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Yang L, Su Q, Xu N, Xu L, Zhao J, Fan C, Li Y, Li B. Continuous epileptic negative myoclonus as the first seizure type in atypical benign epilepsy with centrotemporal spikes. Medicine (Baltimore) 2020; 99:e22965. [PMID: 33126368 PMCID: PMC7598858 DOI: 10.1097/md.0000000000022965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To figure out which diagnosis is more suitable and which antiepileptic drugs are more sensitive to epileptic negative myoclonus (ENM) as the first seizure type in atypical benign epilepsy with centrotemporal spikes.We reviewed the electroencephalogram (EEG) database of Linyi People's Hospital Affiliated to Shandong University and medical records of patients with ENM onset. The characteristics of epileptic seizures, onset age, treatment process, growth and development history, past disease history, family history, degree of mental deterioration, cranial imaging, and video-EEG were studied retrospectively and followed up.There were 4 cases with ENM onset and 1 with continuous ENM, 3 males and 1 female. The onset age was from 2 years 3 months to 8 years 7 months. The cranial magnetic resonance imaging (MRI) and developmental quotient, as well as the family, personal, and past disease history, were normal. Frequent falls and drops were the main clinical manifestations. Five months after the onset of ENM, case 1 had focal seizures in sleep. ENM was the first and only manifestation in all the other 3 children. Discharges of interictal EEG were in bilateral rolandic areas, especially in midline areas (Cz, Pz), electrical status epilepticus in sleep was found in 3 cases. One child was sensitive to levetiracetam, the other 3 were sensitive to clonazepam.ENM can affect the upper or lower extremities. ENM as the first or only symptom was a special phenomenon in benign epilepsy with centrotemporal spikes (BECTS) variants. Ignorance of midline spikes mainly in Cz or Pz in BECTS might lead to missed diagnosis of ENM. Whether benzodiazepines are viable as a choice of BECTS variants with electrical status epilepticus in sleep when ENM is the first symptom still needs a large sample evidence-based observation.
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Affiliation(s)
- Li Yang
- Department of Pediatrics, Linyi People's Hospital Affiliated to Shandong University, Linyi
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan
| | - Quanping Su
- Central Laboratory, Linyi People's Hospital Affiliated to Shandong University
| | - Na Xu
- Department of Pediatrics, Linyi People's Hospital Affiliated to Shandong University, Linyi
| | - Liyun Xu
- Department of Pediatrics, Linyi People's Hospital Affiliated to Shandong University, Linyi
- Department of Pediatrics, Shandong Medical College, Linyi, Shandong, People's Republic of China
| | - Juan Zhao
- Department of Pediatrics, Linyi People's Hospital Affiliated to Shandong University, Linyi
| | - Chao Fan
- Department of Pediatrics, Linyi People's Hospital Affiliated to Shandong University, Linyi
| | - Yufen Li
- Department of Pediatrics, Linyi People's Hospital Affiliated to Shandong University, Linyi
| | - Baomin Li
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan
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Abstract
The progressive myoclonic epilepsies (PMEs) represent a rare but devastating group of syndromes characterized by epileptic myoclonus, typically action-induced seizures, neurological regression, medically refractory epilepsy, and a variety of other signs and symptoms depending on the specific syndrome. Most of the PMEs begin in children who are developing as expected, with the onset of the disorder heralded by myoclonic and other seizure types. The conditions are considerably heterogenous, but medical intractability to epilepsy, particularly myoclonic seizures, is a core feature. With the increasing use of molecular genetic techniques, mutations and their abnormal protein products are being delineated, providing a basis for disease-based therapy. However, genetic and enzyme replacement or substrate removal are in the nascent stage, and the primary therapy is through antiepileptic drugs. Epilepsy in children with progressive myoclonic seizures is notoriously difficult to treat. The disorder is rare, so few double-blinded, placebo-controlled trials have been conducted in PME, and drugs are chosen based on small open-label trials or extrapolation of data from drug trials of other syndromes with myoclonic seizures. This review discusses the major PME syndromes and their neurogenetic basis, pathophysiological underpinning, electroencephalographic features, and currently available treatments.
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Affiliation(s)
- Gregory L Holmes
- Department of Neurological Sciences, Larner College of Medicine, University of Vermont College of Medicine, Stafford Hall, 118C, Burlington, VT, 05405, USA.
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Caciotti A, Melani F, Tonin R, Cellai L, Catarzi S, Procopio E, Chilleri C, Mavridou I, Michelakakis H, Fioravanti A, d'Azzo A, Guerrini R, Morrone A. Type I sialidosis, a normosomatic lysosomal disease, in the differential diagnosis of late-onset ataxia and myoclonus: An overview. Mol Genet Metab 2020; 129:47-58. [PMID: 31711734 DOI: 10.1016/j.ymgme.2019.09.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/23/2019] [Accepted: 09/23/2019] [Indexed: 01/12/2023]
Abstract
Lysosomal storage diseases (LSDs) are rare to extremely rare monogenic disorders. Their incidence, however, has probably been underestimated owing to their complex clinical manifestations. Sialidosis is a prototypical LSD inherited as an autosomal recessive trait and caused by mutations in the NEU1 gene that result in a deficiency of alpha-N-acetyl neuraminidase 1 (NEU1). Two basic forms of this disease, type I and type II, are known. The dysmorphic type II form features LSD symptoms including congenital hydrops, dysmorphogenetic traits, hepato-splenomegaly and severe intellectual disability. The diagnosis is more challenging in the normosomatic type I forms, whose clinical findings at onset include ocular defects, ataxia and generalized myoclonus. Here we report the clinical, biochemical and molecular analysis of five patients with sialidosis type I. Two patients presented novel NEU1 mutations. One of these patients was compound heterozygous for two novel NEU1 missense mutations: c.530A>T (p.Asp177Val) and c.1010A>G (p.His337Arg), whereas a second patient was compound heterozygous for a known mutation and a novel c.839G>A (p.Arg280Gln) mutation. We discuss the impact of these new mutations on the structural properties of NEU1. We also review available clinical reports of patients with sialidosis type I, with the aim of identifying the most frequent initial clinical manifestations and achieving more focused diagnoses.
