1
|
Clinical and molecular characterization of Unverricht-Lundborg disease among Egyptian patients. Epilepsy Res 2021; 176:106746. [PMID: 34474241 DOI: 10.1016/j.eplepsyres.2021.106746] [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: 05/16/2021] [Revised: 08/17/2021] [Accepted: 08/22/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE Unverricht-Lundborg disease (ULD) is a common type of progressive myoclonic epilepsy (PME). It is caused mostly by biallelic dodecamer repeat expansions in the promoter region of CSTB gene. Despite highly prevalent in the Mediterranean countries, no studies have been reported from Egypt. This article study the presence of CSTB gene mutations among Egyptian patients clinically suspected with ULD, and describes the clinical and genetic characteristics of those with confirmed gene mutation. METHODS Medical records of patients following up in two specialized epilepsy clinics in Cairo, Egypt were retrospectively reviewed. Twenty patients who belonged to 13 unrelated families were provisionally diagnosed with ULD based on the clinical presentation. Genetic testing was done. Clinical characteristics, demographic data and EEG findings were documented. RESULTS Genetic studies confirmed the presence of the CSTB dodecamer repeat expansion in 14 patients from 8 families (frequency 70 %). The mean duration of the follow-up was 5 years. Male to female distribution was 1:1 with a mean age of onset 9.7 years. Consanguinity was noted in 4 families. Eight patients had their first seizure between the age of 10 and 20 years. Myoclonic jerks ranged in severity from mild in three unrelated patients to severe in one. Only 3 had cognitive impairment. CONCLUSION Our study confirms the presence of CSTB mutation among Egyptian patients suspected with ULD. There was no clear phenotype-genotype correlation among the studied group of patients. In addition, we noticed variable inter and intra familial severity among patients from the same family.
Collapse
|
2
|
Sipilä JOT, Hyppönen J, Kytö V, Kälviäinen R. Unverricht-Lundborg disease (EPM1) in Finland: A nationwide population-based study. Neurology 2020; 95:e3117-e3123. [PMID: 32943486 PMCID: PMC7734927 DOI: 10.1212/wnl.0000000000010911] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/22/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the epidemiology and prognosis of Unverricht-Lundborg disease (EPM1) in a nationwide, population-based setting. METHODS Data from multiple registries were combined and analyzed. Clinical data were obtained from medical records. All patients treated for EPM1 in Finland between January 1, 1998, and December 31, 2016 were included. RESULTS A total of 135 persons with EPM1 (54% women) were identified and 105 were alive on December 31, 2016 (point prevalence 1.91/100,000 persons). The age-standardized (European Standard Population 2013) prevalence was 1.53/100,000 persons. Annual incidence during the study period was 0.022/100,000 person-years, with a mean age at onset of 9.4 ± 2.3 years (range 7.0-14.6 years, no sex difference). The median age at death (n = 34) was 53.9 years (interquartile range 46.4, 60.3; range 23.2-63.8), with no sex differences. The immediate cause of death was a lower respiratory tract infection in 56% of deaths. The survival rates of the patients were comparable to matched controls up to 40 years of age, but poorer during long-term follow-up (cumulative survival 26.4% vs 78.0%), with a hazard ratio (HR) for death of 4.61. The risk of death decreased with increasing age at onset (HR 0.76 per year, 95% confidence interval 0.65-0.89). In approximately 10% of all cases, the disease progression appeared very mild; some patients retained functional independence for decades. CONCLUSIONS Unverricht-Lundborg disease is rare in Finland but still more common than anywhere else in the world. The disease course appears somewhat more severe than elsewhere, disability mounts early, and death occurs prematurely.
Collapse
Affiliation(s)
- Jussi O T Sipilä
- From the Division of Clinical Neurosciences (J.O.T.S.), Heart Center (V.K.), and Center for Population Health Research (V.K.), Turku University Hospital and University of Turku; Department of Neurology (J.O.T.S.), Siun Sote North Karelia Central Hospital, Joensuu; Kuopio Epilepsy Center, Department of Clinical Neurophysiology (J.H.), and Epilepsy Center, Neuro Center (R.K.), Kuopio University Hospital, Member of the European Reference Network for Rare and Complex Epilepsies EpiCARE; Administrative Center (V.K.), Hospital District of Southwest Finland, Turku; and Institute of Clinical Medicine (R.K.), University of Eastern Finland, Kuopio.
