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Saini L, Mukherjee S, Gunasekaran PK, Saini AG, Ahuja C, Sharawat IK, Sharma R, Bhati A, Suthar R, Sahu JK, Sankhyan N. The profile of epilepsy and its characteristics in children with neurocutaneous syndromes. J Neurosci Rural Pract 2024; 15:233-237. [PMID: 38746526 PMCID: PMC11090591 DOI: 10.25259/jnrp_510_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/26/2023] [Indexed: 10/02/2024] Open
Abstract
OBJECTIVES The profile of seizures in neurocutaneous syndromes is variable. We aimed to define the characteristics of epilepsy in children with neurocutaneous syndromes. MATERIALS AND METHODS Cross-sectional study over 18 months at a tertiary care pediatric hospital, including children with neurocutaneous syndromes aged between 1 and 15 years, using the 2017-International League Against Epilepsy classification. RESULTS In 119 children with neurocutaneous syndromes, 94 (79%) had epilepsy. In eight children with neurofibromatosis one with epilepsy, 5 (62.5%) had generalized motor tonic-clonic seizures, 1 (12.5%) had generalized motor epileptic spasms, 1 (12.5%) had generalized motor automatism, and 1 (12.5%) had a focal seizure. In 69 children with tuberous sclerosis complex with epilepsy, 30 (43.5%) had generalized motor epileptic spasms, 23 (33.3%) had focal seizures, and nine (13.0%) had generalized motor tonic-clonic seizures. In 14 children with Sturge-Weber syndrome with epilepsy, 13 (92.8%) had focal seizures, and 1 (7.2%) had generalized motor tonic seizures. Statistically significant associations were found between epilepsy and intellectual disability (P = 0.02) and behavioral problems (P = 0.00). CONCLUSION Profiling seizures in children with neurocutaneous syndromes are paramount in devising target-specific treatments as the epileptogenesis in each syndrome differs in the molecular pathways leading to the hyperexcitability state. Further multicentric studies are required to unravel better insights into the epilepsy profile of neurocutaneous syndromes.
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Affiliation(s)
- Lokesh Saini
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Swetlana Mukherjee
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, Uttarakhand, India
| | | | - Arushi Gahlot Saini
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, Uttarakhand, India
| | - Chirag Ahuja
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, Uttarakhand, India
| | - Indar Kumar Sharawat
- Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Rajni Sharma
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, Uttarakhand, India
| | - Ankita Bhati
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Renu Suthar
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, Uttarakhand, India
| | - Jitendra Kumar Sahu
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, Uttarakhand, India
| | - Naveen Sankhyan
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, Uttarakhand, India
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Durkin J, Poe AR, Belfer SJ, Rodriguez A, Tang SH, Walker JA, Kayser MS. Neurofibromin 1 regulates early developmental sleep in Drosophila. Neurobiol Sleep Circadian Rhythms 2023; 15:100101. [PMID: 37593040 PMCID: PMC10428071 DOI: 10.1016/j.nbscr.2023.100101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/30/2023] [Accepted: 08/06/2023] [Indexed: 08/19/2023] Open
Abstract
Sleep disturbances are common in neurodevelopmental disorders, but knowledge of molecular factors that govern sleep in young animals is lacking. Evidence across species, including Drosophila, suggests that juvenile sleep has distinct functions and regulatory mechanisms in comparison to sleep in maturity. In flies, manipulation of most known adult sleep regulatory genes is not associated with sleep phenotypes during early developmental (larval) stages. Here, we examine the role of the neurodevelopmental disorder-associated gene Neurofibromin 1 (Nf1) in sleep during numerous developmental periods. Mutations in Neurofibromin 1 (Nf1) are associated with sleep and circadian disorders in humans and adult flies. We find in flies that Nf1 acts to regulate sleep across the lifespan, beginning during larval stages. Nf1 is required in neurons for this function, as is signaling via the Alk pathway. These findings identify Nf1 as one of a small number of genes positioned to regulate sleep across developmental periods.
