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Hierro F, Tomé ML, Grenha J, Santos H, Santos F, Nunes J. Molybdenum Cofactor Deficiency in the Neonate: Expanding the Phenotype. Pediatr Neurol 2024; 153:113-115. [PMID: 38367485 DOI: 10.1016/j.pediatrneurol.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/24/2023] [Accepted: 01/22/2024] [Indexed: 02/19/2024]
Affiliation(s)
- Fátima Hierro
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
| | - Maria Luís Tomé
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Joana Grenha
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Helena Santos
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Fátima Santos
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Joana Nunes
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Lucignani G, Vattermoli L, Rossi-Espagnet MC, Guarnera A, Napolitano A, Figà-Talamanca L, Campi F, Ronci S, Dionisi Vici C, Martinelli D, Gandolfo C, Longo D. A New Pattern of Brain and Cord Gadolinium Enhancement in Molybdenum Cofactor Deficiency: A Case Report. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1072. [PMID: 37371303 DOI: 10.3390/children10061072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/14/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023]
Abstract
Molybdenum cofactor deficiency (MoCD) is a rare and severe autosomal recessive in-born error of metabolism caused by the mutation in MOCS1, MOCS2, MOCS3 or GEPH genes, with an incidence ranging between 1 in 100,000 and 200,000 live births. The clinical presentation with seizures, lethargy and neurologic deficits reflects the neurotoxicity mediated via sulphite accumulation, and it occurs within the first hours or days after birth, often leading to severe neurodegeneration and the patient's death within days or months. The Imaging of Choice is a brain-specific MRI technique, which is usually performed without contrast and shows typical radiological findings in the early phase, such as diffuse cerebral oedema and infarction affecting the cortex and the basal ganglia and the white matter, as well as in the late phase, such as multicystic encephalomalacia. Our case report represents a novelty in the field, since the patient underwent a contrast-enhanced MRI to exclude a concomitant infectious disease. In the frame of the clinical presentation and laboratory data, we describe the MoCD Imaging findings for MRI morphological and advanced sequences, presenting a new contrast-enhanced MRI pattern characterized by the diffuse and linear leptomeningeal enhancement of brain, cord and spinal roots. The early identification of molybdenum cofactor deficiency is crucial because it may lead to the best multidisciplinary therapy for the patient, which is focused on the prompt and optimal management of the complications.
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Affiliation(s)
- Giulia Lucignani
- Functional and Interventional Neuroradiology Unit, Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio, 4, 00165 Rome, Italy
| | - Leonardo Vattermoli
- Department of Diagnostic Imaging and Interventional Radiology, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Maria Camilla Rossi-Espagnet
- Functional and Interventional Neuroradiology Unit, Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio, 4, 00165 Rome, Italy
| | - Alessia Guarnera
- Functional and Interventional Neuroradiology Unit, Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio, 4, 00165 Rome, Italy
- Neuroradiology Unit, NESMOS Department Sant'Andrea Hospital, La Sapienza University, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Antonio Napolitano
- Medical Physics Unit, Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio, 4, 00165 Rome, Italy
| | - Lorenzo Figà-Talamanca
- Functional and Interventional Neuroradiology Unit, Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio, 4, 00165 Rome, Italy
| | - Francesca Campi
- Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio, 4, 00165 Rome, Italy
| | - Sara Ronci
- Neonatal Intensive Care Unit, Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio, 4, 00165 Rome, Italy
| | - Carlo Dionisi Vici
- Department of Pediatric Specialties and Liver-Kidney Transplantation, Division of Metabolic Diseases and Drug Biology, Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio, 4, 00165 Rome, Italy
| | - Diego Martinelli
- Unit of Metabolism, Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio, 4, 00165 Rome, Italy
| | - Carlo Gandolfo
- Functional and Interventional Neuroradiology Unit, Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio, 4, 00165 Rome, Italy
| | - Daniela Longo
- Functional and Interventional Neuroradiology Unit, Bambino Gesù Children's Hospital IRCCS, Piazza Sant'Onofrio, 4, 00165 Rome, Italy
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Lai LM, Gropman AL, Whitehead MT. MR Neuroimaging in Pediatric Inborn Errors of Metabolism. Diagnostics (Basel) 2022; 12:diagnostics12040861. [PMID: 35453911 PMCID: PMC9027484 DOI: 10.3390/diagnostics12040861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 02/04/2023] Open
Abstract
Inborn errors of metabolism (IEM) are a group of disorders due to functional defects in one or more metabolic pathways that can cause considerable morbidity and death if not diagnosed early. While individually rare, the estimated global prevalence of IEMs comprises a substantial number of neonatal and infantile disorders affecting the central nervous system. Clinical manifestations of IEMs may be nonspecific. Newborn metabolic screens do not capture all IEMs, and likewise, genetic testing may not always detect pathogenic variants. Neuroimaging is a critical component of the work-up, given that imaging sometimes occurs before prenatal screen results are available, which may allow for recognition of imaging patterns that lead to early diagnosis and treatment of IEMs. This review will demonstrate the role of magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (1H MRS) in the evaluation of IEMs. The focus will be on scenarios where MRI and 1H MRS are suggestive of or diagnostic for IEMs, or alternatively, refute the diagnosis.