| | - Jelena Hyppönen
- From the Division of Clinical Neurosciences (J.O.T.S.), Heart Center (V.K.), and Center for Population Health Research (V.K.), Turku University Hospital and University of Turku; Department of Neurology (J.O.T.S.), Siun Sote North Karelia Central Hospital, Joensuu; Kuopio Epilepsy Center, Department of Clinical Neurophysiology (J.H.), and Epilepsy Center, Neuro Center (R.K.), Kuopio University Hospital, Member of the European Reference Network for Rare and Complex Epilepsies EpiCARE; Administrative Center (V.K.), Hospital District of Southwest Finland, Turku; and Institute of Clinical Medicine (R.K.), University of Eastern Finland, Kuopio
| | - Ville Kytö
- From the Division of Clinical Neurosciences (J.O.T.S.), Heart Center (V.K.), and Center for Population Health Research (V.K.), Turku University Hospital and University of Turku; Department of Neurology (J.O.T.S.), Siun Sote North Karelia Central Hospital, Joensuu; Kuopio Epilepsy Center, Department of Clinical Neurophysiology (J.H.), and Epilepsy Center, Neuro Center (R.K.), Kuopio University Hospital, Member of the European Reference Network for Rare and Complex Epilepsies EpiCARE; Administrative Center (V.K.), Hospital District of Southwest Finland, Turku; and Institute of Clinical Medicine (R.K.), University of Eastern Finland, Kuopio
| | - Reetta Kälviäinen
- From the Division of Clinical Neurosciences (J.O.T.S.), Heart Center (V.K.), and Center for Population Health Research (V.K.), Turku University Hospital and University of Turku; Department of Neurology (J.O.T.S.), Siun Sote North Karelia Central Hospital, Joensuu; Kuopio Epilepsy Center, Department of Clinical Neurophysiology (J.H.), and Epilepsy Center, Neuro Center (R.K.), Kuopio University Hospital, Member of the European Reference Network for Rare and Complex Epilepsies EpiCARE; Administrative Center (V.K.), Hospital District of Southwest Finland, Turku; and Institute of Clinical Medicine (R.K.), University of Eastern Finland, Kuopio
| |
Collapse
|
3
|
Madan N, Carvalho KS. Neurological Complications of Cardiac Disease. Semin Pediatr Neurol 2017; 24:3-13. [PMID: 28779863 DOI: 10.1016/j.spen.2017.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This article focuses on the complex interactions between the cardiovascular and neurologic systems. Initially, we focus on neurological complications in children with congenital heart disease both secondary to the underlying cardiac disease and complications of interventions. We later discuss diagnosis and management of common syncope syndromes with emphasis on vasovagal syncope. We also review the diagnosis, classification, and management of children and adolescents with postural orthostatic tachycardia syndrome. Lastly, we discuss long QT syndrome and sudden unexpected death in epilepsy (SUDEP), reviewing advances in genetics and current knowledge of pathophysiology of these conditions. This article attempts to provide an overview of these disorders with focus on pathophysiology, advances in molecular genetics, and current medical interventions.
Collapse
Affiliation(s)
- Nandini Madan
- From the Section of Cardiology, Department of Pediatrics, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA.
| | - Karen S Carvalho
- Section of Neurology, Department of Pediatrics, St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA
| |
Collapse
|
4
|
Devinsky O, Hesdorffer DC, Thurman DJ, Lhatoo S, Richerson G. Sudden unexpected death in epilepsy: epidemiology, mechanisms, and prevention. Lancet Neurol 2016; 15:1075-88. [DOI: 10.1016/s1474-4422(16)30158-2] [Citation(s) in RCA: 369] [Impact Index Per Article: 46.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 06/29/2016] [Accepted: 06/29/2016] [Indexed: 12/24/2022]
|
6
|
Terra VC, Cysneiros R, Cavalheiro EA, Scorza FA. Sudden unexpected death in epilepsy: from the lab to the clinic setting. Epilepsy Behav 2013; 26:415-20. [PMID: 23402930 DOI: 10.1016/j.yebeh.2012.12.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 12/17/2012] [Indexed: 11/30/2022]
Abstract
Sudden unexpected death in epilepsy (SUDEP) is defined as sudden, unexpected, witnessed or unwitnessed, non-traumatic, and non-drowning death in a patient with epilepsy. Sudden unexpected death in epilepsy is probably the most common cause of epilepsy-related deaths. Many predisposing and initiating factors may coexist and contribute to SUDEP, but the mechanisms are poorly understood. Cardiac and respiratory deregulation seems to have a major role in SUDEP. Here, we review several advances in understanding the mechanisms involved in SUDEP.
Collapse
Affiliation(s)
- Vera C Terra
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil.
| | | | | | | |
Collapse
|
8
|
Nobili L, Proserpio P, Rubboli G, Montano N, Didato G, Tassinari CA. Sudden unexpected death in epilepsy (SUDEP) and sleep. Sleep Med Rev 2011; 15:237-46. [DOI: 10.1016/j.smrv.2010.07.006] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Revised: 07/12/2010] [Accepted: 07/16/2010] [Indexed: 11/30/2022]
|
9
|
Terra VC, Scorza FA, Arida RM, Cavalheiro EA, Sakamoto AC, Machado HR. Sudden unexpected death in epilepsy. FUTURE NEUROLOGY 2010. [DOI: 10.2217/fnl.10.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Epilepsy is one of the most common serious neurological conditions worldwide, and sudden unexpected death in epilepsy (SUDEP) is the main cause of epilepsy-related death. Although the exact pathophysiological causes of SUDEP are still unknown, potential risk factors include young age of epilepsy onset, duration of epilepsy, frequently recurrent seizures, winter temperatures and cardiac abnormalities such as arrhythmias during and between seizures. Unfortunately available pharmacological treatment for epilepsy remains limited in seizure control and consequently in SUDEP control, so alternative treatment should be considered in patients with refractory epilepsy. This article will revisit the possible related causes and preventative actions for SUDEP.
Collapse
Affiliation(s)
| | - Fulvio A Scorza
- Disciplina de Neurologia Experimental, Universidade Federal de São Paulo/Escola Paulista de Medicina, São Paulo, Brazil
| | - Ricardo M Arida
- Departamento de Fisiologia. Universidade Federal de São Paulo/Escola Paulista de Medicina, São Paulo, Brazil
| | - Esper A Cavalheiro
- Disciplina de Neurologia Experimental, Universidade Federal de São Paulo/Escola Paulista de Medicina, São Paulo, Brazil
| | - Américo C Sakamoto
- Centro de Cirurgia de Epilepsia (CIREP), Departamento de Neurociências & Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Hélio R Machado
- Centro de Cirurgia de Epilepsia (CIREP), Departamento de Neurociências & Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| |
Collapse
|
10
|
Striano P, D’Amato E, Pezzella M, Mainardi P, Zara F, Striano S. Sudden death in Unverricht–Lundborg patients: is serotonin the key? Neurol Sci 2009; 31:115-6. [DOI: 10.1007/s10072-009-0193-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2009] [Accepted: 11/02/2009] [Indexed: 10/20/2022]
|