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Affiliation(s)
- Jaclyn Durkin
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Amy R. Poe
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Samuel J. Belfer
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Anyara Rodriguez
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Si Hao Tang
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - James A. Walker
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Matthew S. Kayser
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Chronobiology and Sleep Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
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3
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O'Sullivan R, Bissell S, Hamilton A, Bagshaw A, Richards C. Concordance of objective and subjective measures of sleep in children with neurodevelopmental conditions: A systematic review and meta-analysis. Sleep Med Rev 2023; 71:101814. [PMID: 37422998 DOI: 10.1016/j.smrv.2023.101814] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/30/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023]
Abstract
The purpose of this systematic review and meta-analysis is to delineate the concordance of objective and subjective measures of sleep in children with neurodevelopmental conditions (NDCs). A systematic literature search identified 31 studies that compare objective and subjective estimates of sleep parameters in autism, ADHD or rare genetic syndromes associated with intellectual disability. The meta-analyses revealed smaller mean differences and larger correlations indicative of greater concordance for parameters associated with sleep scheduling compared to parameters associated with sleep duration and night awakenings. Relative to objective measures, subjective measures produced: 1) greater estimates of total sleep time, sleep efficiency and time in bed; and 2) lower estimates of wake after sleep onset and number of night awakenings. Subgroup analyses also revealed differences in concordance between measurement comparison types (e.g., stronger correlations between actigraphy and sleep diaries, compared to actigraphy and questionnaires) and NDC diagnostic groups. The results predominantly replicate concordance trends observed in typically-developing samples, although some NDC-specific patterns of concordance were identified. This indicates that objective and subjective sleep measures retain broadly similar properties across populations, although researchers and clinicians should be cautious of the impact of NDC-related characteristics on sleep parameter estimates. These findings should inform sleep assessment design and the interpretation of sleep parameter estimates in NDCs, increasing the rigour of sleep parameter description across research and clinical settings.
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Affiliation(s)
- Rory O'Sullivan
- School of Psychology, University of Birmingham, UK; Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, UK.
| | - Stacey Bissell
- School of Psychology, University of Birmingham, UK; Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, UK
| | - Anna Hamilton
- School of Psychology, University of Birmingham, UK; Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, UK
| | - Andrew Bagshaw
- School of Psychology, University of Birmingham, UK; Centre for Human Brain Health, University of Birmingham, UK
| | - Caroline Richards
- School of Psychology, University of Birmingham, UK; Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, UK
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Saini L, Mukherjee S, Gunasekaran PK, Malhi P, Saini AG, De D, Padhy S, Ahuja C, Suthar R, Sahu JK, Sankhyan N, Yadav J, Sharawat IK. Sleep Problems in Children With Neurocutaneous Syndromes: A Cross-Sectional Study. J Child Neurol 2022; 37:864-870. [PMID: 35918819 DOI: 10.1177/08830738221114560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: The prevalence and patterns of sleep disturbances in neurocutaneous syndromes are variable and understudied. Methods: Cross-sectional study for 18 months at a tertiary care pediatric hospital, involving 100 children with neurocutaneous syndromes aged between 4 and 10 years using the Children's Sleep Habits Questionnaire-Abbreviated. Results: In 100 children with neurocutaneous syndromes, 47 (47%) had significant sleep problems. In subgroup analysis, 7 of 17 children with neurofibromatosis 1, 24 of 63 children with tuberous sclerosis complex, 10 of 12 children with Sturge-Weber syndrome, 2 of 3 children with linear nevus sebaceous syndrome, and each of the children with hypomelanosis of Ito, McCune-Albright syndrome, megalencephaly-capillary malformation syndrome, and unclassified neurocutaneous syndrome had significant sleep problems. Conclusion: The prevalence of sleep problems in our study population was not more than that observed in the general pediatric population. Prospective multicentric studies are needed to comprehend sleep problems in children with neurocutaneous syndromes.
