Lissencephaly syndromes: clinical aspects

LIS1 and DCX: Implications for Brain Development and Human Disease in Relation to Microtubules

Proper lamination of the cerebral cortex requires the orchestrated motility of neurons from their place of birth to their final destination. Improper neuronal migration may result in a wide range of diseases, including brain malformations, such as lissencephaly, mental retardation, schizophrenia, and autism. Ours and other studies have implicated that microtubules and microtubule-associated proteins play an important role in the regulation of neuronal polarization and neuronal migration. Here, we will review normal processes of brain development and neuronal migration, describe neuronal migration diseases, and will focus on the microtubule-associated functions of LIS1 and DCX, which participate in the regulation of neuronal migration and are involved in the human developmental brain disease, lissencephaly.

Clinical and MRI findings of lissencephaly in a mixed breed dog

A 7-year-old castrated male mixed-breed dog was presented with a complaint of acute pain. The dog had suffered from isolated seizures for two years. Magnetic resonance imaging (MRI) of the brain revealed a smooth brain surface due to lack of gyri and sulci formation of the cerebrum and thick cortical grey matter. Additionally, ventriculomegaly and an arachnoid cyst were noted. Multiple spinal cord compressions induced by intervertebral disc protrusion were observed on a cervical MRI. Based on these findings, the dog was diagnosed as having lissencephaly concurrent with intervertebral cervical disease. After therapy for seizure and cervical pain, the clinical signs were completely resolved. To the author's knowledge, this is the case report to diagnose lissencephaly in a mixed-breed dog.

Long-term follow-up of type 1 lissencephaly: survival is related to neuroimaging abnormalities

AIM

To evaluate survival, clinical, and genetic characteristics of all patients with classic or type 1 lissencephaly born between 1972 and 1990 in the Netherlands, who at the time were enrolled in an observational study.

METHOD

We re-evaluated 24 patients (11 males, 13 females) for long-term follow-up and survival information.

RESULTS

Mean length of follow-up was 14 years (SD 9 y 8 mo). Eleven patients were alive at follow-up. All patients showed severe intellectual disability, intractable epilepsy, and complete dependency on care. Life expectancy was related to the severity of the lissencephaly on neuroimaging. Molecular analysis of the LIS1 gene was not possible at the time of the original study and was now requested by eight parents. This revealed a pathogenic nonsense mutation or deletion in seven patients.

INTERPRETATION

Our study provides information about the long-term course of lissencephaly and the relationship between lissencephaly severity and prognosis. It also shows that renewed attention to genetic counselling remains valued by families of patients with a severe congenital neurological disease.

Ocular findings in lissencephaly

PURPOSE

To report our retrospective study of 20 cases with lissencephaly and describe ocular and visual abnormalities associated with this disorder.

METHODS

Patients with lissencephaly were identified and classified into classic (type I) or cobblestone (type 2) lissencephaly on the basis of a review of clinical records and neuroimaging studies. Only patients examined by an ophthalmologist were included in the study.

RESULTS

Only 1 patient had a normal ocular examination. Ocular abnormalities included optic nerve hypoplasia and atrophy, retinal dysplasia, retinal nonattachment, macular hypoplasia, anterior segment malformation, and strabismus.

CONCLUSIONS

Ocular abnormalities in classic (type 1) lissencephaly are less severe. Central, steady, and maintained fixation may be present despite the presence of optic nerve hypoplasia, optic atrophy, macular hypoplasia, strabismus, or refractive errors. Retinal and anterior segment abnormalities were observed only in cobblestone (type 2) lissencephaly. These patients often have severe visual impairment because of retinal or cortical disease.

Structure-function correlations in patients with malformations of cortical development

Malformations of cortical development (MCD) are a diverse group of diseases that exhibit both genetic and phenotypic heterogeneity. While previous studies have described the clinical, MRI, and/or EEG features of specific malformations, structure and function have not been correlated across a wide spectrum of these disorders. We reviewed the medical records of 22 patients with MCD due to abnormal neuronal migration and cortical organization, and correlated levels of clinical disability with specific MRI and EEG findings. The extent of abnormality on MRI was significantly correlated with clinical disability. Compared with patients with other lesions, those with lissencephaly were more disabled. Although background slowing, suppression, fast activity, and interictal epileptiform activity were not individually predictive, the overall degree of EEG abnormality was significantly correlated with clinical disability, as were alterations in the posterior head rhythm and physiologic sleep features.

The unfolding story of two lissencephaly genes and brain development

Formation of our highly structured human brain involves a cascade of events, including differentiation, fate determination, and migration of neural precursors. In humans, unlike many other organisms, the cerebral cortex is the largest component of the brain. As in other mammals, the human cerebral cortex is located on the surface of the telencephalon and generally consists of six layers that are formed in an orderly fashion. During neuronal development, newly born neurons, moving in a radial direction, must migrate through previously formed layers to reach their proper cortical position. This is one of several neuronal migration routes that takes place in the developing brain; other modes of migration are tangential. Abnormal neuronal migration may in turn result in abnormal development of the cortical layers and deleterious consequences, such as Lissencephaly. Lissencephaly, a severe brain malformation, can be caused by mutations in one of two known genes: LIS1 and doublecortin (DCX). Recent in vitro and in vivo studies, report on possible functions for these gene products.