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Affiliation(s)
- Lillian M. Lai
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA;
- Department of Radiology, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA
| | - Andrea L. Gropman
- Department of Neurology, Children’s National, Washington, DC 20010, USA;
| | - Matthew T. Whitehead
- Department of Radiology, Children’s National, Washington, DC 20010, USA
- Correspondence: ; Tel.: +1-202-476-5000
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Kaminiów K, Kozak S, Paprocka J. Neonatal Seizures Revisited. CHILDREN-BASEL 2021; 8:children8020155. [PMID: 33670692 PMCID: PMC7922511 DOI: 10.3390/children8020155] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/02/2021] [Accepted: 02/12/2021] [Indexed: 12/29/2022]
Abstract
Seizures are the most common neurological disorder in newborns and are most prevalent in the neonatal period. They are mostly caused by severe disorders of the central nervous system (CNS). However, they can also be a sign of the immaturity of the infant’s brain, which is characterized by the presence of specific factors that increase excitation and reduce inhibition. The most common disorders which result in acute brain damage and can manifest as seizures in neonates include hypoxic-ischemic encephalopathy (HIE), ischemic stroke, intracranial hemorrhage, infections of the CNS as well as electrolyte and biochemical disturbances. The therapeutic management of neonates and the prognosis are different depending on the etiology of the disorders that cause seizures which can lead to death or disability. Therefore, establishing a prompt diagnosis and implementing appropriate treatment are significant, as they can limit adverse long-term effects and improve outcomes. In this review paper, we present the latest reports on the etiology, pathomechanism, clinical symptoms and guidelines for the management of neonates with acute symptomatic seizures.
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Affiliation(s)
- Konrad Kaminiów
- Students’ Scientific Society, Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (K.K.); (S.K.)
| | - Sylwia Kozak
- Students’ Scientific Society, Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (K.K.); (S.K.)
| | - Justyna Paprocka
- Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
- Correspondence:
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Hinderhofer K, Mechler K, Hoffmann GF, Lampert A, Mountford WK, Ries M. Critical appraisal of genotype assessment in molybdenum cofactor deficiency. J Inherit Metab Dis 2017; 40:801-811. [PMID: 28900816 DOI: 10.1007/s10545-017-0077-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 07/10/2017] [Accepted: 07/21/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Molybdenum cofactor deficiency (MoCD) is an ultra-orphan, life-threatening disease. Substrate substitution therapy has successfully been performed in single cases of MoCD type A and clinical trials are underway for drug registration. We present an innovative approach for classification of genotype severity to test the hypothesis that milder sequence variants in MoCD result in a less severe disease phenotype quantitated by patient survival. METHODS All available worldwide published cases with clinical and genetic data were included (n = 40). We stratified the already published disease causing sequence variants as mild or severe with the use of in silico prediction programs, where possible and assessed the possible impact of the variants on the expression of the gene or function of the expressed protein. In a compound heterozygous situation the mildest sequence variant determined the genotype. Subsequently, clinical manifestations and outcomes of both groups were compared. RESULTS Patients with a severe genotype showed a median survival of 15 months and had a lower probability of survival compared to patients with mild genotypes who were all alive at last reported follow-up (p = 0.0203, Log-rank test). DISCUSSION The severity of the genotype assessed by in silico prediction and further classification explained survival in molybdenum cofactor deficiency and may therefore be considered a confounder for the outcome of therapeutic clinical trials requiring adjustment in the clinical trial design or analysis. These results should further be investigated by future in vitro or in vivo functional studies. Caution should be taken with this approach for the classification of variants in molecular genetic diagnostics or genetic counseling.