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Affiliation(s)
- Lokesh Saini
- Department of Pediatrics, 410775All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Swetlana Mukherjee
- Department of Pediatrics, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Prahbhjot Malhi
- Department of Pediatrics, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arushi Gahlot Saini
- Department of Pediatrics, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dipankar De
- Department of Dermatology, Venereology and Leprosy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Susanta Padhy
- Department of Psychiatry, 410730All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Chirag Ahuja
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Renu Suthar
- Department of Pediatrics, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jitendra Kumar Sahu
- Department of Pediatrics, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Sankhyan
- Department of Pediatrics, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jaivinder Yadav
- Department of Pediatrics, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Indar Kumar Sharawat
- Department of Pediatrics, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Moavero R, Voci A, La Briola F, Matricardi S, Toldo I, Mancardi MM, Negrin S, Messana T, Mazzone L, Valeriani M, Curatolo P, Bruni O. Sleep disorders and neuropsychiatric disorders in a pediatric sample of tuberous sclerosis complex: a questionnaire-based study. Sleep Med 2021; 89:65-70. [PMID: 34915263 DOI: 10.1016/j.sleep.2021.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE AND BACKGROUND Sleep disorders (SD) are very common in childhood, especially in certain genetic syndromes. Tuberous Sclerosis Complex (TSC) is a genetic syndromesassociated with a high rate of SD, although these are still under-recognized. The aim of this study was to assess the prevalence of SD in TSC, and to evaluate the relationship between sleep, epilepsy and TSC-associated neuropsychiatric disorders (TAND). METHODS We administered the Sleep Disturbance Scale for Children (SDSC) and the Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD) to parents of 177 children with TSC referring to different Italian centers. We also collected information on epilepsy and TAND. RESULTS SDSC score was positive in 59.3% of patients, being positive in 30.4% of patients without and in 63.6% of those with epilepsy (p = 0.005). However, in a multivariate logistic model considering antiseizure medications and nocturnal seizures, epilepsy ceased to be a significant risk factor for positive SDSC (OR = 2.4; p = 0.17). As for TAND, SDSC was positive in 67.9% of patients with and in 32.5% of those without TAND (p < 0.001). After adding in a multivariate logistic model active epilepsy, age, and pharmacotherapies, TAND continued to be a significant risk factor for positive SDSC (p = 0.01, OR = 1.11). CONCLUSIONS Our results revealed a high prevalence of SD in children with TSC. Epilepsy didn't increase the risk for SD, while a very strong association was found with TAND. An early detection of SD is of utmost importance in order to plan an individualized treatment, that in some cases might also ameliorate behavior and attention.
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Affiliation(s)
- Romina Moavero
- Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Via Montepellier 1, 00133, Rome, Italy; Child Neurology Unit, Neuroscience Department, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Alessandra Voci
- Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Via Montepellier 1, 00133, Rome, Italy
| | - Francesca La Briola
- Child Neuropsychiatry Unit - Epilepsy Center, ASST SS. Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Sara Matricardi
- Child Neurology and Psychiatry Unit, Children's Hospital "G. Salesi", Ospedali Riuniti Ancona, Via Corridoni 11, 60123, Ancona, Italy
| | - Irene Toldo
- Pediatric Neurology and Neurophysiology Unit, Department of Woman's and Child Health, Padua University Hospital, Via N. Giustiniani 3, 35128, Padua, Italy
| | - Maria Margherita Mancardi
- Unit of Child Neuropsichiatry, Department of Clinical and Surgical Neurosciences and Rehabilitation, IRCCS Gaslini, Via Gerolamo Gaslini 5, 16147, Genova, Italy
| | - Susanna Negrin
- Epilepsy and Clinical Neurophysiology Unit, Scientific Institute, IRCCS Eugenio Medea, Conegliano, Treviso, Italy
| | - Tullio Messana
- IRCCS Istituto Delle Scienze Neurologiche, UOC Neuropsichiatria Dell'età Pediatrica, Via Altura 3, 40139, Bologna, Italy
| | - Luigi Mazzone
- Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Via Montepellier 1, 00133, Rome, Italy
| | - Massimiliano Valeriani
- Child Neurology Unit, Neuroscience Department, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy; Center for Sensory-Motor Interaction, Aalborg University, Fredrik Bajers Vej 7 D3, Aalborg, D-9220, Denmark
| | - Paolo Curatolo
- Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Via Montepellier 1, 00133, Rome, Italy
| | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Rome, Italy
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Miszewska D, Sugalska M, Jóźwiak S. Risk Factors Associated with Refractory Epilepsy in Patients with Tuberous Sclerosis Complex: A Systematic Review. J Clin Med 2021; 10:jcm10235495. [PMID: 34884198 PMCID: PMC8658289 DOI: 10.3390/jcm10235495] [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: 10/15/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Epilepsy affects 70-90% of patients with tuberous sclerosis complex (TSC). In one-third of them, the seizures become refractory to treatment. Drug-resistant epilepsy (DRE) carries a significant educational, social, cognitive, and economic burden. Therefore, determining risk factors that increase the odds of refractory seizures is needed. We reviewed current data on risk factors associated with DRE in patients with tuberous sclerosis. METHODS The review was performed according to the PRISMA guidelines. Embase, Cochrane Library, MEDLINE, and ClinicalTrial.gov databases were searched. Only full-text journal articles on patients with TSC which defined risk factors related to DRE were included. RESULTS Twenty articles were identified, with a cohort size between 6 and 1546. Seven studies were prospective. Three factors appear to significantly increase DRE risk: TSC2 mutation, infantile spasms, and a high number of cortical tubers. CONCLUSIONS A proper MRI and EEG monitoring, along with genetic testing, and close observation of individuals with early onset of seizures, allow identification of the patients at risk of DRE.
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