, 77030, USA
| | - Sarah Risen
- Department of Pediatrics, Division of Neurology and Developmental Neuroscience, Baylor College of Medicine, 6701 Fannin St, Suite 1250, Houston, TX, 77030, USA
| | - J Lloyd Holder
- Department of Pediatrics, Division of Neurology and Developmental Neuroscience, Baylor College of Medicine, 6701 Fannin St, Suite 1250, Houston, TX, 77030, USA. .,Jan and Dan Duncan Neurological Research Institute, Texas Children's Hospital, 1250 Morsund Street, Suite 925, Houston, TX, 77030, USA.
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11
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Myers KA, Johnstone DL, Dyment DA. Epilepsy genetics: Current knowledge, applications, and future directions. Clin Genet 2018; 95:95-111. [PMID: 29992546 DOI: 10.1111/cge.13414] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/03/2018] [Accepted: 07/06/2018] [Indexed: 12/12/2022]
Abstract
The rapid pace of disease gene discovery has resulted in tremendous advances in the field of epilepsy genetics. Clinical testing with comprehensive gene panels, exomes, and genomes are now available and have led to higher diagnostic rates and insights into the underlying disease processes. As such, the contribution to the care of patients by medical geneticists, neurogeneticists and genetic counselors are significant; the dysmorphic examination, the necessary pre- and post-test counseling, the selection of the appropriate next-generation sequencing-based test(s), and the interpretation of sequencing results require a care provider to have a comprehensive working knowledge of the strengths and limitations of the available testing technologies. As the underlying mechanisms of the encephalopathies and epilepsies are better understood, there may be opportunities for the development of novel therapies based on an individual's own specific genotype. Drug screening with in vitro and in vivo models of epilepsy can potentially facilitate new treatment strategies. The future of epilepsy genetics will also probably include other-omic approaches such as transcriptomes, metabolomes, and the expanded use of whole genome sequencing to further improve our understanding of epilepsy and provide better care for those with the disease.
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Affiliation(s)
- K A Myers
- Department of Pediatrics, University of McGill, Montreal, Canada.,Research Institute of the McGill University Health Centre, Montreal, Canada
| | - D L Johnstone
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada
| | - D A Dyment
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Canada.,Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Canada
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12
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Hur YJ, Koh S, Millichap J, Nangia S, Jennings LJ, Nordli DR. Clinical and Electroencephalographic Characteristics of Infantile-Onset Epilepsies Caused by Genetic Mutations. J Pediatr 2017; 184:172-177.e1. [PMID: 28410084 DOI: 10.1016/j.jpeds.2017.01.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/06/2016] [Accepted: 01/19/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To determine whether certain characteristic electroencephalography (EEG) features are indicative of a genetic cause in early-life epilepsy. STUDY DESIGN We enrolled a total of 100 patients with infantile-onset (<3 years) epilepsy due to known genetic cause (n = 50) and nongenetic cause (acquired, structural, or unknown, n = 50). The genetic group was classified into synaptopathies, channelopathies, mTOR (mammalian target of rapamycin)-opathies, and chromosomal abnormalities. The nongenetic group included epilepsy of unknown cause and structural abnormalities such as brain tumor, focal cortical dysplasia and encephalomalacia. The clinical features, magnetic resonance imaging, and video EEG obtained before 3 years of age and again at follow-up were reviewed. Specifically, the background rhythms and patterns of interictal epileptiform discharges were analyzed to define the EEG characteristics. RESULTS The genetic group was more likely to have seizure recurrence beyond infancy and significant developmental delay (P <.01). The genetic and nongenetic groups showed different EEG patterns in the initial EEGs that persisted in follow-up EEGs. Diffuse slowing with pleomorphic focal/multifocal epileptiform discharges were present more often in the genetic (86%) compared with the nongenetic group (20%) in the initial EEGs (P <.01). The last available follow-up EEG features were similar (81% in genetic versus 17% in nongenetic) to the EEG performed prior to 3 years of age. CONCLUSIONS Our findings suggest a simple guide for genetic screening in children with early-onset epilepsy. Genetic testing may be indicated and useful in infants with delayed development, no obvious cause, and significant EEG background slowing with pleomorphic focal or multifocal epileptiform discharges.
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Affiliation(s)
- Yun Jung Hur
- Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Pediatrics, Haeundae Paik Hospital, Inje University College of Medicine, Pusan, Republic of Korea
| | - Sookyong Koh
- Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, GA
| | - John Millichap
- Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Srishti Nangia
- Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lawrence J Jennings
- Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Douglas R Nordli
- Epilepsy Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL; Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA.
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13
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Electroclinical phenotype in Rubinstein-Taybi syndrome. Brain Dev 2016; 38:563-70. [PMID: 26867510 DOI: 10.1016/j.braindev.2015.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 12/09/2015] [Accepted: 12/10/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Rubinstein-Taybi syndrome (RSTS) is a rare congenital disorder (1:125.000) characterized by growth retardation, psychomotor developmental delay, microcephaly and dysmorphic features. In 25% of patients seizures have been described, and in about 66% a wide range of EEG abnormalities, but studies on neurological features are scant and dated. The aim of this study is to describe the electroclinical phenotype of twenty-three patients with RSTS, and to try to correlate electroclinical features with neuroradiological, cognitive and genetic features. PATIENTS AND METHODS Electroclinical features of twenty-three patients with RSTS (age between18months and 20years) were analyzed. Sleep and awake EEG was performed in twenty-one patients, and brain MRI in nineteen patients. All subjects received cognitive evaluation. RESULTS EEG abnormalities were observed in 76% (16/21) of patients. A peculiar pattern prevalent in sleep, characterized by slow monomorphic activity on posterior regions was also observed in 33% (7/21) of patients. Almost no patient presented seizures. Eighty-four percentage of patients had brain MRI abnormalities, involving corpus callosum and/or posterior periventricular white matter. Average General Quotient (GQ) was 52, while average IQ was 55, corresponding to mild Intellectual Disability. The homogeneous electroclinical pattern was observed mainly in patients with more severe neuroradiologic findings and moderate Intellectual Disability/Developmental Disability (ID/DD). No genotype-phenotype correlations were found. CONCLUSION The specific electroclinical and neuroradiological features described may be part of a characteristic RSTS phenotype. Wider and longitudinal studies are needed to verify its significance and impact on diagnosis, prognosis and clinical management of RSTS patients.
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