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Affiliation(s)
| | - Konstantin Mechler
- Pediatric Psychopharmacology, Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, J 5, 68159, Mannheim, Germany.
| | - Georg F Hoffmann
- Pediatric Neurology and Metabolic Medicine, Center for Pediatric and Adolescent Medicine, and Center for Rare Disorders, Heidelberg University Hospital, Heidelberg, Germany
| | - Anette Lampert
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
- Cooperation Unit Clinical Pharmacy, Heidelberg University Hospital, Heidelberg, Germany
| | - William K Mountford
- University of North Carolina Wilmington, Wilmington, NC, USA
- Quintiles Inc., Smyrna, GA, USA
| | - Markus Ries
- Pediatric Neurology and Metabolic Medicine, Center for Pediatric and Adolescent Medicine, and Center for Rare Disorders, Heidelberg University Hospital, Heidelberg, Germany
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Sharma S, Prasad AN. Inborn Errors of Metabolism and Epilepsy: Current Understanding, Diagnosis, and Treatment Approaches. Int J Mol Sci 2017; 18:ijms18071384. [PMID: 28671587 PMCID: PMC5535877 DOI: 10.3390/ijms18071384] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/21/2017] [Accepted: 06/23/2017] [Indexed: 12/22/2022] Open
Abstract
Inborn errors of metabolism (IEM) are a rare cause of epilepsy, but seizures and epilepsy are frequently encountered in patients with IEM. Since these disorders are related to inherited enzyme deficiencies with resulting effects on metabolic/biochemical pathways, the term “metabolic epilepsy” can be used to include these conditions. These epilepsies can present across the life span, and share features of refractoriness to anti-epileptic drugs, and are often associated with co-morbid developmental delay/regression, intellectual, and behavioral impairments. Some of these disorders are amenable to specific treatment interventions; hence timely and appropriate diagnosis is critical to improve outcomes. In this review, we discuss those disorders in which epilepsy is a dominant feature and present an approach to the clinical recognition, diagnosis, and management of these disorders, with a greater focus on primarily treatable conditions. Finally, we propose a tiered approach that will permit a clinician to systematically investigate, identify, and treat these rare disorders.
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Affiliation(s)
- Suvasini Sharma
- Department of Pediatrics, Lady Hardinge Medical College, New Delhi 110001, India.
| | - Asuri N Prasad
- Department of Pediatrics and Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Children's Hospital of Western Ontario and London Health Sciences Centre, London, ON N6A5W9, Canada.
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Abstract
Inborn errors of metabolism (IEM) are rare conditions that represent more than 1000 diseases, with a global prevalence of approximately 1:2000 individuals. Approximately, 40%-60% of IEM may present with epilepsy as one of the main neurologic signs. Epilepsy in IEM may appear at any age (fetal, newborn, infant, adolescent, or even adult). Different pathophysiological mechanisms may be responsible for the clinical phenotype, such as disturbances in energy metabolism (mitochondrial and fatty oxidation disorders, GLUT-1, and cerebral creatine deficiency), accumulation of complex molecules (lysosomal storage disorders), toxic mechanisms (organic acidurias and urea cycle disorders), or impairment of neurotransmission. Early diagnosis and, in some cases, an effective treatment may result in an excellent evolution of the IEM, in particularly seizure control. This review attempts to delineate a summary of IEM that may present with seizures or epilepsy and emphasizes the management in treatable conditions.
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Affiliation(s)
- Jaume Campistol
- From the *Neurology Department, Hospital Sant Joan de Déu, Barcelona University, Barcelona, Spain; Center for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain; Institute of Pediatric Research, Sant Joan de Déu, Barcelona, Spain.
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Grings M, Moura AP, Parmeggiani B, Motta MM, Boldrini RM, August PM, Matté C, Wyse ATS, Wajner M, Leipnitz G. Higher susceptibility of cerebral cortex and striatum to sulfite neurotoxicity in sulfite oxidase-deficient rats. Biochim Biophys Acta Mol Basis Dis 2016; 1862:2063-2074. [PMID: 27523630 DOI: 10.1016/j.bbadis.2016.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 07/27/2016] [Accepted: 08/09/2016] [Indexed: 12/22/2022]
Abstract
Patients affected by sulfite oxidase (SO) deficiency present severe seizures early in infancy and progressive neurological damage, as well as tissue accumulation of sulfite, thiosulfate and S-sulfocysteine. Since the pathomechanisms involved in the neuropathology of SO deficiency are still poorly established, we evaluated the effects of sulfite on redox homeostasis and bioenergetics in cerebral cortex, striatum, cerebellum and hippocampus of rats with chemically induced SO deficiency. The deficiency was induced in 21-day-old rats by adding 200ppm of tungsten, a molybdenum competitor, in their drinking water for 9weeks. Sulfite (70mg/kg/day) was also administered through the drinking water from the third week of tungsten supplementation until the end of the treatment. Sulfite decreased reduced glutathione concentrations and the activities of glutathione reductase and glutathione S-transferase (GST) in cerebral cortex and of GST in cerebellum of SO-deficient rats. Moreover, sulfite increased the activities of complexes II and II-III in striatum and of complex II in hippocampus, but reduced the activity of complex IV in striatum of SO-deficient rats. Sulfite also decreased the mitochondrial membrane potential in cerebral cortex and striatum, whereas it had no effect on mitochondrial mass in any encephalic tissue evaluated. Finally, sulfite inhibited the activities of malate and glutamate dehydrogenase in cerebral cortex of SO-deficient rats. Taken together, our findings indicate that cerebral cortex and striatum are more vulnerable to sulfite-induced toxicity than cerebellum and hippocampus. It is presumed that these pathomechanisms may contribute to the pathophysiology of neurological damage found in patients affected by SO deficiency.