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Affiliation(s)
- Anna Caciotti
- Paediatric Neurology Unit and Laboratories, Meyer Children's Hospital, Florence, Italy
| | - Federico Melani
- Paediatric Neurology Unit and Laboratories, Meyer Children's Hospital, Florence, Italy
| | - Rodolfo Tonin
- Paediatric Neurology Unit and Laboratories, Meyer Children's Hospital, Florence, Italy
| | - Lucrezia Cellai
- Paediatric Neurology Unit and Laboratories, Meyer Children's Hospital, Florence, Italy
| | - Serena Catarzi
- Paediatric Neurology Unit and Laboratories, Meyer Children's Hospital, Florence, Italy; Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Elena Procopio
- Metabolic and Muscular Unit, Meyer Children's Hospital, Florence, Italy
| | - Chiara Chilleri
- Paediatric Neurology Unit and Laboratories, Meyer Children's Hospital, Florence, Italy
| | - Irene Mavridou
- Division of Enzymology and Cellular Function, Institute of Child Health, Athens, Greece
| | - Helen Michelakakis
- Division of Enzymology and Cellular Function, Institute of Child Health, Athens, Greece
| | - Antonella Fioravanti
- Structural Biology, Research Center-VIB (Flanders Interuniversity Institute for Biotechnology), University of Brussels, Belgium
| | - Alessandra d'Azzo
- Dep. of Genetics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Renzo Guerrini
- Paediatric Neurology Unit and Laboratories, Meyer Children's Hospital, Florence, Italy; Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Amelia Morrone
- Paediatric Neurology Unit and Laboratories, Meyer Children's Hospital, Florence, Italy; Department of NEUROFARBA, University of Florence, Florence, Italy.
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Meinck HM. [Myoclonus as a movement disorder]. DER NERVENARZT 2017; 88:1133-1140. [PMID: 28852800 DOI: 10.1007/s00115-017-0399-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Myoclonus is often a diagnostic and therapeutic challenge due to its broad phenomenological variability and limited therapeutic options. This article gives a short survey and characterizes in detail two common types of myoclonus, cortical myoclonus and reticular reflex myoclonus. Clinical testing and electrophysiological investigations provide relevant local diagnostic indications for the generating structure(s). Such indications would influence not only the strategies of neuroimaging and laboratory investigations aimed at clarifying the underlying cause but also the selection of drugs to suppress myoclonus.
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Affiliation(s)
- H-M Meinck
- Neurologische Klinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
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Chen J, Zheng G, Guo H, Lu X, Wu C, Wang X, Tao W. Epileptic Negative Myoclonus as the First and Only Symptom in a Challenging Diagnosis of Benign Epilepsy With Centrotemporal Spikes. Child Neurol Open 2017; 4:2329048X17715965. [PMID: 28815192 PMCID: PMC5548311 DOI: 10.1177/2329048x17715965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/15/2017] [Accepted: 03/23/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the clinical and neurophysiological characteristics of epileptic negative myoclonus as the first and only ictal symptom of benign epilepsy with centrotemporal spikes. METHODS Electrophysiological evaluations included polygraphic recordings with simultaneous video electroencephalogram monitoring and tests performed with patient's upper limb outstretched in standing posture. Epileptic negative myoclonus manifestations, electrophysiological features, and responses to antiepileptic drugs were analyzed. RESULTS The authors report 2 patients with benign epilepsy with centrotemporal spikes, who had epileptic negative myoclonus as the first and only seizure type. Video electroencephalogram monitoring results showed that their negative myoclonus seizures were emanating from the contralateral central and the parietal regions. Epileptic negative myoclonus was controlled by administration of valproate and levetiracetam. CONCLUSION Epileptic negative myoclonus can be the first and only seizure type of benign epilepsy with centrotemporal spikes, and long-term follow-up monitoring should be the care for the recurrence and/or presence of other types of seizures.
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Affiliation(s)
- Jing Chen
- Neurology department, Children's Hospital of Nanjing Medical University, Gulou District, Nanjing, People's Republic of China
| | - Guo Zheng
- Neurology department, Children's Hospital of Nanjing Medical University, Gulou District, Nanjing, People's Republic of China
| | - Hu Guo
- Neurology department, Children's Hospital of Nanjing Medical University, Gulou District, Nanjing, People's Republic of China
| | - Xiaopeng Lu
- Neurology department, Children's Hospital of Nanjing Medical University, Gulou District, Nanjing, People's Republic of China
| | - Chunfeng Wu
- Neurology department, Children's Hospital of Nanjing Medical University, Gulou District, Nanjing, People's Republic of China
| | - Xiaoyu Wang
- Neurology department, Children's Hospital of Nanjing Medical University, Gulou District, Nanjing, People's Republic of China
| | - Wei Tao
- Neurology department, Children's Hospital of Nanjing Medical University, Gulou District, Nanjing, People's Republic of China
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