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Affiliation(s)
- Mateus Grings
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Alana Pimentel Moura
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Belisa Parmeggiani
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Marcela Moreira Motta
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Rafael Mello Boldrini
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Pauline Maciel August
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Cristiane Matté
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600-Anexo, CEP 90035-003, Porto Alegre, RS, Brazil
| | - Angela T S Wyse
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600-Anexo, CEP 90035-003, Porto Alegre, RS, Brazil
| | - Moacir Wajner
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600-Anexo, CEP 90035-003, Porto Alegre, RS, Brazil; Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, CEP 90035-903, Porto Alegre, RS, Brazil
| | - Guilhian Leipnitz
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600-Anexo, CEP 90035-003, Porto Alegre, RS, Brazil.
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Hart AR, Sharma R, Rittey CD, Mordekar SR. Neonatal hypertonia - a diagnostic challenge. Dev Med Child Neurol 2015; 57:600-610. [PMID: 25495611 DOI: 10.1111/dmcn.12658] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2014] [Indexed: 01/31/2023]
Abstract
In comparison to hypotonia, hypertonia is less commonly expressed in the neonatal period. The scientific literature on the causes of neonatal hypertonia is scant, with no suggested diagnostic algorithm easily available to clinicians. Aetiologies include conditions affecting the central nervous system and spine, and rare peripheral neuromuscular disorders leading to hypertonia. Aetiology onset may be antepartum, peripartum with either transient hypertonia or persistent hypertonia which may appear later, or from a postnatal event/disease. This review discusses neonatal hypertonia and a diagnostic approach to neonatal hypertonia is suggested.
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Affiliation(s)
- Anthony R Hart
- Department of Paediatric Neurology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Ruchi Sharma
- Department of Paediatric Neurodisability, Sheffield Children's Hospital NHS Foundation Trust, Ryegate Children's Centre, Sheffield, UK
| | - Christopher D Rittey
- Department of Paediatric Neurology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Santosh R Mordekar
- Department of Paediatric Neurology, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
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Higuchi R, Sugimoto T, Tamura A, Kioka N, Tsuno Y, Higa A, Yoshikawa N. Early features in neuroimaging of two siblings with molybdenum cofactor deficiency. Pediatrics 2014; 133:e267-71. [PMID: 24379235 DOI: 10.1542/peds.2013-0935] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We report the features of neuroimaging within 24 hours after birth in 2 siblings with molybdenum cofactor deficiency. The first sibling was delivered by emergency cesarean section because of fetal distress and showed pedaling and crawling seizures soon after birth. Brain ultrasound revealed subcortical multicystic lesions in the frontal white matter, and brain MRI at 4 hours after birth showed restricted diffusion in the entire cortex, except for the area adjacent to the subcortical cysts. The second sibling was delivered by elective cesarean section. Cystic lesions were seen in the frontal white matter on ultrasound, and brain MRI showed low signal intensity on T1-weighted image and high signal intensity on T2-weighted image in bifrontal white matter within 24 hours after birth, at which time the infant sucked sluggishly. Clonic spasm appeared at 29 hours after birth. The corpus callosum could not be seen clearly on ultrasound or MRI in both infants. Cortical atrophy and white matter cystic lesions spread to the entire hemisphere and resulted in severe brain atrophy within ~1 month in both infants. Subcortical multicystic lesions on ultrasound and a cortex with nonuniform, widespread, restricted diffusion on diffusion-weighted images are early features of neuroimaging in patients with molybdenum cofactor deficiency type A.
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Affiliation(s)
- Ryuzo Higuchi
- Department of Perinatal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-0012, Japan.
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